Correct answer-B. Rationales: Benzodiazepines such as lorazepam are considered to be first-line therapy for the treatment of acute withdrawal syndrome and the prevention and treatment of seizure activity and delirium tremens. Antiepileptic therapy has long been studied for the prevention of seizures in acute withdrawal syndrome for lessening the overall syndrome. Placebo-controlled trials have demonstrated that phenytoin is ineffective for the secondary prevention of alcohol withdrawal seizures. In addition, phenobarbital use has been attributed to respiratory depression in high doses or when combined with alcohol. For the treatment of Wernicke’s encephalopathy and thiamine deficiency, the administration of thiamine is recommended; however, this would not be a first-line therapy. Haloperidol has also been used to control the psychiatric symptoms of alcohol withdrawal, including combativeness, delirium, and anxiousness. However, it has been shown to be significantly less effective than benzodiazepines in preventing delirium and can cause torsades de pointes by prolonging the QT interval.

Nursing process step: Analysis

Correct answer-D. Rationales: Cocaine has direct effects on the heart that include increased myocardial oxygen consumption, coronary artery spasm, ischemia, and myocardial infarction. Tricyclic antidepressants cause arrhythmias in overdoses. Benzodiazepines cause drowsiness and confusion in overdoses. Opioids cause respiratory depression.

Nursing process step: Assessment

Correct answer-D. Rationales: Restraining the client will increase his agitation. Reassure him that he isn’t losing his mind and that the effects of the drug will wear off. Instruct him to keep his eyes open to decrease the intensity of hallucinations. Keeping the room well lit reduces shadows that may be misinterpreted by the client, thereby adding to his agitation.

Nursing process step: Intervention

Correct answer-B. Rationales: The highest priority for a client who has ingested PCP is meeting safety needs of the client—as well as those of the staff. PCP effects are unpredictable and prolonged, and the client may lose control easily. After safety needs have been met, the client’s physical, psychosocial, and medical needs can be met.

Nursing process step: Intervention

Correct answer-D. Rationales: The antidote for acetaminophen toxicity is acetylcysteine, which enhances conversion of toxic metabolites to nontoxic metabolites. Deferoxamine mesylate is the antidote for iron intoxication. Succimer is an antidote for lead poisoning, and flumazenil reverses the sedative effects of benzodiazepines.

Nursing process step: Intervention

Correct answer-B. Rationales: Fluoride ions in hydrofluoric acid bind with calcium and cause severe hypocalcemia, which can lead to tetany and death. Chvostek’s sign is elicited by tapping the side of the face over the facial nerve. If hypocalcemia is present, the client’s facial muscles will contract. Fluoride ions don’t directly affect glucose, magnesium, or potassium levels.

Nursing process step: Evaluation

Correct answer-C. Rationales: Formalin is a characteristic breath odor in methanol poisoning because formic acid is a metabolite of methanol. The client’s urine may also have a formalin odor. A number of poisons may be indicated by the presence of associated breath odors. Bitter almond, for example, is characteristic of cyanide. The odor of moth balls is characteristic of camphor and naphthalene. Garlic is characteristic of arsenic, organophosphates, phosphorous, selenium, and thallium.

Nursing process step: Analysis

Correct answer-D. Rationales: Medical therapy for ethylene glycol ingestion includes blocking the metabolism of the drug by saturating alcohol dehydrogenase sites with ethanol to prevent the production of toxic metabolites. The dehydrogenase sites are saturated when ethanol levels are 100 mg/dL. Hypercalcemia isn’t present because ethylene glycol toxicity causes hypocalcemia from chelation of calcium by oxalates. Hypokalemia isn’t present because metabolites cause severe acidosis and hyperkalemia. Ethylene glycol toxicity doesn’t cause hypertension although the client may become hypotensive 4 to 12 hours after ingestion.

Nursing process step: Assessment

Correct answer-C. Rationales: Although all of the options can be anticipated during the care of this client, supporting the child’s airway take priority. Clients with methanol intoxication are at risk for sudden respiratory arrest because methanol and its metabolites depress the brain stem.

Nursing process step: Analysis

Correct answer-B. Rationales: Amphetamines are central nervous system stimulants that cause sympathetic stimulation, including hypertension, tachycardia, vasoconstriction, and hyperthermia. Hot, dry skin is seen with anticholinergic agents such as jimsonweed. Pupils are dilated, not constricted, with amphetamine overdose.

Nursing process step: Assessment

Correct answer-A. Rationales: A client receiving gastric lavage should have 100 to 300 mL of fluid instilled. The fluid should then be removed by gravity or gentle suction. Larger amounts may cause the pyloric sphincter to open and force the toxins into the intestine. The client should be placed in the left lateral Trendelenburg position. A large-bore gastric tube (22 to 36 French) should be used. The average size for an adult is 32 to 36 French. Activated charcoal is usually instilled after lavage has been completed.

Nursing process step: Intervention

Correct answer-A. Rationales: The primary problem is impaired gas exchange at the cellular level. Carbon monoxide displaces oxygen on the hemoglobin, which leads to hypoxia, thereby causing confusion. Carbon monoxide poisoning won’t cause a primary airway compromise. The other two options are incorrect.

Nursing process step: Analysis

Correct answer-D. Rationales: Cocaine is a stimulant drug. It causes hypertension, hyperthermia, dilated pupils, seizures, and tachycardia.

Nursing process step: Assessment

Correct answer-A. Rationales: The cyanide antidote should be administered before decontaminating the GI tract. Because cyanide is rapidly absorbed and causes cellular hypoxia, reversing the hypoxia takes priority. The Lilly Cyanide Kit, used to treat cyanide poisoning, contains an amyl nitrite inhaler and sodium nitrite, which create methemoglobin and attract cyanide away from the respiratory enzyme cytochrome oxidase. Sodium thiosulfate is also used; it forms nontoxic thiocyanate. Performing gastric lavage, administering activated charcoal, and managing seizures are correct, but not immediate, interventions.