Chapter 26: Chemical Exposure Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. What is true when considering activated charcoal for gastrointestinal decontamination to treat a toxic substance ingestion?

a. It acts by enhancing gastric motility to reduce absorption.

b. It is administered only through a nasogastric tube.

c. It may be used when petroleum distillates are ingested.

d. Its use is controversial, though in specific situations can be used.

ANS: D a. Administer intravenous diphenhydramine and possibly epinephrine. b. Contact the Poison Control center to ask about appropriate antidotes.

The use of activate charcoal is controversial, though in specific situations can be used for gastrointestinal decontamination. It absorbs ingested substances and reduces absorption and may cause bowel obstruction; it does not increase bowel motility. It may be given orally or by nasogastric tube. Because it is associated with vomiting, it should not be used when caustic substances, alcohols, and petroleum distillates are ingested.

2. A lawn maintenance worker is brought to the emergency department after an accident in which a large amount of pesticide was sprayed all over his clothing. He can relate the details of the accident to the emergency department personnel. What is the priority treatment on admission?

NURSINGTB.COM c. Place on a cardiorespiratory monitor and establish intravenous access. d. Remove the patient’s clothing and irrigate the skin for 15 to 30 minutes.

ANS: D

Most skin exposure to chemicals must be treated immediately with copious irrigation with water, so this is the initial priority in a stable patient. Since he can converse with staff, he is likely to be stable. If signs of anaphylaxis occur, diphenhydramine and epinephrine are indicated. The Poison Control center should be contacted, but this is not the priority. After irrigation to minimize exposure, other interventions, such as cardiorespiratory monitoring and IV access, may be necessary.

Multiple Response

1. A child is brought to the emergency department (ED) when a grandparent suspects ingestion of a tricyclic antidepressant medication found in the bathroom. What symptoms will the ED professionals expect to observe if this is the case? (Select all that apply.)

a. Excessive salivation b. Flushed skin c. Hallucinations d. Hypothermia e. Mydriasis f. Urinary frequency

ANS: B, C, E

Tricyclic antidepressants will cause anticholinergic effects, including flushing of the skin, hallucinations or psychosis, and mydriasis. These medications also cause dry mucous membranes, hyperthermia, and urinary retention.