Chapter 27 Toxicology Flashcards by Bruce Wayne

A poison is a substance that is:
A) toxic by nature, no matter how it enters the body or in what quantities it is taken.
B) damaging to the tissues and cells, especially if injected or taken in large quantities.
C) legal or illegal, and has the potential of causing permanent damage if it is ingested.
D) capable of making a person ill, at a minimum, and has a great chance of causing death.

Ans: A
Page: 1325
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

2.  A therapeutic dose of Valium simply relaxes one person, but causes severe central nervous system depression in another patient. This is an example of:
A)  synergism.
B)  potentiation.
C)  hypersensitivity.
D)  an idiosyncrasy.

Ans: D
Page: 1326
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

The bioavailability and excretion rate of a toxin are influenced by the:
A) amount of toxin and the relative speed at which it is metabolized.
B) type of toxin and the condition of the patient’s underlying health.
C) route by which the toxin entered the body and the age of the patient.
D) the presence of other substances in the body at the time of exposure.

Ans: A
Page: 1327
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

Management for an ingested poison focuses mainly on:
A) the prompt induction of vomiting.
B) administering a counteracting agent.
C) neutralizing the poison in the stomach.
D) treating the systemic effects that result.

Ans: C
Page: 1327
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

When poisoning occurs because of a toxic environment:
A) the patient typically does not present with symptoms for hours.
B) you are more likely to encounter more than one patient at the scene.
C) you should limit your exposure to the environment to less than 5 minutes.
D) exposure continues, even after the patient is removed from the environment.

Ans: B
Page: 1327
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

From an anatomic and physiologic perspective, inhaled toxins:
A) generally provide a large window of opportunity for treatment.
B) quickly reach the alveoli and rapidly gain access to the circulatory system.
C) typically take between 15 and 20 minutes to exert a systemic effect.
D) often take several hours before clinical signs and symptoms manifest.

Ans: B
Page: 1327-1328
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

7.  Clinical signs and symptoms following exposure to a toxin will manifest MOST rapidly if the patient:
A)  is older than 70 years of age.
B)  ingests a large quantity of toxin.
C)  breathes in the toxic chemical.
D)  is exposed by the injection route.

Ans: D
Page: 1328
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

8.  Which of the following toxins causes the MOST serious consequences when absorbed through the skin?
A)  Dry lime
B)  Poison oak
C)  Pesticides
D)  Sulfuric acid

Ans: C
Page: 1328
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

Unlike an opioid, an opiate:
A) is a natural product derived from opium.
B) produces a distinctly different toxidrome.
C) is not reversed by naloxone administration.
D) is a synthetic, non–opium-derived narcotic.

Ans: A
Page: 1328
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

10.  You would NOT expect a person using methamphetamine to present with:
A)  insomnia.
B)  bradypnea.
C)  restlessness.
D)  hypertension.

Ans: B
Page: 1329
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

11.  Exposure to sarin or tabun would result in:
A)  hyperthermia.
B)  pupillary dilation.
C)  severe tachycardia.
D)  excessive lacrimation.

Ans: D
Page: 1329
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

12.  Any sympathomimetic drug will cause:
A)  ataxia.
B)  tachycardia.
C)  hallucinations.
D)  hypothermia.

Ans: B
Page: 1329
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

13.  Which of the following drugs is classified as an anticholinergic?
A)  Diazinon
B)  Atropine
C)  Thiopental
D)  Phenylephrine

Ans: B
Page: 1329
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

14.  You would expect a person to be hypertensive and tachycardic following exposure to all of the following, EXCEPT:
A)  cocaine.
B)  parathion.
C)  phenobarbital.
D)  pseudoephedrine.

Ans: C
Page: 1329
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

15.  The odor of bitter almonds on a patient's breath should make you suspicious for exposure to:
A)  cyanide.
B)  arsenic.
C)  phosphorus.
D)  turpentine.

Ans: A
Page: 1329
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

16.  An acetone breath odor is common following exposure to all of the following toxins, EXCEPT:
A)  aspirin.
B)  isopropyl alcohol.
C)  camphor.
D)  methyl alcohol.

Ans: C
Page: 1329
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

17.  Most ingested poisons will cause:
A)  headache and seizures.
B)  tremors and weakness.
C)  salivation and coma.
D)  nausea and vomiting.

Ans: D
Page: 1330
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

Drug abuse is MOST accurately defined as:
A) the habitual use of illicit drugs for the purpose of inducing a euphoric feeling.
B) any use of drugs that causes physical, psychological, or legal harm to the user.
C) the use of legal medications that is not in accordance with a physician’s order.
D) inadvertent misuse of a licit or illicit drug that causes physical harm to the user.

Ans: B
Page: 1330
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

19.  The emotional state of craving a drug to maintain a feeling of well-being is called:
A)  addiction.
B)  habituation.
C)  physical dependence.
D)  psychological dependence.

Ans: D
Page: 1331
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

20.  A middle-aged woman who has been taking 2 mg of clonazepam each day for 6 months finds that she now requires 4 mg each day to achieve the same effect. This is an example of:
A)  tolerance.
B)  drug abuse.
C)  habituation.
D)  physical dependence.

Ans: A
Page: 1331
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

21.  A person who compulsively uses a drug, despite the fact that he or she knows the drug will cause physical or psychological harm, is:
A)  tolerant.
B)  addicted.
C)  dependent.
D)  an abuser.

Ans: B
Page: 1331
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

Alcohol potentiates Valium. This means that:
A) Valium makes alcohol a toxic substance.
B) alcohol antagonizes the effects of Valium.
C) alcohol enhances the effects of Valium.
D) the use of alcohol negates the use of Valium.

Ans: C
Page: 1331
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

Which of the following statements regarding alcoholism is correct?
A) A person who consumes alcohol is considered to be physically dependent if abrupt cessation of drinking causes withdrawal symptoms.
B) Patients with alcoholism typically do not become psychologically dependent on alcohol until they have been drinking for many years.
C) Delirium tremens occur any time a person suddenly stops drinking excessive amounts of alcohol, regardless of whether or not he or she is addicted.
D) Increased blood pressure and hallucinations are common physical manifestations when a short-term alcoholic slowly tapers his or her consumption.

Ans: A
Page: 1333-1334
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

24.  Which of the following is atypical of an alcoholic?
A)  Drinking early in the day
B)  Green tongue syndrome
C)  Memory loss or blackouts
D)  Chronically pale face and palms

Ans: D
Page: 1333-1334
Type: General Knowledge

How well did you know this?

Not at all

Perfectly

25. Patients with alcoholism are prone to subdural hematomas and gastrointestinal bleeding because: A) they fall more frequently than sober people. B) their blood-clotting mechanisms are impaired. C) they are at higher risk for violent assault. D) alcohol causes significant immunocompromise.

Ans: B Page: 1335 Type: General Knowledge

``` 26. Toxic effects of alcohol on the liver include all of the following, EXCEPT: A) coagulopathy. B) hypoglycemia. C) hyperglycemia. D) gastrointestinal bleeding. ```

Ans: C Page: 1335 Type: General Knowledge

``` 27. Which of the following is the MOST immediate danger to an unresponsive patient with acute alcohol intoxication? A) Acute hypovolemia B) Aspiration of vomitus C) Profound bradycardia D) Ventricular dysrhythmias ```

Ans: B Page: 1335 Type: General Knowledge

``` 28. Symptoms of delirium tremens usually begin within ___ to ___ hours after the last alcohol intake. A) 12, 24 B) 24, 48 C) 48, 72 D) 72, 96 ```

Ans: C Page: 1335 Type: General Knowledge

``` 29. Patients with delirium tremens often experience: A) hallucinations. B) AV heart blocks. C) hypothermia. D) acute hypertension. ```

Ans: A Page: 1335 Type: General Knowledge

30. When caring for an unresponsive patient with a toxicologic emergency, you should: A) intubate at once, obtain baseline vital signs, transport immediately, and perform all other interventions en route to the hospital. B) administer high-flow oxygen, perform a detailed secondary assessment, obtain vital signs, and transport to the closest hospital. C) try to neutralize any ingested toxins, secure a definitive airway, obtain baseline vital signs, start an IV line, and transport as soon as possible. D) protect the airway, perform a rapid assessment, obtain vital signs, try to gather a medical history from the family, and transport promptly.

Ans: D Page: 1331-1333 Type: General Knowledge

``` 31. Which of the following interventions is influenced strongly by the amount of time that has elapsed since a patient ingested a toxic substance? A) Transport B) IV therapy C) Intubation D) Gastric lavage ```

Ans: D Page: 1331 Type: General Knowledge

32. Which of the following questions often yields the LEAST reliable answer when questioning a patient who intentionally exposed himself or herself to a toxic substance? A) Have you vomited? B) Why did you take the substance? C) When did you take the substance? D) How much of the substance did you take?

Ans: B Page: 1332 Type: General Knowledge

``` 33. Your FIRST priority when dealing with a patient who may have overdosed is to: A) ascertain what the patient took. B) enter the scene carefully. C) request law enforcement. D) assess the patient's airway. ```

Ans: C Page: 1331 Type: General Knowledge

34. The clinical presentation of a stimulant abuser includes: A) excitement, hypertension, tachycardia, and dilated pupils. B) somnolence, hypotension, bradycardia, and a staggering gait. C) hypotension, tachycardia, constricted pupils, and hypothermia. D) an irregular pulse, hyperpyrexia, hypotension, and bradycardia.

Ans: A Page: 1336 Type: General Knowledge

``` 35. Crack is a combination of: A) cocaine, baking soda, and water. B) marijuana, heroin, and baking soda. C) heroin, cocaine, and distilled water. D) ecstasy, marijuana, and alcohol. ```

Ans: A Page: 1336 Type: General Knowledge

``` 36. Which of the following ECG abnormalities is MOST suggestive of cocaine toxicity? A) Narrowing of the PR interval B) Marked flattening of the T wave C) Narrowing of the QRS complex D) Prolongation of the QT interval ```

Ans: D Page: 1336 Type: General Knowledge

37. A person who is “speedballing” is: A) highly addicted to methamphetamine, cocaine, and marijuana and mixes all three drugs together to achieve various levels of euphoria. B) using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high. C) packaging cocaine in small plastic bags and swallowing them for the purpose of transporting the cocaine from one location to another location. D) using heroin to withdraw or detoxify himself or herself from cocaine by gradually increasing the amounts of heroin taken while decreasing the amounts of cocaine used.

Ans: B Page: 1336 Type: General Knowledge

38. Which of the following types of medications does NOT contain amphetamine? A) Diet pills B) Nasal decongestants C) Drugs used to treat insomnia D) Drugs used to treat attention deficit disorder

Ans: C Page: 1337 Type: General Knowledge

``` 39. Unlike the effects of cocaine, the effects of methamphetamine: A) last much longer. B) often result in paranoia. C) can be reversed with naloxone. D) predispose the patient to violence. ```

Ans: A Page: 1337 Type: General Knowledge

``` 40. Appropriate prehospital treatment for a patient who has overdosed on a stimulant and is excessively tachycardic and violent includes all of the following, EXCEPT: A) IM haloperidol. B) beta-adrenergic antagonists. C) benzodiazepines if seizures occur. D) fluid boluses if hypotension occurs. ```

Ans: B Page: 1337 Type: General Knowledge

``` 41. Signs and symptoms of marijuana use include all of the following, EXCEPT: A) euphoria. B) drowsiness. C) bloodshot eyes. D) decreased appetite. ```

Ans: D Page: 1338 Type: General Knowledge

``` 42. LSD is classified as a: A) psychedelic. B) hallucinogen. C) sympatholytic. D) sedative/hypnotic. ```

Ans: B Page: 1338 Type: General Knowledge

``` 43. A 100-pound violent young woman who requires four large paramedics to subdue and contain her is MOST likely under the influence of: A) PCP. B) LSD. C) ketamine. D) mescaline. ```

Ans: A Page: 1339 Type: General Knowledge

44. Priority care for an unresponsive patient who has overdosed on phenobarbital includes: A) administering oxygen and giving naloxone. B) administering diazepam to prevent seizures. C) securing the airway and preventing aspiration. D) observing the ECG closely for lethal dysrhythmias.

Ans: C Page: 1340 Type: General Knowledge

``` 45. Fluid-refractory hypotension following a barbiturate overdose is treated MOST effectively with: A) dopamine. B) naloxone. C) atropine. D) calcium. ```

Ans: A Page: 1340 Type: General Knowledge

``` 46. Which of the following interventions generally is preferred for a patient who overdosed on a barbiturate more than 1 hour ago? A) Gastric lavage B) Syrup of ipecac C) Urine alkalinization D) Activated charcoal ```

Ans: D Page: 1340-1341 Type: General Knowledge

``` 47. Which of the following is a sign of severe barbiturate withdrawal? A) Diaphoresis B) Hallucinations C) Nausea and vomiting D) Abdominal cramping ```

Ans: B Page: 1341 Type: General Knowledge

48. If you are treating a patient with a suspected benzodiazepine overdose and find that the patient is hypotensive, bradycardic, and comatose: A) avoid administering flumazenil and transport the patient immediately. B) you should consider concomitant overdose with another CNS depressant. C) it is likely that the patient is also under the influence of methamphetamine. D) you should rapidly administer 2 mg of naloxone via the IV, IO, or IM route.

Ans: B Page: 1341 Type: General Knowledge

``` 49. Which of the following drugs is a narcotic? A) Meperidine B) Flumazenil C) Secobarbital D) Lorazepam ```

Ans: A Page: 1341 Type: General Knowledge

50. When heroin passes through the liver: A) the liver rapidly metabolizes the drug, removes the toxic ingredients, and excretes it via the renal system. B) it rapidly becomes hepatotoxic, continues to exert narcotic effects, and causes liver failure within 24 to 36 hours. C) it is metabolized into acetyl-morphine, which continues to exert narcotic effects that may outlast the effects of naloxone. D) absorption through the rest of the body decreases markedly, allowing its narcotic effects to be reversed easily with naloxone.

Ans: C Page: 1342 Type: General Knowledge

``` 51. Cardiac arrest following a narcotic overdose is usually the result of: A) seizures. B) renal failure. C) respiratory arrest. D) a cardiac dysrhythmia. ```

Ans: C Page: 1342 Type: General Knowledge

52. The recommended dose and method for administering naloxone to a patient who overdosed on a narcotic and is unresponsive and hypoventilating is: A) 0.1 mg/kg rapidly until the patient's respirations improve. B) 0.4 to 2 mg rapidly until the patient regains consciousness. C) 5 to 10 mg via the endotracheal tube until the pupils dilate. D) 2 mg injected slowly until the patient's respirations improve.

Ans: D Page: 1342 Type: General Knowledge

``` 53. Which of the following cardiac rhythm disturbances MOST commonly results from inadvertent overdose of a prescribed cardiac medication? A) Atrial flutter B) Bradycardia C) Tachycardia D) Atrial fibrillation ```

Ans: B Page: 1343 Type: General Knowledge

``` 54. Which of the following cardiac medications has a small therapeutic window and the GREATEST propensity to reach toxic levels? A) Digoxin B) Vasotec C) Cardizem D) Lisinopril ```

Ans: A Page: 1344 Type: General Knowledge

55. Organophosphates exert their effect by: A) destroying the body's acetylcholine. B) agonizing the sympathetic nervous system. C) stimulating the cholinergic nervous system. D) blocking the parasympathetic nervous system.

Ans: C Page: 1344 Type: General Knowledge

``` 56. Signs and symptoms of organophosphate poisoning include: A) vomiting. B) tachycardia. C) constipation. D) pupillary dilation. ```

Ans: A Page: 1344 Type: General Knowledge

57. The toxicity of carbon monoxide arises primarily from: A) its destructive properties on ferric ions. B) its affinity for hemoglobin in red blood cells. C) the fact that carbon monoxide destroys hemoglobin molecules. D) its ability to markedly decrease the metabolic rate.

Ans: B Page: 1344 Type: General Knowledge

58. Carboxyhemoglobin: A) is a combination of oxygen and hemoglobin. B) effectively carries oxygen to the body's cells. C) is the chemical by-product of cyanide poisoning. D) is hemoglobin combined with carbon monoxide.

Ans: D Page: 1345 Type: General Knowledge

``` 59. The LEAST common sign or symptom of carbon monoxide toxicity is: A) nausea and vomiting. B) cherry red skin color. C) pallor or cyanosis. D) roaring sensation in the ears. ```

Ans: B Page: 1345 Type: General Knowledge

60. Pulse oximetry will not provide a true assessment of arterial oxygenation in patients with carbon monoxide toxicity because: A) the device falsely interprets oxyhemoglobin as carboxyhemoglobin. B) carbon monoxide damages the computer chip inside the pulse oximeter. C) the device cannot determine whether carbon monoxide or oxygen is bound to the hemoglobin. D) carbon monoxide turns the blood dark red, which indicates low oxygen content.

Ans: C Page: 1345 Type: General Knowledge

``` 61. The MOST important prehospital treatment intervention for a patient with carbon monoxide poisoning is: A) high-flow oxygen. B) establishing vascular access. C) cardiac rhythm monitoring. D) monitoring pulse oximetry. ```

Ans: A Page: 1345 Type: General Knowledge

``` 62. With hyperbaric oxygen therapy, carbon monoxide is typically eliminated from the body within: A) 15 to 20 minutes. B) 60 to 90 minutes. C) 90 to 120 minutes. D) 120 to 240 minutes. ```

Ans: A Page: 1345 Type: General Knowledge

``` 63. When chlorine gas comes in contact with the body's mucous membranes, it forms: A) boric acid. B) a strong alkali. C) sulfuric acid. D) hydrochloric acid. ```

Ans: D Page: 1345 Type: General Knowledge

64. Upon arriving at the scene of an incident involving a chlorine gas spill, you should: A) begin triaging all patients. B) park the ambulance upwind. C) remove all patients from the scene. D) don a protective breathing apparatus.

Ans: B Page: 1346 Type: General Knowledge

``` 65. Cyanide blocks the utilization of oxygen at the cellular level by: A) binding to monoamine oxidase. B) directly destroying red blood cells. C) binding to the hemoglobin molecule. D) combining with cytochrome oxidase. ```

Ans: D Page: 1346 Type: General Knowledge

``` 66. Treatment for cyanide poisoning may include all of the following, EXCEPT: A) amyl nitrite. B) methylene blue. C) calcium gluconate. D) hydroxocobalamin. ```

Ans: C Page: 1346-1347 Type: General Knowledge

``` 67. In adult patients, oral ingestion of a caustic substance: A) is usually intentional. B) causes immediate death. C) contraindicates intubation. D) requires activated charcoal. ```

Ans: A Page: 1347 Type: General Knowledge

68. Unlike dermal exposure to a strong acid, dermal exposure to a strong alkali: A) requires longer irrigation with water because alkalis are less water soluble. B) should not be treated by irrigation with water as this will worsen the burn. C) should be neutralized on the skin by applying lemon juice or dilute vinegar. D) generally causes less damage to the skin because alkalis are water soluble.

Ans: A Page: 1348 Type: General Knowledge

``` 69. If administered in conjunction with nitrates, sildenafil would MOST likely cause: A) hypertensive crisis. B) severe hypotension. C) coronary vasospasm. D) ventricular tachycardia. ```

Ans: B Page: 1349 Type: General Knowledge

``` 70. Gamma-hydroxybutyrate is MOST commonly used to: A) induce euphoria. B) enhance the senses. C) treat chronic coughing. D) facilitate sexual assault. ```

Ans: D Page: 1349 Type: General Knowledge

71. Which of the following statements regarding methyl alcohol is correct? A) Also referred to as methanol, methyl alcohol is colorless and odorless and requires large amounts to cause toxicity. B) It is not recognized as a poison, although it has many properties of a poison when consumed in sufficient quantities. C) Methyl alcohol is also known as wood alcohol, and is present in paints, paint removers, windshield washer fluid, and varnishes. D) The signs and symptoms of methyl alcohol poisoning typically appear within 15 to 20 minutes following ingestion of as little as 5 to 10 mL.

Ans: C Page: 1349-1350 Type: General Knowledge

``` 72. The hyperpnea and tachypnea associated with methyl alcohol intoxication is secondary to: A) hypoxemia. B) heart failure. C) metabolic acidosis. D) an elevated blood pH. ```

Ans: C Page: 1350 Type: General Knowledge

``` 73. What is a lethal dose of ethylene glycol in a 190-pound man? A) 50 mL B) 120 mL C) 150 mL D) 175 mL ```

Ans: D Page: 1350 Type: General Knowledge

``` 74. A patient who ingested a significant amount of ethylene glycol 6 hours ago would MOST likely present with: A) slurred speech and ataxia. B) hypertension and tachycardia. C) an ethanol odor on the breath. D) flank pain and absent urination. ```

Ans: A Page: 1350 Type: General Knowledge

75. Spray paints and lacquer thinner contain __________, and typically cause __________________ when they are inhaled recreationally. A) toluene, hallucinations and mania B) carbon tetrachloride, CNS depression C) methylene chloride, pulmonary edema D) benzene, drunken behavior and dizziness

Ans: A Page: 1351 Type: General Knowledge

76. Tricyclic antidepressant medications: A) are the first-line therapy for the treatment of depression. B) may produce toxic effects with even minimal dosing errors. C) generally require high doses to achieve a therapeutic effect. D) are very safe because they have a large therapeutic window.

Ans: B Page: 1353 Type: General Knowledge

``` 77. Which of the following medications is NOT a tricyclic antidepressant? A) Prozac B) Aventyl C) Sinequan D) Tofranil ```

Ans: A Page: 1353-1354 Type: General Knowledge

78. Common signs and symptoms of a tricyclic antidepressant overdose include: A) excessive salivation and diarrhea. B) tachypnea and severe hypertension. C) altered mental status and tachycardia. D) constricted pupils and AV heart block.

Ans: C Page: 1353 Type: General Knowledge

``` 79. The MOST common cause of death following a tricyclic antidepressant overdose is: A) respiratory failure. B) a cardiac dysrhythmia. C) intracerebral hemorrhage. D) pulmonary aspiration. ```

Ans: B Page: 1353 Type: General Knowledge

80. A major issue for people taking MAOIs is that: A) they are associated with a high rate of suicidal behavior. B) they have a high potential for lethal drug interactions. C) high doses are required to achieve a therapeutic effect. D) they must be used in conjunction with other antidepressants.

Ans: B Page: 1354 Type: General Knowledge

``` 81. Early signs of MAOI overdose include all of the following, EXCEPT: A) nystagmus. B) tachycardia. C) hyperactivity. D) hypoventilation. ```

Ans: D Page: 1354 Type: General Knowledge

``` 82. Which of the following antidepressant medications has the HIGHEST safety margin? A) Doxepin B) Imipramine C) Paroxetine D) Nortriptyline ```

Ans: C Page: 1354 Type: General Knowledge

83. Which of the following statements regarding SSRIs is correct? A) SSRIs have fewer anticholinergic and cardiac effects than tricyclics. B) Bradycardia with AV heart block is a hallmark sign of SSRI toxicity. C) The most popular SSRIs include Pamelor, Zonalon, and Norpramin. D) They are the least preferred antidepressant because they are cardiotoxic.

Ans: A Page: 1354 Type: General Knowledge

``` 84. Lithium is MOST commonly used to treat patients with: A) depression. B) schizophrenia. C) chronic anxiety. D) bipolar disorder. ```

Ans: D Page: 1355 Type: General Knowledge

85. Inadvertent lithium toxicity would MOST likely occur in a patient who is taking: A) a tricyclic antidepressant. B) NSAIDs. C) SSRIs. D) any medication used to control blood pressure.

Ans: B Page: 1355 Type: General Knowledge

``` 86. Severe salicylate toxicity produces: A) bradypnea. B) metabolic acidosis. C) increased pH levels. D) respiratory acidosis. ```

Ans: B Page: 1355 Type: General Knowledge

``` 87. Prehospital treatment for a patient who overdosed on aspirin may include: A) flumazenil. B) an antipyretic. C) calcium chloride. D) sodium bicarbonate. ```

Ans: D Page: 1356 Type: General Knowledge

88. A patient who ingested a significant quantity of acetaminophen less than 24 hours ago would MOST likely present with: A) malaise, nausea, and a loss of appetite. B) signs of renal failure and severe vomiting. C) pain in the right upper abdominal quadrant. D) flushed skin, high fever, and abdominal pain.

Ans: A Page: 1356 Type: General Knowledge

``` 89. Death from acetaminophen overdose is MOST often caused by: A) metabolic alkalosis. B) acute splenic rupture. C) progressive liver failure. D) gastrointestinal bleeding. ```

Ans: C Page: 1356 Type: General Knowledge

``` 90. Once in the body, approximately 90% of inorganic lead accumulates in: A) bone. B) the liver. C) the spleen. D) white blood cells. ```

Ans: A Page: 1357 Type: General Knowledge

``` 91. Hematologic manifestations of lead poisoning include: A) anemia. B) leukopenia. C) coagulopathy. D) polycythemia. ```

Ans: A Page: 1357 Type: General Knowledge

``` 92. Which of the following is NOT a common sign of lead poisoning? A) Irritability B) Hypotension C) Hypertension D) Constipation ```

Ans: B Page: 1357 Type: General Knowledge

``` 93. You should be MOST suspicious that a patient has systemic iron toxicity if he or she presents with: A) bradypnea. B) hypertension. C) severe nausea. D) hematemesis. ```

Ans: D Page: 1357 Type: General Knowledge

``` 94. A metallic taste in the mouth, explosive diarrhea, and a skin rash are MOST indicative of: A) lead poisoning. B) cyanide poisoning. C) arsenic poisoning. D) mercury poisoning. ```

Ans: C Page: 1358 Type: General Knowledge

95. The dieffenbachia plant is also referred to as “dumb cane” because: A) ingestion typically results in death in less than 5 minutes. B) its leaves are highly toxic to the ears and cause deafness. C) ingestion can result in the patient being unable to speak. D) its toxic effects cause stupor, ataxia, and bizarre behavior.

Ans: C Page: 1358 Type: General Knowledge

``` 96. The toxic chemical in castor beans is: A) ricin. B) cyanide. C) lantadene A. D) caladium oxalate. ```

Ans: A Page: 1358 Type: General Knowledge

97. The foxglove plant contains ______________ and can result in ______________ when it is ingested. A) lantadene A, renal failure B) cardiac glycosides, dysrhythmias C) solanine, severe gastroenteritis D) caladium oxalate crystals, bradycardia

Ans: B Page: 1358, 1360 Type: General Knowledge

``` 98. The poisonous part of the apricot plant is/are the _______, which contain(s) _______. A) leaves, iron B) root, tyramine C) bulb, oxalic acid D) seed, cyanide ```

Ans: D Page: 1359 Type: General Knowledge

``` 99. Poisoning with ________________ is MOST often the result of improper food storage or canning. A) Listeria B) Salmonella C) Toxoplasma D) Clostridium botulinum ```

Ans: D Page: 1361 Type: General Knowledge

``` 100. A young man is found unresponsive by his girlfriend. Your assessment reveals marked respiratory depression; a slow, weak pulse; and pinpoint pupils. There are numerous medication bottles found in his home. Of these, he has MOST likely ingested: A) Valium. B) Sudafed. C) Benadryl. D) Percodan. ```

Ans: D Page: 1329 Type: Critical Thinking

101. A 45-year-old man is found unresponsive in an alley. During your assessment, you note that he is tachycardic and breathing rapidly. He has an obvious odor of alcohol on his breath. Your MOST immediate concern should be to: A) obtain a blood glucose reading. B) take actions to prevent aspiration. C) determine the etiology of his tachycardia. D) start an IV line and administer naloxone.

Ans: B Page: 1335 Type: Critical Thinking

102. You are caring for an alcoholic patient who has been abstinent for about 2 days. The patient is confused, restless, and tells you that he sees snakes crawling on the walls. His blood pressure is 76/52 mm Hg, pulse rate is 140 beats/min and weak, and respirations are 24 breaths/min with adequate depth. In addition to administering oxygen, you should: A) treat his hypotension with crystalloid fluid boluses. B) administer 6 mg of adenosine to slow his heart rate. C) sedate him with 5 mg of Valium and transport at once. D) provide emotional support only and transport immediately.

Ans: A Page: 1335-1336 Type: Critical Thinking

103. You are dispatched to an apartment complex for a suicide attempt. While you are en route, an on-scene law enforcement officer advises you that the patient, who is unresponsive, ingested an unknown quantity of an unknown drug. Upon arriving at the scene, you should: A) identify what the patient took before providing treatment. B) gain rapid access to the patient and begin your assessment. C) safely gain access to the patient while looking for an egress route. D) ask the police officer to bring the patient to the ambulance.

Ans: C Page: 1333 Type: Critical Thinking

``` 104. You arrive at the scene of an unknown drug-related emergency. Law enforcement is present and has ensured scene security. The patient, a young male, is found sitting at the kitchen table. He is laughing uncontrollably and tells you, “Life sure is good!” Your partner finds a basin of water and an empty box of baking soda on the counter. You should be MOST suspicious that this patient: A) is speedballing. B) has injected heroin. C) was snorting cocaine. D) has smoked crack cocaine. ```

Ans: D Page: 1336 Type: Critical Thinking

105. You are transporting a patient who is under the influence of methamphetamine. The patient, who is clearly anxious, has a blood pressure of 160/90 mm Hg, a pulse rate of 140 beats/min, and a respiratory rate of 24 breaths/min. The patient suddenly becomes violent and begins thrashing around, trying to get off the stretcher. After asking your partner to stop the ambulance to assist you with the patient, you should: A) assess his blood glucose level. B) administer IM haloperidol. C) start an IV line and give him morphine. D) administer a beta blocker and reassess.

Ans: B Page: 1337 Type: Critical Thinking

``` 106. During your assessment of a 33-year-old woman who you suspect is under the influence of a drug, the patient tells you that she was “listening to the painting on the wall” before you arrived. Her pulse rate and blood pressure are both elevated. This clinical presentation is MOST consistent with the use of: A) LSD. B) PCP. C) marijuana. D) methamphetamine. ```

Ans: A Page: 1338 Type: Critical Thinking

107. A 29-year-old woman was found unresponsive by her husband. When you arrive at the scene and begin your assessment, you note that the patient's respirations are slow and shallow, her pulse is slow and weak, and her pupils are markedly dilated. Your partner begins assisting the patient's ventilations as you assess her blood pressure, which is 70/48 mm Hg. The patient's husband hands you an empty bottle of phenobarbital, which was filled the day before, and tells you that his wife takes the medication for seizures. After establishing vascular access, you should: A) administer crystalloid fluid boluses to improve her blood pressure. B) give her up to 10 mg of naloxone to reverse the effects of the drug. C) instruct your partner to hyperventilate the patient at 24 breaths/min. D) begin a dopamine infusion at 10 µg/kg/min and titrate as needed.

Ans: A Page: 1340 Type: Critical Thinking

108. An unresponsive middle-aged man ingested a half-full bottle of Valium approximately 20 minutes ago. His respirations are slow and shallow, his pulse is slow and weak, and his blood pressure is significantly low. The cardiac monitor reveals sinus bradycardia. You should: A) insert a Combitube, establish vascular access, administer up to 4 liters of normal saline, and give him 0.1 mg/kg of naloxone. B) administer oxygen via nonrebreathing mask, start an IV line, and give 150 mg of amiodarone to prevent lethal ventricular dysrhythmias. C) immediately intubate his trachea, hyperventilate him to minimize acidosis, establish vascular access, and administer up to 10 mg of flumazenil. D) assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.

Ans: D Page: 1341 Type: Critical Thinking

109. You are transporting a chronic heroin abuser to whom you have just administered naloxone. The patient is responsive to verbal stimuli, and his respirations, blood pressure, and pulse rate have improved following your treatment. With an estimated time of arrival at the hospital of 20 minutes, which of the following should concern you the MOST? A) There is a high potential that the patient will suddenly become violent. B) The patient will require immediate intubation if his respirations decrease. C) The patient may deteriorate and require further naloxone administration. D) Low doses of naloxone often precipitate seizures in chronic heroin abusers.

Ans: C Page: 1342 Type: Critical Thinking

110. You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should: A) insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport. B) continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately. C) insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital. D) insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport.

Ans: B Page: 1342 Type: Critical Thinking

111. A woman drives her husband to your EMS station after he was exposed to a large amount of pesticide. Your assessment reveals that he is responsive to pain only, is hypoventilating, is markedly bradycardic, and is incontinent of urine and feces. The cardiac monitor reveals marked sinus bradycardia. As your partner assists the patient's ventilations, you should: A) establish vascular access and begin administering atropine sulfate. B) administer 1 to 2 mg of pralidoxime IM and transport immediately. C) obtain a 12-lead ECG tracing to detect signs of myocardial injury. D) start an IV line and give sodium bicarbonate to alkalinize his urine.

Ans: A Page: 1344 Type: Critical Thinking

112. You are dispatched to a residence for a 61-year-old woman with flu-like symptoms. Upon your arrival, the patient greets you at the door. She complains of a headache and nausea, and tells you that she has vomited twice. Her husband, who is lying on the couch in the living room, began experiencing the same symptoms at about the same time. You should: A) remove both patients from the residence at once. B) immediately open all of the windows in the house. C) carefully assess the residence for any unusual findings. D) suspect that both patients have been exposed to cyanide.

Ans: A Page: 1345 Type: Critical Thinking

113. A 69-year-old man presents with confusion, a headache, dyspnea, and palpitations after he rescued his two grandchildren from their burning house. During your assessment, you note that he has an odd odor on his breath; however, he denies being diabetic. You should: A) start an IV line of normal saline and administer 10 mL of a 10% solution of calcium chloride. B) administer 1 to 2 g of pralidoxime infused with normal saline solution over a 5- to 10-minute period. C) start an IV line, sedate and chemically paralyze the patient, and then perform endotracheal intubation. D) have him inhale amyl nitrate for 20 seconds and then 100% oxygen for 40 seconds out of each minute.

Ans: D Page: 1346 Type: Critical Thinking

114. A 22-year-old man experienced an acid chemical burn to his left forearm. He complains of intense pain and tingling in his fingers. He is conscious and alert, and denies any other symptoms. You should: A) cover the burn and transport at once. B) begin immediate irrigation with water. C) apply a light coat of baking soda to the burn. D) administer oxygen via nonrebreathing mask.

Ans: B Page: 1348 Type: Critical Thinking

115. You respond to a local motel for a young woman who was sexually assaulted. Upon your arrival, you find the patient sitting on the bed talking to a police officer. The last thing she remembers is meeting “some guy” at a nightclub the evening before and then having a few drinks with him. She is conscious, but sleepy. Her respirations are 12 breaths/min and regular, pulse rate is 56 beats/min and strong, and blood pressure is 102/58 mm Hg. The cardiac monitor reveals sinus bradycardia at 50 to 60 beats/min. You should: A) assist her ventilations with a bag-mask device, start an IV line, administer 0.5 mg of atropine, and transport. B) give her supplemental oxygen, conduct a secondary assessment at the scene to collect evidence, and transport her. C) administer high-flow oxygen, monitor her oxygen saturation, begin transport, and start an IV line en route to the hospital. D) conclude that she was unknowingly administered a narcotic analgesic, start an IV line, and give her 2 mg of naloxone.

Ans: C Page: 1349 Type: Critical Thinking

116. A known alcoholic man is found unresponsive by a law enforcement officer. An empty container of antifreeze was found near him. Your assessment reveals that his respirations are deep and rapid, his pulse rate is rapid and weak, and his pupils are dilated and sluggishly reactive. As your partner administers high-flow oxygen to the patient, you should: A) start an IV line and give 1 mEq/mg of sodium bicarbonate. B) assess his blood glucose level and apply a cardiac monitor. C) start an IV line and begin administering a saline fluid bolus. D) give him 100 mg of thiamine IM and assess his blood pressure.

Ans: B Page: 1350-1351 Type: Critical Thinking

``` 117. You are transporting a young female who intentionally ingested a large quantity of her prescribed Pamelor. She is conscious, but drowsy, and complains of a dry mouth and blurred vision. The cardiac monitor reveals sinus tachycardia at 120 beats/min. You are administering high-flow oxygen and have established a patent IV line. With regard to her ECG rhythm, you should be especially alert for: A) QRS widening. B) AV heart block. C) QT interval narrowing. D) a prolonged PR interval. ```

Ans: A Page: 1353 Type: Critical Thinking