,Question 1
A patient presents to the emergency department in the manic phase of bipolar affective disorder.
Which statement by the ER nurse is most therapeutic?
1. “I want you to tell me what you are feeling right now.”
2. “I need you to stay in this room and someone will stay here with you.”
3. “Tell me what is going on in your life right now that may have made you feel out of control for
the past few days.”
4. “We are worried that you may be a danger to yourself or others, so psychiatry will come down to
discuss what you are feeling.”
Correct Answer: 2. “I need you to stay in this room and someone will stay here with you.”
Rationale:
During mania, communication should be brief, direct, and concrete. Setting clear limits and providing
structure helps reduce overstimulation. Open-ended questions may worsen pressured speech and flight
of ideas.
Question 2
Atropine is effective for overdoses caused by:
1. Antihistamines
2. Poison mushrooms
3. Lysergic acid diethylamide (LSD)
4. Seeds of the Jimson weed plant
Correct Answer: 2. Poison mushrooms
Rationale:
Certain mushroom overdoses produce a cholinergic toxidrome. Atropine, an anticholinergic agent,
counteracts these effects.
• Antihistamines → anticholinergic toxidrome
• LSD → sympathomimetic
• Jimson weed → anticholinergic (atropine would worsen symptoms)
,Question 3
An ED nurse notes third-degree heart block on telemetry. Which substance did the patient most likely
overdose on?
1. Digoxin
2. Lorazepam
3. Ethylene glycol
4. Acetaminophen
Correct Answer: 1. Digoxin
Rationale:
Digoxin toxicity is strongly associated with life-threatening arrhythmias, including AV blocks. The other
substances do not typically cause conduction blocks.
Question 4
Effective treatment for an overdose of tricyclic antidepressants (TCAs) should result in:
1. Widening of the QT interval
2. Serum pH above normal
3. Decreasing blood pressure
4. Pupil dilation
Correct Answer: 2. Serum pH above normal
Rationale:
TCA overdose is treated with sodium bicarbonate, aiming for a serum pH of 7.45–7.55. This reduces
cardiotoxicity and narrows the QRS. TCAs already cause hypotension and widened QRS/QT.
Question 5
Effective treatment for heat stroke should result in:
1. Onset of shivering
2. Cessation of sweating
3. A Glasgow Coma Scale (GCS) above 8
4. A core body temperature of 102°F (38.9°C)
, Correct Answer: 4. A core body temperature of 102°F (38.9°C)
Rationale:
The goal of treatment is rapid cooling to a safe target temperature.
• Shivering increases heat production
• Sweating aids cooling
• Neurologic status improves after temperature control
Question 6
Which laboratory study is most likely to be altered in the hours following coral snake envenomation?
1. Coagulation studies
2. Arterial blood gases (ABGs)
3. Hematology studies
4. Renal function tests
Correct Answer: 2. Arterial blood gases (ABGs)
Rationale:
Coral snake venom is neurotoxic, leading to respiratory depression and hypoxia, which is reflected in
abnormal ABGs.
Coagulation abnormalities are more typical of crotalid (pit viper) bites.
Question 7
A patient bitten by a bat asks what may occur if they refuse rabies prophylaxis. The nurse explains rabies
infection can lead to:
1. Encephalitis causing fear of air currents and water
2. Descending paralysis leading to respiratory failure
3. Cardiomyopathy requiring pacemaker placement
4. Inflammatory fluid shifts causing hypotension
Correct Answer: 1. Encephalitis causing fear of air currents and water
Rationale:
Rabies causes fatal viral encephalitis, classically presenting with hydrophobia and aerophobia. Once
symptoms appear, death is almost inevitable, making prophylaxis critical.
Question 1
A patient presents to the emergency department in the manic phase of bipolar affective disorder.
Which statement by the ER nurse is most therapeutic?
1. “I want you to tell me what you are feeling right now.”
2. “I need you to stay in this room and someone will stay here with you.”
3. “Tell me what is going on in your life right now that may have made you feel out of control for
the past few days.”
4. “We are worried that you may be a danger to yourself or others, so psychiatry will come down to
discuss what you are feeling.”
Correct Answer: 2. “I need you to stay in this room and someone will stay here with you.”
Rationale:
During mania, communication should be brief, direct, and concrete. Setting clear limits and providing
structure helps reduce overstimulation. Open-ended questions may worsen pressured speech and flight
of ideas.
Question 2
Atropine is effective for overdoses caused by:
1. Antihistamines
2. Poison mushrooms
3. Lysergic acid diethylamide (LSD)
4. Seeds of the Jimson weed plant
Correct Answer: 2. Poison mushrooms
Rationale:
Certain mushroom overdoses produce a cholinergic toxidrome. Atropine, an anticholinergic agent,
counteracts these effects.
• Antihistamines → anticholinergic toxidrome
• LSD → sympathomimetic
• Jimson weed → anticholinergic (atropine would worsen symptoms)
,Question 3
An ED nurse notes third-degree heart block on telemetry. Which substance did the patient most likely
overdose on?
1. Digoxin
2. Lorazepam
3. Ethylene glycol
4. Acetaminophen
Correct Answer: 1. Digoxin
Rationale:
Digoxin toxicity is strongly associated with life-threatening arrhythmias, including AV blocks. The other
substances do not typically cause conduction blocks.
Question 4
Effective treatment for an overdose of tricyclic antidepressants (TCAs) should result in:
1. Widening of the QT interval
2. Serum pH above normal
3. Decreasing blood pressure
4. Pupil dilation
Correct Answer: 2. Serum pH above normal
Rationale:
TCA overdose is treated with sodium bicarbonate, aiming for a serum pH of 7.45–7.55. This reduces
cardiotoxicity and narrows the QRS. TCAs already cause hypotension and widened QRS/QT.
Question 5
Effective treatment for heat stroke should result in:
1. Onset of shivering
2. Cessation of sweating
3. A Glasgow Coma Scale (GCS) above 8
4. A core body temperature of 102°F (38.9°C)
, Correct Answer: 4. A core body temperature of 102°F (38.9°C)
Rationale:
The goal of treatment is rapid cooling to a safe target temperature.
• Shivering increases heat production
• Sweating aids cooling
• Neurologic status improves after temperature control
Question 6
Which laboratory study is most likely to be altered in the hours following coral snake envenomation?
1. Coagulation studies
2. Arterial blood gases (ABGs)
3. Hematology studies
4. Renal function tests
Correct Answer: 2. Arterial blood gases (ABGs)
Rationale:
Coral snake venom is neurotoxic, leading to respiratory depression and hypoxia, which is reflected in
abnormal ABGs.
Coagulation abnormalities are more typical of crotalid (pit viper) bites.
Question 7
A patient bitten by a bat asks what may occur if they refuse rabies prophylaxis. The nurse explains rabies
infection can lead to:
1. Encephalitis causing fear of air currents and water
2. Descending paralysis leading to respiratory failure
3. Cardiomyopathy requiring pacemaker placement
4. Inflammatory fluid shifts causing hypotension
Correct Answer: 1. Encephalitis causing fear of air currents and water
Rationale:
Rabies causes fatal viral encephalitis, classically presenting with hydrophobia and aerophobia. Once
symptoms appear, death is almost inevitable, making prophylaxis critical.
Question 1
