Poisoning and Overdose Management Practice Questions
20 free Poisoning and Overdose Management practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
What is the first nursing priority when a patient presents after suspected overdose?
- A Administer activated charcoal before assessing the airway
- B Secure airway, breathing, and circulation, then obtain toxin history
- C Obtain a full toxicology screen before any other intervention
- D Await laboratory results before starting any interventions
Correct answer: Secure airway, breathing, and circulation, then obtain toxin history
The general approach to the poisoned patient begins with stabilization of the ABCs (airway, breathing, circulation) before decontamination, antidotes, or diagnostics.
Which of the following steps is part of the six-phase management of a poisoned patient?
- A Withholding all treatment until the exact poison is identified
- B Stabilization, assessment, decontamination, antidote, enhanced elimination, observation
- C Giving an antidote once and discharging without further monitoring
- D Delaying all treatment for 24 hours to observe for symptoms
Correct answer: Stabilization, assessment, decontamination, antidote, enhanced elimination, observation
Standard poisoned-patient management follows six phases: stabilization, laboratory assessment, decontamination, antidote administration, enhanced elimination, and observation.
A patient with altered mental status and suspected overdose: what should the nurse give empirically while evaluation continues?
- A No treatment until the ingestion history is fully clarified
- B Empiric dextrose for hypoglycemia, thiamine, and naloxone if opioids are suspected
- C Empiric broad-spectrum antibiotics for presumed sepsis
- D Activated charcoal immediately, before securing the airway
Correct answer: Empiric dextrose for hypoglycemia, thiamine, and naloxone if opioids are suspected
In undifferentiated altered mental status, prompt empiric correction of hypoglycemia (dextrose), thiamine, and naloxone (if opioid toxicity is suspected) is recommended while evaluation continues.
Which of the following supports the use of activated charcoal in poisoning?
- A It is only effective if the patient presents 24 hours after ingestion
- B It is most effective when given within 1-2 hours of ingestion for many oral toxins
- C It is equally effective regardless of how long ago the toxin was ingested
- D It should be given to every poisoned patient regardless of airway status
Correct answer: It is most effective when given within 1-2 hours of ingestion for many oral toxins
Activated charcoal is most effective early after ingestion (typically within 1-2 hours) for many oral poisonings, and an protected airway is required to give it safely.
In a patient with acetaminophen overdose, which nursing action is most essential?
- A Discharge the patient if they feel well on arrival
- B Monitor liver enzymes and give N-acetylcysteine guided by the nomogram
- C Limit care to monitoring blood pressure alone
- D Administer vitamin K to prevent liver injury
Correct answer: Monitor liver enzymes and give N-acetylcysteine guided by the nomogram
Acetaminophen overdose can cause hepatotoxicity; monitoring AST/ALT and giving N-acetylcysteine with timing based on the Rumack-Matthew nomogram are the key actions.
A nurse assessing a patient who ingested a large amount of tricyclic antidepressants notes a wide QRS on ECG. The priority nursing management includes:
- A Immediate defibrillation as the sole intervention
- B Sodium bicarbonate with continuous cardiac monitoring
- C Activated charcoal alone followed by discharge home
- D Calcium gluconate infusion with continuous monitoring
Correct answer: Sodium bicarbonate with continuous cardiac monitoring
TCA overdose causes sodium-channel blockade and QRS widening; intravenous sodium bicarbonate plus continuous cardiac monitoring is the standard emergent management.
A patient with suspected opioid overdose presents with respiratory depression and pinpoint pupils. The nurse’s immediate action is:
- A Await laboratory confirmation before treating
- B Administer naloxone per protocol and provide ventilatory support
- C Administer activated charcoal as the only intervention
- D Give a stimulant such as caffeine to reverse sedation
Correct answer: Administer naloxone per protocol and provide ventilatory support
Opioid overdose with respiratory depression and pinpoint pupils calls for prompt naloxone to reverse respiratory depression, alongside airway and ventilatory support.
Which statement about decontamination in poisoning management is correct?
- A Skin or eye decontamination is unnecessary in most exposures
- B Decontamination is done after stabilization and only when safe for staff and patient
- C Vomiting should be induced routinely in all poisoning cases
- D Decontamination should always be delayed until 24 hours after exposure
Correct answer: Decontamination is done after stabilization and only when safe for staff and patient
Decontamination is performed after stabilization and only when it can be done safely for staff and patient, helping to prevent further absorption of the toxin.
In a patient with suspected household chemical ingestion who is alert and stable, the nurse knows:
- A Every such patient requires immediate hospital admission
- B Some low-risk cases may be observed at home if poison control advises and no symptoms develop
- C The patient should be discharged immediately without any observation
- D Treatment decisions should be made without poison control input
Correct answer: Some low-risk cases may be observed at home if poison control advises and no symptoms develop
Per guidelines, some stable patients with low-risk ingestions may be observed at home under poison-control guidance, provided no symptoms appear.
Which nursing intervention is crucial in the observation phase of poisoning management?
- A Check vital signs only once on arrival
- B Continuous cardiac monitoring, frequent vitals, neuro checks, and documentation of the ingestion
- C Discontinue all monitoring once an antidote has been given
- D Monitor respiratory rate alone and nothing else
Correct answer: Continuous cardiac monitoring, frequent vitals, neuro checks, and documentation of the ingestion
Continuous monitoring of vitals, ECG, and neurological status, plus documentation of the ingestion and container, are essential during the observation phase of poisoning care.
A patient ingested a calcium channel blocker overdose. The nurse anticipates which treatment consideration?
- A High-dose insulin therapy with calcium and intravenous fluids
- B Activated charcoal as the only required treatment
- C Standard supportive care with no specific antidotal therapy
- D Nitroglycerin and aspirin as for an acute coronary syndrome
Correct answer: High-dose insulin therapy with calcium and intravenous fluids
Calcium channel blocker toxicity may require high-dose insulin-euglycemia therapy, calcium infusion, and fluids, with monitoring for cardiogenic shock.
In intentional overdose cases, the nurse must also assess for:
- A Only the physical effects of the toxin
- B Underlying psychiatric illness, self-harm risk, and social factors
- C Only the patient's recent dietary history
- D Only the patient's family medical history
Correct answer: Underlying psychiatric illness, self-harm risk, and social factors
Intentional overdose requires assessment of psychiatric history, self-harm risk, and social context as part of holistic care and disposition planning.
Which poison control resource is appropriate for nursing staff to consult in suspected poisoning cases?
- A Rely only on internal hospital protocols
- B Contact the national or regional poison control center for expert guidance
- C Wait for a referral from the patient's primary care provider
- D Consult only published textbook tables of toxins
Correct answer: Contact the national or regional poison control center for expert guidance
Poison control centers provide real-time expert guidance on toxic exposures (e.g., US: 1-800-222-1222); nurses should call early in suspected poisonings.
In a suspected overdose of unknown substance with respiratory depression and sedation, the nurse should:
- A Focus only on gastrointestinal decontamination
- B Stabilize the airway and ventilation, obtain history, check glucose, and give supportive care
- C Defer airway management until the toxin is identified
- D Withhold all support until a specific antidote is available
Correct answer: Stabilize the airway and ventilation, obtain history, check glucose, and give supportive care
When the substance is unknown but the patient has critical signs, supportive stabilization (airway, breathing, glucose) must proceed while history and labs identify the toxin.
A patient with acute poisoning presents with seizure activity. The nurse recognises that contaminated ingestion leading to seizure may require:
- A Simply waiting for laboratory results
- B Airway protection, benzodiazepines for seizure control, and identifying the toxidrome
- C Restraining the patient until the seizure self-terminates
- D Administering activated charcoal during the active seizure
Correct answer: Airway protection, benzodiazepines for seizure control, and identifying the toxidrome
Seizures in poisoning demand immediate management (airway, breathing, benzodiazepines) along with identification of the underlying toxidrome.
The nurse knows that an overdose management plan should include promotion of toxin elimination. Which is a valid elimination enhancement method?
- A No method exists; elimination cannot be enhanced
- B Forced diuresis, hemodialysis, or charcoal hemoperfusion where indicated
- C Routinely inducing vomiting in every poisoning case
- D Relying solely on spontaneous elimination over time
Correct answer: Forced diuresis, hemodialysis, or charcoal hemoperfusion where indicated
Some poisonings warrant enhanced elimination techniques such as urinary alkalinization/forced diuresis, hemodialysis, or hemoperfusion after stabilization and toxin identification.
Which of the following is true regarding decontamination of skin or eyes after chemical poisoning?
- A Decontamination should be delayed until transport to the ICU
- B Immediate irrigation with copious water if safe, before other interventions
- C Brush off dry chemical but avoid flushing with any water
- D Give an antidote only, since decontamination is unnecessary
Correct answer: Immediate irrigation with copious water if safe, before other interventions
For chemical exposures, removing contaminated clothing and flushing skin or eyes immediately with copious water limits further absorption and harm.
A child presents with ingestion of multiple unknown pills, appears stable but parent reports “lots of pills”. The nurse’s best action is:
- A Discharge home with parent observation only
- B Admit for observation and consult poison control even though the child is stable
- C Reassure the parents and follow up by phone the next day
- D Begin home observation only after the first 24 hours pass
Correct answer: Admit for observation and consult poison control even though the child is stable
In pediatric ingestion of unknown or large amounts, admission, monitoring, and poison-control consultation are warranted even when initial signs are mild.
Which statement about poison prevention is correct and relevant to nursing education?
- A Poison prevention is solely the responsibility of parents
- B Teach families to lock up chemicals, keep medicines out of reach, and call poison control early
- C Poisonings are too rare for prevention education to matter
- D Only adults need to take precautions against poisoning
Correct answer: Teach families to lock up chemicals, keep medicines out of reach, and call poison control early
Prevention is central to nursing education: safe storage of chemicals and medicines, keeping them out of children's reach, and early contact with poison control.
When a patient ingests a corrosive substance (acid or alkali), the nurse knows that the primary immediate intervention is:
- A Inducing vomiting to remove the corrosive substance
- B Maintaining the airway and avoiding emesis and charcoal, with careful dilution if appropriate
- C Administering activated charcoal immediately at high dose
- D Neutralizing an acid ingestion with an oral alkali
Correct answer: Maintaining the airway and avoiding emesis and charcoal, with careful dilution if appropriate
For corrosive ingestion, emesis and charcoal can be harmful and are often contraindicated; priorities are airway protection, stabilization, and careful dilution/irrigation when appropriate.