Author Question: A nurse is teaching a new emergency department nurse about emergency medications. When asked to ... (Read 54 times)

nautica902 · **on:** Jul 23, 2018

A nurse is teaching a new emergency department nurse about emergency medications. When asked to describe the uses of pralidoxime (Protopam), the new nurse makes which correct statement?

a. It exerts its greatest effects at muscarinic and ganglionic sites.
b. It is used to treat poisoning by reversible cholinesterase inhibitors.
c. It may not be effective if not given immediately.
d. It reverses the effects of organophosphate insecticides in the central nervous system.

Question 2

A nurse working in the emergency department is assigned to a child who is arriving by ambulance after being involved in a spill of organophosphate insecticides.

What will the nurse expect to be the initial priority for treating this child?
a. Administering diphenhydramine to control secretions
b. Giving diazepam to control seizures
c. Providing mechanical ventilation and oxygen
d. Reporting the spill to the Environmental Protection Agency

yuyiding · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: C
Pralidoxime must be given soon after organophosphate poisoning has occurred because of a process called aging, in which the bond between the organophosphate inhibitor and cholinesterase increases in strength, making pralidoxime ineffective. For some of these poisons, aging can occur within minutes. Pralidoxime has its greatest effects at the neuromuscular junction, not the muscarinic and ganglionic sites. It is used to treat poisoning by irreversible cholinesterase inhibitors. It does not cross the blood-brain barrier and thus does not have effects in the CNS.

Answer to Question 2

ANS: C
All of these courses of action may be part of the treatment. However, the initial concern is to prevent death from apnea caused by laryngospasm, bronchoconstriction, and paralysis leading to apnea; therefore, maintaining an airway is the most important consideration. Pralidoxime is the specific antidote and should be given next. Atropine is used to control secretions. Diazepam is given when seizures occur. Reporting the accident to the proper authorities is not a priority during a life-threatening emergency.