A 4-year-old child is brought to the emergency department with ...

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A 4-year-old child is brought to the emergency department with symptoms of nausea and vomiting and a weak, thready pulse of 120 beats per minute after ingesting several cigarettes at home.
 
  The nurse caring for this child will expect to provide which treatment?
  a. Gastric lavage
  b. Hemodialysis
  c. Respiratory support
  d. Vasoconstrictors

Question 2

A patient reports a desire to stop smoking and asks what is available without a prescription to help with smoking cessation. The nurse tells the patient that which method is best?
 
  a. Abrupt discontinuation to shorten withdrawal effects
  b. Nicotine replacement and 1-800-QUITNOW
  c. Nicotine replacement products tapered over a year
  d. Support groups without the use of medications

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Answer to Question 1

ANS: C
Nicotine is highly toxic, and the most prominent symptoms are those involving the cardiovascular, GI, and central nervous systems. This child is showing signs of toxicity. Respiratory arrest can occur, because nicotine affects the muscles of respiration. Respiratory support is the key to management; no antidote is available to nicotine poisoning. Nicotine undergoes rapid metabolism, so recovery can occur in a few hours. Gastric lavage, hemodialysis, and vasoconstrictors are not recommended.

Answer to Question 2

ANS: B
Nicotine addiction can be treated with pharmacologic agents or counseling, but the combination of these two approaches is more effective than either one alone. Abrupt cessation is better than tapering off, because the withdrawal effects are not so prolonged; however, this approach is not recommended as the best way to quit. Nicotine replacement products should be discontinued after a few weeks to months after quitting smoking, because they contain nicotine, which is both harmful and addicting. Support groups alone can work but are not as effective as the combination of support groups and medications.

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