1. Question

Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication, 

nurse Gina should be prepared for which common adverse effect?

o A. Seizures o B. Shivering

o C. Anxiety o D. Chest pain

Incorrect

Correct Answer: A. Seizures

Seizures are the most common serious adverse effect of using 

flumazenil to reverse benzodiazepine overdose. The effect is magnified

if the client has a combined tricyclic antidepressant and 

benzodiazepine overdose. Benzodiazepine reversal has correlations 

with seizures. Seizures may happen more frequently in patients who 

have been on benzodiazepines for long-term sedation or in patients 

who are showing signs of severe tricyclic antidepressant overdose. The

required dosage of Flumazenil should be measured and prepared by 

the practitioners to manage seizures. Flumazenil use requires caution 

in patients relying on a benzodiazepine for seizure control. o Option B: Shivering is not an adverse effect of flumazenil. 

Monitor the patient for the possible return of sedation, mostly in 

those who are tolerant of benzodiazepines. Patients should have 

monitoring for respiratory depression, benzodiazepine 

withdrawal, and other residual effects of benzodiazepines for at 

least 2 hours. o Option C: Anxiety is a rare adverse effect for people using 

flumazenil. Flumazenil has some associations with precipitation of

seizures in patients with benzodiazepine dependence with a 

history of seizures. Flumazenil overdose is extremely rare. There 

is no precise antidote for flumazenil toxicity. In mild to severe toxicity, symptomatic and supportive treatment should be a 

consideration. o Option D: An overdose of flumazenil in a patient who is not

a chronic benzodiazepine user would not be expected. Chronic 

benzodiazepines users may experience withdrawal with abrupt 

discontinuation of the drug. Administration of benzodiazepines or 

barbiturates may be necessary for seizure control.  2. Question

Nurse Tamara is caring for a client diagnosed with bulimia. The most 

appropriate initial goal for a client diagnosed with bulimia is to:

o A. Avoid shopping for large amounts of food. o B. Control eating impulses. o C. Identify anxiety-causing situations. o D. Eat only three meals per day. Incorrect

Correct Answer: C. Identify anxiety-causing situations

Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing 

situations that stimulate the bulimic behavior and then learn new ways

of coping with the anxiety. Bulimia nervosa is a condition that occurs 

most commonly in adolescent females, characterized by indulgence in 

binge-eating, and inappropriate compensatory behaviors to prevent 

weight gain. o Option A: Controlling shopping for large amounts of food 

isn’t a goal early in treatment. It is important to educate patients 

who abuse laxatives that these medications work in the 

gastrointestinal tract after the areas where caloric absorption has occurred primarily. It is crucial to inform patients that a period of 

edema and weight gain may follow up to several weeks after 

discontinuation of purging behavior. o Option B: Managing eating impulses and replacing them 

with adaptive coping mechanisms can be integrated into the plan

of care after initially addressing stress and underlying issues. The 

primary objective of treatment is a cessation of the binging and 

purging behavior. Selective serotonin reuptake inhibitors such as 

fluoxetine, citalopram, and sertraline have shown to reduce 

symptoms of bulimia nervosa. Fluoxetine is the only FDA 

approved medication for bulimia nervosa. It appears that a higher

dose (60 mg) is significantly better than a placebo in decreasing 

the frequency of binge and vomiting episodes. o Option D: Eating three meals per day isn’t a realistic goal 

early in treatment. Patients with bulimia nervosa who purge by 

vomiting often brush their teeth immediately after purging, which

can accelerate dental erosion. The clinician should instruct the 

patients who persist in vomiting to rinse their mouths with water 

or fluoride rather than brushing their teeth within 30 minutes of 

each episode. Consider consulting a dentist to address dental 

issues associated with vomiting.  3. Question

A female client who’s at high risk for suicide needs close supervision. 

To best ensure the client’s safety, Nurse Mary should:

o A. Check the client frequently at irregular 

intervals throughout the night. o B. Assure the client that the nurse will hold in 

confidence anything the client says. o C. Repeatedly discuss previous suicide attempts with 

the client. o D. Disregard decreased communication by the client 

because this is common with suicidal clients.

Incorrect

Correct Answer: A. Check the client frequently at irregular 

intervals throughout the night

Checking the client frequently but at irregular intervals prevents the 

client from predicting when observation will take place and altering 

behavior in a misleading way at these times. Once the patient is 

deemed to be at risk for suicide, then intervention steps must be 

initiated right away. The individual must not be left alone. Enlist the 

help of a support person while at home. The suicidal individual must be

treated in a safe and secure place. In addition, the place has to be 

monitored. o Option B: This may encourage the client to try to 

manipulate the nurse or seek attention for having a secret suicide

plan. Assessing the individual’s judgment is critical. One should 

try and determine how the individual can handle stress. Does he 

or she have an impairment in decision making? Does the 

individual know that jumping in front of a train is dangerous? 

Reflect empathy and concern. Offer a hand to help. Provide the 

patient with confidence that he or she can overcome the issues. o Option C: This may reinforce suicidal ideas. Help develop 

internal coping strategies (e.g., exercise, journaling, reading, 

developing a hobby). Utilize the help of healthcare professionals 

to follow up on therapy. Once the individual is safe as an inpatient

or outpatient, a formal treatment plan should be established. The next step is to refer all patients deemed to be at higher risk for suicide to a mental health counselor as soon as possible. Every 

state has laws and procedures regarding this process which must 

be incorporated into the clinical practice when addressing 

individuals at high suicide risk. o Option D: Decreased communication is a sign of 

withdrawal that may indicate the client has decided to commit 

suicide; the nurse shouldn’t disregard it. In some cases, 

assessment of the mental status may provide a clue to the 

individual’s potential for self-harm. Depressed patients will often 

tend to appear unclean and unkempt. The clothing may not be 

ironed or dirty. The risk of suicide is often high in people who 

appear very anxious or depressed. The patient may exhibit a flat 

affect or no emotions at all. Some depressed patients may 

develop hallucinations that may be telling him or her to kill 

themselves. The majority of these hallucinations are auditory.  4. Question

Which of the following drugs should Nurse Mary prepare to administer 

to a client with a toxic acetaminophen (Tylenol) level?

o A. Deferoxamine mesylate (Desferal) o B. Succimer (Chemet) o C. Flumazenil (Romazicon) o D. Acetylcysteine (Mucomyst)

Incorrect

Correct Answer: D. Acetylcysteine (Mucomyst)

The antidote for acetaminophen toxicity is acetylcysteine. It enhances 

conversion of toxic metabolites to nontoxic metabolites. 

Acetaminophen (N-acetyl-para-aminophenol, paracetamol, APAP) 

toxicity is common primarily because the medication is so readily 

available, and there is a perception that it is very safe. More than 60 

million Americans consume acetaminophen on a weekly basis. All 

patients with high levels of acetaminophen need admission and 

treatment with N-acetyl-cysteine (NAC). This agent is fully protective 

against liver toxicity if given within 8 hours after ingestion. o Option A: Deferoxamine mesylate is the antidote for iron 

intoxication. Desferal is indicated for the treatment of acute iron 

intoxication and chronic iron overload due to transfusiondependent anemias. Desferal is an adjunct to, and not a 

substitute for, standard measures used in treating acute iron 

intoxication, which may include the following: induction of emesis

with syrup of ipecac; gastric lavage; suction and maintenance of 

a clear airway; control of shock with intravenous fluids, blood, oxygen, and vasopressors; and correction of acidosis. o Option B: Succimer is an antidote for lead poisoning. 

Succimer is an oral heavy metal chelating agent used to treat 

lead and heavy metal poisoning. Succimer has been linked to a 

low rate of transient serum aminotransferase elevations during 

therapy, but its use has not been linked to cases of clinically 

apparent liver injury with jaundice. Succimer does not 

significantly chelate essential metals such as zinc, copper, or 

iron, and its specificity, safety and oral availability make it 

preferable to other chelating agents for treating lead poisoning 

such as Ca-EDTA which must be given intravenously and 

dimercaprol (British anti-Lewisite [BAL) which requires 

intramuscular administration. o Option C: Flumazenil reverses the sedative effects of 

benzodiazepines. Flumazenil is a benzodiazepine antagonist. 

Flumazenil is also indicated for the management and treatment 

of benzodiazepine overdose in adults. It is useful in reversing 

coma due to benzodiazepine overdose. Flumazenil is more 

effective in reversing sedation or coma in patients with 

benzodiazepine intoxication rather than in patients with multiple 

drug overdoses.