Toxicology

Sample questions.

8 free toxicology questions with answers and explanations. MedRelay's full question bank covers every NREMT domain, plus live scenarios that grade the decision, not just the answer.

1. Question 1

   You respond to a garage where a 55-year-old male was found slumped over. His wife found him 30 minutes after he had been working alone with the garage door closed. On arrival he is conscious with confusion, headache, and nausea. SpO2 98%, HR 104. The garage has a running lawn mower inside. You move him outside. What is the critical management step beyond oxygen administration?

   • A.Move all persons from the CO-contaminated environmentCorrect
   • B.SpO2 98% confirms adequate oxygenation — monitor only
   • C.Administer naloxone — confusion may be from opioid exposure
   • D.Transport in the prone position for CO poisoning

   Why:Correct. CO poisoning requires: evacuation from the source, high-flow NRB oxygen regardless of SpO2 (SpO2 is unreliable), and assessment for other exposed persons. Family members, pets, and anyone in the structure must be evacuated. CO is odorless — the patient and others may not know the extent of exposure. SpO2 98% is a false reassurance.

2. Question 2

   At a warehouse, two workers collapse after chemical exposure. Your partner wants to rush in. What should you do?

   • A.Stage and request hazmatCorrect
   • B.Enter quickly
   • C.Open their lunchbox
   • D.Start PCR first

   Why:Correct. Multiple collapses after chemical exposure indicate a hazardous scene. Stage, isolate, request hazmat, and avoid secondary contamination.

3. Question 3

   At a mall corridor, a 45-year-old female has taken unknown pills. Which scene item is most useful for ED handoff?

   • A.Shoes only
   • B.Television remote
   • C.Medication containersCorrect
   • D.Pillow color

   Why:Correct. Medication containers can show drug names, quantities, and doses.

4. Question 4

   At a college dorm, a 19-year-old female is unconscious with low glucose. Why should oral glucose be avoided?

   • A.It treats chest pain
   • B.It works too fast
   • C.Aspiration riskCorrect
   • D.It causes stroke

   Why:Correct. Oral glucose is unsafe when the patient cannot swallow or protect the airway.

5. Question 5

   You respond to a 38-year-old male who intentionally ingested a large quantity of acetaminophen and alcohol 5 hours ago. He is conscious with GCS 14, mildly nauseated, HR 98, BP 118/76. He looks well. He says he only took aspirin and wine. However his girlfriend found an empty Tylenol bottle and an empty wine bottle. Why is his statement that he only took aspirin important to evaluate carefully?

   • A.Aspirin and Tylenol are the same drug — no clarification needed
   • B.The alcohol negates the acetaminophen toxicity
   • C.Treat as acetaminophen overdoseCorrect
   • D.If he says aspirin then it must be aspirin

   Why:Correct. Patient misreporting of ingested substances is common in overdose — minimization, shame, confusion, and impaired cognition all contribute. Many patients conflate aspirin and Tylenol (acetaminophen). The empty Tylenol bottle is objective evidence that must be communicated to the receiving team. Acetaminophen has a deceptively benign initial presentation — the toxic window for N-acetylcysteine closes within 8-10 hours.

6. Question 6

   You respond to an 18-year-old female who ingested approximately 30 diphenhydramine (Benadryl) tablets 1 hour ago. She is conscious with GCS 14, HR 138, BP 108/76, dry flushed skin, dilated pupils, urinary retention, and confusion. She is not vomiting. What toxidrome is this and can activated charcoal be administered?

   • A.Cholinergic toxidrome — charcoal not indicated
   • B.Sympathomimetic toxidrome — administer naloxone
   • C.Anticholinergic toxidrome (dry as a boneCorrect
   • D.Sedative-hypnotic toxidrome — airway management only

   Why:Correct. Diphenhydramine overdose produces anticholinergic toxidrome: dry flushed skin, dilated pupils, tachycardia, urinary retention, confusion, hyperthermia. The mnemonic applies. Activated charcoal within 1 hour with an intact gag reflex and medical direction may be appropriate. GCS 14 indicates adequate airway protection currently.

7. Question 7

   You respond to a 43-year-old male found at home by his wife. He was complaining of visual changes and yellow halos around lights earlier today. He has a history of heart failure and takes digoxin. He has been nauseated and vomited twice. HR is 42, BP is 88/52, GCS is 11. What do the yellow-green visual halos combined with bradycardia and nausea indicate and what should you have immediately accessible throughout transport?

   • A.Digoxin toxicityCorrect
   • B.Normal digoxin effects — no additional precautions needed
   • C.Stroke with visual field defect — transport to a stroke center
   • D.Normal medication side effect — transport Priority 3

   Why:Correct. Digoxin toxicity and AED readiness: digoxin toxicity causes bradyarrhythmias but also predisposes to ventricular fibrillation and other lethal arrhythmias. The AED must be immediately accessible throughout transport. The classic triad (xanthopsia, nausea/vomiting, bradyarrhythmia) confirms the diagnosis. Priority 1 ALS transport for Digibind. Do not attempt to slow the heart rate further — the bradycardia is from the toxicity.

8. Question 8

   A patient sprayed with pepper spray is coughing and anxious. No airway swelling is present. What is appropriate care?

   • A.Induce vomiting
   • B.Epinephrine for all
   • C.Aspirin for pain
   • D.Fresh air and irrigationCorrect

   Why:Correct. Remove from exposure, provide fresh air, irrigate affected areas, and reassess airway and breathing.