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PCCN (Adult) study materials
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PCCN (Adult) practice questions

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Question 1Clinical Judgment

A patient with suspected infection has which laboratory finding most consistent with tissue hypoperfusion?

  1. Lactate 4.2 mmol/L Correct answer.
  2. Platelets 150,000/mm3
  3. WBC 18,000/mm3
  4. Hemoglobin 10.8 g/dL

Explanation

An elevated lactate reflects anaerobic metabolism and is a marker of hypoperfusion in sepsis; it should prompt reassessment and treatment. White cell count, hemoglobin, and platelet values may be abnormal in infection or anemia but do not directly indicate poor tissue perfusion.

Question 2Clinical Judgment

A patient with COPD and chronic hypercapnia has an SpO2 of 84% on room air. What initial oxygen saturation target should the nurse use?

  1. 100% oxygen
  2. 70% to 74%
  3. 88% to 92% Correct answer.
  4. 94% to 98%

Explanation

In patients with COPD who retain CO2, oxygen is titrated to an SpO2 of about 88% to 92% to reduce the risk of worsening hypercapnia while correcting hypoxemia. Higher targets are used for most other acute conditions but not routinely for this group.

Question 3Clinical Judgment

A 12-lead ECG shows new ST-segment elevation in leads II, III, and aVF in a patient with crushing chest pain. Which action is most time-critical?

  1. Give oral potassium
  2. Schedule a stress test
  3. Activate cath lab Correct answer.
  4. Obtain a chest x-ray

Explanation

New ST elevation with ischemic symptoms identifies a STEMI, and immediate reperfusion is the priority. The cardiac catheterization laboratory should be activated without waiting for nonessential tests.

Question 4Clinical Judgment

A patient with acute kidney injury has a potassium level of 6.8 mEq/L and peaked T waves on the monitor. Which medication is given to stabilize the cardiac membrane?

  1. Regular insulin with dextrose
  2. Furosemide
  3. Sodium bicarbonate
  4. Calcium gluconate Correct answer.

Explanation

IV calcium stabilizes the myocardial cell membrane in severe hyperkalemia and is given when ECG changes are present. Insulin with dextrose and other therapies shift or remove potassium but do not immediately protect the heart.

Question 5Clinical Judgment

An older adult becomes acutely confused, inattentive, and fluctuating in alertness on the second day after hip surgery. What is the nurse's first action?

  1. Assess for reversible causes Correct answer.
  2. Apply wrist restraints immediately
  3. Transfer to a quiet room without assessment
  4. Administer a sedative medication

Explanation

Acute fluctuating confusion suggests delirium, and the nurse should first look for causes such as hypoxia, pain, infection, urinary retention, constipation, and medication effects. Restraints and sedatives can worsen delirium and are not initial treatment.

Question 6Clinical Judgment

Which finding best indicates that an insulin infusion is effectively treating diabetic ketoacidosis?

  1. Anion gap decreasing Correct answer.
  2. Urine ketones increasing
  3. Serum potassium rising
  4. Serum bicarbonate falling

Explanation

Resolution of DKA is reflected by closure of the anion gap as ketone production stops and bicarbonate rises. Glucose may fall before the acidosis resolves, so it is not the sole measure of effectiveness.

Question 7Clinical Judgment

A patient with moderate-to-severe ARDS has a PaO2/FiO2 ratio of 120 despite lung-protective ventilation. Which intervention improves oxygenation and has a mortality benefit?

  1. Prone positioning Correct answer.
  2. Routine suctioning every hour
  3. High tidal volume ventilation
  4. Flat supine positioning

Explanation

Prone positioning for prolonged periods improves oxygenation and reduces mortality in moderate-to-severe ARDS. It recruits dorsal lung regions and reduces ventral overdistention.

Question 8Clinical Judgment

Which home report best suggests worsening heart failure and should prompt early follow-up?

  1. 3-lb weight gain in 2 days Correct answer.
  2. Heart rate of 72 beats/min
  3. Weight loss of 1 lb
  4. Blood pressure 130/80 mm Hg

Explanation

Rapid weight gain reflects fluid retention and is an early sign of heart failure decompensation. Daily weights should be obtained at the same time with similar clothing.

Question 9Clinical Judgment

A patient arrives with sudden right-sided weakness and facial droop; last known well was 45 minutes ago. What is the priority action?

  1. Activate the stroke team Correct answer.
  2. Lower blood pressure aggressively
  3. Give IV glucose
  4. Give aspirin immediately

Explanation

The patient has a possible acute ischemic stroke within the thrombolysis window, so emergency stroke evaluation and imaging must begin immediately. Treatment decisions follow imaging and assessment.

Question 10Clinical Judgment

A patient with an upper GI bleed has a heart rate of 122 beats/min, blood pressure 88/54 mm Hg, and cool extremities. What is the initial nursing action?

  1. Discharge home
  2. Give an NSAID
  3. Give oral iron
  4. Start IV fluids Correct answer.

Explanation

Tachycardia, hypotension, and cool extremities indicate hypovolemic shock from blood loss; IV access and volume resuscitation are immediate priorities. Oral iron and NSAIDs play no role in acute resuscitation.

Question 11Clinical Judgment

Which finding describes a stage 2 pressure injury?

  1. Eschar obscuring wound base
  2. Partial-thickness dermal loss Correct answer.
  3. Intact skin with nonblanchable erythema
  4. Full-thickness loss with fascia visible

Explanation

A stage 2 pressure injury involves partial-thickness loss of skin with exposed dermis; it may appear as a shallow open ulcer or a ruptured blister. Intact nonblanchable erythema is stage 1, and full-thickness loss indicates stage 3 or deeper.

Question 12Clinical Judgment

A patient in DKA has a serum potassium of 3.1 mEq/L. What should the nurse anticipate before insulin is started?

  1. Replace potassium first Correct answer.
  2. Give phosphate
  3. Start insulin immediately
  4. Give sodium bicarbonate

Explanation

Insulin shifts potassium into cells and can cause dangerous hypokalemia, so potassium must be repleted before insulin when the level is low. Bicarbonate and phosphate are not routine initial treatments for this problem.

Question 13Clinical Judgment

The monitor shows a wide-complex tachycardia at 180 beats/min in an unresponsive patient with no palpable pulse. What should the nurse do first?

  1. Start CPR and defibrillate Correct answer.
  2. Give adenosine
  3. Perform vagal maneuvers
  4. Perform synchronized cardioversion

Explanation

A pulseless wide-complex tachycardia is treated as ventricular fibrillation or pulseless ventricular tachycardia: start CPR and deliver defibrillation as soon as possible. Synchronized cardioversion and medications are for patients with a pulse.

Question 14Clinical Judgment

Which nursing action best prevents falls in a hospitalized older adult?

  1. Give sedative at bedtime
  2. Hourly rounding with toileting Correct answer.
  3. Raise bed to highest position
  4. Apply physical restraints

Explanation

Proactive rounding that addresses pain, position, toileting, and personal needs reduces falls. Restraints and sedatives increase confusion, weakness, and injury risk.

Question 15Clinical Judgment

A patient with advanced dementia grimaces and guards the abdomen during repositioning but cannot report pain. How should the nurse assess pain?

  1. Use a behavioral pain scale Correct answer.
  2. Assume the patient has no pain
  3. Wait for a verbal pain report
  4. Give a placebo first

Explanation

Patients with advanced dementia may express pain through facial expression, guarding, and changes in behavior, so a validated behavioral pain scale should be used. Self-report is preferred when possible, but waiting for verbal report can leave pain untreated.

Question 16Clinical Judgment

A patient who has received heparin for 6 days has a platelet count fall from 250,000 to 90,000/mm3 and develops a new leg thrombosis. What is the priority action?

  1. Stop heparin; use another anticoagulant Correct answer.
  2. Continue the heparin infusion unchanged
  3. Give warfarin alone
  4. Transfuse platelets

Explanation

This presentation suggests heparin-induced thrombocytopenia with thrombosis; heparin must be stopped and a non-heparin anticoagulant started promptly. Warfarin alone can worsen thrombosis and platelet transfusion is generally avoided.

Question 17Clinical Judgment

A patient with acute kidney injury has urine output of 0.2 mL/kg/hr for 4 hours and a potassium of 6.1 mEq/L. Which action is the priority?

  1. Encourage a high-protein diet
  2. Give an NSAID for pain
  3. Restrict all fluids without an order
  4. Notify the provider and obtain an ECG Correct answer.

Explanation

Oliguria with hyperkalemia requires immediate provider notification and cardiac monitoring because dangerous arrhythmias can occur. The ECG helps identify hyperkalemic changes requiring urgent treatment.

Question 18Clinical Judgment

A patient with acute pancreatitis has severe epigastric pain and repeated vomiting. Which order should the nurse expect?

  1. Start an anticholinergic
  2. Give oral contrast
  3. Encourage a large fatty meal
  4. IV fluids and analgesia Correct answer.

Explanation

Acute pancreatitis is managed with aggressive IV fluid resuscitation, pain control, and early appropriate nutrition as tolerated. Fatty meals and unnecessary interventions can worsen symptoms.

Question 19Clinical Judgment

A patient taking digoxin has a heart rate of 42 beats/min, nausea, visual changes, and a potassium of 5.8 mEq/L. What should the nurse do?

  1. Give IV calcium
  2. Hold digoxin and notify provider Correct answer.
  3. Encourage ambulation
  4. Administer another dose of digoxin

Explanation

Bradycardia, GI symptoms, visual disturbances, and hyperkalemia suggest digoxin toxicity; the drug should be held and the provider notified immediately. Calcium is avoided in digoxin toxicity because it can worsen arrhythmias.

Question 20Clinical Judgment

A patient admitted 36 hours after the last alcohol drink has tremors, hallucinations, a heart rate of 120 beats/min, and blood pressure 170/100 mm Hg. Which medication is indicated?

  1. Haloperidol alone
  2. Benzodiazepine Correct answer.
  3. Flumazenil
  4. Naloxone

Explanation

These findings indicate alcohol withdrawal delirium, for which benzodiazepines are first-line to prevent seizures and complications. Antipsychotics alone do not treat the underlying withdrawal and can lower the seizure threshold.

Question 21Clinical Judgment

Which task can the RN delegate to an unlicensed assistive personnel (UAP)?

  1. Vital signs on a stable patient Correct answer.
  2. IV push medication administration
  3. Teaching insulin injection
  4. Initial assessment of chest pain

Explanation

Taking vital signs on a stable patient is a routine task within UAP scope under nurse supervision. Assessment, teaching, and IV push medications require the RN.

Question 22Clinical Judgment

A dying patient is alert and states a wish for comfort care, but the family demands full resuscitation. There is no advance directive. What should the nurse do?

  1. Follow the family's request
  2. Ignore the patient's statement
  3. Support and document the patient's choice Correct answer.
  4. Call the ethics committee before any discussion

Explanation

A competent adult's own treatment decision takes precedence over family preferences. The nurse should support the patient, document the discussion, and involve the team and ethics resources as needed.

Question 23Clinical Judgment

Which finding is an early sign of hypoxemia in an adult?

  1. Restlessness Correct answer.
  2. Coma
  3. Severe bradycardia
  4. Central cyanosis

Explanation

Restlessness, anxiety, and confusion often occur early as the brain senses inadequate oxygen. Cyanosis is a late sign, and coma indicates severe deterioration.

Question 24Clinical Judgment

A patient with septic shock remains hypotensive with a MAP of 58 mm Hg after 30 mL/kg of crystalloid and has a lactate of 5 mmol/L. Which vasopressor should the nurse anticipate first?

  1. Dopamine infusion
  2. Vasopressin
  3. Norepinephrine Correct answer.
  4. Phenylephrine

Explanation

Norepinephrine is the first-line vasopressor in septic shock after adequate fluid resuscitation. It raises mean arterial pressure and is preferred over dopamine because of fewer arrhythmias.

Question 25Clinical Judgment

A patient with acute decompensated heart failure has blood pressure 78/40 mm Hg, bibasilar crackles, and a lactate of 3 mmol/L. What is the priority?

  1. Give a large crystalloid bolus
  2. Start a beta blocker
  3. Place the patient flat
  4. Start NIV and vasopressors Correct answer.

Explanation

This patient has cardiogenic shock with pulmonary edema; noninvasive ventilation supports oxygenation and vasopressors maintain perfusion while the cause is treated. Large fluid boluses can worsen pulmonary edema.

Question 26Clinical Judgment

A patient develops hives, facial swelling, and wheezing minutes after receiving IV penicillin. What is the priority medication?

  1. IV methylprednisolone
  2. Intramuscular epinephrine Correct answer.
  3. Nebulized albuterol
  4. Oral diphenhydramine

Explanation

Anaphylaxis with airway swelling and wheezing is treated first with intramuscular epinephrine; delay increases the risk of fatal airway obstruction. Antihistamines and corticosteroids are adjuncts, and albuterol does not reverse systemic mediator release.

Question 27Clinical Judgment

A postoperative patient is found unresponsive with a respiratory rate of 6/min and pinpoint pupils after receiving IV hydromorphone. What should the nurse prepare to administer?

  1. Flumazenil
  2. N-acetylcysteine
  3. Atropine
  4. Naloxone Correct answer.

Explanation

Pinpoint pupils, respiratory depression, and unresponsiveness after an opioid strongly indicate opioid toxicity. Naloxone is a competitive opioid antagonist that reverses hypoventilation and should be given promptly.

Question 28Clinical Judgment

Ten minutes into a packed RBC transfusion, a patient reports chills and flank pain; temperature rises from 37.0 to 38.6 C. What is the nurse's first action?

  1. Stop the transfusion and keep the IV line open Correct answer.
  2. Give acetaminophen and continue the transfusion
  3. Obtain a urine sample for hemoglobin
  4. Slow the transfusion and reassess in 15 minutes

Explanation

A febrile or hemolytic transfusion reaction requires stopping the transfusion immediately while keeping IV access for emergency drugs and fluids. The unit and tubing are returned to the blood bank, and the provider is notified.

Question 29Clinical Judgment

A patient has frequent watery stools and a positive stool test for Clostridioides difficile. Which precautions should the nurse implement?

  1. Standard only
  2. Airborne
  3. Contact Correct answer.
  4. Droplet

Explanation

Clostridioides difficile is spread by spores, so contact precautions are required until diarrhea resolves. Hand hygiene with soap and water is preferred because alcohol does not reliably kill spores.

Question 30Clinical Judgment

A patient with type 1 diabetes is diaphoretic and confused, and a point-of-care glucose is 42 mg/dL. The patient has a patent IV line but cannot swallow safely. What should the nurse administer first?

  1. Subcutaneous insulin
  2. IM glucagon
  3. Oral glucose gel
  4. IV dextrose Correct answer.

Explanation

Severe hypoglycemia in a patient who cannot swallow safely is treated with IV dextrose, which raises glucose rapidly. Glucagon is an alternative when IV access is unavailable, and oral glucose is unsafe with impaired swallowing.

Question 31Clinical Judgment

A patient begins a generalized tonic-clonic seizure. Which action should the nurse take first?

  1. Place a tongue blade between the teeth
  2. Restrain the arms and legs
  3. Give oral lorazepam immediately
  4. Protect from injury; turn to side Correct answer.

Explanation

During a generalized seizure, the priority is preventing injury and maintaining airway patency by turning the patient to the side. Nothing should be placed in the mouth, and restraints can cause injury.

Question 32Clinical Judgment

While a central venous catheter is being removed, the patient suddenly becomes dyspneic and hypotensive. The nurse suspects air embolism. Which position should the nurse place the patient in?

  1. Prone position
  2. High Fowler position
  3. Left lateral Trendelenburg position Correct answer.
  4. Right lateral decubitus with head flat

Explanation

Air embolism during central line removal is managed by placing the patient in left lateral Trendelenburg position to trap air away from the pulmonary outflow tract while giving 100% oxygen. This position helps limit obstruction of pulmonary blood flow.

Question 33Clinical Judgment

A patient with a new tracheostomy has coarse breath sounds and audible secretions. What should the nurse do first?

  1. Deflate the cuff
  2. Increase oxygen flow to 10 L/min
  3. Instill 5 mL of normal saline into the tracheostomy
  4. Suction the tracheostomy Correct answer.

Explanation

Coarse breath sounds and audible secretions indicate retained secretions that should be cleared by suctioning. Routine saline instillation is not recommended, and cuff deflation or high-flow oxygen does not remove the obstruction.

Question 34Clinical Judgment

A patient becomes acutely dyspneic and hypotensive after a central line insertion. Breath sounds are absent on the right, and the trachea is deviated to the left. What complication should the nurse suspect?

  1. Atelectasis
  2. Pulmonary embolism
  3. Pleural effusion
  4. Tension pneumothorax Correct answer.

Explanation

Absent breath sounds, tracheal deviation away from the affected side, and hypotension after central line insertion suggest tension pneumothorax. This is an emergency requiring immediate needle decompression.

Question 35Clinical Judgment

A stable patient has a regular narrow-complex tachycardia at 190 beats/min and a blood pressure of 118/72 mm Hg. What should the nurse try first?

  1. IV adenosine
  2. Synchronized cardioversion
  3. Vagal maneuvers Correct answer.
  4. IV amiodarone

Explanation

For stable narrow-complex SVT, vagal maneuvers are the first intervention and can terminate the arrhythmia. Adenosine is used if vagal maneuvers fail, while cardioversion is reserved for instability.

Question 36Clinical Judgment

A patient has a heart rate of 44 beats/min, blood pressure 82/48 mm Hg, and dizziness. What medication should the nurse anticipate giving first?

  1. Adenosine
  2. Epinephrine infusion
  3. Metoprolol
  4. Atropine Correct answer.

Explanation

Symptomatic bradycardia with hypotension and dizziness is initially treated with atropine. If atropine is ineffective, transcutaneous pacing or an epinephrine infusion may be needed.

Question 37Clinical Judgment

A patient has been seizing continuously for 6 minutes. Which medication should the nurse expect to administer first?

  1. Oral phenytoin
  2. IV fosphenytoin
  3. IV lorazepam Correct answer.
  4. IV levetiracetam

Explanation

Continuous seizure activity lasting 5 minutes or more defines status epilepticus and requires a benzodiazepine first. Lorazepam is a first-line benzodiazepine, followed by a longer-acting antiseizure medication.

Question 38Clinical Judgment

A patient taking sertraline and tramadol develops agitation, diaphoresis, hyperreflexia, and clonus. Which condition should the nurse suspect?

  1. Alcohol withdrawal
  2. Neuroleptic malignant syndrome
  3. Serotonin syndrome Correct answer.
  4. Anticholinergic toxicity

Explanation

Serotonin syndrome presents with mental status changes, autonomic hyperactivity, and neuromuscular findings such as clonus and hyperreflexia. The trigger is serotonergic drugs, which should be stopped.

Question 39Clinical Judgment

A patient who started haloperidol has a temperature of 39.8 C, muscle rigidity, altered mental status, and a creatine kinase of 4,000 U/L. Which condition should the nurse suspect?

  1. Serotonin syndrome with clonus
  2. Malignant hyperthermia reaction
  3. Neuroleptic malignant syndrome Correct answer.
  4. Exertional heat stroke

Explanation

Neuroleptic malignant syndrome is caused by dopamine antagonists and causes rigidity, hyperthermia, altered mental status, and elevated creatine kinase. The antipsychotic should be stopped and supportive care started.

Question 40Clinical Judgment

During surgery with inhaled anesthesia, a patient develops masseter rigidity, tachycardia, and a rapidly rising end-tidal CO2. Which medication should the nurse prepare?

  1. Physostigmine
  2. Haloperidol
  3. Dantrolene Correct answer.
  4. Succinylcholine

Explanation

Malignant hyperthermia is a hypermetabolic reaction to inhaled anesthetics or succinylcholine. Dantrolene is the specific antidote, along with stopping the trigger and aggressive cooling.

Question 41Clinical Judgment

A patient with chemotherapy-induced neutropenia has a temperature of 38.4 C. What should the nurse do first?

  1. Place in protective isolation and wait for cultures
  2. Give oral acetaminophen and reassess in 4 hours
  3. Draw blood cultures and give antibiotics Correct answer.
  4. Obtain a chest x-ray before any treatment

Explanation

Febrile neutropenia is an emergency because infection can progress rapidly. Blood cultures should be drawn and broad-spectrum antibiotics started promptly, ideally within 1 hour.

Question 42Clinical Judgment

A patient with cirrhosis becomes confused and has asterixis. Which medication should the nurse expect to be prescribed?

  1. Lactulose Correct answer.
  2. Omeprazole
  3. Spironolactone
  4. Furosemide

Explanation

Asterixis and confusion in cirrhosis suggest hepatic encephalopathy from ammonia accumulation. Lactulose acidifies the colon and traps ammonia, with a goal of two to three soft stools daily.

Question 43Clinical Judgment

A patient has serum sodium 124 mEq/L, concentrated urine, and no edema. Which order should the nurse anticipate?

  1. Rapid IV 0.9% sodium chloride bolus
  2. Fluid restriction Correct answer.
  3. Oral furosemide
  4. Free water intake

Explanation

SIADH causes euvolemic hyponatremia with concentrated urine due to excess ADH. Fluid restriction is the initial treatment; hypertonic saline is reserved for severe symptomatic hyponatremia.

Question 44Clinical Judgment

After pituitary surgery, a patient has urine output of 400 mL/hr, serum sodium 152 mEq/L, and urine specific gravity 1.002. Which medication should the nurse anticipate?

  1. Vasopressin antagonist
  2. Desmopressin Correct answer.
  3. Regular insulin
  4. Furosemide

Explanation

Large volumes of dilute urine with hypernatremia after pituitary surgery indicate central diabetes insipidus from ADH deficiency. Desmopressin replaces ADH and reduces urine output.

Question 45Clinical Judgment

A patient with sickle cell disease has severe bone pain and a temperature of 37.8 C. Which intervention should the nurse anticipate?

  1. Withhold analgesia until imaging is complete
  2. Apply cold packs to painful areas
  3. Restrict fluids to prevent edema
  4. Administer IV fluids and opioid analgesia Correct answer.

Explanation

Vaso-occlusive sickle cell crisis is treated with IV hydration, prompt opioid analgesia, and oxygen if hypoxemic. Cold exposure and fluid restriction can worsen sickling and pain.

Question 46Clinical Judgment

A patient with a T4 spinal cord injury has a sudden blood pressure of 210/110 mm Hg, pounding headache, and diaphoresis. What should the nurse do first?

  1. Place the patient flat and apply warm blankets
  2. Perform a bladder scan after 30 minutes
  3. Sit upright and find the trigger Correct answer.
  4. Give sublingual nifedipine

Explanation

Autonomic dysreflexia is a hypertensive emergency in high spinal cord injury and is triggered by noxious stimuli such as bladder distension. The first actions are sitting the patient upright and removing the trigger.

Question 47Clinical Judgment

A patient with Graves disease has fever 40.2 C, heart rate 150, agitation, and vomiting. Which medication should the nurse anticipate giving first along with supportive care?

  1. Methimazole alone
  2. Levothyroxine
  3. Propranolol Correct answer.
  4. Radioactive iodine

Explanation

Thyroid storm is managed with a beta blocker to control heart rate and agitation, along with thionamide therapy, iodine after thionamide, and corticosteroids. Levothyroxine and radioactive iodine are not acute treatments.

Question 48Clinical Judgment

A patient with known adrenal insufficiency has vomiting, blood pressure 78/50 mm Hg, and serum sodium 128 mEq/L. Which medication should the nurse anticipate administering?

  1. IV hydrocortisone Correct answer.
  2. Dextrose 50% alone
  3. Oral potassium binder
  4. Insulin infusion

Explanation

Adrenal crisis presents with hypotension, hyponatremia, and vomiting and is treated promptly with IV hydrocortisone and volume resuscitation. Dextrose is added only if hypoglycemia is present.

Question 49Clinical Judgment

A patient taking warfarin has an INR of 7.5 and is actively bleeding from the gums and venipuncture sites. Which intervention should the nurse anticipate?

  1. Administer oral warfarin 2 mg
  2. Give IV vitamin K and prothrombin complex Correct answer.
  3. Give fresh frozen plasma only after INR normalizes
  4. Give vitamin K alone and observe

Explanation

Active major bleeding with a supratherapeutic INR from warfarin requires rapid reversal with vitamin K and prothrombin complex concentrate. FFP may be used if PCC is unavailable but is not the preferred rapid agent.

Question 50Clinical Judgment

A patient receiving IV doxorubicin reports burning at the peripheral IV site, and the nurse notes swelling. What should the nurse do first?

  1. Apply warm compresses and continue the infusion
  2. Flush the line with 10 mL normal saline
  3. Remove the IV catheter immediately and elevate the arm
  4. Stop the infusion and leave the catheter in place Correct answer.

Explanation

Doxorubicin is a vesicant, and burning with swelling indicates extravasation. The infusion should be stopped and the catheter left in place so the drug can be aspirated and an antidote administered per protocol.