A nurse is monitoring a patient who recently received a local anesthetic for signs of local anesthetic systemic toxicity (LAST). Which of the following clinical manifestations should the nurse recognize as early signs of LAST?

Respiratory arrest and coma

Ventricular arrhythmias and cardiac arrest

Hypotension and tachycardia

Tinnitus, metallic taste, and perioral numbness

Answer and Explanation

The Correct Answer is D

A. Respiratory arrest and coma: These are late, life-threatening manifestations of local anesthetic systemic toxicity (LAST) that occur after CNS and cardiovascular collapse. Recognizing early signs is critical to preventing progression to this severe stage.
B. Ventricular arrhythmias and cardiac arrest: These are also late signs of LAST, resulting from the anesthetic’s depressant effects on cardiac conduction. By the time these occur, toxicity is advanced and may require immediate resuscitation measures.
C. Hypotension and tachycardia: Although cardiovascular symptoms may eventually develop, they are typically preceded by neurological signs. Early identification and management of CNS symptoms can often prevent progression to cardiovascular compromise.
D. Tinnitus, metallic taste, and perioral numbness: These are classic early signs of LAST and indicate CNS involvement. They often occur within minutes of administration and should prompt immediate intervention to stop drug absorption and initiate supportive care.

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Correct Answer is D

Explanation

A. The Cytochrome P-450 Enzyme System: This system plays a major role in drug metabolism, particularly in the liver, but it does not significantly affect drug distribution. Its primary influence is on the biotransformation of drugs into active or inactive metabolites.
B. Renal function: Renal function primarily affects drug excretion. Impaired kidney function can lead to drug accumulation and toxicity but has a minimal direct effect on the distribution of drugs throughout tissues and organs.
C. Gastric pH: Gastric pH influences drug absorption in the gastrointestinal tract, especially for pH-sensitive drugs. However, it plays little to no role in the actual distribution of the drug once it enters systemic circulation.
D. Blood flow: Blood flow is the most significant factor affecting drug distribution. Highly perfused organs like the brain, liver, and kidneys receive drugs more quickly and in higher concentrations than poorly perfused tissues, influencing the onset and intensity of drug action.

A. "The risk of suicidal thoughts is highest during the first few weeks of treatment." B. "Antidepressants eliminate the risk of suicidal thoughts in all patients." C. "Suicidal thoughts are a common side effect experienced by most patients." D. "Suicidal thoughts only occur in patients with a history of suicide attempts."

Correct Answer is A

Explanation

A. "The risk of suicidal thoughts is highest during the first few weeks of treatment.": This is the most accurate statement. During the initial weeks of antidepressant therapy, especially in adolescents and young adults, the risk of suicidal ideation may increase as energy levels improve before mood stabilizes. Close monitoring during this period is critical.
B. "Antidepressants eliminate the risk of suicidal thoughts in all patients.": While antidepressants help many patients, they do not eliminate the risk of suicidal thoughts. Some individuals may continue to experience or even develop new suicidal ideation, particularly early in treatment.
C. "Suicidal thoughts are a common side effect experienced by most patients.": Suicidal ideation is a serious but not common side effect. It occurs in a subset of patients, particularly younger individuals, and must be monitored closely, but it is not experienced by the majority.
D. "Suicidal thoughts only occur in patients with a history of suicide attempts.": Suicidal ideation can develop in individuals without a previous history. Risk factors include age, underlying psychiatric conditions, and individual response to medication—not just past behavior.

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A nurse is monitoring a patient who recently received a local anesthetic for signs of local anesthetic systemic toxicity (LAST). Which of the following clinical manifestations should the nurse recognize as early signs of LAST?

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