# Categorize each action for a client with tricyclic-antidepressant overdose and a wide QRS complex as indicated or unsafe.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=515765&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Categorize each action for a client with tricyclic-antidepressant overdose and a wide QRS complex as indicated or unsafe.

**1.** Support airway and ventilation

Select a category
Unsafe
Indicated

**2.** Begin continuous ECG and blood-pressure monitoring

Select a category
Unsafe
Indicated

**3.** Administer prescribed sodium bicarbonate

Select a category
Unsafe
Indicated

**4.** Treat seizures with an authorized benzodiazepine

Select a category
Unsafe
Indicated

**5.** Contact the poison center

Select a category
Unsafe
Indicated

**6.** Administer physostigmine for delirium

Select a category
Unsafe
Indicated

**7.** Give flecainide for the wide QRS complex

Select a category
Unsafe
Indicated

## Explanation

Airway support, continuous ECG monitoring, poison-center consultation, seizure treatment, and sodium bicarbonate are indicated; physostigmine and class IA or IC antiarrhythmics are unsafe in this sodium-channel-blocker presentation.

## In-depth explanation

Quick answer
Treat the sodium-channel blockade and prevent seizures and dysrhythmias.

Why this is correct
A wide QRS, hypotension, and seizures after a tricyclic overdose signal life-threatening sodium-channel blockade. Sodium bicarbonate and supportive toxicology care are prioritized.

Easy analogy or mental picture
Open the blocked cardiac sodium highway; do not add another blocker.

Memory hook
Wide QRS after TCA: bicarbonate and monitor.

NCLEX decision rule
Match the antidotal strategy to the conduction mechanism and avoid drugs that worsen conduction or seizures.

Why the other choices are wrong
Physostigmine can provoke dangerous complications in TCA overdose, and additional sodium-channel-blocking antiarrhythmics can worsen conduction.References
1AHA Focused Update: Life-Threatening PoisoningPoison-center consultation, sodium bicarbonate, and high-dose insulin recommendations

## Clinical scenario

TCA overdose response
Protect airway, treat seizures, trend QRS and blood pressure, administer ordered sodium bicarbonate, and consult toxicology.

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