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This activity is approved for 1.50 contact hour(s) of continuing education (which includes 0.0 hours of pharmacology) by the American Association of Nurse Practitioners. Activity ID 18043162. This activity was planned in accordance with AANP CE Standards and Policies.


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DOI: 10.1097/JXX.0000000000000065


Purpose: To provide information about the potential adverse health outcomes following chlorpyrifos (CPF) exposure and the NP role in health promotion and education.


Learning Objectives/Outcomes: After completing this continuing education activity, you should be able to:


1. Recognize characteristics of organophosphate (OP) insecticides and regulations over their use.


2. Identify the evidence-based association between CPF exposure and adverse neurodevelopmental outcomes in children.


3. Illustrate the role of the NP in assessment of adverse effects and pesticide public safety promotion and education.


1. Environmental Protection Agency (EPA) recommendations for a CPF ban in 2015 were supported by


a. a review of the literature of the cognitive effects of neurotoxins in adults.


b. the National Academy of Neuropsychology.


c. research associating exposure to CPF with neurodevelopmental disorders in children


2. The CPF pesticides safety review by the EPA will be reevaluated


a. in 2019.


b. between 2020-2021.


c. in 2022 or after.


3. Organophosphate insecticides


a. are registered for agricultural use only.


b. are in a class of naturally-derived phosphorus-based chemicals.


c. have a variety of applications and widely ranging toxic properties.


4. Toxic doses of OP insecticides cause an acute


a. adrenergic overstimulation in the central nervous system.


b. cholinergic overstimulation in the central and peripheral nervous system.


c. breakdown of acetylcholine in neural synapses.


5. All of the following are symptoms of acute acetylcholinesterase toxicity except


a. pupillary dilation.


b. muscle twitching and weakness.


c. loss of consciousness.


6. Organophosphates are absorbed via all except


a. osmosis.


b. inhalation.


c. dermal contact.


7. Evidence shows that chronic subacute exposure to OPs may result in


a. changes in executive function.


b. repressed growth hormone production.


c. fetal death.


8. OP exposure has been associated with all of the following except


a. infertility.


b. disruption of fetal brain development.


c. psychosis.


9. A 2016 EPA review of CPF health risks found


a. a potential exposure risk for humans from dietary sources and drinking water.


b. a high death rate for birds and fish.


c. particularly significant risks for children over 12 years of age and adults.


10. The Columbia Center for Children's Environmental Health (CCEH) study found that at 36-months, children with high levels of prenatal CPF exposure showed


a. higher rates of bone and skin cancer.


b. delays in cognitive and psychomotor development.


c. higher incidence of birth defects.


11. The 7-year Columbia CCEH study evaluation found that, for each standard deviation of CPF exposure, full-scale IQ declined by


a. 1.4%.


b. 2.8%.


c. 4.0%.


12. CCEH data of children 11 years after high dose prenatal exposure to CPF found a statistically significant increase in


a. stuttering.


b. abnormal gait.


c. tremor.


13. How is prenatal OP exposure measured?


a. maternal blood test


b. maternal urine test


c. umbilical cord blood test


14. Populations more vulnerable to the risks associated with OP exposure include pregnant mothers,


a. low income families and food packers.


b. children younger than 2 years and agricultural workers.


c. vegetarians and older adults.


15. How long does CPF remain in the air after application?


a. 4-11 hours.


b. 12-24 hours.


c. 36-48 hours.


16. Surface applications to soil have an estimated half-life of


a. 7-15 days.


b. 16-30 days.


c. more than 60 days.


17. Which foods, included in the "Dirty Dozen," have the highest potential for pesticide residues?


a. bananas, green beans and cabbage


b. lettuce, turnips and mangoes


c. tomatoes, potatoes and grapes


18. Encourage patients to decrease exposure to dietary OP residue by


a. soaking produce for 12-15 minutes in a solution of 1% baking soda and water.


b. washing and lightly scrubbing produce with soapy water.


c. cleansing produce using a dilute bleach and water solution.