Medication
What side effects can occur when furosemide (Lasix) is given too quickly by direct IV injection?
Tinnitus and hearing loss, occasionally permanent. Occurs more frequently with large IV doses at rapid injection rates (>4 mg/min), in patients with significant renal impairment, or in those receiving concurrent ototoxic drugs (ex. aminoglycosides, ethacrynic acid).
Electrolyte depletion (electrolyte imbalance): hypokalemia, hypochloremia, hypomagnesemia and hypocalcemia.
Fluid depletion resulting in orthostatic hypotension, acute hypotensive episodes or impairment of renal function
Who can initiate or cancel a Code Omega?
See “Code OMEGA-Massive Transfusion Policy”
Code OMEGA may be initiated and/or cancelled by a staff physician. Fellows, residents or nurses may communicate activation/cancellation of Code Omega on behalf of the staff physician
What is the routine schedule in changing a PICC line dressing?
Post 24 hours after PICC line insertion and every 7 days
See “Central Lines Management Policy (Adult)” Appendix C
The maximum infusion time for any single unit of PRBCs is _____.
4hours. See the “Adult blood and blood product administration policy and procedure”
Explain the rationale for prescribing lactulose for a patient with hepatic encephalopathy
Hepatic encephalopathy is caused by the buildup of ammonia in the blood, a substance that is normally removed by the liver. Ammonia crosses the blood-brain barrier and results in edema of a type of brain cells (astrocytes) leading to neurological symptoms like confusion, disorientation and poor coordination.
Lactulose works by:
The correct dose will cause 3 to 4 loose bowel movements per day
According to the Heparin IV guideline, what IV device should be used when setting up the IV line?
A J-set, which is used to prevent backflow of medication into the main IV line in the event of an occlusion below the port. J-sets are used with high risk medications.
Who’s allowed to cancel a Code Blue?
Only the Code Team leader, Emergency Department physician, ICU Attending Physician/ICU Fellow, or Anesthesia may cancel a Protected Code Blue. Vital signs of the patient for whom the Protected Code Blue was called should be documented and the ACCESS team called if required.
The only exception to this policy is if a protected code blue was activated by mistake.
Upon removal of Inadine, you notice that the color of the dressing has changed from orange to white, what does this indicate?
The dressing slowly releases Povidone Iodine into the wound bed. When it turns white that means all the iodine has been released and thus the dressing is due for a change
If a blood transfusion cannot be initiated within 30 minutes of retrieval, what is your action?
Return back to the blood bank, inform MD as needed and documentation
From the blood transfusion policy:
Blood must NOT be put in the refrigerator on the unit to be kept cool, nor should it be allowed to warm prior to administration. If the transfusion cannot be initiated within 30 minutes of retrieval, the blood must be returned to TMS. Blood cannot be returned to the TMS inventory if it is out of the monitored refrigerator more than 60 minutes from time of issue.
What is the name of the drug used to treat opioid induced respiratory depression? What is the usual dose administered?
Naloxone comes in an ampule of 0.4mg/1ml.
Small doses are used to ensure that the analgesic effect is not fully reversed.
Dilute 1 amp (0.4 mg) in 10 mL with NS. Administer 0.04 mg (1 mL of diluted solution) over 5-10 seconds. May be repeated every 2 minutes until respiratory depression has resolved.
In emergent cases these dosing guidelines may be exceeded. For example, in known or suspected opioid overdose you can administer 0.4-2 mg initially and repeat every 2-3 minutes until reversal is seen. If no response is observed after 10 mg, there may be another cause of respiratory depression.
Which fluid is IVIG compatible with?
D5W
See the “Adult blood and blood product administration policy and procedure”
IVIG is only compatible with D5W.
If your patient is on telemetry, when should you call the CCU nurse for an ECG rhythm reading?
How often you should assess skin integrity and range of motion for a patient who is awake and in limb restraints?
Q1H
See “Nursing documentation record for care of patients in restraint /seclusion and constant care”
List the safety checks required prior to infusing any blood product
See the “Adult blood and blood product administration policy and procedure”
Check online order, know the reason, ensure consent form is signed, and check the policy and procedure in the hospital intranet as needed.
2 nurses check the blood product and verify MRN, name, DOB, blood type, blood product, blood product unit number, etc.
The palliative care team wants to order a medication to help manage a patient’s dyspnea. What are they most likely to order?
Morphine – Opioid, lessens the subjective feeling of SOB within the CNS
B) Form 3 expires in:
A) 72 hours
B) 2 weeks
How often should you offer fluid, mouth care and toileting for a patient who is awake and in limb restraints
Q2H
See “Nursing documentation record for care of patients in restraint /seclusion and constant care
What is the first step for all suspected blood transfusion reactions?
If a transfusion reaction occurs, stop PRBC infusion. Clamp off blood line and run Normal Saline via a separate IV line. Inform physician immediately.
What do you do if the CCU nurse informs you that your patient is having a life threatening rhythm, (i.e. V-tach)?
Check the patient and inform the MD. stat. Stay with patient, perform assessment and initiate any treatments/interventions as necessary.
From the telemetry policy:
The CCU nurse will notify the patient’s nurse when significant arrhythmias occur, using the designated telemetry phone or wireless phone. The CCU nurse will initiate a Code Blue and notify the most responsible physician and the patient’s RN when a life threatening arrhythmia occurs.
A chest tube dressing should be changed every
72 hours