Medication
How do you decied if dopamine is effective?
The urine out put will increase
Vaso-occlusive sickle cell crisis.
Answer: Severe joint and bone pain
Rationale: During a vaso-occlusive crisis, sickled red blood cells block blood vessels, causing tissue ischemia and severe pain, especially in the bones and joints. Pain is often the primary symptom requiring treatment.
A. Patient with heartburn after lunch
B. Patient with chest pain rated 4/10 and diaphoresis
C. Patient in sickle cell crisis requesting pain medication
D. Patient with chronic back pain with a history of UTI.
Answer: B
Rationale: Chest pain accompanied by sweating (diaphoresis) may indicate an acute myocardial infarction (heart attack). This is a potentially life-threatening emergency.
CAD
Answer: LDL 185 mg/dL
Rationale: Elevated LDL ("bad cholesterol") contributes to plaque formation in coronary arteries and increases the risk of MI and stroke. Patients with CAD should aim to keep LDL levels low.
A. Patient with BP 90/50 after receiving lisinopril
B. Patient with BP 86/46, confusion, and cool skin
C. Patient with BP 140/82
D. Patient with BP 152/88
Answer: B
Rationale: Confusion and cool skin indicate poor tissue perfusion and possible shock.
Priority Rule: Low BP plus symptoms is more dangerous than the number itself.
Medication used for DIC?
Answer: FFP
Rational: replaces clotting factor
Most concerning for MI.
Answer: Crushing chest pain radiating to the left arm
Rationale: Classic MI symptoms include crushing chest pain, pressure, or heaviness that may radiate to the left arm, jaw, neck, back, or shoulder. Immediate evaluation is required.
A. 138/84 mm Hg
B. 126/78 mm Hg
C. 92/52 mm Hg with dizziness
D. 142/86 mm Hg
Answer: C
Rationale: Symptomatic hypotension can cause decreased perfusion to the brain, heart, and kidneys and requires immediate intervention.
Myocardial Infarction (MI)
Answer: A. Troponin I elevated
Rationale: Troponin is the most specific and sensitive marker for heart muscle injury. Elevated troponin levels indicate myocardial damage and are a key diagnostic test for MI.
Tip: "Troponin = Heart muscle damage."
A. Diabetic requesting a snack with AC of 65
B. Patient asking about discharge instructions
C. Post-kidney transplant patient with restlessness
D. Patient reporting mild incisional soreness after pacemaker placement.
Answer: C
Rationale: Acute changes in mental status can indicate hypoxia, infection, electrolyte imbalance, or poor tissue perfusion.
Medication used for low urine output.
Furosemide (Lasix)
Rationale: Furosemide is a loop diuretic and is given when the patient's condition warrants immediate removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not remove fluid quickly.
Most characteristic of Left -sided heart failure
Answer: Crackles in the lungs
Rationale: Left-sided heart failure causes blood to back up into the lungs, producing pulmonary congestion, crackles, dyspnea, orthopnea, and decreased oxygenation.
A. BP 132/78 mm Hg
B. BP 154/84 mm Hg with headache
C. BP 160/88 mm Hg with headache and blurred vision
D. BP 146/82 mm Hg
Answer: C
Rationale: hypertension with neurologic symptoms may indicate a hypertensive crisis, placing the patient at risk for stroke and organ damage.
Pericarditis
Answer: Elevated ESR
Rationale: inflammatory disorder. ESR and C-reactive protein (CRP) are often elevated because they are markers of inflammation.
Tip: Pericarditis = Inflammation → ↑ ESR and ↑ CRP.
A. Pt. with pericarditis and a pain rated 5/10
B. Pt. with pericarditis and Heart rate 104 bpm
C. Pt. with pericarditis and Oxygen saturation 90% on room air
D. Pt. with pericarditis and Temperature 100°F
Answer: C
Rationale: An oxygen saturation of 90% indicates severe hypoxemia. Airway and breathing take priority over all other findings.
Interacts with contrast dye.
Metformin
Rational:
Metformin is held before and after contrast dye because the dye can sometimes temporarily affect kidney function
Most important acute kidney transplant rejection.
Answer: Decreased urine output
Rational: One of the most important findings
A. Dialysis patient with a WBC of 12,000
B. Patient with BP 146/88 mm Hg
C. Patient requesting pain medication- pain 10/10
D. Patient with glucose of 155 mg/dL
Answer: A
Rationale: A high WBC often suggests:
Disseminated Intravascular Coagulation (DIC)
Answer: Platelets 40,000/mm³
Rationale: DIC causes massive consumption of platelets and clotting factors. A platelet count of 40,000/mm³ places the patient at high risk for spontaneous bleeding.
A. Pt. with myocarditis with a Heart rate 88 bpm
B. Pt. with myocarditis c/o fatigue after walking
C. Pt. with myocarditis with frequent PVCs noted on the monitor
D. Temperature 99.5°F (37.5°C)
Answer: C
Rationale: Myocarditis can affect the heart's electrical conduction system. PVCs may progress to life-threatening dysrhythmias.
Major side effect of Furosemide
Cause significant potassium loss.
Rational: A low potassium level and places the patient at risk for dysrhythmias.
Major symptom Pulmonary embolism.
Answer: Sudden shortness of breath (dyspnea)
Rational:Most common symptom
A. Potassium 5.3 mEq/L
B. Potassium 5.6 mEq/L
C. Hemoglobin 9.8 g/dL
D. Magnesium 1.8 mEq/L
Answer: B
Rationale: Hyperkalemia with ECG changes can rapidly progress to lethal dysrhythmias and cardiac arrest.
Priority Rule: Potassium changes beats almost every other priority.
Vascular Disorder (Deep Vein Thrombosis)
Answer: d-dimer
Rationale: D-dimer is produced when blood clots are broken down. Elevated levels suggest active clotting and fibrinolysis and are commonly seen with DVT, PE, and DIC.
A. Pt. with endocarditis with a temperature 101°F
B. Pt. with endocarditis Patient with splinter hemorrhages
C. Patient with endocarditis with sudden left-sided weakness
D. Patient with endocarditis c/o extreme fatigue
Answer: C
Rationale:
Vegetations can break loose from infected heart valves and travel to the brain, causing a stroke.