Pharm
Your patient has been started on a heparin drip at 10am at 20 units/kg/hr with a goal to titrate heparin to a therapeutic unfractionated heparin level. When should your first unfractionated heparin level (heparin assay) be drawn?
1400
When a post-op patient is on VA ECMO via central canulation and your ECMO specialist states that an emergency has happened and you are now OFF ECMO, what would be your role as the bedside nurse?
To give code drugs
While listening for your neighbor nurse’s lunch, her 4-month-old who has undergone a Glenn repair 1 day ago has an episode of agitation where he is hypertensive, hypoxic, and screaming with his eyes closed. Before she left, she relayed she had just given a dose of Dilaudid and shouldn’t need any PRNs. Before speaking with the team, what non-pharmacological interventions would be most appropriate to try for this patient?
Raise head of the bed
After totaling your hourly outputs on a 4kg post-op patient, which would be most important to notify your provider about?
16ml of sanguineous chest tube output
What can cause your patient’s lactate to rise?
What medication is least likely to decrease your respiratory drive?
Precedex
You suspect your intubated patient has just had an unplanned extubation. What is the first step you do?
Press your staff assist
Your patient with an unrepaired TGA is going to the OR for surgery in the morning. Your provider is at the bedside assessing the patient and states she is worried that his PDA is closing. What vital sign changes would you expect to see on the monitor first if the PDA was closing?
Left foot O2 sat dropping
After signing off a unit of PRBCs with your neighboring nurse, they ask you if it’s okay to hang the blood with their milrinone drip as they only have a single lumen PICC line and no other access. What is your best response to this question?
None of the above
Uncompensated Respiratory Alkalosis
Increase the RR
Increase the Vt
Suction
Sodium Bicarb
Your post-operative cardiac patient is tachycardic, warm to touch, flushed, and hypotensive. What vasoactive drug would be best to use during this situation?
Vasopressin
What scenario is most important to talk to your ECMO specialist about before completing for best safety?
Changing a diaper
Pulmonary overcirculation is least likely to occur in which of the following cardiac surgeries?
Arterial Switch
What do you expect a Norwood's saturations to be if they were hypertensive?
<75%
Scenario 2
Hypoxic, Compensated
Increase the FiO2
Increase PEEP or PC
Suction
Minimize metabolic demand
As you are caring for a 1yo with cardiomyopathy, you notice that her rhythm suddenly changes. After assuring she has a pulse, checking a BP, and calling a provider to the bedside, you are asked to prepare a dose of Magnesium Sulfate to give from the code cart. Which dose of mag sulfate would you expect to administer to this 7kg patient?
350mg
When should you change the clave of a central venous line? (3 answers)
If visibly soiled
Before drawing blood cultures
After blood cultures
If visibly soiled
Before drawing blood cultures
After blood cultures
Every 7 days
Every 96 hours
Notice charting! [Today is Tuesday and IV tubing says “change Wednesday” but last clave date charted indicates to change on Tuesday]
Your preoperative TOF patient is agitated and has an O2 sat of 62%. Select all the possible interventions that could improve this patient’s condition.
An unrepaired VSD's saturations will be <90%. True or False?
Scenario 3
Uncompensated Metabolic Acidosis
Bicarb
Volume replacement
Sedation, paralysis (minimize metabolic demand)
You are caring for an 8kg patient who is recovering from cardiac surgery and is on a Milrinone drip, which they decreased from 1 mcg/kg/min to 0.5mcg/kg/min after rounds today. When doing your 4pm vital signs, you notice that your patient’s diaper is dry, and that he has only had one wet diaper of 24ml at 12:00 on your shift. What is the best choice for your next action?
Notify your providers as this patient likely has a decrease in UOP
You are caring for a post operative patient who is currently on the following drips in their manifold: Milrinone, Nicardipine, Precedex, Fentanyl, and Lasix. While you’re receiving report, multiple alaris pumps begin alarming, alerting you of an occlusion in the IV tubing. You check your drip lines and tubing, and ensure that everything is unclamped, without kinks, and all stopcocks are open appropriately. What is most likely the cause of this IV occlusion?
Not all of the medications infusing are compatible
Which of the vessels does a BT Shunt connect?
Branch of the Aorta to the pulmonary artery
What signs would indicate your patient's BTT shunt is clotting?
decreased saturations, decrease in HR, decrease in BP, decrease in EtCO2 and then no EtCO2
Scenario 4
Uncompensated Metabolic Acidosis
Sodium Bicarb
Volume
Milrinone
Epi
High risk intubation