Medications
What class of drug is pantoprazole?
proton pump inhibitor (PPI)
Your patient has been diagnosed with heart failure and you are assessing for edema. You note pitting edema in their lower legs and ankles bilaterally, about 4mm in depth and rebounds in 10-15 seconds. How would you grade this pitting edema?
+2
You are preparing to insert an indwelling foley catheter. Demonstrate how to put on sterile gloves.
First to complete correctly gets the points!
Your patient voided 300mL in the bedpan, where do you document this?
24 hr Intake & Output (specifically output)
You are interpreting your patients cardiac rhythm strip and notice tall, peaked T-waves and widened QRS complexes. You obtain bloodwork for serum lytes. What do you anticipate to see on your patients bloodwork?
Hyperkalemia
Your patient with CHF has a new order for furosemide 60mg IV direct BID. The vial for furosemide has a concentration of 40mg/4ml. The IV monograph states that furosemide can be given IV direct undiluted. How many mls will you administer?
6ml
Describe where to auscultate heart sounds and name respective areas.
Aortic: 2nd IC space Rt of sternum
Pulmonic: 2nd IC space Lt of sternum
Erb's Point: 3rd IC space Lt of sternum
Tricuspid: 4th IC space Lt of sternum
Mitral: 5th IC space Lt midclavicular line
Describe and demonstrate how to measure the length needed for NG insertion.
Tip of the nose -> ear lobe -> xiphoid process
You are covering another nurse's patient so they can take a break. The nurse on break failed to mention their patient's code status when giving report. Where can you find this information?
Goals of Care sheet (physician orders)
Your patient is admitted with a COPD exacerbation. Interpret their ABG results:
pH 7.33
PCO2 65
HCO3 31
PO2 64
According to your Scheduled MAR, your patient is due for metoprolol 25mg PO at 10:00. On assessment, their HR is 39. Is it safe to continue with administration of metoprolol? Why or why not?
No. Hold the metoprolol and call MD. Metoprolol is a beta-blocker and severe bradycardia is a contraindication.
During your hourly rounds, you find your patient lying in bed with their eyes closed. Chest rise and fall is present, but appears slow and patient is snoring. You call out your patient's name with no response. After a sternal rub, they open their eyes briefly, groan, and withdraw to painful stimuli (non-localized). What is your patient's GCS?
Eye: +2
Verbal: +2
Motor: +4
= GCS 8
Describe how to measure and insert an oropharyngeal airway (OPA).
Measure from corner of mouth to angle of jaw (mandibular angle)
Insert "upside down" so curved end hits hard palate, about halfway in turn 180 degrees and follow natural curve of tongue
80 y/o patient, A+Ox3 GCS 15, has a indwelling foley catheter and incontinent of stool once per shift, uses a walker, only able to mobilize from bed to chair and can make slight, frequent position changes in bed. Will often call to be boosted up in bed. Will eat lunch and supper, but only about 50% of each meal. Document the Braden Score.
Score ~15-17 At Risk, but advanced to Moderate Risk due to age and poor intake of protein.
Your patient is admitted with diabetic ketoacidosis. Interpret their ABG results:
pH 7.27
PCO2 28
HCO3 13
PO2 92
Partially compensated metabolic acidosis
Your patient has type I diabetes and is insulin dependent. You obtain their POC glucose just before their lunch arrives. They are ordered to have 5 units of insulin (Trurapi) subcut with medium correction with meals. The glucometer reads 15.6. How many units of insulin will you administer?
10 units
What clinical manifestations might you expect for a patient in septic shock? (list at least 4)
-altered LOC or decreased GCS
-anxiety/discomfort
-tachycardia
-weak pulses
-hypotension
-fever or low temp
-increased RR and/or laboured breathing
-decreased/low urine output
-diaphoresis or clammy skin
-pallor
Interpret the following cardiac rhythm strip.
Atrial rate/rhythm: 50bpm, regular
Ventricular rate/rhythm: 50bpm, regular
PR interval: ~0.20
P-QRS ratio: 1:1
QRS duration: ~0.08
QT interval: ~0.40
QTc interval: ~0.37
ST: isoelectric
Rhythm interpretation: Sinus Bradycardia
You obtain the following 0800 vitals:
BP 88/52
HR 113
RR 22
SpO2 90% on room air
Temp 37.8
Document on your graphics sheet and identify your next action according to NEWS2.
First team to finish documenting and correctly identify next action gets the points!
Your patient is on a continuous IV heparin gtt as part of the ACS protocol. Their 0600 aPTT comes back reading 96 seconds. According to the Heparin PPO, what is your next action?
Stop infusion for 30 minutes
Decrease by 100units/h
Repeat aPTT 6 hours from time pump is turned off
Your patient had been administered hydromorphone (Dilaudid) 4mg PO q3h with 1mg subcut breakthroughs overnight for pain. On your morning assessment, GCS is 10, RR is 6, and pupils are pinpoint. You call the physician. What medication do you anticipate to be ordered? What is the drug class and mechanism of action?
naloxone (Narcan) - short-acting opioid antagonist - binds to and inhibits the u-opioid receptor (MOR), displacing opioid molecules and blocking them from attaching to receptors. effects are almost immediate
Your patient has been admitted with a stroke and currently require hourly neuro assessments. Describe and demonstrate a neuro assessment for this patient.
Vitals
Level of consciousness
GCS
Vision
Facial palsy
Language/speech
Sensory
Upper/lower motor/coordination
Neglect
Program the following secondary infusion in the volumetric pump:
Pip-tazo 3.375g in 100ml over 30 minutes
Whichever team finishes first and correctly gets the points!
Transcribe the following order onto the MAR:
dalteparin (Fragmin) 5000 units subcut daily
First team to finish correctly gets the points!
Your patient has a mechanical valve and they are due to have warfarin 3mg PO @ 1800. Their morning bloodwork comes back, and their INR is 1.3. You call to inform the physician. What order do you anticipate? Why?
Increase the warfarin dose. The target therapeutic INR range for this patient would be 2.0-3.5. <2.0 increases risk of clotting from mechanical valve, >3.5 increases risk of severe bleeding events.