Ethics
You think one of your nurse friends is diverting narcotics. Who do you speak to?
Ask to speak privately with manager or director. Report facts
Your patient has fine crackles, decreased O2 saturation and a decreased level of consciousness. Name 2 priority interventions.
Oxygen
Diuretic
CXR/BNP
What order should you give these meds to your septic patient?
Morphine 2mg IVP Q4hr prn mod pain (pain 8/10)
Zosyn 3.375 IVPB Q8hr 1st dose now
Protonix 40 mg IVP daily
zosyn
morphone
protonix
Before this action you need
Need x-ray confirmation
HOB >30 degrees
check patency
Actions before giving NG/OG meds
What kind PMH would you expect for a patient with a Creatinine of 7.2?
ESRD on dialysis
You find an antibiotic hanging with a full bag that was supposed to be given at 0600 - What next?
tell nurse, call pharmacy to retime, med error report
What ventilator mode do you expect for a patient weaning off the ventilator
Spontaneous breathing mode
Prioritize nursing diagnosis:
1.Impaired Electrolyte Imbalance AEB diarrhea and low K+
2.Decreased Cardiac output AEB low blood pressure
3. Ineffective Health Management AEB pt not check blood sugars
2
1
3
Name 3 medications that need filter tubing
What is TPN, lipids
Amiodarone
Mannitol
What medication might my patient be on if their INR is 3.2?
Warfarin/Coumadin
A preconceived, deeply held, usually negative, judgment formed about other groups
What is: Prejudice
Your patient's ABG is
pH 7.28, CO2 60, P02- 60%, HCO3- 24.
What two ways can you reduce the CO2 to balance the pH
Increase RR
Increase volume of breaths
Prioritize tasks upon receiving this new patient.
stat ABG
stat EKG for chest pain 9/10
Oxygen
check vital signs
What is:
vitals
Oxygen
Stat EKG
Stat ABG
This IVP medication can cause ototoxicity if given too quickly
What is Furosemide/Diuretics
Aminoglycoside Antibiotics.
What labs are ordered if a MD wants a Pan culture of a paitent?
UA with culture
Blood culture x2 15 min apart (peripheral)
Sputum culture
Your patient confides in you that they want to hurt themselves. Name 3 crucial steps to ensure your patients safety
1. Stay (or have someone) in the room with the patient.
2. Tell your charge nurse, and document in chart
3. Call MD patient is on suicide watch
Pulmonary edema associated with ARDS is caused by:
a) right ventricular failure with Pulmonary HTN
b) fluid overload related to fluid resuscitation
c) Increased permeability of aveolar/capillary membrane
C
Which items are in the primary assessment?
Pain
Exposure
Airway
Sequence of Events
What is: Exposure and Airway
And order for .9 NS as 125 ml/hr is given with a drop factor of 15 drops/ml. What is the correct drops/min required to deliver this volume?
What is 31 drops/min
Your patient has calcium level of 9.0 with an albumin level of 2.5, what is your corrected calcium level?
What is: 10.2
In civil cases, the legal criteria against which nurse's conduct is compared to determine if an act was negligent or malpractice occured.
What is: The Standard of Care
Calculate the P/F ratio and then determine which level of ARDS the patient is in
ABG - pH 7.25, CO2- 65, PaO2- 58, HCO3- 24
FI02- 55%
P/F Ratio is 105
Moderate ARDS
Prioritize:
1. vented patient 100% fi02/prone/ periodically desats to 83%
2. B/P is 75/42 pt awake and alert but dizzy HR is SVT 175.
3. Confused pt with left sided weakness is trying to get OOB
See pt 2 first, needs nursing intervention
delegate 1 to respiratory
delegate 2 to patient care tech or fellow RN
Name 3 vasopressors used in critical care.
Epinephrine
Norepinephrine
Vasopressin
Neosynephrine / Dopamine
Come up with an ABG that shows metabolica acidosis with partial respiratory compensation.
what is: decreased pH, decreased HCO3 with decreased CO2