Week 2 critical thinking

A provider’s order states that they must be notified if the patient’s mean arterial pressure (MAP) is below 70. Which of the following patient status would require the RN to report to the provider?

• Postoperative patient with a BP of 116/42

• Newly admitted patient with a BP of 150/87

• Patient with left ventricular failure who has a BP of 110/70

• Patient with a MI who has a BP of 140/86

Answer explanation

To calculate the MAP; (SBP + 2xDBP/3). Most blood pressure monitors calculates this for you, however it is important to practice this yourself.

At what angle do you administer SQ injections?

• 90 degrees

• 45 degrees

• 15 degrees

• 10 degrees

A patient is scheduled for surgery. The patient's warfarin is placed on hold and vitamin K 7.5 mg subcutaneous is ordered before the procedure. Pharmacy delivers vitamin K with a concentration of 10 mg/mL. Calculate the number of milliliters the patient will receive. (Round final answer to the nearest hundredths).

While assessing an older patient, jugular venous distention is noted with the head of the bed elevated to 45 degrees. What does this finding indicate?

• Jugular vein atherosclerosis

• Incompetent jugular vein valves

• Increased ventricular filling pressure

• Decreased intravascular fluid volume

Answer explanation

The jugular veins empty into the superior vena cava then into the right atrium and ventricle. JVD in a patient sitting at a 45 degree angle reflects an increase in atrial and ventricular pressure.

Your patient with CHF reports “I went to bed feeling fine, but when I woke up, I felt like I was suffocating”. How would this be charted?

• Orthopnea

• Pulses alternans

• Paroxysmal nocturnal dyspnea

• Acute bilateral plural effusions

Answer explanation

Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation.

Pulsus alternans is the alteration between strong and weak peripheral pulses during palpation.

Orthopnea indicates that the patient cannot lie flat because of dyspnea.

A patient with a seizure disorder has carbamazapine 150 mg by mouth e times per day ordered. The carbamazepine is available in a 100mg/5mL oral suspension. How many mL would be administered with each dose?

A patient has been admitted with pulmonary edema is scheduled to receive the following medications. Which medication would the RN question, prior to administering?

• Captopril (Capoten) 25mg

• Furosemide (Lasix) 60 mg

• Digoxin (Lanoxin) 0.125mg

• Carvedilol (Coreg) 3.125 mg

Answer explanation

Carvedilol is an appropriate medication for the treatment of CHF, however; it is not used in patients experiencing pulmonary edema because of the risk of worsening the heart failure. Beta blockers can reduce myocardial contractility, so so care must be taken in patients with volume overload.

Beta blockers reduce myocardial contractility, which is the reduction of the force of the hearts contractions.

Which lab test result will the RN monitor to evaluate the effects of therapy for a patient who has acute pancreatitis

• Lipase

• Calcium

• Bilirubin

• Potassium

Which finding would you need to report the fastest to the provider regarding a patient with acute pancreatitis?

• Nausea and vomiting

• Hypotonic bowel sounds

• Muscle twitching and finger numbness

• Upper abdominal tenderness and guarding

Answer explanation

Muscle twitching and finger numbness indicate hypocalcemia, a dangerous complication of pancreatitis. Hypocalcemia can occur because of an increase in lipase breaks down fats in the abdominal cavity, which then releases free fatty acids that can form calcium soaps through a process called saponification. This process can actually remove calcium from the blood stream and sequesters this calcium. This calcium is no longer soluble. All of this leads to a decrease in calcium.

A patient with osteoporosis has calcitrol 0.25mcg by mouth ordered daily. The calcitrol is available in a 1mcg/mL oral solution. How many milliliters would the patient receive with each dose?