Fairview Southdale Hospital Total Points: 50 RN/LPN Medication Assessment Passing: 45 1. Your diabetic patient is to be started on an insulin drip at 8 units/hour. The insulin is supplied: 100 units in 100 ml NS. At what rate (ml/hr) should you set your IV pump? 2. Your patient s MAR reads: Insulin: NPH 15 units subcutaneous and Regular 6 units subcutaneous q a.m. NPH 8 units subcutaneous and Regular 4 units subcutaneous q p.m. BG four times daily with Regular insulin coverage as follows: 150-200 2 units subcutaneous 201-250 4 units subcutaneous 251-300 6 units subcutaneous 301-350 8 units subcutaneous 351-400 10 units subcutaneous The patient s blood glucose is 300 at 0715. What type(s) and how much insulin would you give? (last dose of insulin given yesterday p.m.) Type(s) Dose(s) 3. At 1100, the patient in question #2, has a blood glucose of 224. What type(s) and how much insulin would you give? Type(s) Dose(s) 4. Match each insulin type with onset of action (a or b) and route of administration (c or d). a. short acting b. intermediate acting c. long acting Onset of action: Route of adm: NPH Regular Lispro Glargine Which insulin is also given intravenously?
5. After subcutaneous injection, the onset of action for NPH insulin is: a. 10-30 minutes b. 30-60 minutes c. 1-2 hours d. 4-6 hours 6. Order reads: NPH 21 units subcutaneous and Regular 14 units subcutaneous every a.m. Available: U-100 NPH and U-100 Regular a. Indicate with a line across the syringe below the total number of units administered. b. Indicate with a second line across the syringe the break between the two different insulins, with the insulin you drew up last closest to the needle. The following questions refer to medication orders. 7. Order reads: Docusate sodium 50 mg po daily Available: Docusate sodium 10 mg/ml You will give cc per dose. 8.. Digoxin 0.375 mg IV daily Available: Digoxin 0.5 mg/2ml. You will give ml per dose. 9. SoluMedrol 100 mg IV t.i.d. Available: SoluMedrol 125 mg/2ml. You will give ml per dose. 10. Clindamycin 2700 mg/day IV in three divided doses. Available: Clindamycin phosphate 600 mg/4 ml. Calculate mg/dose and ml/dose.
11. Order: Diltiazem (Cardizem) 0.25 mg/kg, IV bolus over 2 minutes. Patient's weight: 178 pounds. Available: BLUE RED Which Cardizem vial would you choose? Blue or Red? Patient will receive mg and ml by direct IV. 12. Coumadin 7.5 mg, po daily. Available: Coumadin 2 ½ mg. tablets How many tablets will you give?. 13. Digoxin (Lanoxin) 250 mcg po daily. Available: Lanoxin 125 mcg and Lanoxin 0.25 mg. Which strength will you use?. How many tablets will you give?. 14. Hytrin 4 mg po daily. Available: Hytrin 1mg, 2mg, 5 mg, and 10 mg capsules. Which strength will you give?. How many capsules will you give/dose?. 15. Ranitidine hydrochloride (Zantac) 50 mg. IV q 8 h Available: Zantac 25mg/mL. You will give ml/dose and mg/day.
16. Ciprofloxacin (Cipro) 0.5 g po q 12h. Available: Cipro 250 mg and 500 mg tablets. Which strength will you use?. You will give tablet(s)/dose. For each patient care situation, identify the following statements as safe or unsafe. Based on your answer, state your action(s) and rationale for your action(s). Items 17-19 refer to the following scenario: Your 68 y.o. patient is admitted with a diagnosis of TIA and history of atrial fibrillation. 17. Order: Coumadin 3 mg po daily. Labs: INR: 5.6 Safe Unsafe 18. Order: Excedrin i - ii po q 4 h prn for headache. Safe Unsafe 19. A patient wants to leave without discharge medication instructions. Safe Unsafe
What instructions need to be given, if his discharge medication is coumadin? Items 20-22 refer to the following scenario: Your 44 y.o. diabetic patient is admitted with the following labs: Blood glucose 360; Creatinine: 2.0; Na+ 137; K+ 5.2; Cl-101; CO 2 22 Her last meal was 4 hours ago. No sliding scale insulin is ordered. 20. Order: K-Dur 8 meq po b.i.d. Safe Unsafe 21. Order: IV D 5.45 NS 100 ml/hr Safe Unsafe 22. The following day: Blood glucose 580 at 1540 hours. Order: 15 units NPH at 1600 hours Safe Unsafe
Items 23-25 refer to the following scenario: Your 26 y.o. patient returned from the recovery room 6 hours ago S/P appendectomy. He is NPO. Allergies: PCN and Sulfa 23. Order: Timentin (ticarcillin/clavulanate) 3g IV q. i. d. Gentamicin 60 mg IV t. i. d. Safe: Unsafe 24. Order: Morphine 1 mg dose, 10 minute lockout, 6 mg hourly limit. Safe Unsafe 25. The respiratory assessment of the opioid naïve patient after a high dose of morphine is: Rate = 10, Quality = Irregular (I), Depth = Shallow (S) and the Sedation
Level = Mostly Sleeping (4). Order: Narcan 0.1 mg IV push q 3 minutes prn X 3 doses. Safe Unsafe Items 26-28 refer to the following scenario: Your patient is a 71 y.o. female; admitted after a syncopal episode at home. History: HTN, renal failure, CHF, DM Medications: Insulin, digoxin, lasix, lisinopril A.M. Assessment: A & O x 3, c/o stomach ache, blurred vision with yellow haziness, HA and tinnitus V.S.: BP 80/60; RR 18; HR 60, irregular; BG 110 Diabetic breakfast tray just arrived. 26. Order: Digoxin 0.125 mg po every day Safe Unsafe 27. Order: Insulin 10 units NPH subcutaneous q a.m. Safe Unsafe 28. Order: Lasix 40 mg po now.
Safe Unsafe 29. Your patient is a 83 y.o. female who is admitted for CVA. Her admission PTT result is >100 seconds Order: Heparin drip at 800 units/hour. Safe Unsafe 30. Your patient is post-op right total knee surgery. He is on a morphine PCA for pain and is having difficulty sleeping. He asks you for the sleeping pill that he knows his doctor prescribed. MAR reads: Restoril 15 mg P.O. q hs for sleep. Safe Unsafe 31. Your 52 y.o generally healthy post-op total abdominal hysterectomy patient is complaining of surgical pain. She is NPO and has not had any analgesia since leaving the PACU. V.S: T=98.6, P=72, R=18 and regular, BP= 132/78 MAR reads: Demerol 50 mg IM q4h prn Morphine 1 mg IV q ½ -1 hour prn Percocet 1 tablet p.o. q4h prn Which medication will you administer?
32. Order: 1000 cc D 5 LR with 20 meq KCl in over 8 h. The bag was hung at 0700. At 1100 there are 600 cc left in the bag. The IV is: on schedule ; ahead ; behind. If it is not on schedule, how far ahead or behind is it? ml 33. Order: Dilantin 200 mg in 100 ml NS. Infusion rate not to exceed 50 mg/minute. What is the LEAST amount of time over which this medication could infuse? Item 34 refers to the following medication label information: Label reads: 2 g Nafcillin Sodium. When reconstituted with 6.6 ml diluent, each vial contains 8 ml solution. Each ml of solution contains nafcillin sodium, as the monohydrate, equivalent to 200 mg nafcillin, buffered with 10 mg sodium citrate. 34. Order: Nafcillin 0.5 g IM q 6h You will administer ml Nafcillin/dose. For each item in the box, fill in the abbreviation or the interpretation. Abbreviations 35. q24h 39. mg 43. qday 47. sublingual 36. BID 40. prn 44. hs 48. sc 37. ml 41. ac 45. noc 49. po 38. TID 42. mcg 46. after meals 50. meq
**Bonus Questions** Rewrite the following orders using the SAFEST terms: 51) 5U Reg Insulin SC q a.m. 52) MS.5 mg IV q ½ h prn 53) Ativan 1.0 mg IV q 3h prn END