Dosage Critical Care

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Sample questions from Dosage Critical Care

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the pediatric intensive care unit, a 9-year-old receiving a continuous unfractionated heparin infusion for a pulmonary embolism has an aPTT of 118 seconds (therapeutic range 60-85 seconds). The child is alert, has no visible bleeding, and has stable vital signs. The infusion is running at 22 units/kg/hr; the protocol directs the nurse to hold the infusion for 1 hour and decrease the rate by 3 units/kg/hr when the aPTT is above 100 seconds. Which action should the nurse take?

   • A.Administer protamine sulfate immediately to reverse the heparin.
   • B.Ask the unlicensed assistive personnel to decrease the infusion by 3 units/kg/hr.
   • C.Hold the infusion and then restart it at 19 units/kg/hr as directed by the protocol.
   • D.Continue the infusion and repeat the aPTT in 1 hour because there is no bleeding.

   Rationale: The aPTT is above the protocol threshold, so the nurse should implement the ordered hold and rate reduction, then obtain follow-up coagulation testing as directed. Continuing the infusion risks bleeding, while protamine is not indicated solely for this result in a stable client without bleeding. An unlicensed assistive personnel cannot adjust a high-alert medication infusion.

2. 2.At change of shift in a cardiac intensive care unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 45-year-old receiving nitroglycerin after a myocardial infarction whose headache is rated 5/10 and whose blood pressure is 118/70 mm Hg.
   • B.A 74-year-old with atrial fibrillation receiving a digoxin infusion whose apical pulse is 58/min and whose potassium is 3.0 mEq/L.
   • C.A 63-year-old receiving furosemide for pulmonary edema who has produced 700 mL of urine in the past 2 hours and reports less dyspnea.
   • D.A 52-year-old 1 hour after cardiac catheterization who has a small, unchanged area of bruising at the radial access site and a warm hand.

   Rationale: The client receiving digoxin has bradycardia and hypokalemia, which increase the risk of digoxin toxicity and potentially life-threatening dysrhythmias; the infusion should be evaluated promptly. A nitroglycerin-related headache with stable blood pressure is an expected effect, and the diuresis client is improving. Unchanged bruising with a warm hand does not suggest acute access-site compromise.

3. 3.In the medical intensive care unit, a 61-year-old client with septic shock is receiving norepinephrine through a peripheral IV while central access is being arranged. Refer to the client's chart. Which actions should the nurse take now? Select all that apply.

   • A.Stop the infusion through the affected peripheral IV and avoid flushing the catheter.
   • B.Notify the provider promptly about the site change and the blood pressure remaining below the ordered target.
   • C.Leave the infusion in place until central access is available because the blood pressure is below target.
   • D.Establish or use an alternative patent access site for the vasopressor according to policy while arranging central access.
   • E.Apply a warm compress and massage the site while the norepinephrine continues to infuse.

   Rationale: The 1000 note describes pallor, coolness, and swelling at the peripheral site, consistent with possible extravasation; the infusion should be stopped there without flushing, and the provider should be notified. The MAP has fallen from 67 to 59 mm Hg despite the infusion, so the nurse should also escalate the persistent hypotension and arrange safe alternative access according to policy. Continuing the infusion at the compromised site or massaging it could worsen tissue injury; local treatment should follow the facility extravasation protocol.

4. 4.A pharmacist calls the surgical intensive care unit about a 36-year-old client whose weight was entered as 90 kg instead of 60 kg for a weight-based insulin infusion. The pump is programmed at 9 units/hr, and the current glucose is 82 mg/dL, down from 210 mg/dL 1 hour ago. The client is awake and reports no symptoms. What is the nurse's priority action?

   • A.Give the scheduled subcutaneous insulin dose to prevent rebound hyperglycemia.
   • B.Wait for the next hourly glucose result because the client is asymptomatic.
   • C.Reduce the infusion to 6 units/hr and recheck the glucose in 1 hour.
   • D.Stop the insulin infusion, assess the client, and check the glucose again promptly while notifying the provider.

   Answer and rationale are in the full material.

5. 5.A primigravida at 30 weeks is in the emergency department with severe preeclampsia and is receiving magnesium sulfate at 2 g/hr after a loading dose. She is drowsy but arousable; respiratory rate is 10/min, oxygen saturation is 93% on room air, patellar reflexes are absent, and urine output is 20 mL/hr. Which action should the nurse take first?

   • A.Stop the magnesium infusion and notify the provider immediately.
   • B.Increase the maintenance fluid rate to improve urine output.
   • C.Continue the infusion and reassess the reflexes in 30 minutes.
   • D.Administer the next prescribed antihypertensive before reassessing the client.

   Answer and rationale are in the full material.