Clinical Questions from a Nursing Student

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hi all nurses! i have many questions that i have compiled during my time working as an undergrad nurse. these are questions that i think about lying in bed at night after a day of work! so i apologize if my questions are all over the place because they truly are about anything that occurred during some of my shifts! thanks ahead of time for any answers or words of advice... alright here we go..18 questions coming at cha!:

1) are pts allowed to leave the ward as they please if independent & stable? like go down for smokes of cafeteria? does dr need to write permission for this?:confused:

2) scenario:

>500mg/100ml metrondiazole (flagyl) over 20 mins given at 2100

>400mg/200ml ciprofloxacin over 60 mins given at 2100

- would i give the flagyl first because it is the faster med? i checked the iv manual for compatibility b/w the two meds and it said “compatible admixed” does this mean that it would be okay to attach the cipro to primary line right after the met has finished? what if the two meds were not compatible? would i need to flush the line from the very top port where the first med had been connected?

3) pt brings own meds in that the doctor has ordered. does pharm need to see & label them?

4) how does bowel elimination protocol work? 5 levels, when you know what level is appropriate. they say to start at the lowest level (fruit lax) and work your way up as needed. but if the patient hasn’t had a bm in 6 days i don’t think that fruit lax is gonna cut it?

5) how do you know if the central line is non-tunnelled or tunnelled? i think it has something to do with whether or not the line has a cuff under the skin which would make it tunnelled?

6) do only open-ended central lines have clamps on the port lines? when the ports have positive-pressure devices on the ends do you close clamps before removing syringe or after? i heard that the clamps can somehow cause the positive-pressure devices to fail?

7) iv abx in hospital – how long on average do abx doses last? do all abx change to po route at the end of the course or do some just d/v on iv route?

8) do you need to waste meds like heparin (vials) or just narcotics?

9) if pt is npo, does pt receive no meds? certain meds? all meds with only sips of water?

10) what the heck is med pass(?)?

11) do all patients have a specified care plan?...i’ve only seen a few of these in kardexes.

12) charting: do you write the time that the assessment was actually done or time of actual documentation. what will hold up in court?

13) is written consent the doctor’s order to go ahead with treatment? where do i find this, i can't find it anywhere in the patient's chart!

14) pt going for bone scan#2, techs want pt to have a cath in so that the bladder will be completely empty. no dr’s order for this, does nurse just do it and ask for a cover order later?

15) when changing an iv solution due to new orders for ivf change, do you prime brand new tubing along with the new solution or can i just spike the new solution with the existing line if the iv fluids are compatible?

16) when an order says give 1l ns bolus pre-dose of med. how fast does “bolus” run at?

17) what can you say to patient’s when they make comments like “i’m not in very good shape am i?” or “i’m at the end of my tether”, “the lord is going to take me”... (i get all clammy and don't know what to say!:eek: i know that silence is okay sometimes but sometimes it's more appropriate to have some sort of response for the poor patient)

18) for intake should i record intermittent medications as well? or is this only for patients when specific intake is needed? do i record intake for every patient with an iv infusion running?

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You probably could have looked up all the answers with rationale in the time it took you to type all that. Just sayin'.

Good Luck! :)

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Specializes in General Internal Medicine, ICU.

I think that most, if not all, of the questions you pose can be answered if you consulted your textbooks, school notes, and asked the nurses, doctors and other healthcare provider that you work with.

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Specializes in LDRP.

ok ill take a stab at a few of these.

1) Are pts allowed to leave the ward as they please if independent & stable? Like go down for smokes of cafeteria? Does Dr need to write permission for this? normally, in an acute setting no, but depends on the unit.

2) Scenario:

>500mg/100ml Metrondiazole (Flagyl) over 20 mins given at 2100

>400mg/200ml Ciprofloxacin over 60 mins given at 2100

- Would I give the Flagyl first because it is the faster med? I checked the IV manual for compatibility b/w the two meds and it said “compatible admixed” does this mean that it would be okay to attach the Cipro to primary line right after the Met has finished? What if the two meds were not compatible? Would I need to flush the line from the very top port where the first med had been connected?

if they are compatible you can piggy back them and when the shorter one runs out, it will automatically start running the other one

3) Pt brings own meds in that the doctor has ordered. Does pharm need to see & label them?

patient will take the meds sent from pharmacy, not from home.

4) How does bowel elimination protocol work? 5 levels, when you know what level is appropriate. They say to start at the lowest level (fruit lax) and work your way up as needed. But if the patient hasn’t had a BM in 6 days I don’t think that fruit lax is gonna cut it?

i dont know ask a nurse at the hospital your at.. or your teacher.

5) How do you know if the central line is non-tunnelled or tunnelled? I think it has something to do with whether or not the line has a cuff under the skin which would make it tunnelled?

6) Do only open-ended central lines have clamps on the port lines? When the ports have positive-pressure devices on the ends do you close clamps before removing syringe or after? I heard that the clamps can somehow cause the positive-pressure devices to fail?

7) Iv abx in hospital – how long on average do abx doses last? Do all abx change to PO route at the end of the course or do some just d/v on IV route? depends ont he abx, pt and MD... sometimes they will leave with PO abx, sometimes not.

8) Do you need to waste meds like Heparin (vials) or just narcotics?

generally just narcs.. check your hospital policy.

9) If Pt is NPO, does pt receive no meds? Certain meds? All meds with only sips of water?

it will be included in the order. all three of these options are possibilities.

10) What the heck is Med Pass(?)? when the nurse gives out her meds to her patients..

11) Do all patients have a specified care plan?...I’ve only seen a few of these in kardexes. yes. not all places have them written out.

12) Charting: do you write the time that the assessment was actually done or time of actual documentation. What will hold up in court?

the time it was done

13) Is written consent the doctor’s order to go ahead with treatment? Where do I find this, I can't find it anywhere in the patient's chart!

the doctor writing an order and putting it in the chart is the order to go ahead with treatment.. i dont know hat you mean by written consent? probably something the patient signs.

14) Pt going for bone scan#2, techs want pt to have a cath in so that the bladder will be completely empty. No dr’s order for this, does nurse just do it and ask for a cover order later?

there needs to be an MD order.

15) When changing an IV solution due to new orders for IVF change, do you prime brand new tubing along with the new solution or can I just spike the new solution with the existing line if the IV fluids are compatible?

you can just spike it if they are compatible.. if not you need new tubing.

16) When an order says give 1L NS bolus pre-dose of med. How fast does “bolus” run at?

im not sure, see if there is a protocol at the hospital youre at, if not it should be in the order...

17) What can you say to patient’s when they make comments like “I’m not in very good shape am I?” or “I’m at the end of my tether”, “the lord is going to take me”... (I get all clammy and don't know what to say! I know that silence is okay sometimes but sometimes it's more appropriate to have some sort of response for the poor patient)

ask them what they mean by that and if they want to talk about it.

18) For intake should I record intermittent medications as well? Or is this only for patients when specific intake is needed? Do I record intake for every patient with an IV infusion running?

if the pt is on I&O, record all intake.. most patients are on I&O in the hospital.. if you dont know ask, or just record the I&O anyway. better to record something thats not needed than to not record something that was needed..

the ones i didnt answer i didnt know... good luck.

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Thanks for your answers anyways! Many of these questions I had asked during clinical but didn't always get a clear answer so I figured this site is a good resource too.

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1) Are pts allowed to leave the ward as they please if independent & stable? Like go down for smokes of cafeteria? Does Dr need to write permission for this?:confused:

Yes you would need an order. My hospital is smoke free so they would have to leave the campus therefore, if they really need to smoke they must leave AMA.

2) Scenario:

>500mg/100ml Metrondiazole (Flagyl) over 20 mins given at 2100

>400mg/200ml Ciprofloxacin over 60 mins given at 2100

- Would I give the Flagyl first because it is the faster med? I checked the IV manual for compatibility b/w the two meds and it said “compatible admixed” does this mean that it would be okay to attach the Cipro to primary line right after the Met has finished? What if the two meds were not compatible? Would I need to flush the line from the very top port where the first med had been connected?

Are these PB? Doesn't really matter which runs first. I am not sure what your asking about flushing the line from the top but you would get each drug it's own secondary tubing. If they are incompatiable I would let the saline run for a bit before hanging the next.

3) Pt brings own meds in that the doctor has ordered. Does pharm need to see & label them?

At my hosp. pt can use home meds. You need a doctors order and the pharm needs to check the med they brought in.

4) How does bowel elimination protocol work? 5 levels, when you know what level is appropriate. They say to start at the lowest level (fruit lax) and work your way up as needed. But if the patient hasn’t had a BM in 6 days I don’t think that fruit lax is gonna cut it?

You have to use your judgement on this. If its been 6 days you probably don't want to go right for the enema, but something more then prune juice is probably going to be needed.

5) How do you know if the central line is non-tunnelled or tunnelled? I think it has something to do with whether or not the line has a cuff under the skin which would make it tunnelled?

6) Do only open-ended central lines have clamps on the port lines? When the ports have positive-pressure devices on the ends do you close clamps before removing syringe or after? I heard that the clamps can somehow cause the positive-pressure devices to fail?

I don't work with centrals but pos pressure would be closing the clamp while your were still pushing your flush.

7) Iv abx in hospital – how long on average do abx doses last? Do all abx change to PO route at the end of the course or do some just d/v on IV route?

Depends on the situation. Sometimes it is the same as oral. Sometimes If they have had 4 days IV zithromax then they will be sent home with 3 days of oral. sometimes they are sent home with none.

8) Do you need to waste meds like Heparin (vials) or just narcotics?

My hosp recently changed the policy that no meds are wasted down the drain.

9) If Pt is NPO, does pt receive no meds? Certain meds? All meds with only sips of water?

Depends. This you have to ask the doctor

10) What the heck is Med Pass(?)? Passing meds

11) Do all patients have a specified care plan?...I’ve only seen a few of these in kardexes.

No. Not like you see in school

12) Charting: do you write the time that the assessment was actually done or time of actual documentation. What will hold up in court?

time it was done. always chart as you go.

13) Is written consent the doctor’s order to go ahead with treatment? Where do I find this, I can't find it anywhere in the patient's chart!

If you mean something like a surgical consent that is in the orders. if it is just a general constant the everyone signs when they are admitted, check near the face sheet with the patients address and ins info is.

14) Pt going for bone scan#2, techs want pt to have a cath in so that the bladder will be completely empty. No dr’s order for this, does nurse just do it and ask for a cover order later?

You need an order. I'd ask the doctor before doing that. Can't the patient just urinate before? putting a foley or straigh cath seems a bit extreme.

15) When changing an IV solution due to new orders for IVF change, do you prime brand new tubing along with the new solution or can I just spike the new solution with the existing line if the IV fluids are compatible?

You could use the same tubing if compatible

16) When an order says give 1L NS bolus pre-dose of med. How fast does “bolus” run at?

500mL/hr is the fast pumps will be set for or you could clarify the order and ask if they want it left wide open

17) What can you say to patient’s when they make comments like “I’m not in very good shape am I?” or “I’m at the end of my tether”, “the lord is going to take me”... (I get all clammy and don't know what to say!:eek: I know that silence is okay sometimes but sometimes it's more appropriate to have some sort of response for the poor patient)

Yeah, thats a hard one

18) For intake should I record intermittent medications as well? Or is this only for patients when specific intake is needed? Do I record intake for every patient with an IV infusion running? it's just easiest if you do an I&O on everyone, but yes for sure with an IV running.

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thank you jra2127, i appreciate it! :)

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No problem. They were fun questions.

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