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Week 14. Rx = prescription

Rx, Latin: recipe, to take, prescription.

Below are three archetypal pharmacology test questions for your reading pleasure (yeah!), so that you might also experience the exquisite pain that is the biweekly proctored pharm exam.

Type I. The Lab-Values-From-Hell Question.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105° F. The patient’s skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:
a. iodine-131 (131I).
b. propylthiouracil (PTU).
c. intravenous levothyroxine.
d. methimazole (Tapazole).
Answer: These are actually all great things that might help this patient experiencing a thyroid storm, but this being the ER, pick the drug that will act the fastest, which is PTU.

Type II. The "Which Patient Will Die First?" Question. The nurse working on a high acuity medical-surgical unit is…
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Week 13. DM = Diabetes Mellitus

Diabetes, Greek, to pass; mellitus, Latin, honeyed or sweet.

In 1552 B.C., Egyptian physician Hesy-Ra noticed that ants were attracted to the urine of those with a mysterious disease that also caused emaciation.

150 AD, Greek physician Arateus described the illness as, "the melting down of flesh and limbs into urine."

Today we know diabetes as a disorder of carbohydrate metabolism--the body cannot utilize and store sugars effectively. Characteristic symptoms include the three polys: polyuria, polydipsia, and polyphagia (lots of pissing, drinking, eating). Long term, poor management of the illness can lead to cardiovascular disease, blindness, kidney disease, and amputations.

Diabetes (type II) is also a disease of civilization; modern technology led to surplus calories compacted into innocuous servings, less physical activity, and obesity rates resulting from both increased energy intake and lack of energy expenditure.

A diabetic can be spotted from a singular, extended hand…

Week 12. pH= power of hydrogen

The K├╝bler-Ross stages of grief provide a perfect model to comprehend blood pH (among other things). Denial, neutral, pH 7.35-7.45: One feels neither acidic or alkaline, somewhat ambivalent, almost okay. Also, maybe this was all just a misunderstanding, a nightmare, a midautumn night's dream. Just wake up, and all that transpired will poof, and one can carry on like before.

Anger, acidosis, pH 6.90-7.35: One's so metabolically upset one's lungs are hyperventilating, or so busy yelling & arguing one forgets to breathe and kidneys are dropping sodium bicarb like crazy. Blame, frustration, accusation. Do not keep sliding left down that slippery slope, because acidosis means denaturalization of one's proteins--past the tipping point one plummets all the way to uncertain death.

Bargaining, neutral, pH 7.35-7.45: One tries to make a deal, make the most of things, strike a bargain with supernatural entities, dead ancestors, former partners, the universe. I'll do anythin…

Week 11. CN = charge nurse

Here's a day in the life of a charge nurse, framed within the structure of the monomyth, or the hero’s journey (saving Murdock's The Heroine's Journey for another time).


The Ordinary World: The charge nurse, an intelligent, independent and capable professional, enjoys a quiet night’s sleep in her warm bed on a late October night, the windows cracked just so, allowing the chill of winter to creep in and crisp the air in her bedroom.

The Call to Adventure: After working the day before, she had accidentally left her pager on, and as a consequence she is abruptly woken up by it before the skies were beginning to brighten, with a request for her to come in to the hospital and help manage the floor from 7am to 7pm.

(Near) Refusal of the Call: The nurse hesitates. Having worked yesterday, she knows there are several transfers, shortage in coverage due to multiple admissions and an RN calling in sick, two one-on-one safety sitters required, therefore fewer CNAs on the floor...not a f…

Week 10. CPR = cardiopulmonary resuscitation

Scenario 1. 
An alarmingly white, well-lit airport. Ticket counter.  Your partner grimaces, collapses.  You turn to ask for help, and when you turn back, your partner has turned into a plastic mannequin lying supine on the floor.  No breathing, no pulse. You must compress the mannequin’s chest hard enough with interlaced hands to light up two green lights above the left clavicle.  Two breaths.  Thirty compressions. Please, call 9-1-1! Someone, get an AED... Analyzing: shock advised.  Charging.  CLEAR!  Shock delivered. Resume CPR. Your partner may turn back into a real person, but meanwhile, compressions and breaths keep blood pumping and oxygen circulating. Your partner’s life--interlaced in your hands.
Scenario 2.
The comfort of your home. Your cute 7-month-old mouths toys on a colorful playmat.  You turn around, and NO, this cannot be happening. Baby has been replaced with an open-mouthed, nonresponsive, rubber infant.  Luckily, you are a nurse practitioner and know exactly what t…

Week 9. HF = heart failure

Starling's Law: the healthy heart can handle precisely the volume of blood brought to it by veins. The greater the volume and fiber length, the more Romeo-and-Juliet-like actin and myosin behave, and the heart pulses as hard and fast as necessary to pump all of one's blood through the body once in one minute.

In the failing heart, Starling's law breaks down. In 40 minutes, death from pulmonary congestion can occur. (Some online instructor, long ago, thought it funny to include a picture of a tombstone in green grass on this particular PowerPoint slide. Incidentally, the Chinese call marriage the dirt grave of love.)

Do people still believe in love? Surely, some do, because there's such a thing as broken heart syndrome. Sadness -> stress hormones -> vascular constriction -> chest pain, shortness of breath, hypotension, arrhythmia, possible heart failure. It is literally possible to feel one's heart break, over and over, years apart, especially since humans …

Week 8. PRN = pro re nata, as needed

Pain, like taste and attraction/connection between people, is highly subjective and individualized. There's no one-size-fits-all pain pill or absolute guarantee of relief. Different people's experiences of the same procedure vary widely. Vicodin may have been candy for House, MD, but might do little for others.


While living pain-free, one does not ponder pain intensity scales, Wong-Baker faces or WHO analgesic ladders, but if one is in pain on an hourly, daily, seasonal basis, those pain measures and meds are like saying the right thing and going to the right houses/neighborhood as a trick-or-treater and getting the good candy.

But sometimes one's family doesn't want one to get the good candy, those big candy bars or entire bags of Skittles and M&Ms. Even if one is end-stage-something-rather, one's family somehow isn't convinced one won't end up on the streets trying to score more candy. So non-opioid analgesics it is. And pain, coming in waves, dull th…