Questioning Medical Orders: What Every Nurse Should Know

Which stat order for Mr. Palmer should the nurse question?

• A. Oxygen per nasal cannula at 4 L per minute.
• B. Enoxaparin (Lovenox) 40 mg subcutaneously.
• C. Troponin level.
• D. Computed tomography (CT) angiogram.

Answer: (B)

In this scenario, the nurse should question the order for Enoxaparin (Lovenox) 40 mg subcutaneously due to safety considerations. Lovenox is a low molecular weight heparin used for thromboprophylaxis and treatment of deep vein thrombosis and pulmonary embolism. Before administering Lovenox, it is crucial to assess the patient's coagulation status, including recent platelet counts, as Lovenox can pose risks, particularly in patients with a history of heparin-induced thrombocytopenia or compromised renal function. Administering Lovenox without proper assessment could lead to adverse effects such as increased bleeding risk. In contrast, the orders for oxygen therapy, troponin level testing, and a CT angiogram are all standard practices that support immediate patient care and assessment in a potentially critical situation. Oxygen delivery via a nasal cannula can be essential for patients experiencing respiratory distress, while monitoring troponin levels is important for diagnosing myocardial injury. A CT angiogram can be critical for evaluating vascular conditions, such as pulmonary embolism and aortic dissection, ensuring proper and timely medical intervention.

As you journey towards becoming a Certified Medical-Surgical Registered Nurse, it’s crucial to understand the importance of questioning medical orders when patient safety is at stake. Let’s break it down by examining a hypothetical scenario revolving around Mr. Palmer.

Imagine you’re assessing Mr. Palmer's chart, and you see an order for Enoxaparin (Lovenox) 40 mg subcutaneously. Now, let me ask you this: would you question this order? The correct answer is yes, you should. Here’s why.

Enoxaparin is a low molecular weight heparin that’s often used to prevent blood clots, but it isn't without its risks. Particularly for patients with conditions like heparin-induced thrombocytopenia (HIT) or impaired renal function, administering Lovenox without checking the patient's coagulation status can lead to serious complications. I mean, the last thing any nurse wants is to increase a patient's bleeding risk, right?

So, let’s explore the thought process here. Before giving Lovenox, you’d need to check recent platelet counts and assess the overall coagulation status. Skipping these checks could compromise patient safety significantly. It’s like driving a car without checking if there’s enough fuel – you might get lucky for a while, but eventually, you risk breaking down.

Now, on the flip side, consider the other orders listed for Mr. Palmer. Oxygen via nasal cannula at 4 L per minute? Essential for a patient in respiratory distress. Troponin level tests? You bet! They’re a staple for diagnosing heart issues. And don’t forget about the computed tomography (CT) angiogram—it’s critical for visualizing potential vascular problems like pulmonary embolism or aortic dissection. These are orders you'd want to go ahead with—no questions asked.

Understanding the rationale behind medical orders plays a vital role in nursing practice. Every day, you’re faced with decisions that could impact patient outcomes. The ability to assess and question orders like that of Lovenox allows you to be an advocate for your patients, ensuring they receive care that’s timely and effective.

But, let's not forget the emotional weight of these responsibilities. There’s a profound impact on patient health when you question orders, especially in critical situations. You might feel that pressure, the weight of those decisions in the moment. It’s ok to feel a bit overwhelmed—it speaks to your commitment to patient safety.

Incorporating critical thinking into your nursing practice will not only help you ace the Certified Medical-Surgical Registered Nurse examination, but it will also ready you for the real-world crisis situations you’ll face in your career. So, as you prepare for your exam, remind yourself of the importance of advocating for your patients, encouraging an environment where questioning becomes part of routine care.

Now, as you study for this important certification, remember that being a nurse isn’t just about performing tasks; it’s about making informed decisions that prioritize patient welfare. Keep pushing forward—you’ve got this!