scary RN questions

[Dred Pirate]

I will start by saying, I love the RN's I work with - well, most of them. I see them and interact with the more than my fellow pharmacists - but dang, every now and then I get one of the questions that scare the hell out of me. (although most MD's would probably say the same about RPh's) - all professionals have those wack jobs and we all have an off day.

Lets get a list of some of the funny/scary questions we have gotten.

I had this one - from a seasoned RN even. I have this insulin drip - how fast do I run it? Like over 15 minutes or so? (our insulin drips have 250 units of insulin in them) - ya, please don't do that....

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[confettiflyer]

:::holding bed pan with stool in it:::

"Hey, where does this go?"

.......

 

[holymolys]

I once had a nurse ask me why pharmacy decided to put 40 meq of KCl in a bag when doc's order mentions nothing about being in fluids.

 

[Corpseman]

Do you have any questions?

*scoff* no, *eye roll* I'm a nurse.

 

[Caffeine QAM]

I will start by saying, I love the RN's I work with - well, most of them. I see them and interact with the more than my fellow pharmacists - but dang, every now and then I get one of the questions that scare the hell out of me. (although most MD's would probably say the same about RPh's) - all professionals have those wack jobs and we all have an off day.

Lets get a list of some of the funny/scary questions we have gotten.

I had this one - from a seasoned RN even. I have this insulin drip - how fast do I run it? Like over 15 minutes or so? (our insulin drips have 250 units of insulin in them) - ya, please don't do that....

At least they asked. Apparently, some nurses think the "default" infusion time for IVPBs is an hour.

 

[gwarm01]

I can't think of anything scary, but I do love when a nurse gets mad at me for telling her two drugs are incompatible. Blame chemistry, not me!

 

[Dred Pirate]

I can't think of anything scary, but I do love when a nurse gets mad at me for telling her two drugs are incompatible. Blame chemistry, not me!

I always say, sorry, I can't change science...

 

[gwarm01]

I always say, sorry, I can't change science...

I stopped saying sorry when I realized it made me feel like I had done something wrong. Of course, then I probably came off as having a bad attitude.

 

[generallyspeaking]

Nurses can be difficult eye exam patients too. "your son's pupils aren't reactive to light because I pharmacologically dilated them. No you don't need to go to the ER and I will not have my malpractice insurance cover that trip because we know the cause of your pupils being dilated: I put drops in them."

 

[Monsterdaddy]

1) RN - I'm not sure if I should give this warfarin dose?
Me - Why not?
RN - Well, the order says INR should be 2-3.
Me - And?
RN - His INR is only a 1.

2) RN - I'm missing this bag
Me - We tubed it 15 minutes ago
RN - Really? Oh, here it is, it's hanging on the patient.

3) RN - Is NS compatible with half NS?

4) RN - I know I can open the capsules but can I crush them?

 

[Rockinacoustic]

"We can't find the fentanyl patch we placed on the patient yesterday. Can you send another?"

 

[radio frequency]

"We can't find the fentanyl patch we placed on the patient yesterday. Can you send another?"

Yikes!

 

[Dalteparin]

RN: I'm supposed to give 0.25 mg. Why is it having me take out 0.5 mg tabs?
Me: We only have the 0.5 mg. You'll need to cut it in half.
RN: But why does it say 0.25 mg?
Me: Because it's half of a 0.5 mg.
RN: I don't get it.

 

[ldiot]

RN: I'm supposed to give 0.25 mg. Why is it having me take out 0.5 mg tabs?
Me: We only have the 0.5 mg. You'll need to cut it in half.
RN: But why does it say 0.25 mg?
Me: Because it's half of a 0.5 mg.
RN: I don't get it.

Which half do I give them?

 

[Dred Pirate]

Do I apply the testosterone gel right to his testicles?

 

[KARM12]

I'll take a million stupid questions over the one that doesn't get ask.

I've also had plenty of RNs who have caught mistakes. If someone asks a question, take it seriously and help them.

 

[Dred Pirate]

I'll take a million stupid questions over the one that doesn't get ask.

I've also had plenty of RNs who have caught mistakes. If someone asks a question, take it seriously and help them.

I agree completely - hence my first post - but I wanted a thread to give us a good laugh

 

[Its Z]

I don't think we would appreciate reading other health care disciplines discussing "Scary Pharmacist Questions."

 

[KARM12]

I don't think we would appreciate reading other health care disciplines discussing "Scary Pharmacist Questions."

Z!!!! You are back!

 

[FarmD711]

I don't think we would appreciate reading other health care disciplines discussing "Scary Pharmacist Questions."

I for one would enjoy such a thread


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[Dred Pirate]

I don't think we would appreciate reading other health care disciplines discussing "Scary Pharmacist Questions."

I am pretty sure there are those threads, and I for one, would be fine with starting one here to help those new grads from making an arse out of themselves

 

[FarmD711]

I am pretty sure there are those threads, and I for one, would be fine with starting one here to help those new grads from making an arse out of themselves

Yeah if anyone has a link to suck a thread please post. I'm very interested


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[zelman]

I don't think we would appreciate reading other health care disciplines discussing "Scary Pharmacist Questions."

I think everyone involved in academia/precepting would appreciate knowing what info should be reinforced in school/rotations.

 

[Promethean]

I'm an RN and I'm not offended by this thread. People, in all professions, have moments when they just aren't putting their thoughts together right. Maybe nurses who asked really boneheaded questions were on hour 14 of what was supposed to have been a 12 hour shift. At least they asked!

My story is that I worked with a nurse who needed to administer 75 milligrams of a drug. But we only had 25 milligram pills. So, he pulled out his medication calculator to check his math while he poured the med. Really, guy? Really? It is like quarters. You only have quarters, but you need 75 cents. How many quarters do you need?

What is terrifying is that this dude really was such a concrete thinker that he couldn't make that conceptual jump. And that he didn't trust his own mind as much as he did a $2 electronic device. In other matters, he was sharp enough. But any time he had to do even the simplest arithmetic, he was reaching for a computer to do it for him.

 

[Promethean]

As for the question about "Okay, so I know we can open capsules, but can we crush them?"

That isn't as weird as it sounds. Some capsules have little pellets in them instead of a loose powder. Some of those particles are large enough that they either won't go through an NG/gastric tube, or else that they clog them up. A clogged jejunostomy tube can mean a couple thousand dollar excursion down to IR for an exchange... and a patient with no enteral access for food and fluids in the meantime. It is tempting to dump the pellets into the mortar and pestle and grind them down into a powder that will easily pass through the tube without risking a clog.

Since such drugs are usually in pellets to allow them to absorb slowly and so be an extended release form of the drug, they probably shouldn't be crushed and an order should be obtained for a formulation of the drug more appropriate for that route of administration.

If a nurse has run into this problem before and needs to give a lot of drugs through a tube, it isn't at all unreasonable that s/he would reach out for advice from the pharmacist.

 

[W19]

I am (was) also a nurse and I used to help many nursing students with drug calculations (what they call procalc in the nursing world) and all I am going to say: It's a scary world out there...

 

[owlegrad]

I think it's important to have a sense of humor and I for one have heard some very dumb questions from pharmacists. Wouldn't be offended at all to see such a thread.

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[Dred Pirate]

I think it's important to have a sense of humor and I for one have heard some very dumb questions from pharmacists. Wouldn't be offended at all to see such a thread.

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like when someone I know insisted a RN/MD gets a EKG before administering IM haldol to a patient who was acutely agitated and throwing chairs around

 

[sakigt]

I had a pharmacist insist we needed to push calcium chloride through a central line....in a code. And we couldnt run Levophed in a peripheral line, ever.

*grabs them by shoulders*
*moves them out of the way*

 

[confettiflyer]

Not a pharmacist, but a 4th year pharmacy student:

"So bridging (Lovenox and warfarin), which one do we discontinue?"

Pharmacy resident from another program:

"Albuterol...that's a beta blocker (straight face)."

---____---


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[owlegrad]

Lol i didn't mean to turn this into an RPh bashing thread!

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[WVUPharm2007]

I don't think we would appreciate reading other health care disciplines discussing "Scary Pharmacist Questions."

I hope it exists and I would like to read it.

 

[Humble Sloth]

"We can't find the fentanyl patch we placed on the patient yesterday. Can you send another?"

It's like opiates grow legs of o their own and walk away. Often.

 

[FunnyPharm2019]

when I was a pharm tech my morning job was to call the MD offices to follow up on refill requests. most of the time a nurse would answer, and for whatever reason, the worst nurses were always the ones in the OB offices. one time I called for a refill on a nuvaring and the nurse said "we sent the refill authorization yesterday." I told her the only thing they had sent us was an escript for estrogen patches. her response: "yeah, that's the same thing." dear lord.


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[gwarm01]

I had a pharmacist insist we needed to push calcium chloride through a central line....in a code. And we couldnt run Levophed in a peripheral line, ever.

*grabs them by shoulders*
*moves them out of the way*

Classic book-smart pharmacist with no concept of the big picture. I guess we'll just let the patient die then, would hate to hurt their arm.

 

[KatleyS]

I once had a RN tell me she needed me to do the math for her because she said "I'm just a nurse so I don't do math."

*sigh*

 

[zelman]

I once had a RN tell me she needed me to do the math for her because she said "I'm just a nurse so I don't do math."

*sigh*

Not a question, but this reminded me of...

ADON: "Nurses can't split tablets because then they'd be a pharmacy."

 

[Lnsean]

Do I apply the testosterone gel right to his testicles?

really? what kind of hospital has pt on testosterone gel inpatient....that seems like an outpatient thing.

 

[confettiflyer]

Not really a scary nurse question, but whenever we have patients on certain chemotherapy and the nurse asks for special precautions, I love the look on their face when I matter of factly tell them they need to avoid pt's semen/ejaculate.


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[Dred Pirate]

really? what kind of hospital has pt on testosterone gel inpatient....that seems like an outpatient thing.

continuation of home med

 

[drhenPharmD]

I would also love to see a scary pharmacist's questions thread

 

[Promethean]

I would also love to see a scary pharmacist's questions thread

Roll on over to allnurses.com

 

[Jibby321]

Roll on over to allnurses.com

Plenty of LULZ there. Lol.

 

[FarmD711]

Link?

Yeah I didn't find anything pharmacy related


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[Jibby321]

Yeah I didn't find anything pharmacy related


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Just reading that site in general. I haven't been on in awhile but didn't see anything directly pharmacy related. This was a couple months back.

 

[BidingMyTime]

4) RN - I know I can open the capsules but can I crush them?

This is a GOOD question, not all capsules that can be opened, can have their contents crushed. (ie Prilosec, okay to open the capsules and mix the contents with applesauce or something, not okay to chew or crush the contents.


I have had some of the questions mentioned in the threads. Of course, the scariest questions back before everything was taking out of Omnicell/Pyxis is when the nurse would give a wrong drug out of the cart, THEN call and say, I just gave drug A....that's generic for drug B isn't it? (um, NO, its not, why didn't you call BEFORE you gave it?????)

Always funny when they call because they can't find a drug that they apparently have no idea how to spell or pronounce. Like, I can't find the X-A-Nax, and I'm like what???? I expect having to decipher drugs from retail patients, not from nurses, especially when they are common, 50+ year old drugs.