Question 1 of 10
Medication Use Process (Prescribing, Transcribing and Documenting, Dispensing, Administering, and Monitoring)
Patient Profile
Medical ward admission (day 1)| Item | Detail |
|---|
| Age / sex | 68-year-old man |
| Height / weight | 175 cm / 82 kg |
| Allergies | No known drug allergies |
| Diagnoses | Community-acquired pneumonia; new-onset atrial fibrillation with rapid ventricular response; hypertension; hyperlipidemia; GERD |
Home medications (as written on the transfer list)| Product | Directions |
|---|
| Cardizem CD 240 mg | 1 capsule by mouth daily |
| Toprol XL 25 mg | 1 tablet by mouth daily |
| Lipitor 40 mg | 1 tablet by mouth daily |
| Protonix 40 mg | 1 tablet by mouth daily before breakfast |
Current inpatient orders| Order | Details |
|---|
| Ceftriaxone | 1 g IV every 24 hours |
| Azithromycin | 500 mg IV every 24 hours |
| Diltiazem infusion | 125 mg/125 mL; titrate 5 to 15 mg/h (currently 10 mg/h) |
| Esomeprazole (nonformulary) | 40 mg IV once daily for stress-ulcer prophylaxis |
| Atorvastatin | 40 mg by mouth daily |
| Apixaban | Pharmacy to dose for stroke prevention in atrial fibrillation |
| Continue home medications | As listed on the transfer list |
Admission labs and ECG| Test | Result | Reference range |
|---|
| Potassium | 3.3 mEq/L | 3.5–5.0 mEq/L |
| Magnesium | 1.6 mg/dL | 1.7–2.2 mg/dL |
| SCr | 1.6 mg/dL | 0.7–1.3 mg/dL |
| WBC | 15.2 × 10³/mm³ | 4.5–11 × 10³/mm³ |
| Hemoglobin | 13.5 g/dL | 13.5–17.5 g/dL |
| Platelets | 220 × 10³/mm³ | 150–400 × 10³/mm³ |
| INR | 1.1 | 0.8–1.2 |
| QTc (ECG) | 516 ms | less than 450 ms (men) |
Admission vital signs| Parameter | Value |
|---|
| Heart rate | 128 beats/min, irregular |
| Blood pressure | 118/72 mm Hg |
| Temperature | 38.6 °C |
| Respiratory rate | 22 breaths/min |
| SpO₂ | 93% on 2 L nasal cannula |
Based on the ECG and electrolyte results, which current inpatient order most warrants reassessment?