PASS the CCRN! Questions With 100% C0rrect Solutions

PASS the CCRN! Questions A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and complains of a headache and nausea. He reports he ran out of blood pressure meds three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach? - ANS Rapidly lower the diastolic pressure to 100 with IV antihypertensive meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive meds. The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure. A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this intervention is having it's intended effect? - ANS ScvO2 of 72% Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%, and urine output greater than 0.5 kg/hr 72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet count decreased significantly to 43,000 and was found to have new DVT on his right upper extremity. What do you suspect is the most likely cause of these findings? - ANS HIT The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period (>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new development of DVT despite being on VTE prophylaxis. TRALI: - ANS is a complication from a blood transfusion reaction, which causes acute lung injury typically within 6 hours of a blood transfusion. 2 Hallmark signs of HIT: - ANS Decrease in platelet count over a 24 hr period. New development of DVT despite being on VTE prophylaxis. Values in Early compensated Hypovolemic shock? - ANS CO 4.0 L/min, HR 135, SV 65, SVR 1700, MAP 65 In hypovolemic states, circulating volume is depleted therefore preload and contractility are decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure to preserve CO, MAP and cerebral perfusion. Post-renal failure values: - ANS Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1.010 BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is typically 1-40 mEq/L. What to do in the event of HIT: - ANS Stop Heparin and administer an alternative direct thrombin inhibitor. Warfarin is contraindicated in HIT? T/F - ANS True - there is also no evidence that shows protamine, corticosteroids, and benadryl are effective treatments for HIT Patients with right ventricular infarctions become preload dependent. Meds that decrease preload should be avoided - which meds are these? - ANS Morphine, Nitro, Beta blockers and diuretics. Polymorphic ventricular tachycardia aka Torsades is treated by? - ANS Magnesium Myocardial contusions generally impact which parts of the heart? and what would the values be? - ANS Atria & right ventricle because of the position of the heart in the chest. PAOP 6, PA Pressure 40/24, RA Pressure 16 Neurogenic shock signs? - ANS CVP: 3, CI: 2.5, SVR: 650, SBP: 88 Neuro shock is associated with a loss of sympathetic tone causing extensive peripheral vasodilation. Clinical signs and symptoms include hypotension, a low SVR, low CVP and low normal CI What causes a larger than normal A wave on a PAOP? - ANS Mitral stenosis - causes increased left atrial pressure during atrial contraction. Pulmonary HTN will result in what? - ANS Elevated PA pressures but have no impact on PAOP. Infective Endocarditis can cause what kind of impairment? - ANS Neurologic impairment. One of the risks of infective endocarditis is the bacterial strand breaking in the heart and throwing bacterial emboli forward into the lungs from the right side of the heart or to the brain/body from the left side of the heart. Neurologic impairment could be a sign? - ANS Embolic ischemic stroke. Post bariatric surgery should avoid what kind of meds? - ANS Extended release meds due to absorption concerns post-operatively Chlorpropamide is a what? - ANS sulfonylurea drug that is used in DI as an antidiuretic. It is primarily a glucose lowering agent. (hypoglycemia) Will a cardiac transplant patient respond to atropine? - ANS No - pacing is the best instrument for symptomatic bradycardia. Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is what symptom? - ANS SIADH - causes retention of water. Urine production is minimal and concentrated & leads to an increased urine osmolality. What does Neo drug increase? - ANS SVR - Peripheral constriction Treatment for narrow complex, regular rhythm? - ANS Administer 6mg adenosine rapidly IVP Half life of metformin? - ANS 6 hours - close monitoring is required to ensure the blood glucose level does not climb too quickly while dextrose is being administered. Most accurate reflection of daily fluid balance? - ANS Record a daily weight at the same time each day. Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs of what? - ANS Cardiac tamponade A patient with hyponatremia would need what? - ANS Help maintaining a safe environment. HypoNa impairs judgment, and causes confusion. Peritoneal dialysis works on the principles of both? - ANS Diffusion and osmosis. HHNS leads to what? - ANS Large fluid deficits and may require multiple liters of fluid, which is determined by the patient's level of dehydration and hyperosmolality. What parameters are consistent with Pulsus Paradoxes? - ANS Decrease in SBP>10 during inspiration. Before administering rtPA what must happen? - ANS Lower the BP to at least 185/110. An elevated BP prior to rtPA can cause hemorrhage. Ibutilide can cause what? - ANS Torsades A person with disecting AAA would receive what drug? - ANS PRN IV narcotic analgesia - BP management is a priority in the care of a patient with a dissecting AAA. Pain is the primary driver of HTN. Autonomic hyperreflexia is what? - ANS This disorder is seen with spinal injuries occurring above the T6 spine. Cause of autonomic hyperreflexia? - ANS Bladder obstruction, constipation, pressure ulcers, and pain. Usually when the noxious stimulus is identified and removed, the symptoms resolve. Checking urinary catheter for obstruction is the most appropriate next action. MEDS for asymptomatic left ventricular systolic dysfunction? - ANS ACE or (ARB), beta-blockers and statins for all patients with a history of MI and for all patients with a reduced ejection fraction. What is the Z point technique? - ANS is a method used to estimate ventricular end diastolic pressure. It is taken just before the closure of the mitral valve and is especially useful when an A wave does not exist on the PAOP tracing such as in atrial fib. Ascites position for relief? - ANS Place pt on left side. DIC lab values? - ANS Fibrinogen decreased FSP elevated Platelets decreased D-dimer elevated Decreased Albumin is an indicator of what? - ANS Protein deficiency and poor nutrition, which are major contributors to poor wound healing. A continous infusion of Lorazepam for greater than 3 days can lead to an accumulation of? - ANS Propylene glycol. Inability to communicate in full sentences may be a sign of what? - ANS Severity of asthma (high risk) Management of high ICP includes? - ANS Osmotic diuretics, hypertonic saline & antihypertensives. Causes increased left atrial pressure during atrial contraction - results in a larger than normal A wave on the PAOP tracing? - ANS Mitral Stenosis Pulmonary htn will result in elevated PA pressures but have no impact on? - ANS PAOP Elevated urine osmolality; decreased serum osmolality; decreased serum sodium? - ANS SIADH Absolute contraindication for thrombolytic therapy? - ANS Aortic dissection Crackles in bilateral lower lobes and a s3 heart sounds are indicative of what? Tx? - ANS Fluid overload Furosemide 40 mg IV x 1 now Narrow pulse pressure - CO 3L/min, HR 135, SV 30, SVR 2100 are all signs of what? - ANS Cardiogenic shock HUS is marked by what? - ANS Renal failure Thrombocytopenia & hemolytic anemia DIC lab values? - ANS Decreased Fibrinogen FSP elevated Platelets decreased D-dimer elevated HOB position for ICP? Other tx? - ANS 45 degrees Increase sedation or mannitol as prescribed. Opening the Ventriculostomy drain requires specific orders? - ANS True Brain death criteria? - ANS Positive Apnea test Absent Oculovestibular and Oculocephalic reflex Respiratory acidosis ST elevation is indicative of what? - ANS Cardiac ischemia and should be treated as myocardial infarction CDC indications for urinary catheter include: - ANS end-of-life care, strict I&O, immobility, select surgical procedures, sacral wounds, urinary retention/obstruction A saddle embolus is life threatening and requires which immediate intervention? - ANS IV thrombolytic for clot lysis. Subcutaneous and IV heparin inhibit thrombus growth and promote resolution of the formed clot, but will treat the a saddle pulmonary embolus. Indiscrimate pacing spikes indicate that the pacer is not what? - ANS Not sensing or seeing the cardiac activity present. Sensitivity should be decreased. A sudden increase in left atrial diastolic pressure will result in? - ANS Mitral regurgitation Late stages of shock results in what lab values? - ANS Increased Potassium Decreased Bicarbonate Increased Lactic acid Juxtaglomerular cells secrete what? - ANS Renin in response to reduced glomerular filtration pressure. Secondary adrenal insufficiency is caused by: - ANS Long term steroid use, additional stress can overwhelm the hypothalamic -pitutary-adrenal system. Neosynephrine stimulates what? Side effects would include: - ANS alpha receptors - causes vasoconstriction, resulting in increase BP Reflexive bradycardia Heptojugular Reflex is suggestive of which following condition? - ANS Right sided heart failure Fever is associated with what? - ANS Worse neuro outcomes. This is secondary to the increase in cerebral metabolism and oxygen consumption Low volume ventilation, less than 10 mL/kg to minimize what? - ANS Pneumothorax - over inflation can cause volutrauma, which can lead to a spontaneous pneumothorax. Decreased right atrial pressure (RAP/CVP) could be caused by? - ANS Sepsis High pressure alarm on ventilator is commonly caused by? - ANS secretions or increased resistance in the airways. Major abdominal surgery may cause which pulmonary complication? - ANS Atelectasis - tx would be pulmonary hygiene and chest x-ray What would minimize pancreatic stimulation? - ANS Begin feedings via jejunal route - enteral feedings are preferred. Utilization of jejunal feedings maintain gut integrity and minimize pancreatic stimulation. QRS complex is upright in both leads? Negative deflection in both leads depicts an extreme? Negative QRS deflection in Lead 1 and positive deflection in Lead aVF are associated with? - ANS Axis is normal Extreme Right axis deviation Right axis deviation Priority data to collect for delirium and changes in QTc? - ANS CAM-ICU and 12 lead ECG Pacemaker setting in A-fib? - ANS VVI Atria cannot be paced when in atrial fibrillation Alpha cells produce? Beta cells? Delta cells? - ANS Glucagon Insulin Somatostatin Serum Osmolality of 320 is indicative of: - ANS DI - profound dehydration will lead to an elevated serum osmolality because of water loss. Contraindications of rtPA include: - ANS Gastro or other bleeding complications (within 3 months) First sign of problems from a shunt include: - ANS change in LOC or mental status Ominous sign of acute asthma exacerbation: - ANS Hypercapnia or elevated PaCO2 indicates patient is becoming fatigued and going into acute respiratory failure. Nephrogenic DI would cause what? - ANS the kidneys not respond to ADH Lactated ringers at 100ml hr before and after procedure is often prescribed to prevent what? - ANS Contrast induced nephropathy Keeping the TV (tidal volume) low is the best way to decrease pressures and avoid what? - ANS Barometric trauma in ARDS Which of the following parameters most accurately estimates end-organ perfusion? - ANS Urinary output, lactate, ScvO2 Aortic stenosis cause increased noise during systole and impaired outflow, leading to: - ANS Pulmonary edema and crackles. Tx for neurogenic shock? - ANS Vasoconstrictor (phenylephrine) over large volume of fluid resuscitation Liver failure labs: - ANS Elevated bilirubin Decreased albumin elevated PTT, PT & INR When the liver fails: - ANS ammonia levels build causing encephalopathy. Bilirubin levels rise causing jaundice and coagulation times often prolong putting patient at risk for bleeding. Patients with HIT may develop: - ANS Thrombosis, DVT, PE, STROKE, MI, Renal impairment Vancomycin has a risk of nephrotoxicity and RN should monitor which lab value: - ANS Elevated serum creatinine Cerebral insults include: - ANS ipsilateral pupil changes and contralateral motor extremity changes. Diuretic phase of ATN would include which lab value: - ANS Decreased urine osmolality Kernig's sign is indicative of: - ANS Meningitis - pt cannot extend the knee when the hip is flexed. DKA patients have a profound decrease in what: - ANS Fluids Pancreatitis leads to what? - ANS ARDS, DIC, hypovolemic shock Glycopyrrolate is part of medical mgmnt for: - ANS Respiratory failure in patient with chronic pulmonary dz. Thrombolytic therapy using rtPA is most common tx for: - ANS ischemic stroke Inclusion criteria for thrombolytic therapy: - ANS over the age of 18 less than 3 hours of onset CT scan verifying ischemic stroke Exclusion criteria for thrombolytic therapy: - ANS Seizure activity with onset stroke symptoms major surgery or trauma past 3months Adverse effects of Increasing PEEP causes: - ANS Hypotension Inattention, alterations in perception, disorganized thinking and memory impairment: - ANS Delirium An elevated Lactate level would include which tx: - ANS Central line and additional IV fluids ARDS defined as: - ANS PaO2/FiO2 less than or equal to 300 with bilateral infiltrates on chest X-ray and refractory hypoxemia. P/F ratio less than 100: - ANS Severe ARDS a STAT CT is first priority to dx what: - ANS Hemorrhagic or ischemic event When P2 component is greater than the P1 indicates: - ANS Poor brain compliance Venous Pulmonary HTN results from: - ANS Left - sided heart fx and ineffective pumping of blood. Pulmonary arterial HTN results from: - ANS Vasoconstriction of vasculature leading to and within the lungs Management of Pancreatitis: - ANS Preventing hypoxemia, resting pancreas, pain mgmnt, volume resuscitation. Inner layer of the heart muscle, between the endocardium? - ANS Myocardium Higher cognitive functions (Impulsivity) and personality are controlled by what part of the brain: - ANS Frontal lobe tachycardia, tachypnea, and left shoulder pain indicates possible what: - ANS Anastomotic leak Intubation: FiO2 < 60% Maintain plateau pressures <30 Maintain Tidal volume < 8 - ANS Goals for ventilated pts. Position with the HOB 30 degrees with midline neck alignment: - ANS First line therapy for optimizing cerebral perfusion. Is Serum osmolality elevated or decreased in DI? - ANS Elevated due to volume loss - the urine will be dilute (decreased urine osmo) and hemoconcentration with increased sodium levels. Beta Blockers, ACE, & Aldosterone antagonists are used for: - ANS Heart failure pts. Right BBB & 2nd TYPE 2 heart block: - ANS Located in Bundle of HIS and R bundle branch are located in anterior wall, so both of these may be affected in anterior MI. Side effect of dexamethasone: - ANS decreased potassium and calcium levels, hypoglycemia, and myopathy that results in proximal muscle weakness. Ablify, haldol, seroquel, and droperidol can cause what? - ANS QT prolongation Which electrolyte is affected with hypothermia: - ANS Hypokalemia Cardiac tamponade is a risk after what? - ANS discontinuation of epicardial pacing wires. Signs include decreased cardiac output, increased preload and intra-cardiac pressures, and decreased contractility. hyperglycemia, hypocalcemia and hypokalemia are r/t to pancreatitis? - ANS True DIC lab values: - ANS Decreased fibrinogen Increased D-dimer Decreased platelets Tx for heart failure: - ANS Positive inotropic agents, diuretics & vasodilators ARDS tx: - ANS High levels of PEEP & low tidal volume What is the best indicator for neurogenic shock? - ANS Bradycardia Low cardiac output and hypotension are consistent across shock states. Gold standard of care for acute coronary syndrome? - ANS PCI PCI should be completed within 90 mins for STEMI and 24 hours for NTE-ACS. If not possible to get patient in cath lab within 90-120 mins, fibrinolytics should be considered. Tx for metabolic syndrome: - ANS reduce the risk of coronary artery disease and the secondary goal is to treat or prevent the onset of type 2 diabetes. Risk factors for developing acute kidney injury: - ANS HTN/PAD/Diabetes Epidural hematoma are associated with what kind of skull fx: - ANS Arterial in origin and with a linear skull fracture ABG reveals pH 7.22, PaO2 42, PaCO 56, HCO3 28 - what is highest priority? - ANS Increase PEEP Which arrhythmia is commonly associated with chronic left sided heart failure? - ANS A-fib 2nd degree type II and 3rd degree av block are complications associated with occlusion of the left anterior descending artery during acute coronary syndrome. Which set of lab values are consistent with a patient with HHS? - ANS Anion gap 10 Urine ketones: negative Serum potassium: 4.3 Blood glucose 1050 Tongue swelling and difficulty breathing. You should anticipate? - ANS Epi: 0.3 mg IM Not Epi: 1mg IV A patient with chronic, severe mitral insufficiency is prone to which of the following dysrhythmias? - ANS A-fib A medication regimen for a patient with hypertrophic Cardiomyopathy would include? - ANS CCB & Beta blockers A mechanically ventilated patient has been started on inhaled (Flolan) for the tx of ARDS and refractory hypoxemia. Which hemodynamic value evaluates the effectiveness of this intervention? - ANS Decreased PAP Which of following is recommended to prevent shivering during induction and the maintenance phase in therapeutic hypothermia? - ANS Blow warm air across the face or body The pt is placed on CRRT - The nurse know which is a priority when receiving CRRT? - ANS Frequent electrolyte monitoring to minimize electrolyte shifts 78 yr old female fell at home 1 wk ago. She has been on Coumadin for A-fib for over 1 year. She presents with a complaint of headache. Her family states: "Mom has been acting weird for the past couple days." Scenario is consistent with? - ANS Subdural hematoma A subdural bleed is usually a slow accumulating, venous bleed. Abnormal neuro changes may not be seen for days or weeks. Epidural hematoma? - ANS May bleed and accumulate rapidly since they result from arterial bleeding. Cerebral Aneurysm rupture? - ANS Is associated with patient complaining of "worst HA in their life." During a pt's admission to the ICU, the RN notes Hgb 9g/dl and Hct 27 ml/dl. Which meds should be confirmed with the provider prior to administration? - ANS Sulfa-trimethoprim (Bactrim) Anemia can be caused or exacerbated by some meds, including sulfa, antibiotics and ACE. A 56 yr male presents in heart block with a ventricular rate of 38 caused from an intentional overdose from CCB. What is appropriate antidote? - ANS Calcium Which is the earliest sign of Supratentorial (Uncal) herniation? - ANS Ipsilateral pupil dilation. Pt post-operative day 2 after a right hemicolectomy for ischemic bowel. The post-operative course has been complicated with pain control concerns. As the patient is getting out of bed for the first time the patient complains of sudden wet sounding cough. The assesses new onset tachycardia - ANS Pulmonary embolism - clinical signs of sudden SOB, anxiety points to PE Glucagon is an antidote for? - ANS Beta blockers Which port do you get to measure mixed venous blood? - ANS Distal port DIC - which medication does the nurse anticipate to be ordered and started urgently? - ANS Heparin continous infusion 4 units/kg/hr Other tx would be to eliminate the cause. Which lab value would expect to see in a patient with pancreatitis? - ANS Decreased Albumin, elevated amylase and lipase Reversal for warfarin overdose? - ANS Vit K A pt with 3 vessel CABG with PA catheter in place. Pt has crackles in bilateral bases, s3,s4 heart sounds are audible, in addition to holosystolic murmur. The nurse suspects mitral valve insufficiency. Which set of data confirms this suspicion? - ANS CVP elevated PA pressure elevated PAOP elevated As mitral regurgitation develops blood moves back into the right atrium from the left ventricle. This in turn causes an increase in left atrial pressure, pulmonary artery pressure, and cvp pressure. Pt with traumatic brain injury, what intervention should you include to prevent an increase in ICP? - ANS Keep patient's head in a neutral midline position. You are caring for a patient with an acute episode of asthma exacerbation. The first line of treatment is: - ANS beta 2 agonist - immediate tx of asthma exacerbation is to bronchodilate the airways to facilitate ventilation. Beta 2 agonists such as albuterol are a mainstay in the management of asthma and can be administered via nebulizer if needed. Which of the following would be expected in a patient experiencing herniation & Cushing's triad? - ANS Wide pulse pressure, bradycardia, increased systolic pressure Medication to treat hyperactive delirium? - ANS Haloperidol An increase in PEEP complication? - ANS A decrease in the RAP Patient is at risk for decreased right atrial filling and decreased cardiac output due to an increased intrathoracic pressure. Any time PEEP is increased, watch for signs of decreased cardiac output resulting from decreased venous return. Elevated P2 waves in an ICP waveform are a sign of: - ANS Increased intracranial pressure The P2 wave of an ICP occurs just after systole and indicates the compliance of the brain, or it's ability to respond to pressure. P2 should be lower than P1; elevation indicates decreased compliance due to increased ICP The benefit of the TIPS procedure is: - ANS Relieve portal venous pressure Which of the following heart block complications would you monitor for in the setting of an anterior wall MI? - ANS 2nd degree Type II Which of the following is indicated during the embolization of an AV malformation? - ANS Heparin - anticoagulation will prevent clot formation. A patient was 48-hours post aortic valve replacement. Which of following would be a major goal for this patient? - ANS Prevent thrombus - clot formation on the valve is a major complication of valvular replacement, especially a mechanical valve. Pt has cardiogenic shock and cardiogenic pulmonary edema. Which of the following therapies would be most effective for this patient? - ANS Ventricular assist device to increase coronary artery perfusion. Beta blocks to what for cardiac contractility? - ANS Decrease What does Plateau pressure measure? - ANS It reflects lung pressure and is needed to calculate static (lung) compliance. Salicylate overdose treatment? - ANS Activated charcoal, urine alkalization, dialysis. Pericardial friction run would show what on an 12 lead EKG? - ANS ST elevation in II, III, aVF, and V2-V5 The doc asks the nurse to determine the capture threshold. Which of the following should the nurse do? - ANS Slowly decrease the mA output until the capture is lost. A pt with ARDS needs to receive how many ml/kg of tidal volume? - ANS 4-5ml/kg tidal volume in order to prevent volutrauma. A lower respiratory rate will help provide this. Short expiratory time, PEEP, and larger tidal volumes will all promote air trapping or auto peep. Thus increasing intrathoracic pressure and reducing cardiac output. Which of the following is an appropriate strategy when providing mechanical ventilation for the patient with status asthmaticus? - ANS Use lower respiratory rates A patient is admitted with serum calcium of 15.1 mEq/L. Which of the following interventions should the nurse anticipate? - ANS Rule out hypokalemia, then administer diuretics. Which of the following patients is likely to experience a heart block? - ANS Mitral Valve repair The patient with chronic alcohol abuse is admitted with a serum phosphorus of 1.8 mEq/L. The nurse will need to observe the patient closely for: - ANS Hypoventilation Low phosphorous causes what? - ANS constipation, not diarrhea Which of following nursing behaviors is usually most helpful to patients and families regarding end-of-life decisions? - ANS acting as an arbitrator between family members. Pt receiving PCA, morphine 1 mg per hour IV infusion, and 2 mg q 15 minutes as PRN doses. Pt is having episodes of sleep apnea and is arousable only by touch. Priority interventions include: - ANS STOP the continuous infusion and give naloxone slow IV until patient awakens. Which patient according to ranson's criteria has poorest prognosis when it comes to acute pancreatitis? - ANS WBC 32,000; Glucose 220; LDH 400 A shunt requires more than oxygen to correct hypoxemia, for example: - ANS PEEP Will a V/Q mismatch respond to oxygen administration? - ANS True What should the patient watch out for when it comes to Myasthenia gravis: - ANS Muscle weakness Which of the following is the earliest indication that the patient may be aspirating oral feedings? - ANS Tachypnea and tachycardia The patient was admitted status post motor vehicle crash. The patients sustained an intracranial bleed, is hypotensive, and is tachycardic. The patient's clinical status is most likely due to which of the following? - ANS Shock from multiple trauma Neurogenic shock and brain herniation result in bradycardia? - ANS True Pt states he is "sick of it all." Which is the best intervention: - ANS Consult with Doc regarding a psych consult. Traumatic injury, patient's arterial blood gas shows Respiratory alkalosis - what interventions is best at this time? - ANS Increase FIO2/assess for pain. Acute anterior wall myocardial infarction and suddenly develops a loud holosystolic murmur, loudest at the left sternal border, 5th intercostal space, tachypnea, and bibasilar crackles. Which of the following would provide most definitive diagnosis of this problem? - ANS Increased oxygen saturation in the pulmonary artery and the right ventricle. Patient agitated with a RASS score of +3 and behavioral pain scale of 10 (range 3-13). Spo2 AND BREATH sounds are unchanged. BP and heart rate are somewhat higher. Interventions? - ANS Give morphine 2mg IV Increasing prop won't do anything for the pain.