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SAINT BARNABAS HEALTH CARE SYSTEM
Preparation for Nursing Pharmacology Test
PHARMACOLOGY REVIEW GUIDE
In order to successfully pass the 50 item pharmacology exam, nurses must
achieve an overall score of 80%. However, nurses are only allowed to get 2 calculation
questions wrong from the Drug Calculation section of the exam (3 errors in calculation
questions means an automatic failure and the nurse must re-take the exam). For the
calculation questions on the exam, the nurse must show all work that led to arriving at
the answer. Only ONE retake is permitted. Time allotted for exam: 1 1/2 hour (90 min.).
I.
Categories of Medications
Know the actions, use, serious side effects and specific nursing measures for
administration of the following frequently ordered medications or categories of
medications
Cardiovascular/Antiarrhythmics
Beta Blockers eg. metoprolol
(Lopressor); atenolol (Tenormin)
ACE inhibitors – eg. enalapril
(Vasotec)
Digoxin (Lanoxin)
Nitroglycerine: transdermal
patch & paste
Adrenergics – dopamine
infusion (Intropin)
Verapamil (Veracaps SR)
Hormones – levothyroxine
(Synthroid)
Agents for Depression/Sedation
Fluoxetine (Prozac)
Lorazepam (Ativan)
Antidiabetic Agents
Insulins: Regular, & NPH
Humalog, Humulin, Lantus
Metformin (Glucophage)
Glyburide (Diabeta)
Insulin Pen use
Anti-inflammatory Agents
Prednisone/methylprednisolone
Dexamethasone (Decadron)
NSAIDS – eg.Ibuprophen, Aleve
Cox-2 Inhibitors- eg Celebrex
Analgesics/Narcotics
Hydromorphone (Dilaudid)
Morphine sulfate & MS Contin
Oxycodone-acetaminophen.
(Percocet)
Diuretics
Hydrochlorothiazide (Esidrix)
Spironolactone (Aldactone)
Furosemide (Lasix )
7/2005
Rev. 1/2007, 1/2010, 5/2015, 11/2015
Anti-infectives/Anti-fungals
Ampicillin
Cefazolin (Ancef/Kefzol)
Gentamicin sulfate (Garamycin)
Vancomycin
Anticoagulants/Hematologic Agents
Heparin sodium
Warfarin sodium (Coumadin)
Enoxaparin sodium (Lovenox)
Dalteparin sodium (Fragmin)
Antiulcer/Antiemetics
Famotidine (Pepcid)
Omeprazole (Prilosec)
Ondansetron (Zofran)
Flumazenil (Romazicon)
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Antiseizure
Phenytoin sodium (Dilantin)
High Alert Medications: Identified by
TJC (The Joint Commission) -concentrated KCL, concentrated NaCl,,
insulin, heparin
Antidotes
Protamine Sulfate
Naloxone HCl (Narcan)
Vitamin K (Aquamephyton)
II.
III.
Herbal Interactions: anticoagulants and
ginko biloba
Important to Know:
1. Medication administration based on RN standards of practice.
2. How to administer intramuscular injections – variations by weight, size, age.
3. Nursing responsibilities for first-dose of any medication.
4. Nursing documentation for PRN medications.
5. How to draw up and administer insulin subcutaneously and how to use an insulin
pen.
6. Heparin/Lovenox/Fragmin injection techniques and sites
7. Specific lab values to be monitored for patients on Lovenox/Fragmin, Heparin,
Coumadin, Vancomycin
8. How to apply topical/ transdermal medication/patches
9. IV push medications
10. How to administer eye and ear drops – adults and pediatric
11. How to administer sustained release (SR, LX, LA etc.) tablets/capsules
12. Distinguish S/S of hypoglycemia & the interventions for treating it.
13. Measures for effective pain management – dosing schedule, documentation, use
of appropriate pain scale eg. FLACC, BPS, CPOT, Wong-Baker, Numeric.
14. Safety measures for administration of TPN (total parenteral nutrition)
15. How to administer meds via NG tube
16. IV administration of diluted KCl only via central line or large vein
17. Monitoring for IV infiltration of vesicants (e.g. Dopamine)
18. Heparin Infusion weight-based dosages
Conversions
1 kg = 1000 gm
1 gm = 1000 mg
1 mg = 1000 mcg
7/2005
Rev. 1/2007, 1/2010, 5/2015, 11/2015
1 liter = 1000 ml
1 kg = 2.2 lbs
1 tsp = 5 ml
1 oz = 30 ml
1 tbsp = 3 tsp
1 inch = 2.54 cm
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IV.
Policies - The following SBHCS policies apply to the administration of
medication and must be followed at all times.
TOPIC
GOLDEN RULES
ADDITIONAL INFORMATION
PAIN
Patients must receive adequate If the medications ordered are not
pain control.
controlling the patient’s pain, a new
order should be obtained from the
physician. Don’t let the patient suffer.
Pain assessment, interventions,
and outcomes must be
documented completely
Documentation includes: pain
assessment, treatment, comfort level
achieved (the pain goal for that
patient), interventions when treatment
is inadequate, and new outcomes
from those interventions
DOUBLE
IDENTIFICATION
To identify each patient
receiving medication, the nurse
must use 2 forms of
identification.
TELEPHONE
ORDERS
All telephone orders must be
completely read back and
verified to the physician as
soon as they are recorded on
the medical record and
BEFORE they are executed.
Forms of identification include the
patient’s ID BAND (a must!); asking
the patient his name, the MR number,
date of birth, phone number, photo
license, etc.
The order read back and verification
includes the patient’s name, date and
time of the order, the name of the
med, the dose, the route, the
frequency of administration, any
parameters or criteria for
administration.
VERBAL
ORDERS
Verbal orders can only be
accepted in an emergency
situation.
An emergency situation is one in
which the health of the patient would
be compromised if there were a delay
in administering the medication.
For accuracy, all verbal orders
must be read back and verified
to the Physician completely as
soon as they are written in the
medical record.
The order read-back and verification
includes the patient’s name, date and
time of the order, the name of the
med, the dose, the route, the
frequency of administration, any
parameters or criteria for
administration.
a. Use a leading zero in front of the
decimal dose of a medication.
Correct: 0.35 mg Incorrect .35 mg
ANNOTATION Correct & complete written
FOR
orders are required for each
WRITTEN
medication to be administered.
ORDERS
If any part of an order is
missing, unclear, illegible,
7/2005
Rev. 1/2007, 1/2010, 5/2015, 11/2015
b. Do Not use a ‘trailing zero’ after a
whole number dose of a medication
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MISSED
MEDICATION
DOSES
DANGEROUS
ABBREVIATIONS
includes unacceptable
abbreviations, or does not
conform to the patient’s
condition, the nurse must
contact the physician to correct
the problem or clarify the order
before administering the
medication.
Whenever a medication dose
has been missed, the nurse
should contact the physician to
clarify what is best for the
patient.
Correct: 4mg Incorrect: 4.0 mg
Certain previously-acceptable
abbreviations CAN NO
LONGER BE USED in the
medical record.
WRONG
RIGHT
U
IU
Units
International Units
ug
Micrograms, mcg
QD/OD
Daily
QOD
Every other day
The TJC and hospital policy
now prohibits their use.
c. Never use a range of doses or
times.
Correct: Percocet 1 tab. po q4h
Incorrect: Percocet 1-2 tabs q 3-4
hours.
When a medication dose is missed
eg. the patient is off the unit, the
nurse should not assume that the
patient can wait until the next dose is
due. The decision about the missed
dose belongs to the physician.
If these abbreviations appear in sc or sq
a medication order, the order
must be clarified with the
QID
physician and rewritten
correctly.
MS/MSO4
MgSO4
Subcutaneously
Four times a day
Morphine sulfate
(morphine)
Magnesium sulfate
OS/OD/OU Left/right/both eyes
AS/AD/AU Left/right/both ears
V. Some Helpful Hints: Exam candidates may bring one nursing drug reference book
and a calculator (extra batteries recommended) to use during the exam. Example:
Mosby’s Nursing Drug Reference by Linda Skidmore-Roth; Cost: approx. $38.00. No
cell phones may be brought into the exam area or used during the test.
VI. Sample Conversions and Calculations: The problems below represent the types of
calculations that will be presented on the nursing pharmacology exam. The answers are
found at the end of this review guide.
7/2005
Rev. 1/2007, 1/2010, 5/2015, 11/2015
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Conversions:
a.
b.
c.
d.
e.
2 tsp = _____ mL
450 mcg = _____ mg
.048 gm = _____ mg
475 mg = _____ gm
3 tablespoons = _____ mL
f.
g.
h.
i.
j.
2 oz = _____ mL
150 lbs = _____ kg
65 kg = _____ lbs
4.1 mg = _____ mcg
2.5 inches = _____ cm
Calculations:
1.
A child is to receive amoxicillin 50 mg po. The medication in oral suspension is
labeled 125 mg per 5 ml. How many mls should the child receive?
2.
The liquid medication label reads 100 mg per 2 ml. The order is for the patient to
receive 200 mg of the medication. How many mls will be administered?
3.
The patient is to receive digoxin 0.25 mg IV. Digoxin is in prefilled syringes of
0.5 mg per 2 mls. How many mls will be administered by syringe?
4.
The physician orders dynapen 125 mg po stat. The bottle is labeled 25 mg per ml.
How many mls should be given?
5.
Penicillin G sodium for injection contains 250,000 units per ml. How many units
are there in 3.5 mls?
6.
The doctor orders 1000 ml of D5W every 6 hours. How many mls per hour
should the patient receive?
7.
Calculate the drip rate for an IV of D5 ½ NS to run at 20 ml per hour using a
microdrip set (60 gtts per ml).
8.
The patient is to receive Keflex 1 gm P.O. On hand is Keflex 250 mg per tablet.
How many tablets should be administered?
9.
Garamycin comes in a concentration of 80 mg per 2ml. How many mls would be
needed for a dose of 40 mg?
10.
The physician orders 1 liter of NS every 8 hours. How many mls per hour should
the patient receive? Using macrodrip tubing (15 gtts per ml) what is the flow rate
in gtts per minute?
7/2005
Rev. 1/2007, 1/2010, 5/2015, 11/2015
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11.
The patient is to receive Ancef 1 gram every 6 hours in 100 ml of normal saline to
run over 30 minutes. If microdrip tubing is used (60 gtts per ml), what is the rate
of flow in drops per minute?
If macrodrip tubing is used (15 gtts per ml), what is the rate of flow in drops per
minute?
12.
One unit of blood, (250 ml per unit) must be infused over 4 hours. It cannot
remain hanging longer than 4 hours. How fast must you run the blood using
blood tubing of 10 gtts per ml?
13.
Your patient has a PICC (Peripherally Inserted Central Line) and needs to receive
1000ml over 12 hrs. The infusion pump should be set at what rate? (ml/hr)
PHARMACOLOGY REVIEW GUIDE - ANSWER KEY
Conversions:
a.
b.
c.
d.
e.
10 ml
0.45 mg
48. mg
0.475 gm
45 ml
f.
g.
h.
i.
j.
60 ml
68.18 kg
143 lbs
4100 mcg
6.35 cm
Calculations:
1.
2.
3.
4.
5.
6.
2 ml
7.
4 ml
8.
1 ml
9.
5 ml
10.
875,000 units
11.
166.6 ml per hr (167 acceptable)
12.
13.
7/2005
Rev. 1/2007, 1/2010, 5/2015, 11/2015
20 gtts per min.
4 tablets
1 ml
125 ml/hour; 31 or 32 gtts per min.
199 gtts per min. (198 or 200 is acceptable)
50 gtts per min, macrodrip
10 gtts per min
83 ml/hr