ADVANCED Pharmacology in
Nursing Practice
Competency Exam
Logistics & Student Preparation
The pharmacology faculty and Clinical Education & Resource Center faculty/staff are excited to provide
you with this synthesis/learning activity, regarding the nursing knowledge and skills associated with the planning,
administration, and evaluation of medication therapeutics. This competency exam goes far beyond demonstrating
your knowledge. The expectation for this exam is for you to demonstrate synthesis of the pharmacology
knowledge as you integrate it with the performance of the requisite psychomotor skills. The competent
demonstration of these skills is very important as you enter your last semester in the curriculum. So, as part of the
capstone course, you will demonstrate your proficiency through this psychomotor/cognitive exam. You will need
to demonstrate the 6 Rights of Medication Administration (Right Medication, Right Patient, Right Dose, Right
Time, Right Route, and Right Documentation) and the 3 medication checks. You will also be expected to perform
2 patient identifiers to determine that you have the Right Patient. Because this is a psychomotor skills exam, it is
more important to us that you demonstrate versus just being able to state the six rights and 3 med checks, etc.
The Advanced Pharmacology in Nursing Practice Competency Exam will take a total of 30 minutes. In
your assigned room you will rotate through 3 patient care scenarios acting as a medical-surgical nurse in each
case. You will have 7 minutes to assess, interview, utilize available resources, and implement interventions with
your patient. Between cases, you will have 3 minutes to rotate to the RIGHT and prepare to begin the next case.
This activity has been designed to mirror your activities as a nurse in the hospital or clinic involved with
medication administration. A timekeeper will be in each room and automatic timers will be set and when the
buzzer sounds, you will move to the next station.
No feedback will be given between cases. At the end of the third case and in the last 5 minutes your
evaluators will provide feedback. To facilitate time efficient feedback you will follow the following pattern:
receive feedback from your current station and then rotate to the LEFT, visiting each station to receive feedback
on your performance.
At each station you will have the following books as resources: lab, med/surg, and drug. We suggest that
you bring your Personal Digital Assistant (PDA) or a drug book that you are familiar using. Note you only have 7
minutes for each case, so time is precious and of the essence, thumbing through books will not be a luxury you
can afford, since it is not a luxury found in practice. Additionally, you will have the supplies you need to
accomplish the skill
Each case involves the integration of knowledge, performance of skills in a timely manner with ready
recognition and use of appropriate resources, as described below. Students who do not demonstrate proficiency
will have an opportunity to continue their learning the next day at the redo session.
Please bring your stethoscope, PDA or drug book, lab reference, and wear your NAMETAG. Arrive 5-10
minutes early and wait in the undergraduate lounge. If you are late, there is a high probability that you will have
to reschedule to the make-up time on Saturday. Expect the evaluator to be silent and to not make suggestions or
comments during your exam, in order to not interfere with your thought processes.
The Honor code applies to this exam. We expect that you will not talk about the exam until all redos are
completed. For additional information about the honor code, please also refer to University website
(http://www.unc.edu/depts/honor/).
Carol Durham, RN, MSN, EdD (c)
Director, Clinical Education & Resource Center
Advanced Pharmacology in Nursing Practice Competency Exam Objectives
The student will be able to safely and competently provide the nursing care for patients associated with
medication therapeutics t for common and significant health problems of adults.
Thought processes that underlie student preparation and performance:
1. Why is (are) this medication(s) given and its major classification?
2. What are the intended and unintended outcomes for the patient including signs and symptoms
(assessment)?
3. What are the critical parameters about giving or not administering this medication such as
labs/symptoms, other health/social conditions/medications, etc. (prioritized outcomes –
evaluation)?
4. Be prepared to call healthcare practitioner, evaluate labs, understand drug effects on kidneys and
liver.
5. You will be expected to document.
Drug categories to be emphasized in the competency exams (refer to Pharm. Modules & pharm text for
preparation)
 Antimicorbial
 Anticoagulants
 Bronchodilators
 Ophthalmics
 Antinflamatory
 Histamine H2 antagonist
 Inotrope (digoxin)
 Antihypertensives
 Lipid lowering medications
 Hypoglycemics
Skills – the organized, safe performance (appropriate standard precautions, use body mechanics, wear
gloves if you need them) of the following:
 Six medication rights and three patient checks
 Injections (wipe off vials, locate site with landmarks, cleanse site, etc)
 IV medication administration (check IV site, IV bag and medication compatibility)
 Administration of oral meds (use skills check sheet)
 NG tubes (check placement, administer medication)
 IV pumps
 Eye Drops
 Inhalers
 Patient teaching
Tips
In each case it will be assumed you have washed your hands. STAY FOCUSED. Be frugal with time –
do not get bogged down in the details. If there is a phone present at your station USE it. If lab results are
present, they are there for a reason - Do not ignore them.


For each of the medication categories on the competency exam handout, review the general
category in your textbook: Lehne, R. A. (2007). Pharmacology for nursing care. St Louis, MO:
Saunders. Look up a prototype and a comparison drug in the category listed in Lehne in the drug
handbook or PDA software that you plan to bring with you to the exam.
Take notice of :
o Findings – i.e. physical exam findings, vital signs, laboratory result parameters – that are
important for making a decision whether or not it is safe to administer the medication
(“pre-administration assessment”)
o Assessments, including lab results/parameters, necessary to monitor for therapeutic
effects
o Signs & symptoms of toxicity, including signs of liver and kidney dysfunction
o Significant drug interactions
o Essential elements for teaching patients about drugs/routes of administration – focus on
safety
Think about these things in terms of what actions they would prompt you to perform in a clinical
situation.

Remember that you will be able to use your drug reference, but reviewing drug classes before the
exam will be help you to work more quickly during the timed exam. You do not need to
memorize normal lab values, these will be provided.

Procedures: review the following in Harkreader, H. & Hogan, M. A. ((2004). Fundamentals of
nursing: Caring and clinical judgment. St Louis, MO: Saunders) and in your fundamental
nursing skills lab syllabus - N365 Medication Administration Key Concepts & Procedures
o Verification of orders
o Medication administration rights, medication checks, checks for pt. ID
o Review of record for allergies
o Administering oral medications
o Administering subcutaneous injections*:
 syringe and needle selection, maintaining sterility, injection site selection,
injection technique, modifications for certain meds
o Preparation of 2 types of insulin in same syringe
o Intermittent IV medication administration via pump with and without primary IV

Calculations to review:
o Basic dose calculation
o IV solution rate (including setting pump for infusion rate less than one hour)
o Sliding scale insulin by calculation
N362.2 Pharmacology in Nursing Practice Competency Exam Dates
Pharmacology Review with Course Coordinator
Open Lab for skill review TBA
Competency Exam – Tuesday May 1, 2007 from 12 noon – 7:00pm (times will be assigned)
Redos – Wednesday, May 2, 2007 3pm – 7pm by appointment
* review: what is the correct technique for disinfecting the skin at the injection before giving an injection?