1 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 Hormones – levothyroxine Beta Blockers eg. metoprolol (Synthroid) (Lopressor); atenolol (Tenormin) Agents for Depression/Sedation ACE inhibitors – eg. enalapril Fluoxetine (Prozac) (Vasotec) Lorazepam (Ativan) Digoxin (Lanoxin) Nitroglycerine: transdermal Anti-infectives/Anti-fungals patch & paste Ampicillin Adrenergics – dopamine Cefazolin (Ancef/Kefzol) infusion (Intropin) Gentamicin sulfate (Garamycin) Verapamil (Veracaps SR) Vancomycin Antidiabetic Agents Anti-inflammatory Agents Insulins: Regular, & NPH Prednisone/methylprednisolone Humalog, Humulin, Lantus Dexamethasone (Decadron) Metformin (Glucophage) NSAIDS – eg.Ibuprophen, Aleve Glyburide (Diabeta) Cox-2 Inhibitors- eg Celebrex Insulin Pen use Anticoagulants/Hematologic Agents Analgesics/Narcotics Heparin sodium Hydromorphone (Dilaudid) Warfarin sodium (Coumadin) Morphine sulfate & MS Contin Enoxaparin sodium (Lovenox) Oxycodone-acetaminophen. Dalteparin sodium (Fragmin) (Percocet) Antiulcer/Antiemetics Diuretics Famotidine (Pepcid) Hydrochlorothiazide (Esidrix) Omeprazole (Prilosec) Spironolactone (Aldactone) Ondansetron (Zofran) Furosemide (Lasix ) Flumazenil (Romazicon) 7/2005 Rev. 1/2007, 1/2010, 5/2015, 11/2015 2 Antiseizure High Alert Medications: Identified by Phenytoin sodium (Dilantin) TJC (The Joint Commission) -- concentrated KCL, concentrated NaCl,, Antidotes insulin, heparin Protamine Sulfate Naloxone HCl (Narcan) Herbal Interactions: anticoagulants and Vitamin K (Aquamephyton) ginko biloba II. 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 III. Conversions 1 kg = 1000 gm 1 liter = 1000 ml 1 oz = 30 ml 1 gm = 1000 mg 1 kg = 2.2 lbs 1 tbsp = 3 tsp 1 mg = 1000 mcg 1 tsp = 5 ml 1 inch = 2.54 cm 7/2005 Rev. 1/2007, 1/2010, 5/2015, 11/2015 3 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, Documentation includes: pain and outcomes must be assessment, treatment, comfort level documented completely achieved (the pain goal for that patient), interventions when treatment is inadequate, and new outcomes from those interventions DOUBLE To identify each patient Forms of identification include the IDENTIFICA- receiving medication, the nurse patient’s ID BAND (a must!); asking TION must use 2 forms of the patient his name, the MR number, identification. date of birth, phone number, photo license, etc. TELEPHONE All telephone orders must be The order read back and verification ORDERS completely read back and includes the patient’s name, date and verified to the physician as time of the order, the name of the soon as they are recorded on med, the dose, the route, the the medical record and frequency of administration, any BEFORE they are executed. parameters or criteria for administration. VERBAL Verbal orders can only be An emergency situation is one in ORDERS accepted in an emergency which the health of the patient would situation. be compromised if there were a delay in administering the medication. For accuracy, all verbal orders The order read-back and verification must be read back and verified includes the patient’s name, date and to the Physician completely as time of the order, the name of the soon as they are written in the med, the dose, the route, the medical record. frequency of administration, any parameters or criteria for administration. ANNOTATION Correct & complete written a. Use a leading zero in front of the FOR orders are required for each decimal dose of a medication. WRITTEN medication to be administered. Correct: 0.35 mg Incorrect .35 mg ORDERS If any part of an order is b. Do Not use a ‘trailing zero’ after a missing, unclear, illegible, whole number dose of a medication 7/2005 Rev. 1/2007, 1/2010, 5/2015, 11/2015 4 includes unacceptable Correct: 4mg Incorrect: 4.0 mg abbreviations, or does not conform to the patient’s c. Never use a range of doses or condition, the nurse must times. contact the physician to correct Correct: Percocet 1 tab. po q4h the problem or clarify the order Incorrect: Percocet 1-2 tabs q 3-4 before administering the hours. medication. MISSED Whenever a medication dose When a medication dose is missed MEDICATION has been missed, the nurse eg. the patient is off the unit, the DOSES should contact the physician to nurse should not assume that the clarify what is best for the patient can wait until the next dose is patient. due. The decision about the missed dose belongs to the physician. DANGEROUS Certain previously-acceptable WRONG RIGHT ABBREVIA- abbreviations CAN NO TIONS LONGER BE USED in the U Units medical record. IU International Units ug Micrograms, mcg The TJC and hospital policy now prohibits their use. QD/OD Daily QOD Every other day If these abbreviations appear in sc or sq Subcutaneously a medication order, the order must be clarified with the QID Four times a day physician and rewritten correctly. MS/MSO4 Morphine sulfate (morphine) MgSO4 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 5 Conversions: a. 2 tsp = _____ mL f. 2 oz = _____ mL b. 450 mcg = _____ mg g. 150 lbs = _____ kg c. .048 gm = _____ mg h. 65 kg = _____ lbs d. 475 mg = _____ gm i. 4.1 mg = _____ mcg e. 3 tablespoons = _____ mL j. 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 6 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.