STUDY GUIDE AND BLUEPRINT
There are 91 items on this test. Twenty (20) questions will be selected from each week of class for a total of 60 questions. This test is cumulative for the nursing process (15) and drug-math problems with and without labels (15). There will be one “place-holder” question at the very end to remind you to tear up your paper in front of the camera. The question formats include XX multiple-choice, XX select all that apply (SATA), X matching, X items to place in rank order, and 15 drug-math problems.
ALWAYS KEEP IN MIND – FOR ANY TEST
Concentrate on classes of medications, which typically work in similar ways and have similar nursing considerations (these are what the nurse should know while assessing, administering, and evaluating treatment).
Both the generic and trade name of medications are included on exams. The NCLEX exam only provides the generic, so work on memorizing that name first.
Remember what the “therapeutic outcome” or “having a therapeutic effect” means – those mean that the drug is working as it is supposed to do!
THIS IS A FINAL EXAM
As a final exam the content is cumulative of the nursing process and drug math calculations. The remainder of the test content is set up as in the two previous tests.
DRUG MATH PROBLEMS
You will be given an onscreen calculator for calculating the problems (the calculator will appear at the top of the test), but you may use your own simple calculator during the test. However, you may not use your phone as a calculator or for any other reason during the test. You may use blank pieces of paper and pencil for your calculations during the test – you will show the blank paper(s) front and back to the camera at the beginning of the test, and you will show the paper(s) front and back at the end of the test, then tear them up in front of the camera. When answering math problems, you will type in the correct answer into an essay format box on the computer screen. If you also include the steps of setting up your problem on the answer screen, I will be able to help you figure out where you went wrong if you miss it!
Recognize what the health care provider’s order means so you can set up the problem correctly. It does not matter which method you use to calculate the problem, although the formula method (desired/have X volume) is a very popular and convenient way to work math problems. Don’t forget you need to convert to like units so you can calculate correctly. Additionally, don’t forget to review those presentations and the conversions and abbreviations with which you were asked to commit to memory. Abbreviations are included on any pharmacology test.
When reviewing drug-math labels, look on the label for how the drug is prepared. For example, how many milligrams are in each tablet or mL? And important point – once you have located what you need to calculate the problem, quit looking and stop.
If you have a reconstitution problem where you must add a diluent to the powder in the vial to prepare the drug for administration, what is the concentration (concentrations are always in two parts)? Once you locate the information needed, you will then use the order to calculate what must be administered to the patient. If the question asks what amount of diluent is used for reconstitution, that is the amount of liquid added to the vial to prepare the drug for administration. [The amount of diluent is NEVER used in calculating how much medication will be administered to the patient. In fact, you will never use it again!]
Review IV calculation problems. You’ll need to calculate heparin infusions, IV calculations for mL/hr and gtt/min and figure out how many hours and minutes are left with an intravenous infusion. Hint: write the units of measurement to the side of your paper first and circle it, so you can set up your problems for the units of measurement to cancel out in the correct order.
Review the nursing process – nursing assessment, diagnosis/planning, implementation, and evaluation – for each test.
Nursing assessments are what must be monitored BEFORE a drug is given and ensures it is safe to give the drug. These might include vital signs, specific lab work, urine output, level of consciousness, level of pain, intake and output, and weight. For example, the nurse checks the blood pressure before giving an antihypertensive drug to ensure the patient’s blood pressure is not too low.
Diagnosis/planning includes selecting a NANDA and a measurable goal with time frame. Look for NANDAs that focus on risks for side effects. For example, a potential NANDA for an antihypertensive drug is “Risk for falls”, because the drug may lower blood pressure too low. Patient goals should be realistic, objective, and patient focused.
Implementation means preparing and administering the drug to the patient. This includes teaching patients what they should know before and throughout therapy. Teaching should include common side effects, reportable adverse effects, what an allergic reaction might look like, what to do when an allergic reaction occurs, how to take a drug, precautions they should take, and why the drug is given.
Evaluations are completed AFTER a drug is given to determine if the drug is having the appropriate therapeutic effect/benefit. This means the drug is working! Examples follow: (a) an antibiotic is given to eradicate an infection. Evaluations indicating that the antibiotic has the appropriate therapeutic effect might include decrease in patient temperature, decrease in the amount of WBC, and reduction of symptoms; and (b) an antihypertensive agent is given to decrease blood pressure, so evaluations indicating that the antibiotic has the appropriate therapeutic effect might include a decrease in blood pressure.
Study with the selected objectives; use your book to fill in any blanks you might have to help you review for the test.
CARDIOVASCULAR AND RENAL AGENTS
Provide information about patient teaching, nursing diagnoses, and nursing implications for (a) digoxin, (b) antiarrhythmics (Classes I – IV), (c) nitroglycerine, (d) antihypertensives [ACEI, ARBs, alpha1-blockers, direct vasodilators], (e) coagulation-modifiers [anticoagulants, platelet inhibitors, thrombolytics], and (f) antilipemics [niacin, psyllium, omega 3, fibrates, bile-acid sequestrants, cholesterol absorption inhibitors, HMG-CoA reductase inhibitors]
Compare and contrast heparin and warfarin therapies, including (a) lab tests, (b) administration, (c) antidotes, and (d) patient teaching (including diet)
Provide information about patient teaching, nursing diagnoses, and nursing implications for (a) diuretics [loop, thiazide, K+ sparing, osmotic, carbonic-anhydrase inhibitors] and (b) fluid [crystalloid and colloid] and electrolyte replacement therapy
ANTI-ANEMIC, NUTRITIONAL & GASTROINTESTINAL AGENTS
Differentiate between the use of enteral nutrition and total parenteral nutrition (TPN)/hyperalimentation (HAL) including the (a) route of administration, (b) potential complications, and (c) nursing implications
Given a patient receiving iron supplements, prioritize (a) nursing implications, and (b) patient teaching
Provide information about patient teaching and nursing considerations for (a) gastrointestinal agents (H2 antagonists, proton-pump inhibitors, antacids, carafate, Cytotec), (b) antidiarrheal agents (adsorbents, anti-motility, and intestinal flora modifiers), (c) laxatives (bulk-forming, emollient, hyperosmotic, saline, and stimulant), (d) anti-emetics (anticholinergics, antihistamines, prokinetics, serotonin blockers, and tetrahydrocannabinoids), and (e) vitamin and mineral supplements
DERMATOLOGY, OPHTHALMIC & OTIC AGENTS
Differentiate indications for use and nursing considerations among the following otic and ophthalmic agents: (a) fluorescent dyes, (b) anticholinergics, (c) artificial tears, (d) antiinfectives, (e) antiinflammatory, (f) antiglaucoma, (g) antihistamines, (h) local anesthetics, (i) decongestants, and (j) cerumenolytics
Identify medications that may adversely affect the otic nerve with appropriate nursing interventions
Provide information about patient teaching and nursing considerations for dermatologic conditions, including acne
Provide information about patient teaching (including application) for (a) ophthalmic agents (drops and ointment), (b) otic agents (adult and pediatric patient < 3 years old), and (c) dermatologic (topical) therapy
IMMUNE, BIOLOGIC MODIFIER & CHEMOTHERAPY AGENTS
Provide information about patient teaching, nursing diagnoses, and nursing implications for (a) immunosuppresant agents, (b) antineoplastic agents, and (c) biologic response modifying agents
For antineoplastic agents, describe precautions for the (a) patient and (b) the nurse relating to the life-threatening problems of bone marrow depression
For vaccinations, describe (a) common side effects with treatments, (b) adverse reactions for which the healthcare provider must be notified, (c) conditions for which a patient should consult with a healthcare provider before receiving a vaccination, (d) when a patient should temporarily not receive a vaccination, and (e) conditions for which a patient may never receive a vaccination
DRUG MATH CALCULATIONS
Recognize abbreviations for recommended times for administering medications
Be able to convert between military time and A.M.-P.M. time
Be able to read a drug label
Be able to convert between apothecaries’ and metric system of measurement
When given a statement of physician order, will be able to determine how much medication the nurse would administer to the patient (oral, parenteral, and units).
Use labels for calculating drug math problems
Accurately calculate the following: milliliters given per hour (mL/h), milliliters given per minute (mL/min), drops given per minute (gtt/min), and total volume and length of time over which the IV is to infuse
Be able to convert a heparin drip from units/hour to mL/hour, and vice versa
Calculate time left for intravenous infusions, given the drop factor, gtts/minute, amount of fluid left, and amount of time remaining for infusion
(Exclude drug math I got this)