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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 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
Humalog, Humulin, Lantus
Metformin (Glucophage)
Glyburide (Diabeta)
Insulin Pen use
Analgesics/Narcotics
Hydromorphone (Dilaudid)
Morphine sulfate & MS Contin
Oxycodone-acetaminophen.
(Percocet)
Diuretics
Hydrochlorothiazide (Esidrix)
Spironolactone (Aldactone)
Furosemide (Lasix )
Prednisone/methylprednisolone
Dexamethasone (Decadron)
NSAIDS – eg.Ibuprophen, Aleve
Cox-2 Inhibitors- eg Celebrex
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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Rev. 1/2007, 1/2010, 5/2015, 11/2015
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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

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Rev. 1/2007, 1/2010, 5/2015, 11/2015
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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, Documentation includes: pain

and outcomes must be
documented completely
assessment, treatment, comfort level
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
TION must use 2 forms of
identification.
TELEPHONE All telephone orders must be
ORDERS completely read back and
verified to the physician as
soon as they are recorded on
the medical record and
BEFORE they are executed.
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 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
must be read back and verified
to the Physician completely as
soon as they are written in the
medical record.
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,
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
b. Do Not use a ‘trailing zero’ after a
whole number dose of a medication

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Rev. 1/2007, 1/2010, 5/2015, 11/2015
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includes unacceptable Correct: 4mg Incorrect: 4.0 mg

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.
MISSED Whenever a medication dose
MEDICATION has been missed, the nurse
DOSES should contact the physician to
clarify what is best for the
patient.
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.

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.

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Rev. 1/2007, 1/2010, 5/2015, 11/2015
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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?

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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. 10 ml f. 60 ml
b. 0.45 mg g. 68.18 kg
c. 48. mg h. 143 lbs
d. 0.475 gm i. 4100 mcg
e. 45 ml j. 6.35 cm

Calculations:

1. 2 ml 7. 20 gtts per min.

2. 4 ml 8. 4 tablets
3. 1 ml 9. 1 ml
4. 5 ml 10. 125 ml/hour; 31 or 32 gtts per min.
5. 875,000 units 11. 199 gtts per min. (198 or 200 is acceptable)
6. 166.6 ml per hr (167 acceptable) 50 gtts per min, macrodrip
12. 10 gtts per min
13. 83 ml/hr

7/2005
Rev. 1/2007, 1/2010, 5/2015, 11/2015