NR 293
NR 293 Exam Review
1) Review Medication errors regarding six rights of med administration
a) Right dose-the wrong dose can be given if the script is not written correctly. No trailing
zeros and always a zero before a decimal. (Ex. 0.5 mL or 2.5 mL) Always make sure
the medication dose is correct for the patient if questioning a dose make sure to ask the
pharmacist.
b) Right patient
c) Right route
d) Right time
e) Right drug
f) Right documentation
g) There can also be two more rights In some facilities: right to refuse or right indication or
reason.
2) Review nursing process
a) ADPIE: Assessment, nursing Diagnosis, planning, implementation, and evaluation.
3) Review objective and Subjective data
a) Objective data is data that can be measured or seen.
b) Subjective data is data that is voiced to the nurse.
4) Review different routes of med administration, advantages and disadvantages
a) Enteral route: oral, sublingual, buccal, rectal (can also be topical)
b) Parenteral route: Intravenous (IV), intramuscular (IM), subcutaneous, intradermal,
intraarterial, intrathecal, intraarticular (This route does not have a first pass effect)
5) Review pharmacokinetics… absorption distribution metabolism and excretion
a) Pharmacokinetics- The study of what the body does to the drug, half-life is the time
required for the drug to be removed 50% from the body, after about 5 half-lives the drug
is considered to be effectively removed. Steady state is where there is a steady amount
of the drug in the body being eliminated and absorbed with each dose.
i) Absorption
(1) Bioavailability- the extent of drug absorption----the first pass effect is the portion
of the drug that is metabolized by the liver making the bioavailability for the
body much smaller.
ii) Distribution
(1) Transportation of the drug in the bloodstream to the targeted cells site of action.
Albumin is the most common protein in the blood that carries the majority of
protein-bond drug molecules
, iii) Metabolism or Biotransfomation (Liver p450)
(1) The chemical alteration or biotransformation of the drug.
(2) Liver takes a lipid soluble drug to metabolize the drug into a water-soluble drug
so the kidneys can excrete it in your urine faster.
(3) Metabolism can also inactivate some drugs so that helps the body get rid of
things or usually a reason we want that drug to be inactivated
(4) now bio activation of prodrugs that means it takes an inactive drug and makes it
active so right there looking we might be able to change it into a format that we
can get it out of the body quicker take it from lipid to water soluble it can either
inactivate drug or activate a drug
(5) The toxicity levels can also be increased or decreased
(a) If the liver inactivates the drug, then there is less risk for toxicity
(b) If the liver activates the drug there is an increased risk for toxicity
(6) Biochemical alteration of a drug into an inactive metabolite, a more soluble
compound, a more potent active metabolite (as in the conversion of an inactive
prodrug to its active form), or a less active metabolite.
(7) Cytochrome P-450 enzymes (or simply P-450 enzymes), also known as
microsomal enzymes, lipophilic (fal loving), hydrophilic (water loving),
enzymes
iv) Excretion- the process the body eliminates the drug.
(1) Renal excretion (primary organ responsible for excretion), Biliary excretion,
bowel excretion.
6) Review effect of drugs on pediatric patients
a) Absorption----Gastric pH acidic until 1-2 years of age, gastric emptying is slowed, IM
absorption faster and irregular.
b) Distribution---greater total body water means lower fat content, decreased level of
protein binding, immature blood-brain barrier-more drugs enter the brain.
c) Metabolism---liver is immature, dos not produce enough microsomal enzymes, older
children may have increased metabolism, requiring higher doses than infants
d) Excretion---kidney immaturity affects glomerular filtration rate and tubular secretion,
decrease perfusion rate of the kidneys may reduce excretion of drugs.
e) Factor affecting drug dosages---skin is thin and permeable, stomach lacks acid to kill
bacteria, lungs have weaker mucus barriers, body temp less well regulated, and
dehydration occurs easily, liver and kidneys are immature, impairing drug metabolism
and excretion.
7) Review the different classification of drugs ….. C-I C-II etc…look at
chart a) Controlled substances classification
i) Schedule I (C-I)---Highest potential for abuse, so high its unacceptable. Can be
used in research with appropriate limitation. Ex LSD or heroin.
NR 293 Exam Review
1) Review Medication errors regarding six rights of med administration
a) Right dose-the wrong dose can be given if the script is not written correctly. No trailing
zeros and always a zero before a decimal. (Ex. 0.5 mL or 2.5 mL) Always make sure
the medication dose is correct for the patient if questioning a dose make sure to ask the
pharmacist.
b) Right patient
c) Right route
d) Right time
e) Right drug
f) Right documentation
g) There can also be two more rights In some facilities: right to refuse or right indication or
reason.
2) Review nursing process
a) ADPIE: Assessment, nursing Diagnosis, planning, implementation, and evaluation.
3) Review objective and Subjective data
a) Objective data is data that can be measured or seen.
b) Subjective data is data that is voiced to the nurse.
4) Review different routes of med administration, advantages and disadvantages
a) Enteral route: oral, sublingual, buccal, rectal (can also be topical)
b) Parenteral route: Intravenous (IV), intramuscular (IM), subcutaneous, intradermal,
intraarterial, intrathecal, intraarticular (This route does not have a first pass effect)
5) Review pharmacokinetics… absorption distribution metabolism and excretion
a) Pharmacokinetics- The study of what the body does to the drug, half-life is the time
required for the drug to be removed 50% from the body, after about 5 half-lives the drug
is considered to be effectively removed. Steady state is where there is a steady amount
of the drug in the body being eliminated and absorbed with each dose.
i) Absorption
(1) Bioavailability- the extent of drug absorption----the first pass effect is the portion
of the drug that is metabolized by the liver making the bioavailability for the
body much smaller.
ii) Distribution
(1) Transportation of the drug in the bloodstream to the targeted cells site of action.
Albumin is the most common protein in the blood that carries the majority of
protein-bond drug molecules
, iii) Metabolism or Biotransfomation (Liver p450)
(1) The chemical alteration or biotransformation of the drug.
(2) Liver takes a lipid soluble drug to metabolize the drug into a water-soluble drug
so the kidneys can excrete it in your urine faster.
(3) Metabolism can also inactivate some drugs so that helps the body get rid of
things or usually a reason we want that drug to be inactivated
(4) now bio activation of prodrugs that means it takes an inactive drug and makes it
active so right there looking we might be able to change it into a format that we
can get it out of the body quicker take it from lipid to water soluble it can either
inactivate drug or activate a drug
(5) The toxicity levels can also be increased or decreased
(a) If the liver inactivates the drug, then there is less risk for toxicity
(b) If the liver activates the drug there is an increased risk for toxicity
(6) Biochemical alteration of a drug into an inactive metabolite, a more soluble
compound, a more potent active metabolite (as in the conversion of an inactive
prodrug to its active form), or a less active metabolite.
(7) Cytochrome P-450 enzymes (or simply P-450 enzymes), also known as
microsomal enzymes, lipophilic (fal loving), hydrophilic (water loving),
enzymes
iv) Excretion- the process the body eliminates the drug.
(1) Renal excretion (primary organ responsible for excretion), Biliary excretion,
bowel excretion.
6) Review effect of drugs on pediatric patients
a) Absorption----Gastric pH acidic until 1-2 years of age, gastric emptying is slowed, IM
absorption faster and irregular.
b) Distribution---greater total body water means lower fat content, decreased level of
protein binding, immature blood-brain barrier-more drugs enter the brain.
c) Metabolism---liver is immature, dos not produce enough microsomal enzymes, older
children may have increased metabolism, requiring higher doses than infants
d) Excretion---kidney immaturity affects glomerular filtration rate and tubular secretion,
decrease perfusion rate of the kidneys may reduce excretion of drugs.
e) Factor affecting drug dosages---skin is thin and permeable, stomach lacks acid to kill
bacteria, lungs have weaker mucus barriers, body temp less well regulated, and
dehydration occurs easily, liver and kidneys are immature, impairing drug metabolism
and excretion.
7) Review the different classification of drugs ….. C-I C-II etc…look at
chart a) Controlled substances classification
i) Schedule I (C-I)---Highest potential for abuse, so high its unacceptable. Can be
used in research with appropriate limitation. Ex LSD or heroin.
