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Study Guide for Pharmacology and the Nursing Process
7th Edition Linda Lane Lilley Digital Instant Download
Author(s): Linda Lane Lilley, Shelly Rainforth Collins, Julie S. Snyder
ISBN(s): 9780323293624, 032329362X
Edition: 7
File Details: PDF, 17.97 MB
Year: 2013
Language: english
Study Guide for

Pharmacology and the

Nursing Process
Seventh Edition

Linda Lane Lilley, RN, PhD

Shelly Rainforth Collins, PharmD
Julie S. Snyder, MSN, RN-BC

Study Guide prepared by

Julie S. Snyder, MSN, RN-BC

Adjunct Faculty
School of Nursing
Old Dominion University
Norfolk, Virginia

Student Study Tips by

Diane Savoca
Coordinator of Student Transition
St. Louis Community College at Florissant Valley
St. Louis, Missouri
3251 Riverport Lane
St. Louis, Missouri 63043

STUDY GUIDE FOR PHARMACOLOGY

AND THE NURSING PROCESS, SEVENTH EDITION ISBN: 978-0-323-09129-9

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Although for mechanical reasons all pages of this publication
are perforated, only those pages imprinted with an Elsevier Inc. copyright notice are intended for removal. Details
on how to seek permission, further information about the Publisher’s permissions policies and our arrangements
with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at
our website: www.elsevier.com/permissions.

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such informa-
tion or methods they should be mindful of their own safety and the safety of others, including parties for
whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications.
It is the responsibility of practitioners, relying on their own experience and knowledge of their patients,
to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability, negligence
or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.

International Standard Book Number 978-0-323-09129-9

Executive Content Strategist: Lee Henderson

Content Development Specialist: Jacqueline Twomey
Book Production Manager: Jeffrey Patterson
Project Manager: Clay Broeker
Publishing Services: Lisa Hernandez

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contents

Student Study Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 1 The Nursing Process and Drug Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Chapter 2 Pharmacologic Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter 3 Lifespan Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 4 Cultural, Legal, and Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Chapter 5 Medication Errors: Preventing and Responding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Chapter 6 Patient Education and Drug Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Chapter 7 Over-the-Counter Drugs and Herbal and Dietary Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Chapter 8 Gene Therapy and Pharmacogenomics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Chapter 9 Photo Atlas of Drug Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Chapter 10 Analgesic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Chapter 11 General and Local Anesthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Chapter 12 Central Nervous System Depressants and Muscle Relaxants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Chapter 13 Central Nervous System Stimulants and Related Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Chapter 14 Antiepileptic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 15 Antiparkinson Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Chapter 16 Psychotherapeutic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Chapter 17 Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Chapter 18 Adrenergic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Chapter 19 Adrenergic-Blocking Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 20 Cholinergic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter 21 Cholinergic-Blocking Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Chapter 22 Antihypertensive Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Chapter 23 Antianginal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Chapter 24 Heart Failure Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Chapter 25 Antidysrhythmic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Chapter 26 Coagulation Modifier Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chapter 27 Antilipemic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Chapter 28 Diuretic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Chapter 29 Fluids and Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Chapter 30 Pituitary Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Chapter 31 Thyroid and Antithyroid Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Chapter 32 Antidiabetic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Chapter 33 Adrenal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Chapter 34 Women’s Health Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Chapter 35 Men’s Health Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Chapter 36 Antihistamines, Decongestants, Antitussives, and Expectorants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Chapter 37 Respiratory Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Chapter 38 Antibiotics Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. iii
iv  Contents

Chapter 39 Antibiotics Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Chapter 40 Antiviral Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Chapter 41 Antitubercular Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Chapter 42 Antifungal Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Chapter 43 Antimalarial, Antiprotozoal, and Anthelmintic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Chapter 44 Antiinflammatory and Antigout Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Chapter 45 Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs . . . . . . . . . . . . . . . . . . . 135
Chapter 46 Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific and Miscellaneous Drugs . . . . . . . . . . . . . . . . . . 139
Chapter 47 Biologic Response–Modifying and Antirheumatic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Chapter 48 Immunosuppressant Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Chapter 49 Immunizing Drugs and Biochemical Terrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Chapter 50 Acid-Controlling Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Chapter 51 Bowel Disorder Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Chapter 52 Antiemetic and Antinausea Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Chapter 53 Vitamins and Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Chapter 54 Anemia Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Chapter 55 Nutritional Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Chapter 56 Dermatologic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Chapter 57 Ophthalmic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Chapter 58 Otic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Overview of Dosage Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

Answer Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 Student Study Tips  1

Student Study Tips

CHOOSE TO MANAGE YOUR TIME ■■ Make the goal and actions measurable. State the
Time and money have much in common. They can be goal and each step in the plan for achieving it in a
spent, saved, invested, given away, stolen, and wasted. way that will enable you to measure your progress
The big difference between these two commodities is that toward completion.
you can earn more money. Your time is limited. Learn to
manage your time now and the quality of your life will The following is an example of how this goal and
increase because you will have more time to do what you action process works: You have a chapter test a week
enjoy. from today. The test will cover approximately 45 pages
You may not enjoy studying. What you want is to be of text material, and there are 40 specific pharmacologic
a nurse, and studying is one choice that will get you what terms you must know. In addition, you have been given
you want. Being a nurse will bring you the satisfaction about 20 pages of supplementary handouts in class. What
that you need. I, for one, am very thankful that you have will you do in the next 7 days to prepare for this test?
made this decision. The world needs dedicated skilled
nurses. To meet this need, you must make the decision to Goal Statement:
manage your time effectively. I will study to make a good grade on this exam.
This is a poor goal statement because it is not specific,
sets no time limits, and offers no real way to measure
Establish Goals and Create Action progress. The intent is good, but the implementation of
Plans such a vague goal is usually poor.
One key to time management is having clear goals and an
action plan to accomplish these goals. This is more than Revision 1:
saying, “I want to be a nurse” or “I want to ace my phar- I will spend 2 hours a day studying for the next chap-
macology midterm.” It is a decision to spend time now to ter test in order to get at least an 80% score.
get clarity and direction so that you will have more time This is a better goal statement. If one assumes that 2
later to relax. The following guidelines can help you get hours per day is realistic, then the goal is more specific,
what you want. the grade goal is measurable, and there is a time limit of
sorts. This goal statement might be good enough, but it
could still be improved.
Guidelines for Setting Goals
There are some basic guidelines to follow when setting Final Version:
goals: I will spend 2 hours per day, from 2:30 to 4:30 pm, for
the next 7 days studying for the chapter test in order
■■ Be realistic. The goal must be something that you to score at least 80%.
can reasonably expect to accomplish. A goal of scor- This is what is needed. This version states how much
ing 100% on each and every unit test is not realistic, time, when, how many days, and for what purpose.
but a goal of scoring 85% or better is. Setting clear goals helps you get started and serves as a
■■ Be specific. Goals must set out exactly what needs motivator to keep you working.
to be done. Do not simply state, “I will study for the
exam.” Specify how many hours, what days, and
what times you will study. The more specific the Guidelines for Action Statements
goal statement, the easier it is to establish a plan, A goal, no matter how well stated, is not enough. There
complete that plan, and thus achieve the goal set. must be action statements to help you make day-to-day
■■ Establish a time limit. Specify a time limit for com- progress toward meeting the goal. The guidelines that
pleting each step in the plan and an overall deadline apply to defining your goal also apply to establishing
for accomplishing the goal. the action statements—they should be realistic, specific,
measurable, and time-limited. They spell out what is go-

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1
2  Student Study Tips

ing to be done day to day. Here are three examples of and stress. The important things are maintaining
good action statements for the sample goal: balance and staying focused on your goals.
2. Prioritize items in your “have-to-be-done” category
■■ I will master six pharmacology terms each day. based on your physical and mental health needs.
■■ I will spend from 2:30 to 3:00 pm each day reviewing Examine the consequences of not doing these activi-
class handouts. ties. If you can live without doing an activity, then it
■■ I will review 10 pages of text material from 3:00 to is not a need.
4:00 pm each day. 3. Prioritize your “should-be-done” category based on
your physical and mental health needs. Examine the
These examples should give you a good idea of how consequences of not doing these activities. Can you
to go about developing a clear goal and a set of actions to accomplish your established goals without doing a
carry out to achieve that goal. given activity? If so, then it is not a need.
4. Prioritize your “want-to-do” category. Some recre-
ational time is absolutely essential in any effective
Organize Tasks and Create Schedules time management system. “Want-to-do” activities
It takes time to make time. It is your choice. Either you can often be used as incentives for completing what
set your schedule or others will do it for you. It is 2:30 should be done.
pm. The phone rings and friends want you to go out or 5. Use incentives to accomplish what you should do.
your boss wants you to work overtime or your sister For each person the rewards will be different. Spend
wants you to watch the kids. When you have an action a little time determining what will work for you. It
plan and a schedule, your choices are clear. This is the might be watching your favorite reality show, prime
time you scheduled to review class handouts. Can you time drama, or comedy show; going to the movie
reschedule this review or do you want to keep this prom- theater to see a new release; reading a book for
ise you have made to yourself to accomplish your goal? pleasure; or just spending some time with family or
No matter what you decide, you have maintained control friends.
over your time.
Your goals and action plans are the foundation for
your time management. The next key is to organize tasks
and create schedules.

Guidelines for Organizing Tasks

1. Divide tasks into three categories:
a. Jobs that have to be done, such as going to
class, going to work, eating, and getting ad-
equate rest. These jobs are the easiest to ac-
complish because the consequences of not doing
them are serious. If you do not go to class, Guidelines for Creating Workable
failure is almost a sure thing. If you do not go to Schedules
work, soon there will be no paycheck. The con- You will need three types of schedule: master, weekly,
sequences of not eating or sleeping are obvious. and daily.
b. Jobs that should be done, such as studying, Start by developing a master schedule table on your
paying bills, cleaning the house, and all of those computer that has seven columns and 15 to 17 rows. The
other necessary but unpleasant tasks that are part columns are the days in the week and the rows are the
of life. The “should-be-done” jobs are the most hours in the day. The left-hand column will represent
difficult to accomplish because they are the jobs Sunday and the far right will be Saturday. Start at the top
that are all too easy to put off doing. These are of each column with the time you usually get up in the
also the jobs for which time management skills morning and end each column with the time you usually
are most essential. go to bed. A typical master schedule might begin at 6 am
c. Things that you want to do. These include all and end at 11 pm.
of the fun things that provide pleasure and es- Once the blank schedule sheet is prepared, the next
cape from the routines of class, study, and work. step is to fill in those hours that correspond to the activi-
Most of us are very successful at finding time ties you have to do. These are the hours others control,
to do what we want to do, even when there is and the activities are those that occur at the same hour,
a sizable backlog of “should-be-done” chores on the same day or days, and for several weeks or longer.
waiting. This choice can lead to procrastination For example, the semester’s schedule of classes is the

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 Student Study Tips  3

first set of activities to enter into the master schedule. schedule, take one of the copies you made of the master
Other activities such as work, travel, worship services, schedule and begin to fill in activities in the open blocks
and any other regular activities also belong in the master of time. The first blocks of time you should assign are the
schedule. most important ones for any student—study time. This
The master schedule should contain only those re- is what time management is all about—scheduling the
curring activities that cannot be done at any other time. needed hours for study (Figure 1-2).
Activities such as doing the laundry, watching television, When filling in study hours, consider these im-
and shopping should not be included, because the time portant factors:
when you do them is more flexible. The idea behind
compiling the master schedule is to establish those times ■■ Amount of planned study time. There is an old rule
of the day that are “spent” and therefore cannot be used pertaining to study time, and even though it is an
for any other activities. The empty blocks that remain old rule, it is still a very good guideline. The rule is
represent the time you have to do everything else. Figure to plan 2 hours of study time for each 1 hour spent
1-1 shows a sample master schedule. in class. For example, a three-credit-hour course
Creating a master schedule takes no more than half meets 3 hours per week, so you need to plan 6 hours
an hour, and it will generally serve you for an entire se- of study time per week for this course. Remember,
mester. The only reason to compile a new master sched- this is a general rule. Some courses will not actually
ule is that a significant schedule change has occurred. require as much time as you allot, whereas others
You may get a new work assignment or your nursing will require more. The reason for beginning a se-
practicum site may change and require an additional 15 mester with this approach is simple. It is easy to find
or 20 minutes of travel time. Then a new master schedule things to do with time you do not need for study,
should be drawn up to accommodate the increase in time but once a semester is underway, it can be very dif-
that is now necessary. Once the master schedule is com- ficult to find additional study time. If you do not plan
pleted, make four or five copies of it. These copies will enough study time at the beginning, you will soon
be used to prepare the detailed weekly schedule. find yourself in a constant battle to keep up. The re-
Next, move on to developing your weekly schedule. sult is frustration, anxiety, and a sense of impending
The master schedule helps you identify the time you have doom—feelings you do not need when you want to
available to complete the “should-be-done” and “want- perform at your very best.
to-do” task lists. The weekly schedule is more complex. ■■ Personal prime time. Do you wake up early, ready
It is intended to help you plan for study, recreation, fam- to charge forward, but find it difficult to be produc-
ily time, and all of those other activities that you want tive after 10 pm? Do you do your best work in the
to fit into a typical week. To prepare the detailed weekly afternoon and early evening and prefer to sleep until

SUN MON TUES WED THUR FRI SAT

7:00 GET UP GET UP GET UP
8:00 TRAVEL TRAVEL TRAVEL
9:00 GET UP CLASS CLASS CLASS
10:00 CHURCH CLASS TRAVEL CLASS TRAVEL CLASS
11:00 CHURCH PRACTICUM PRACTICUM
12:00 CLASS PRACTICUM CLASS PRACTICUM
1:00 PRACTICUM PRACTICUM
2:00 PERSONAL PRACTICUM PRACTICUM
3:00 PERSONAL
4:00 AEROBICS AEROBICS AEROBICS
5:00
6:00 DINNER DINNER DINNER DINNER DINNER
7:00 FUN
8:00 FUN
9:00 FUN
10:00 FUN
11:00 BEDTIME BEDTIME BEDTIME BEDTIME BEDTIME BEDTIME FUN

Figure 1-1. The master schedule. This is an essential first step in managing time effectively.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
4  Student Study Tips

SUN MON TUES WED THUR FRI SAT

7:00 GET UP GET UP GET UP
8:00 TRAVEL TRAVEL TRAVEL
9:00 GET UP CLASS STUDY CLASS STUDY CLASS
10:00 CHURCH CLASS TRAVEL CLASS TRAVEL CLASS STUDY
11:00 CHURCH LUNCH PRACTICUM LUNCH PRACTICUM LUNCH STUDY
12:00 CLASS PRACTICUM CLASS PRACTICUM PERSONAL
1:00 STUDY PRACTICUM STUDY PRACTICUM STUDY PERSONAL
2:00 FREE STUDY PRACTICUM STUDY PRACTICUM STUDY PERSONAL
3:00 TRAVEL TRAVEL
4:00 AEROBICS AEROBICS AEROBICS
5:00
6:00 DINNER DINNER DINNER DINNER DINNER
7:00 STUDY STUDY STUDY STUDY STUDY STUDY FUN
8:00 STUDY STUDY STUDY FUN
9:00 STUDY REVIEW REVIEW REVIEW REVIEW FUN
10:00 FUN
11:00 BEDTIME BEDTIME BEDTIME BEDTIME BEDTIME BEDTIME FUN

Figure 1-2. The detailed weekly schedule. Study times should be filled in first.

10 am? Are you a night owl? Answers to these ques- for you. There is a tendency on the first attempt to try to
tions will reveal your prime time, those times of the schedule some important activity for every waking hour.
day when your ability to concentrate is at its best and Ultimately such a schedule will make you feel as though
you can accomplish the most. These are the times there is no time for fun. Determine what is not working
you want to use for study. It is not always possible, for you and make appropriate adjustments. Each week
because of class and work schedules, to schedule all your schedule will come closer to being realistic and ef-
study time in your prime hours, but it is essential that fective. The need to evaluate and revise is the reason for
those hours be used for study as much as possible. It making several copies of the master schedule. Or you
would be foolish to plan to study your toughest ma- may want to use an electronic calendar. It saves time in
terial between 9 and 11 pm when you know that is a the revision process, and saving time is, after all, what
time when just reading the daily paper is a challenge. time management is all about.
■■ Study hours for specific courses and general Your last scheduling activity is to create daily
study hours. The reason for scheduling both general schedules and lists. No matter how carefully and
and specific study times is that the study demands thoughtfully you prepare the detailed weekly schedule, it
of different courses vary from day to day and week cannot include all the tasks you will face. You will have
to week. For instance, you will need some hours of small tasks, infrequent tasks, and unexpected tasks that
study every week to master new material, terms, will need to be added to your schedule. Each day as you
and concepts in pharmacology, but the study time think of things you want or need to do the next day, write
demands will increase in the days just before exams, them down. Carry a small notebook that will fit into a
midterms, and project due dates. The hours set aside pocket or purse. Many cell phones have a list and/or cal-
for specific courses are for accomplishing the day-to- endar feature. Once a day, review the list and set priori-
day study demands; the unassigned study hours are ties for the next day.
for meeting the changing demands posed by these Consider the following when setting priorities:
special circumstances. These unassigned study hours
also let you meet unexpected demands. No matter ■■ There are only 24 hours in each day. Be realistic
how carefully you plan your time, something will about what you are able to accomplish. Do not plan
happen to prevent you from using the time block you to review three chapters of text material on a day
had set aside for learning. when you know there will not be enough time to
cover more than half of one chapter.
Be patient and evaluate what works for you. It ■■ Not everything is important. Rank your tasks as
usually takes two or three attempts over a period of 3 A, B, or C, with A being the most important and C
weeks to arrive at a detailed schedule that works well being the least important. Then go about completing

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 Student Study Tips  5

your As. Procrastinating about your B and C lists is CHOOSE TO USE YOUR RESOURCES
not a sin. For example, going to the dry cleaner is This Study Guide is one of the resources that will help
critical if the outfit you must wear tomorrow is there, you be successful in this course. When you choose to ap-
but if you do not absolutely have to have that outfit ply these study tips, they will help you to be successful in
tomorrow, then the trip to the dry cleaner is a low all of your course work. Three other resources are your
priority and can be postponed to another day. Then it textbook, your instructor, and your classmates.
will be on your A list.
■■ Rewriting to-do lists can steal your time. You may
want to make one weekly list and mark the tasks as Your Textbook
A, B, or C. Put only A tasks on your daily to-do list. The authors of your textbook have taken great care in
If you have extra time you can look at your weekly organizing the information provided in a manner that will
list. Or you can keep your tasks on note cards and assist your learning. Each part starts with study skills
then each day stack them in priority order. tips that build on the tips that are presented in the Study
■■ Planning your route can save you time. Look at Guide. At the beginning of each chapter, you will find
the small tasks listed, such as picking up milk and specific objectives describing what you are expected to
dog food, dropping off dry cleaning, and going to know and be able to do as a result of studying each chap-
the bank. Not only plan to do those errands, but also ter. Each chapter also contains a list of key terms. Take
think about the order in which they should be done. 10 minutes right now to perform a survey of your text-
Planning your route so that it completes a circle from book so that you know what to expect over the term of
home to the cleaners to the grocery store to the bank this course. Look for chapter titles and Key Points. Later
to home will be much more time-efficient than going in this Study Guide you will find tips for mastering your
from home to the grocery store, back home, then to textbook.
the cleaners, back home, then to the bank, and finally
back home again.
■■ As you complete a job on the daily list, cross it
Your Instructor
Some students look at their instructor in awe. She or he
off. Crossing it off tells you that you are making
is so smart and has so much experience. This is true, but
progress and motivates you to move to the next item
he or she is also a teacher who cares about pharmacol-
on the list. If not every item is crossed off, remember
ogy and your learning. Your instructor wants to hear
that tomorrow is another day. Celebrate what you
your questions because this demonstrates that you are
did get done and create a plan for tomorrow that will
interested in learning and you are actively engaged with
help you accomplish your goals.
the material in your textbook and lectures. The instruc-
■■ Remember your goals and planned action steps.
tor is an expert on the content and the type of tests that
When unexpected daily tasks push them onto the B
will be given in the class. Ask questions about what will
list, be sure to revise your plan to get back onto your
be covered on a test and the type of questions you can
time line. Put planning on your A list.
expect. Office hours are designed to make your instructor
■■ Waiting time can be a gift. Small blocks of time
available to you. Choose to get your money’s worth and
are often lost or wasted because it does not seem as
use them!
though anything significant could be accomplished
during them. If you learn to use these small blocks
effectively, you can free up larger blocks for more Your Classmates
time-consuming or fun tasks. If a class ends 10 We all have different learning styles, strengths, and per-
minutes early or if you are waiting for your ride, use spectives on the course material. Participating in a study
the time for study. Take advantage of such “found” group can be a valuable addition to your nursing school
time to review five vocabulary terms, rework a set experience. These groups can be a fun way to learn.
of class notes, or preview the next five pages of as- Teaching others helps us to learn and aids in organizing
signed reading. Using the odd minutes in the day the course material. A study group is made up of students
to your advantage can really help you achieve your who are in the same class and who want to learn by
goals as a student. discussing the course material. There are guidelines for
organizing successful study groups.
Your time is a valuable resource for you to manage
or to waste. The choice is yours. Stop for a few minutes 1. Carefully select members for your group.
and think over the previous strategies on how to manage ■■ Choose students who have abilities and mo-
your time: establishing goals and creating action plans, tivation similar to your own. Socializing and
organizing tasks, and creating schedules. Which of these gossiping can eat up valuable study time.
strategies will you choose to apply? Noncommitted and underprepared classmates
can be a drain.

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6  Student Study Tips

■■ Look for students who have a common time to CHOOSE TO DEVELOP YOUR
meet. VOCABULARY
■■ Select classmates who have different learning
Participating in study groups and learning groups is an
styles from yours. They might understand the asset when you are working to develop a new vocabulary.
reading material or lecture material better than Every specialty or discipline has its own language that
you. They may be able to draw a diagram that must be learned for full mastery to occur. When you learn
will help your learning. vocabulary with a group, you can hear others using the
■■ Find students who have good communication
terms and they start to become real to you. Courses such
skills—people who know how to listen, ask as this one on pharmacology contain extremely complex
good questions, and explain concepts. material, and terminology is a major component of that
2. Clarify the group’s purpose and expectations. complexity. As you learn to integrate this vocabulary into
■■ Where and when will you meet?
your discussions of the discipline, it will seem less like a
■■ How often will you meet? How long will the
foreign language. In technologic, scientific, and medical
meetings be? areas, mastering the vocabulary can make the difference
■■ How much individual preparation between
between being successful and struggling constantly to
meetings is expected? understand the ideas and concepts being presented. It is
■■ Can family members, children, or other students
therefore helpful to adopt some strategies that can make
come to the meetings? the process of vocabulary development easier and more
3. Exchange names, phone numbers, addresses, effective. Working with a study group is one strategy, but
and e-mail addresses. Have a plan in case of there are several more.
emergencies.
4. Plan an agenda for each meeting.
■■ Put the date and goal for the session on the top. Use Dictionaries
■■ List the activities that will help you accomplish You must have a good current desk reference dictionary.
the goal. Current means the most recent edition of whatever dic-
■■ At the end of the study session, list the results of tionary you choose. A dictionary published 10 or 15 years
your efforts and set the date and time for your ago may contain most of what you need, but unless there
next session. have been periodic revisions, as shown on the copyright
■■ Make assignments for the next session. page, it is almost certain to lack some information, and
this may cause you problems. A desk reference dictionary
There are also some useful strategies to follow: is a hard-bound dictionary and not a condensed or paper-
back version. Paperbacks are convenient to carry around,
1. Exchange lecture notes and discuss content for clar- but to get the dictionary to this convenient size, some
ity and completeness. words have been omitted and some definitions have been
2. Divide up difficult reading material and develop a shortened. This is not what you want. You need the most
lesson to teach the information to each other. complete and current edition you can find and afford.
3. Quiz each other by turning objectives at the begin- You may or may not need a medical dictionary. You
ning of each chapter into questions. will probably have access to one or more at your college
4. Use the Critical Thinking and Application and Case or departmental library. The best way to decide whether
Study sections in this Study Guide as a basis for you need to invest in such a specialized dictionary is to
discussions. ask your instructor for his or her advice.
5. Create and take your own practice tests. Discuss the
results.
6. Develop flash cards that review key vocabulary Reference the Key Terms
terms. As soon as you look at any of the chapters in this text,
you will discover the key terms. This list contains the
This list could go on and on. Work with your group terms and definitions the authors consider essential for a
to design the strategy that works for you. Each study full understanding of the material. The key terms will not
group you work with will be different. necessarily contain every term that is unfamiliar to you.
Often in career programs like those in nursing, medi- (This is why you need a good dictionary.) You can begin
cal, and law schools, the course study group will turn into the process of mastering vocabulary by paying particular
a learning group. Learning groups may meet over sev- attention to the key terms.
eral semesters even when the members are not taking
the same classes. Learning groups help you to prepare
for licensing examinations, laboratory work, clinics, or Create Flash Cards
practicum experiences. They focus on understanding and Obtain a supply of note cards. Pick the size that best ac-
application in the field. commodates your handwriting style and size. If 5” × 7”

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 Student Study Tips  7

cards do not fit into your notebook, purse, or book bag used in pharmacology because they are so specialized
and this discourages you from carrying them around with and specific to the field. This calls for the use of other
you, then use 3” × 5” cards. Remember, the flash cards techniques.
these become are one of the best things you can study on
the run.
Learn the Standard Abbreviations
Make sure as you read that you pay attention to the
“shorthand” used. For example, in Chapter 12, the ab-
breviation CNS is used repeatedly. The first time it is
presented, the author identifies it as standing for central
nervous system by putting the abbreviation in parentheses
after the term. Thereafter, the abbreviation is used in lieu
of the long term. The same thing is done for REM in this
chapter. It is essential that you learn these abbreviations
and recall each, not as a set of meaningless letters but as
a key term that must be mastered.

Establish Relationships
REM is an abbreviation for rapid eye movement, and
this term refers to a particular stage of sleep. Chapter 12
deals with CNS depressants. Relating REM to the focus
Use What You Know of this chapter will help you remember that CNS depres-
When you encounter an unfamiliar word, do not auto- sants are used to influence sleep. The idea is to establish
matically assume that you have no idea what it means. a clear relationship between the terms used and the ideas
Use the knowledge you have already acquired in other presented. Words should not be learned in isolation from
nursing courses and throughout your life. the material; otherwise, you may know a lot of words and
For instance, psychotherapeutic appears in the chap- their meanings but not be able to relate them to ideas and
ter title for Chapter 16. Your first reaction may be that content. On tests, you are not likely to be asked just to re-
you do not know what this term means. By using what peat memorized definitions. Instead, you will be asked to
you know, however, you may be able to make an edu- integrate these meanings into your answers to questions
cated guess as to the meaning of the word without con- about nursing practices and applications.
sulting either the text glossary or a dictionary. Another important way of relating words to mean-
This is how you make that educated guess. Consider ings is to link the meanings of closely related terms. The
that the first part of the word is psycho. By this point in words hypnotic and sedative are good examples of this.
your career as a student, you know that psycho refers to In looking at the meanings in the list of key terms, you
the mind. This is a good start. Now consider the next part will find that each refers to a certain class of drugs. Both
of the word. The meaning of therapeutic may or may not classes of drugs influence the CNS, but the drugs in each
be evident to you, but it should remind you of a simpler have a somewhat different effect. It is useful to start with
word, therapy, which is the treatment used to cure or al- the understanding that both affect the CNS but then to
leviate an illness or condition. Put mind and treatment appreciate how the terms relate to each other. Sedatives
together, and it would seem that psychotherapeutic must inhibit the CNS but do not cause sleep; hypnotics at low
refer to the treatment of mental problems. dosages have the same effect, but at higher dosages they
Note that this is an educated guess. It may not be a may induce sleep. In this learning method, you learn
perfect definition, but it will give you a basis for acquir- meanings by looking at the general similarities and then
ing a fuller understanding when the term is defined in the at the specific differences between terms. In doing this,
glossary or introduced and defined in the text of the chap- you have learned both words and should never have any
ter. A sentence in Chapter 16 confirms that this educated problems relating the words to their meanings.
guess is very close to the actual meaning: “The treatment
of mental disorders is called psychotherapeutics.” Using
this approach to analyzing the meaning of a word not CHOOSE TO TAKE EFFECTIVE LECTURE
only confirms that you have a basic understanding of the NOTES
word but also cultivates a mental link between what you
know and the more specific definition provided in the Why Take Notes?
text. Words and their meanings learned in this way are The primary reason for taking notes is to help your
usually easier to grasp and easier to retain. Unfortunately, memory. It is impossible to remember everything that is
this technique will not work with some of the terms

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8  Student Study Tips

said during a 1- to 2-hour lecture. The very act of writing recorded for later review. Writing less and listening more
something down helps strengthen learning and memory. is a good rule to follow for note-taking.
In addition, note-taking helps to focus attention on the Learn to listen for key words and phrases. These
lecture. It is very easy to take mental vacations during a vary with the subject content and with the individual lec-
lecture; note-taking helps keep you involved. turer, so there is no way to provide a single, definitive list
of them. However, there are some verbal signals (words)
that will give you clues that the lecturer is about to give
Note-Taking Problems important information:
1. Selectivity is the biggest challenge. How do you
know what is really important? ■■ Sequence words—first, second, next, then, last,
2. Unfamiliar vocabulary causes confusion. This finally
is particularly true in a course heavy in technical, ■■ Contrast words—but, however, on the other hand
medical, and pharmaceutical terminology such as ■■ Importance words—significant, key, main, main
this one. point, most important
3. Hard-to-read or even illegible handwriting is
frustrating. The use of words and phrases such as these is the
4. It is difficult to listen and write at the same time. lecturer’s way of signaling the relative importance and
It splits one’s focus and often gets in the way of progression of certain facts and ideas. As important as
understanding. these words are, however, it is also necessary to be aware
of the volume, tone, and pace of delivery. Some instruc-
Note-Taking Solutions tors will slow down or repeat ideas that are important.
1. Realize that note-takers are made, not born. You can Other instructors may speak louder and point into the air
learn to be more effective as both a note-taker and to emphasize a point. Get to know your instructor’s style
note-user, but this requires some practice and a and you will be able to anticipate what will be on the
willingness to adopt new techniques. test. Of course, if the instructor says, “One of the most
2. Use the vocabulary development strategies previ- important drugs in the treatment of …,” then you should
ously discussed so that you will have a better under- immediately know that what follows is an important
standing of the lecture material. point for your notes. The instructor has even told you it is
3. Note-taking is a five-stage process that is spread important. As you practice active listening and observing
out over the days and weeks between lectures and in the lecture environment, you will find that your ability
the time when you are reviewing your notes in prep- to discern the important ideas will improve.
aration for a test. Stages 1 and 2 are preparation for the real work that
goes on in the last three stages.

Stage 1: Be Prepared
Note-taking begins before the lecture. Read assigned Stage 3: In-Class Note-Taking
material before class. This provides you with the back- The split-page note format requires a change in the way
ground needed to listen intelligently to the lecture and you set up your notepaper. In this method, each sheet is
to be selective when taking notes. You will have less un- divided into two parts by drawing a line down the full
familiar vocabulary. The lecture will bring the textbook length of the page to create a left-hand column that is 21⁄2
content to life for you. to 3 inches in width and a right-hand column that is 51⁄2
Go to class a few minutes early and review your to 6 inches in width. The right-hand column should be
notes from the previous lecture. This will help warm up used for taking class notes. (The function of the left-hand
your brain so it will be ready to receive new information. column will be explained in the description of Stages 4
and 5.)
There is no magic formula for note-taking. Simply
Stage 2: Active Listening take the best notes you can. Remember, notes are per-
Taking quality class notes requires active listening. This sonal. Do not judge your notes against those of other
is one of the most challenging aspects of being a good classmates. Some will take a lot of notes, and others with
note-taker. It requires an awareness of both the lecturer’s a different background and expectations will take far
language and his or her nonverbal style. You have to pay fewer notes. The key point is to do what works for you.
attention not only to what is said, the verbal aspect, but When what you are doing stops working, then try another
also to the visual, nonverbal, aspect of the presentation. strategy.
Active listening requires selectivity. If you spend Here are some tips for taking effective lecture notes
the lecture time trying to write down every word, you that may make the process easier and more effective for
will not be able to listen to and therefore grasp the ideas. you:
Focus on the most important ideas, terms, and facts to be

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 Student Study Tips  9

■■ Write in your own words most of the time. Writing

ideas in your own style will make them easier to
learn and remember.
■■ Leave space between main points. When you sense
that the lecturer has moved to a new idea, leave a
couple of lines blank on your notepaper. That way, if
the lecturer returns to this point later, you will have
room to add further notes. Even if there is no need
for additional notes, the blank lines will help you
see the organization of the ideas and the relationship
between them. This space can also be used to add
information from the textbook.
■■ Indicate direct cues from the lecturer, such as “This
will be on the test,” “This is a difficult concept,” or Stage 4: Out-of-Class Reworking
even “Know this.” Put a star or a check in your notes The notes you take in class are only one part of the ef-
so you will remember to study this information when fective study of lecture material. Out-of-class reworking
preparing for the test. of these notes is critical, and this is where the left-hand
■■ Be especially aware of the visual presentation. This column of your notepaper comes into use. Ideally, this re-
consists of information written on the chalkboard or working should be done immediately after the class ends,
presented using an overhead projector, slide projec- but this is not always possible. It must be done within
tor, PowerPoint display, or other electronic display. 24 hours, however, to get full benefit from this strategy.
Many lecturers outline key points on the chalkboard Reworking class notes will not take more than 10 to 15
as a means of staying focused on the points they minutes to complete, but it will save you hours of study
want to cover. Use this information to help you stay time later on.
equally focused. Electronic displays are often chosen The following is the recommended method for re-
because the ideas can best be understood when they working your class notes:
are presented visually.
■■ The repetition of certain points is the single most ■■ Read over the class notes. Look for major topics,
useful tip that they are really important. When an key ideas, terms, and the organization pattern. At
idea, term, or fact is important, the lecturer will this point you are not trying to remember everything
almost certainly repeat it. For instance, the lecturer you got from the lecture. You are looking for places
will introduce a new term, define it, give a couple of where your notes are incomplete or confusing. If
examples to clarify the definition, and finally rede- you read your notes soon after the lecture, you will
fine the term. This repetition is a signal that it is very be able to clarify points or add missing material
important for you to learn the information. because most of what was said will still be fresh in
■■ Be alert for questions directed to the class. These your mind. If you wait until the next day (or worse,
questions are another way the speaker stresses im- the next week), what is now only confusing will by
portant information and are also a way for him or her then be a complete mystery. Taking the time to read
to find out how well the students have understood your notes over soon after you take them will save
what has been said. Such questions are thus also much time and frustration later on.
cues that certain information is important. ■■ Write topic heads for lecture segments in the
■■ Be actively involved in what is going on in class. empty left-hand column of your notes. As you read
This means being willing to respond to a question your notes, identify the major topics that were dis-
directed to the class. It also means asking questions cussed. For example, look at Chapter 11 in the text.
when things are not clear. Do not feel that because The chapter title tells you that it is about general and
no-one else is asking questions, you are the only local anesthetics, but the information does not stop
person who does not understand something. It is there. Further topics are discussed and divided into
highly probable that there are others who are just as subgroups. Headings are necessary to break down
confused. Your objective in class is to understand very complex material into understandable blocks.
the lecture and record key ideas in your notes so that You should be doing the same thing with your notes.
you can study effectively. Questions are not dumb if Limit your labels to three to five words. You are not
they relate to the material being presented. trying to rewrite class notes but to make the organi-
zation of the ideas crystal-clear. Sometimes the notes

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
10  Student Study Tips

on the chalkboard or PowerPoint slide will provide 2 days. Studies have repeatedly shown that we forget
the labels for you. Sometimes the labels will be nearly 50% of what we learn in the first 24 hours after we
included in a lesson outline furnished by the instruc- learn it. The reworking process will slow the forgetting
tor. Often, however, you will have to compose your process, but it will not stop it. The longer you wait to re-
own labels. With practice you will develop this skill. view your notes, the more time it will take and the more
Keep at it. These labels are an essential aspect of the difficult it will be when you finally do it.
final stage of this note-taking method. When to do a second, third, or any additional re-
■■ List vocabulary. The left-hand column is also a views depends on the success of the previous review.
great place to put content-specific vocabulary. Look Review each day until you find that you remember and
again at Chapter 11. Notice that there is a list of understand 80% or more of the material (you have to be
key terms for that chapter. This is provided so that the judge). When this is accomplished, the next review
you can immediately begin to focus on the content- can wait for 3 or 4 days. If you find that after the first
specific vocabulary you will have to master for that review you recall or understand only 70% of the material
chapter. You can create your own personal list of (an average amount), then the next review should occur
the terms used in the lecture. As you read over your within 2 or 3 days. If the amount you remember is less
notes, each time you encounter terms from the text than 70%, you should review the material the next day.
or new terms introduced in the lecture, note the word You must assess your own performance on each review
in the left-hand column. Doing this will help you to determine how soon to schedule another review. There
learn the needed vocabulary. are no hard and fast rules for this. A good review does
■■ Expand. Often during a lecture, you will only have not mean you have mastered the material forever, and
time to write fragments of information. These may what you remember clearly at one review may be the
be meaningful at the time you write them but can be very thing you forget the next time around. The only
confusing later. Therefore, as you read your notes, rule is to review frequently. By doing this you will be
fill in those places where there may be such gaps; well-prepared for quizzes, tests, or any other measure of
otherwise, what was a small problem will become a your learning.
big one later on. It will not take long, and it will pay
off. You may use the left-hand column or the lines How to Review To review your notes, cover the
that you left blank for adding such information. right-hand column (class notes) with a blank sheet of
paper. Look at the topics, vocabulary, and further notes
Remember: The reworking must be done the that you added to the left-hand column during the re-
same day as the lecture for it to be efficient and pro- working process. These will serve as your study guide
ductive. The longer the interval between the lecture and for review. Look at the first topic heading you have writ-
this reworking, the greater the likelihood of forgetting. ten. It might be something like “Hypnotics.” Turn that
When you read notes the same day as the lecture, you heading into one or more questions. What are hypnotics?
will be able to recall almost everything said. The rework- When are they used? What are the side effects? Are there
ing process will only take 10 minutes or so to complete, patients for whom hypnotics are inappropriate? Ask these
but it will pay off in a significantly improved set of class questions aloud; do not just think them. Framing ques-
notes. Of equal importance is the fact that the reworking tions orally is what makes this review active. Now
process is preparation for the final, critical stage in the that you have asked a question, the next step is obvious.
note-taking process. Answer it without looking at the covered notes. Say the
answer aloud. This oral question-and-answer process
Stage 5: Frequent, Active Review forces you to state the information in your own words
Notes, no matter how good, need to be studied early and and style. In addition, you are relying on more faculties
often. Learning and memory depend on rehearsal, or re- in your learning than just the visual one of rereading. You
view, and this must be an active process. Rereading notes are speaking and listening, which is more active than just
will improve your understanding and memory somewhat, looking at the words. Recall is strongly enhanced when
but there is a technique you can use that will accomplish you express the information in your own words.
much more. This technique will help you to be an active Another benefit of this review process is that it helps
learner and encourage frequent rehearsal. It is also ef- identify what you do not know. If you ask a question
ficient because it will only take you 10 to 15 minutes to and find yourself struggling to respond, then it will be
completely review 2 or 3 days’ worth of class notes. clear that this is something you have not yet mastered.
When this happens, uncover the class notes pertaining to
When to Review The first review of your notes that topic and read what is needed. Sometimes only three
should be performed within 2 days of the lecture. If the or four words will be needed to trigger recall. When this
lecture has taken place on Monday, your review should happens, immediately cover the notes and resume your
occur on Tuesday or Wednesday. Do not wait more than oral response. Sometimes you will have to read a large

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 Student Study Tips  11

portion of the notes to trigger your memory. The reading Getting the most from a lecture requires active lis-
is now focused on material that you have clearly identi- tening. The same active process applies to the reading of
fied as unknown. This means that your review time will a textbook. Several techniques promote active reading. A
be much more productive. Instead of reading everything good study system such as the PURR method presented
known and unknown, you will now be concentrating in the textbook is one part of the process, but a good
on reinforcing the known material and studying the un- study system can be enhanced by reading with a pencil.
known. The best way to prepare for a test is to take a Making text notations will help you concentrate and also
test. By using the question-and-answer model, you are make future review of the material more productive.
creating and taking your own test. You may discover that There are three notation systems:
many of the questions you asked yourself also appear in
some form on the classroom test covering that same ma- ■■ Highlighting-underlining
terial. If you have already answered the question several ■■ Marginal notation
times for yourself, it will be easy to answer it on the test. ■■ Written text notes

Two-Page Split-Note Variation There is a varia- Each of these notation systems has certain ad-
tion of the split-page notepaper format that some students vantages and disadvantages. No single one will work
find works better for them. If you find that the 6-inch- perfectly all the time. Just as you must use different
wide right-hand column is too narrow for taking class techniques to meet the different needs of your patients,
notes, simply take your class notes on the right-hand you also need to use different techniques of text notation
page in your notebook and use the left-hand page for to meet the different needs you have as a learner. First,
the reworking process. This allows more room for the though, let’s discuss two general guidelines that apply to
charts, diagrams, or complex formulas that are often part the different systems of text notation.
of the lecture material in courses such as pharmacology.
This two-page method will also allow you to incorporate
text notes. To do this, divide the left-hand page into two
columns of equal width. Use the right-hand column for
the reworking of class notes and the left-hand column for
text notes on the same topic.

On-the-Run Action Record the information you find

to be most difficult to remember on 3” × 5” cards and
carry them with you in your pocket or purse. When you
are waiting in traffic or for an appointment, just pull out
the cards and review again. This “found” time may add
points to your test scores that you have lost in the past.

CHOOSE TO MASTER YOUR

TEXTBOOKS General Guidelines
1. Read first. Before you begin to make any text nota-
Many students find themselves falling asleep while read-
tions, you must first read the material. The objective
ing their textbooks. Text material can be long, complex,
of text notations is to identify the important ideas,
sometimes confusing, and often highly technical. It can
facts, and terms just as this is the objective of lis-
seem as though the more you read, the more there is to
tening during a lecture. If you attempt to mark text
learn and the less you understand. Close the book and
while reading it for the first time, everything will
everything you have just read evaporates from your
seem important and you will find yourself making
memory. If you feel like this, just remember—you are not
far too many notations or highlighting far too much
alone. Every student feels this way. However, there are
material.
effective ways to maximize your learning and memory
2. Be selective. Be very selective. The objective of
and maybe even reduce the time it takes to do this.
text notation is much like that of taking notes during
Many different study systems have been devised
a lecture—to pick out the important ideas for im-
to aid in the mastery of textbook material, and each has
mediate learning and for future review. If you have
worked for some students. The model presented here is a
ever looked at a used textbook, you are sure to have
combination of the best elements of this multitude of sys-
seen that the previous owner has highlighted nearly
tems and the best one for dealing with the subject matter
every line on some pages. Excessive marking means
in this pharmacology text.
the reader was not discerning the important ideas

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
12  Student Study Tips

as he or she was reading. If you are taking separate tify the most important information. The combination of
handwritten notes, you should limit what you write text conventions and language conventions helps make
down to the major headings and subheadings, im- the reading and marking of text more successful.
portant and unfamiliar vocabulary, and no more than
two sentences of personal notes for each paragraph.
The object is not to rewrite the chapter but to distill How to Highlight and Underline
the important information. If you are highlighting, Text marking is done to help in future review. This means
limit the material marked to no more than 20% to that text marking is a personal process and should be
25% of the total material. This is not to say that you used to point out only the most important information.
must impose this limit on every paragraph, but it The previous two sections on conventions gave you some
should be an overall goal. concrete ideas on what to mark in your textbook. The
main point is read before you mark.
It is essential that you read meaningful blocks of
Text Notation Systems text before you do any marking. A meaningful block
may be as little as a single paragraph but never less. It
Text Conventions may be as much as an entire chapter. In a text such as
As you read and prepare for making text notations, be Pharmacology and the Nursing Process, in which the
aware of certain conventions used throughout the text. material is highly technical and challenging, it is unlikely
These help the reader focus on what the authors consider that you will want to read more than a section of the
important. By now you have noticed the use of headings chapter at a time before going back to highlight.
in this study tips chapter. Look back at some of them and Look at Chapter 12. The first paragraph mentions the
you will also notice that they are styled differently— boldfaced terms sedatives and hypnotics. As you read this
some are all capitals; others have only the first letter of paragraph the first time, do not mark anything. Instead
each word capitalized. These represent main topics and read for a general understanding of the content. After
subtopics. Now look at a chapter in your text. Examine this, go to the beginning of the section about Sleep and
the way headings and boldfacing draw your eyes to cer- note the following language conventions: two basic ele-
tain words, phrases, and portions of the page. These are ments, different stages, summarized, and is known as.
text conventions provided by the authors to help you un- These are all words and phrases that point out important
derstand the organization of the material and the relation- information that should be highlighted. You may not ac-
ships within the text content. Other text conventions that tually need to highlight all of the information flagged by
you should note are numbered lists, bulleted lists, special these words and phrases. Some of it is probably already
display material, and the like. familiar to you because of earlier courses you have taken
or earlier chapters you have read in this text. Avoid high-
lighting information you have already mastered.
Language Conventions
Another important aspect of text notation is to become
language-sensitive. In a class lecture, when you hear a Review
professor say, for instance, “One of the most important
anesthetics is…,” the words most important are a direct When
cue that this is a significant point for your notes. The How soon after you have done some form of text nota-
same type of cueing often occurs in the text. The authors tion should you review what you have highlighted?
want to make certain that their important ideas are com- Ideally review should begin within 24 to 48 hours after
municated to you, the reader. Because the authors cannot the initial learning has occurred. Psychologists have
speak to you face to face, however, they must rely on a studied learning, memory, and forgetting and have found
certain written style to get important points across. This that we forget approximately 50% of what we learn after
means that you must become aware of that style so that the first day or two. Therefore, the sooner you begin to
you can identify these important ideas. For example, in review, the easier it is to move learning from short-term
a sentence saying “The main use of opioids is to allevi- memory (quickly learned and quickly forgotten) to long-
ate moderate to severe pain,” the phrase main use is the term memory.
author’s way of telling you not only what is coming but
also what you should be taking note of.
Pay attention if a paragraph begins with the phrase How
“The most significant effects...” Whenever an author uses The process for reviewing any text notations follows the
words or phrases such as these, it tells you that some- same general principles that apply to lecture notes. The
thing important is being discussed. When you highlight intent is to make your review an active process in which
text, phrases such as most important, main use, and most real learning takes place. For example, if you have writ-
significant are the cues you should look for to help iden- ten questions in the text’s margins, try to answer these

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 Student Study Tips  13

questions without rereading the text. If you are able to capable. Just remember—start the review process
answer the question to your satisfaction, then move on on the first day of the semester and do some re-
to the next question. If you have highlighted terms and view every single day until the final exam.
definitions, cover the definition and try to define the term 3. Balance your review time between your lecture
without looking at the text. If you are able to do this, you notes, textbook notes or highlighting, and any hand-
have effectively moved material into long-term memory. outs you may have been given.
If you cannot define the term, then read the text defini- 4. Ask your instructor about the exam. If he or she says
tion. As you read, think about the meaning and think the test is mostly on the lecture, then you may want
about strategies you might use to help you remember the to spend more time reviewing your class notes. Ask
term and definition the next time. You will find additional about the type of questions that will be on the exam.
memory strategies in the later section on studying for Will the test consist entirely of multiple-choice ques-
exams. The key is always to focus on being an active tions? Will it have true-or-false items? Will there
learner. be matching, short-answer, or essay questions? You
should not study any differently for a multiple-
choice exam than you should for a short-answer or
How Often essay exam. However, knowing the type or types of
How often you review is a personal matter. The best way questions that will be on the test will help you de-
to judge is to be aware of your success, or lack of it, in velop a strategy for quizzing yourself.
the current review session. If you do very well at recall- 5. Work with your study group to create practice tests.
ing information, then you can probably wait 3 to 4 days For example, if you know the test will consist of
for the next review. If the review goes okay, then the next multiple-choice questions, then as you do your
session should take place within 2 days. If you find your- review, think of the kinds of questions you would
self reviewing your own notations with little understand- ask if you were composing the test. Consider what
ing and limited memory, then the next review should take would be a good question, what would be the right
place the following day. Each time you review, it will get answer, and what would be other answers that would
easier and faster, and as you practice this approach to re- appear right but would in fact be incorrect.
viewing your text notations, you will gradually acquire a 6. Take the practice tests in each chapter and on the
good sense of how often you need to review to maintain Evolve website for the text. Practice writing out the
mastery of the material. answers of short-answer or essay questions. The
best way to prepare for a test is to take one.
7. Study wisely, not hard. Use the study strategies
CHOOSE TO PASS EXAMS offered in this guide so you can save time and be
You can pass your exams by applying the recommenda- able to get a good night’s sleep the night before your
tions and strategies offered in this section. Start by fol- exam. Cramming is not smart, and it is hard work
lowing the dozen basic rules of exam success. that increases stress while reducing learning. When
you cram, your mind is more likely to go blank dur-
ing a test. When you cram, the information is in your
Rules for Success on Exams short-term memory so you will need to relearn it be-
1. Accept your anxiety as normal. Tests are important,
fore a comprehensive exam. Relearning takes more
both in the short-term, from the standpoint of grades
time. The stress caused by cramming may interfere
and successful completion of this course, and also in
with your sleep. Your brain needs sleep to function at
the long-term, from the standpoint of completing the
its best.
program and getting your degree and eventually the
8. Prepare for exams when and where you are most
job you want. This fact can cause stress.
alert and able to concentrate. Use your personal
2. Reduce your stress by studying often, not long.
prime time, which was discussed earlier in the time
The most important rule in preparing for exams
management section. If you are most alert at night,
is simple—spend at least 15 minutes every day
study at night. If you are most alert at 2 am, study in
(Saturdays, Sundays, and holidays included) in re-
the early morning hours. Study where you can focus
viewing the “old” material. The more time you can
your attention and avoid distractions. This may be
find for this each day, the better, but spend at least 15
in the library or in a quiet corner of your home. The
minutes. This one action will do more to reduce test
key point is to keep on doing what is working for
anxiety than anything else you do. The more time
you. If you are distracted or falling asleep, you may
you devote to reviewing past material learned, the
want to change when and where you are studying.
more confident you will feel about your knowledge
9. Relax the last hour before an exam. Your brain
of the topic. This confidence will accompany you
needs some recovery time to function effectively.
into the classroom on the exam day, and it will help
you get the test score you want and of which you are

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
14  Student Study Tips

10. Survey the test before you start answering the ques- of features that can help enormously. First, look at the
tions. Plan how to complete the exam in the time al- objectives at the beginning of each chapter to be studied.
lowed. Read the directions carefully and answer the Even if you have been assigned only small portions of
questions you know for sure first. the chapter, it is important to consider the objectives for
11. Before turning in the exam, make sure that you have the chapter as a whole. Ask yourself whether you have
answered all of the questions. If you are to fill in the met these objectives. This is a quick way of assessing
boxes on an answer sheet that will be read electroni- how much review may be necessary. If you feel confident
cally, be sure you have put only one answer per line that you have accomplished most of the objectives, then
and that you have answered each question. If you the review should go quickly. If you feel uncertain about
must make a correction, be sure to erase carefully many of them, then the review is going to take more
and thoroughly. time.
12. Celebrate your success. Congratulate yourself for The next task is to consider the topic headings and
choosing to pass your exam by applying the exam language conventions. Use them in the same way as you
preparation and exam-taking skills that have been have used the labels in your notes. Turn them into ques-
proven to work. tions and answer these questions aloud. If you can an-
swer them, then there is no need to reread. If you cannot,
then you will need to reread the pertinent text.
Strategies for Reviewing Class Notes Again, this way of reviewing is focusing your time
Look at your class notes. If you have been using the split- and energy mostly where it is needed—on the material
page model described earlier, you have made your own you have not yet mastered. Each time you review the
topic headings in the left-hand column beside the class text (or class notes), the sections of material you reread
notes. Cover the class notes and turn each heading into may differ. This is to be expected. You cannot remember
one or more questions. Think carefully about the answers everything forever, but if you spend time each day doing
and then answer aloud. By answering questions aloud, this type of review, you will remember more and for lon-
you are forcing yourself to think about what you know ger periods of time.
and organizing that knowledge in the way that is most
meaningful to you. If you can answer your questions,
then you have demonstrated that you know the material, Strategies for Reviewing
and there is no immediate need to reread that section of Terminology
notes. If you cannot answer one of your questions, then One aspect of nursing that can seem overwhelming is
you know you need to review that material more inten- the terminology. It is highly technical and specialized.
sively. Uncover the notes and read the pertinent ones. Learning it poses the same kind of challenge as learn-
You are now using your review time effectively, because ing a foreign language. In fact, it almost is a foreign
instead of just rereading everything, which invites bore- language. However, for the concepts and ideas to be mas-
dom—or, worse yet, daydreaming—the rereading is tered, the terms must be mastered. One of the best ways
directed at the material of which you are unsure. The re- to go about doing this is to use a technique you probably
sult is more efficient use of your time and more effective learned in grade school—flash cards. Put each term on
learning. one side of a 3” × 5” note card and the definition or other
essential information about the term on the back. Group
together cards containing terms that have common word
elements (e.g., terms beginning with cardio-) or that con-
cern common concepts (e.g., terms to do with renal func-
tion). The more relationships you can establish among
words, the easier it will be to learn and remember them.

On-the-Run Action
Get in the habit of carrying a deck of 10 to 15 of these
cards with you. When you have a few minutes, review as
many cards as time allows. Sometimes start with the term
side of the card and try to recall what is written on the
Strategies for Reviewing the back. Other times look at the definition on the back of the
Textbook card and try to recall the term. Do not focus exclusively
The technique you used for studying your class notes will on term-to-definition learning because you may be given
also work for studying text material. As mentioned, in definitions or some variation on the exam and be asked to
this book the authors have provided you with a variety provide the terms.

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 Student Study Tips  15

Exam Time losing time or going too quickly. Pace yourself. If you
This is it. The culmination of all your work—lectures, are answering questions quickly and are confident that
notes, flash cards, textbook reading, and handouts. It is the answers are right, do not worry about being ahead of
time to relax. Test anxiety interferes with test perfor- schedule. If you spend too much time on individual ques-
mance. If you have put to use the learning techniques tions, you may try to decide the answers to the last ques-
described in this chapter, you are ready for the exam. You tions quickly, and this increases your chances of making
have mastered the material, and you can do well on the errors. Planning a strategy for finishing the test within
exam. If you continue to experience test anxiety in spite the time allowed helps you maintain a sharp focus on the
of preparing thoroughly for the exam, it might be a good task and enables you to do the best job possible.
idea to visit a professional counselor on your campus. Fourth, start answering the questions. If the test
Avoid cramming and remain confident in the learn- consists of only one type of question, then start with the
ing techniques you have chosen to apply. This can usu- first question. However, if the test has multiple-choice,
ally control normal nervousness. Besides these learning true-or-false, and short-essay questions, for example, you
techniques, however, techniques are also available for must decide where it is best for you to start. If you find
dealing with the various types of exam questions, and essay questions easy to do, then perhaps you should start
these are discussed in this section. None of these strate- with these. There is no reason you have to begin with the
gies can guarantee a 10-point jump in your test score. multiple-choice questions. On the other hand, if you find
Only the degree to which you have mastered the material essay questions a challenge, then do not start with them.
can make that sort of difference. However, each of the Begin the test in a way that will give you confidence.
strategies described in this section may help you answer
one or two questions correctly that you might otherwise
Tips for Answering the Questions
have missed. These test-taking strategies are not in-
■■ Start with the first question or with those types
tended to replace regular study and mastery; however,
of questions you feel most confident answering.
they are intended to enhance your test performance. If
Wherever you choose to start, there is a strategy you
you use these strategies, you will see a positive gain in
can use that can improve your test performance.
your test performance.
■■ Read the question carefully, and if you know the
When the teacher passes out the exam, all your work
answer, indicate it and move on to the next question.
and preparation are about to pay off, but do not just leap
If you cannot immediately think of the answer, give
into the test. Take a couple of minutes to put yourself in
it a few seconds of thought. If the answer comes,
a frame of mind for doing well on the test. At this point,
indicate it and move on. If the answer still does not
you have a perfect test score—you have not answered
come or if the question is confusing, then skip to the
any questions incorrectly yet. It is likely that you will get
next question.
some answers wrong, but do not start out by making mis-
■■ In the first pass through the exam, answer what you
takes that cost you points that you should not have lost.
know and skip what you do not know. Answering the
First, look over the entire test. Do not read it, but
questions you are sure of increases your confidence
turn the pages and look at a question here and a ques-
and saves time. This is buying you time to devote to
tion there. How many items are there on the test? Are all
the questions with which you have more difficulty.
the questions of one type, or is there a mixture of types?
■■ Notice that the subjects of the questions on a particu-
Knowing in advance the length of the test and the types
lar exam are related, that the answers to questions
of questions helps you plan your strategy for taking the
you have skipped may be provided by other ques-
test.
tions on the test, or that a later question may trigger
Second, read the directions. This is the first oppor-
recall of the correct answer. Skipping questions of
tunity you have to make a mistake that could cost points.
which you are unsure offers one more opportunity to
Some directions for true-or-false questions may ask you
get the correct answer.
to correct the statement and make it true. Others may ask
■■ After you have gone through the entire test complet-
you to justify your answer. When you respond with just a
ing the questions to which you are confident you
T or an F, you have lost important points because you did
know the answers, go back to the items you skipped.
not read the directions.
First check the time, however, so you know how
Third, create a plan to complete the test in the
much time you have left to answer these questions.
time allowed. For example, if the test has 50 multiple-
On this second pass through the exam, you will often
choice questions and the time limit is 40 minutes, then
be surprised at how many questions you now can an-
you know you will have to average a little better than
swer that drew a complete blank before.
one item per minute. Obviously you will need to allocate
■■ Answer every question. A question without an an-
more time to essay questions if they are on the exam.
swer is the same as a wrong answer. Go ahead and
Plan to glance at your watch or the classroom clock oc-
guess. You have studied for the test and you know
casionally during the exam to make sure you are not
the material well. You are not making a random

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16  Student Study Tips

guess based on no information. You are guessing Before the strategies for analyzing multiple-choice
based on what you have learned and your best as- questions are discussed, it is important to understand
sessment of the question. each part of a question and its purpose. There are three
■■ When you have answered all the questions on a parts to a multiple-choice question: stem, distractors, and
page, put a check in the upper right corner of this the correct choice.
page. Avoid going back and second-guessing your- First, there is the question stem. This is the com-
self. There is nothing worse than changing right an- plete question that one or more of the response choices
swers to wrong ones. Have confidence in your own will answer.
knowledge and let go of the test. If you are the first
person to complete a test but are sure of what you EXAMPLE:
did, then turn it in. At the same time, do not let what If excessive amounts of water-soluble vitamins are
others in the class are doing affect your test strategy. ingested, what usually happens?
If you are the last person to turn the test in, it does
not mean you know less than those who were faster. Notice that this could just as easily be a short-answer
It simply means that you are a careful, thoughtful question. In this case, the stem is a complete sentence
test-taker. that should be answered by one of the response choices.
The stem can also be an incomplete statement that one or
more of the response choices completes correctly.
Strategies for Specific Types of
Questions EXAMPLE:
For each type of question there are particular strategies The likelihood that a drug will have therapeutic ef-
you can use that can help prevent incorrect responses. fects increases dramatically when:
Many times students miss questions not because of a lack
of information but because of a poor strategy. Sometimes This statement is incomplete, and you must pick out
the error stems from misreading a question, for instance, the response choice that best completes it.
overlooking a key word such as not, or from choosing an The second part of multiple-choice questions is
answer that does not quite fit the question asked. Errors the distractors. These are the response choices that do
like these can be costly. Expect to find some questions on not best answer or complete the stem. They are known
a test to which you do not remember the answer or that as distractors because that is their purpose, to distract
are worded in a confusing way. A perfect test score is a you from the best choice. Good distractors are usually
great goal, but be realistic and accept the fact that perfect very similar to the best choice. If you have not studied
scores may be few and far between. At the same time, enough, a good distractor will be a very tempting choice,
do not lose points because of careless and preventable but you must reduce the allure of distractors.
errors. The third and final part of all multiple-choice ques-
tions is the best choice. This is the choice you want
to pick. Notice that it is the “best” choice. In many
multiple-choice questions there may be more than one
response choice that appears to answer the stem, and the
differences between the responses may be slight. Your
task is therefore to identify the option that best answers
the stem, not necessarily the only right choice.

Recall The most reliable way to ensure that you select

the correct response to a multiple-choice question is to
recall it. Depend on your learning and memory to furnish
Strategy for Multiple-Choice the answer to the question. To do this, read the stem, and
Questions then stop! Do not look at the response options yet. Try to
Multiple-choice questions can be challenging, because recall what you know and, based on this, what you would
students think that they will recognize the right answer give as the answer. After you have taken a few seconds
when they see it or that the right answer will somehow to do this, then look at all of the choices and select the
stand out from the other choices. This is a dangerous one that most nearly matches the answer you recalled. It
misconception. The more carefully the question is con- is important that you consider all the choices and not just
structed, the more each of the choices will seem like choose the first option that seems to fit the answer you re-
the correct response. The successful student can do sev- call. Remember the distractors. Choice B may look okay,
eral things to improve performance on multiple-choice but choice D may be worded in a way that makes D a
questions. slightly better choice. If you do not weigh all the choices,

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 Student Study Tips  17

you are not maximizing your chances of correctly an- only a guideline and should not be taken to be true 100%
swering each question. of the time; however, it can help you reduce the number
Once you have decided on an answer, there is one of choices.
more important step before you mark it. Look at the stem All of these strategies can help you analyze the re-
again. Does your choice answer the question that was sponse choices so that you have the best possible chance
asked? If the question stem asks “why,” be sure the re- of selecting the correct choice. When you are ready to
sponse you have chosen is a reason. If the question stem mark the answer, keep in mind that the final step is al-
is singular, then be sure the option is singular, and the ways to test your response against the stem.
same for plural stems and plural responses. Many times, If, after you have tried all of these strategies, you
checking to make sure that the choice makes sense in re- find yourself still unable to choose a response, there is
lation to the stem will reveal the correct answer. one final strategy. Ask the instructor for clarification
This is the most reliable technique to use for answer- of the question. There is nothing to lose by asking and
ing multiple-choice questions. If you do this for every everything to gain. The worst that can happen is that the
multiple-choice question on the test, your accuracy rate instructor will tell you that he or she cannot answer your
will be very high, and you will not need any further question. The best that can happen is that the instructor
strategy. Unfortunately, however, recall does not always will rephrase the question in a way that resolves the prob-
work, and when it does not, there are some additional lem for you.
strategies you can apply to improve your chances of When asking for such clarification, try to phrase
picking the correct answer. your question in a way that encourages a response. Do
not simply state that you do not understand the question.
Recognition and Elimination Read each of the an- This is generally not the approach that invites an answer.
swer options carefully. Usually at least one of them will If you are having trouble with a term in the stem or re-
be clearly wrong. Eliminate this one from consideration. sponse choices, ask for a definition. If there is a phrase
Now you have reduced the number of response choices that is unclear or a response choice that is confusing, ask
by one and improved the odds. Continue to analyze the for clarification. Anything you do to make your question
options. If you can eliminate one more choice in a four- more specific increases the likelihood that the instructor
option question, you have reduced the odds to 50/50, the will answer it.
same as the odds of correct random guessing for true-or- After all other avenues have been exhausted, remem-
false questions. There are still some strategies that will ber the final rule. Never leave a question unanswered.
help you pick the best choice. In addition, while you are Even if answering is no more than an educated guess
eliminating the wrong choices, recall often occurs. One on your part, go ahead and mark an answer. You might
of the options may serve as a trigger that causes you to be right, but if you leave it blank, you will certainly be
remember what a few seconds ago had seemed com- wrong and lose precious points.
pletely forgotten.

Look-Alike Answers After you have eliminated one Strategy for Short-Answer and Essay
or more choices, you may discover that two of the op- Questions
tions are very similar. This can be very helpful, because it Notice that this strategy applies to both short-answer and
may mean that one of these look-alike answers is the best essay questions. Both types of questions require careful
choice and the other is a very good distractor. Test both thought and planning before you write an answer. It is
of these options against the stem. Ask yourself which helpful to get into the habit of regarding short-answer
one completes the incomplete statement grammatically questions as short-essay questions. Too often students
and which one answers the question more fully and com- lose points on short-answer questions by being too brief.
pletely. The option that best completes or answers the A short answer should usually consist of three or four
stem is the one you should choose. Here, too, pause for sentences, but frequently students interpret “short an-
a few seconds, give your brain time to reflect, and recall swer” to mean four or five words.
may occur. Start answering these questions by analyzing the
question carefully and then framing a response that will
Absolutes The presence of absolute words and fully answer it. Assume that the reader—in this case, the
phrases can also help you determine the correct answer course instructor—does not know anything and that you
to a multiple-choice item. If an answer choice contains have to explain it all. Short-answer and essay questions
an absolute (e.g., none, never, must, cannot), be very require you to show what you know. Do not assume that
cautious. Remember that there are not many things in the instructor can read your mind or read between the
this world that are absolute, and in an area as complex as lines of your response to discern what you knew but did
pharmacology, an absolute in an option may be reason to not include. It is better to have a little more than was
eliminate it from consideration as the best choice. This is needed in your answer than not enough. Extra informa-

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18  Student Study Tips

tion will not hurt, but missing information will always SAMPLE QUESTION:
cost points. Once again, remember that the idea is to gain Discuss the ways in which pediatric and elderly
a point here and there throughout the test, which will re-
sult in a higher score and a better grade for the course. patients are alike in determining appropriate dosage.
Explain why adult dosage may be inappropriate and
Two Key Issues the dangers in using adult dosage in these special
1. In writing answers to short-answer and essay ques-
tions, it is essential to answer exactly the question populations.
that is asked. This means that you must understand 3. Compile a brief written outline. Before you start
the question before you do any writing. Unlike with writing your answer, take a few minutes to organize
true-or-false and multiple-choice questions, which the points you want to cover. This should not be an
you should try to answer using every possible strat- elaborate outline with Roman numerals, capital let-
egy before seeking help, with these questions you ters, and Arabic numbers, but rather a quick sketch
should ask for help before doing anything. The first of the question and the points you want to make in
opportunity you have to lose points in an essay ques- the answer. The circle-and-underline step described
tion occurs with the first reading of the question. If earlier will help make this easy to do.
you misread the question, you may write an excel-
lent answer but not the right one. Such a mistake can SAMPLE OUTLINE1:
be costly. Discuss
2. A good answer must be organized so that it is clear ■■ Pediatric and elderly patients’ similarity with regard
and logical to the reader. Do not read a question and to drug dosage
start writing down whatever ideas spring to mind. ■■ Body weight factor
Spend a minute or two thinking and planning the ■■ Organ function
structure of the answer so that your ideas are clearly Explain
stated and the supporting details relate directly to ■■ Reasons adult dosage inappropriate
each idea. Your instructor, the reader, will have a ■■ Drugs not tested on pediatric and elderly
difficult time grading your essay if he or she has to population
read it two or three times to figure out what you were ■■ Dangers of adult dosage
trying to say. Organization and clarity of expression ■■ Possible organ damage
really pay off in essay exams. ■■ Increased absorption and possible side effects

Five Steps to Good Essay Answers Sketching out an outline like this will organize your
1. Read the questions carefully. As was discussed ideas, speed your writing, and ensure that you are an-
earlier, misreading the question can result in a high- swering the question asked.
quality answer that does not address the question
asked. Read and think about the question’s major fo- 4. Write an answer. With the question analyzed and a
cus. Do not jump on the first familiar phrase or term quick outline in place, it is time to put your answer
and start writing without further thought. on paper. The basic structure of an exam essay or
2. Decide on an approach. Telling you to read the answer to a short-answer question is the same as that
question carefully is good advice, but without some for an in-class composition on an assigned topic.
strategy to apply to the reading it might be difficult Every rule on which composition teachers insist for
advice to carry out. Here is a strategy to help you writing assignments should be followed in writing
read carefully and begin to plan your answer. Look essay answers.
at the question as you read, and identify the words
Any answer of more than four or five sentences
and phrases that tell you what to do. Some standard
should follow the basic three-part essay structure of in-
“what-to-do” words and phrases are used consis-
troduction, body, and conclusion.
tently in essay questions, such as discuss, compare,
The introduction should be only one or two sen-
contrast, explain, tell why, and analyze. Circle each
tences long. It tells the reader what you are going to pres-
of these words or phrases as you read the question.
ent in your answer. There is a relatively simple way to
The second part of the decision step is to underline
write an essay introduction. State the question positively
what you are to write about. This circling and under-
and add a few words that show the main points you in-
lining will force a careful reading of the question and
tend to make in your answer.
help you begin the process of organizing the answer.
The sample question that follows is marked to show
the circle and underline strategy. 1
This is a model of the process of the Decision and Outline
Steps. It is not to be viewed as an accurate outline of pharmaco-
logic content

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 Student Study Tips  19

SAMPLE INTRODUCTION: Strategy for True-or-False Questions

Pediatric and elderly patients have a number of True-or-false items outwardly appear to be fairly simple.
similarities that must be considered in determining drug After all, the statement is either true or false. The odds of
dosage. Two of the most important are body weight and answering correctly are 50/50, and if all else fails, a coin
organ function, and these factors can make adult dosages toss can decide the issue. Appearances are deceiving,
inappropriate for these two populations. however, and true-or-false questions can be very chal-
lenging to answer. Good test strategy should be applied
These two sentences tell the reader exactly what you to answer all types of questions, because the object is to
plan to discuss. From this point on, it becomes your task get the best score you can, and this represents the total
to explain why those two are important and how they points for all correct answers.
affect drug dosage. You have told the reader what to ex-
pect, and you have begun to organize your answer. Read the Question Reading the question may seem
The body is the most important part of any essay like such an obvious part of all test-taking strategies that
answer. In it you want to state the ideas, concepts, and it may appear absurd even to be told to do this. If you do
points that you believe answer the question. These should not pay careful attention to the wording of true-or-false
be stated clearly and positively. Do not ramble on trying statements, however, then you are increasing the odds of
to cover all the possible variations that might fit into an making an otherwise avoidable error. Take the time to
answer. Decide on the most important, most significant read and understand the statement. Read it all the way
points you have to make. Then state them and support through to the end. Do not jump to conclusions based on
and explain with relevant details that show how and why half of the statement.
your points answer the question. For short-answer ques-
tions where three to five sentences are expected, drop the Assume That the Statement Is True As you read
introduction and conclusion, and put all of your energy each true-or-false statement, begin with the assumption
into a clear, concise body. that the statement is true. The idea behind this strategy
For the conclusion, there should be a concluding is that it will cause you to read the statement carefully,
sentence or two to let the reader know that you have fin- which will result in your choosing the correct answer.
ished. Like the introduction, it should be brief and direct. This approach to reading the statement makes the read-
Restate the question, and summarize the key points made ing an active process, because you are then reading to
in your answer. confirm the truth in the statement. You will be analyzing
the statement as you read, looking for any information
SAMPLE CONCLUSION: that would contradict or change the statement from true
It is evident that elderly and pediatric patients are to false. You will also be choosing your answer as you
very similar in their responses to drug dosages. Clearly read rather than waiting to the end to decide whether
the factors of body weight and organ function will play the statement was true or false. Obviously not every
a major role in determining the appropriate dosages for statement will be true, but this step makes you a much
these two groups. more thoughtful reader, and that encourages better test
performance.
5. Read the answer. The writing has been completed. Remember one other important rule when analyzing
Before you turn in the paper, take another minute or true-or-false statements. If any part of the statement is
two and read over what you have written. Look for false, then the entire statement is false. There may be
errors that would make the reader pause, question only one altered word or prefix (such as un- or anti-) that
what you have said, or be unable to read a word or changes a statement from true to false, but that is all that
phrase. Sometimes the mind works much faster than is required.
the pen, and a word or phrase is left out in writing.
Use a caret (^) and insert the word or phrase where Strategies for Analysis Sometimes, no matter how
it belongs. If your writing got a little sloppy and a carefully you have read the question, the answer is not
word is hard to read, cross it out and print it clearly immediately obvious. When that happens, there are a
right above. Proofreading and correcting small errors number of strategies you can use to analyze the question.
like these will make the answer easier to read and Using these strategies will not guarantee that you will get
understand. Anything that contributes to the overall the correct answer, but they will often help you see some-
quality of an answer will influence the grade in a thing about the statement you might have overlooked and
positive manner. You will not have time to rewrite an assist you in identifying the correct answer.
answer, but you should correct obvious errors.

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20  Student Study Tips

birds can fly.” This statement is clearly false. Because

the word not reverses the meaning of the statement, this
makes the statement “It is not true that all birds can fly”
true. Simply put, if the statement is true without the nega-
tive, then it becomes false with the negative. Similarly,
if it is false without the negative, then it is true with the
negative.

Strings A string is a true-or-false statement that re-

quires careful attention. It is a statement that contains a
list of several words or phrases, but often one or more of
the words or phrases is false. It is easy to read the state-
ment and see that the first two or three words or phrases
are true but then to overlook the one that is incorrect,
Absolutes and Qualifiers Absolutes are words with the consequence that you mark the answer as true
such as none, never, all, or always. These words mean when it is actually false. An example of a string is “Many
that there are absolutely no exceptions to the statement. warm-weather crops, such as tomatoes, can be grown
For instance, the statement “All birds fly” means just year-round in southern California, southern Florida,
that. Every bird, past, present, and future, has flown or South America, and South Dakota.” As you read this
does fly. If there is or has been just one bird that has not statement, it is easy to be lured by the words southern
flown or does not fly, then the statement is false. “All” and South into thinking that the statement is true with-
in this statement is an absolute. True-or-false statements out noting the fact that South Dakota is a northern state
that contain such absolutes are usually false. In an area with fairly harsh winters and that there are parts of South
as complex as pharmacology, it is unlikely that there are America where the climate is very cold. The statement
many absolutes. If you are struggling with a question is false, but the string can trick you into thinking that the
that has you stumped, look for absolute words. They may statement is true.
help you determine the answer.
On the other hand, there are words that suggest the These strategies for analyzing true-or-false items can
possibility of exceptions. Such words or phrases are help you increase the number of correct answers, but they
called qualifiers; examples of these are some, possibly, are not intended to replace study and learning. The best
in most cases, and will generally. “Most birds can fly” is way to perform well on any test is to know the answers
an example of a qualified statement. The word most tells based on your own learning. When the answer does not
you that some not precisely specified number of all birds immediately come to mind, however, apply these strate-
can fly. This makes it more probable that the statement is gies. Although they will not necessarily lead to a 10-point
true. difference in your score, they may help you add 2 points
to your score. Better scores mean better course grades,
Stated in the Negative A true-or-false statement and of course, this results in improved self-confidence
that is rendered in the negative can be very difficult to and improved chances of success.
answer. To draw on the earlier example, “It is not true
that all birds can fly” is such a statement. The word not
in this statement can make it much more complex to read CONCLUSION
and answer. There is a relatively simple way to deal with Remember: These study tips are only as valuable as you
this type of statement. Read it as though the negative make them!
were not included, so that it becomes “It is true that all

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 CHAPTER 1 The Nursing Process and Drug Therapy  21

CHAPTER 1
The Nursing Process and Drug Therapy

Chapter Review and NCLEX® 6. During which phase of the nursing process does the
Examination Preparation nurse prioritize the nursing diagnoses?
a. Assessment
Select the best answer for each question. b. Planning
c. Implementation
1. Which phase of the nursing process requires the d. Evaluation
nurse to establish a comprehensive baseline of data
concerning a particular patient? 7. The nurse is preparing to administer morning doses
a. Assessment of medications to a patient and has just checked the
b. Planning patient’s name on the identification band. The patient
c. Implementation has stated his name. Which is the nurse’s next appro-
d. Evaluation priate action?
a. Administer the medications.
2. The nurse monitors the fulfillment of goals, and b. Ask the patient’s wife to verify the patient’s
may revise them, during which phase of the nursing identity.
process? c. Ask the patient to verify his date of birth.
a. Assessment d. Check the chart for the patient’s date of birth.
b. Planning
c. Implementation 8. The nurse is administering a medication and the
d. Evaluation order reads: Give 250 mcg PO now. The tablets in
the medication dispensing cabinet are in milligram
3. The nurse prepares and administers prescribed medi- strength. What is the right dose of the drug in mil-
cations during which phase of the nursing process? ligrams? ___________________________
a. Assessment
b. Planning 9. The nurse is administering a medication and the
c. Implementation order reads: Give 0.125 mg PO now. The tablets in
d. Evaluation the medication dispensing cabinet are in microgram
strength. What is the right dose of the drug in micro-
4. When developing a plan of care, which nursing ac- grams? ___________________________
tion ensures the goal statement is patient-centered?
a. Considering family input 10. Place the steps of the nursing process in order, with
b. Involving the patient (1) being the first step and (5) being the last step.
c. Developing the goal first, and then sharing it _____ a. Implementation
with the patient _____ b. Planning
d. Including the physician _____ c. Evaluation
_____ d. Assessment
5. The nurse includes which information as part of a _____ e. Formulation of nursing diagnoses
complete medication profile? (Select all that apply.)
a. Use of “street” drugs
b. Current laboratory work
c. History of surgeries
d. Use of alcohol
e. Use of herbal products
f. Family history

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22  CHAPTER 1 The Nursing Process and Drug Therapy

Critical Thinking and Application 14. During a busy night shift, the nurse notices a medi-
cation order that reads: “Give amoxicillin, 500 mg
Answer the following questions on a separate sheet of PO three times a day.” What is the most important
paper. thing the nurse must check before giving this medi-
cation to the patient?
11. Below is a list of data gathered during an assessment
of Ms. B., a young woman visiting an outpatient
clinic with what she describes as “maybe an ulcer.” Case Study
Label each item as either objective data (O) or sub-
jective data (S). Read the scenario and answer the following questions
on a separate sheet of paper.
_____ Ms. B. tells the nurse that she smokes a
pack of cigarettes a day.
A 75-year-old woman has been admitted to the hospital
_____ She is 5 feet 5 inches tall and weighs 135 due to nausea and vomiting. She also has a diagnosis of
pounds. hepatitis C. She says she stopped drinking 3 years ago
but has had increasing problems with peripheral edema
_____ The nurse finds that Ms. B.’s pulse rate
and shortness of breath and has had trouble getting out
is 68 beats/min and her blood pressure is
of bed or a chair by herself. Laboratory results show that
128/72 mm Hg.
her liver enzyme levels are slightly elevated; her sodium
_____ Her stool was tested for occult blood by and potassium levels are decreased. Her blood pressure is
a laboratory technician; the results were 160/98 mm Hg, her pulse rate is 98 beats/min, and her re-
negative. spiratory rate is 24 breaths/min. She is afebrile and states
that she is having slight abdominal pain.
_____ Ms. B. says that she does not experience
nausea, but she reports pain and heartburn,
1. From the brief facts given, what information will be
especially after eating popcorn—something
important to consider when obtaining a medication
she and her husband have always done
profile?
while watching TV before bedtime.
_____ She experiences occasional increases in 2. From the nursing diagnoses in Box 1-3, choose at
stomach pain, a “feeling of heat” in her least two current and two “risk for” nursing diagno-
abdomen and chest at night when she lies ses for this patient. How would you determine the
down, and increased incidents of heartburn. priority of the nursing diagnoses?

12. Identify the “Six Rights” of drug administration and 3. The physician wrote the following drug order:
specify ways to ensure that each of these rights is
addressed. November 4, 2013

13. The following items will help in reviewing the nurs- Give Lasix now.
ing process:
Charles Simmons, MD
Data are collected during the (a) ________________
phase of the nursing process.
Patient’s Name: Jane Dow F Age: 75
Data can be classified as (b) _________________ or Medical Record No: 1234567   Date of Birth: 1/16/38
(c) _________________.
To formulate the nursing diagnosis, the nurse must What elements, if any, are missing from the medica-
first (d) ______________ the information collected. tion order? What will you do next?

The planning phase includes identification of 4. After the order is clarified, the pharmacy sends up
(e) ________________ and (f) ________________. furosemide (Lasix), 80-mg tablets, but the patient is
The (g) _________________ phase consists of car- unable to swallow them because of her nausea. Your
rying out the nursing care plan. colleague suggests giving the furosemide to her as
an intravenous injection. What will you do next?
The (h) _________________ phase is ongoing and
includes monitoring the patient’s response to medi- 5. After the patient receives the dose of furosemide,
cation and determining the status of goals. what will you do?

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 CHAPTER 2 Pharmacologic Principles  23

CHAPTER 2
Pharmacologic Principles

Chapter Review and NCLEX® 6. If a drug binds with an enzyme and thereby prevents
Examination Preparation the enzyme from binding to its normal target cell, it
will produce which effect?
Select the best answer for each question. a. Receptor interaction
b. Enzyme affinity
1. Number the following drug forms in order of speed c. Enzyme interaction
of dissolution and absorption, with (1) being the fast- d. Nonspecific interaction
est and (5) being the slowest:
_____ a. Capsules 7. The nurse is reviewing a list of a patient’s medica-
_____ b. Enteric-coated tablets tions, and notes that one of the drugs is known to
_____ c. Elixirs have a low therapeutic index. Which statement ac-
_____ d. Powders curately explains this concept?
_____ e. Orally disintegrating tablets a. The difference between a therapeutic dose and
toxic dose is large.
2. When considering the various routes of drug elimi- b. The difference between a therapeutic dose and
nation, the nurse is aware that elimination occurs toxic dose is small.
mainly by which routes? c. The dose needed to reach a therapeutic level is
a. Renal tubules and skin small.
b. Skin and lungs d. The drug has only a slight chance of being
c. Bowel and renal tubules effective.
d. Lungs and gastrointestinal tract
8. The nurse prepares to obtain a patient’s blood sam-
3. The nurse is aware that excessive drug dosages, ple from a central line for a drug level that is to be
impaired metabolism, or inadequate excretion may drawn just before that medication’s next dose. What
result in which drug effect? is the timing of this blood draw known as?
a. Tolerance a. Half-life
b. Cumulative effect b. Therapeutic level
c. Incompatibility c. Peak level
d. Antagonistic effect d. Trough level

4. Drug half-life is defined as the amount of time re- 9. A drug has a half-life of 4 hours. If at 0800 the drug
quired for 50% of a drug to: level is measured as 200 mg/L, at what time would
a. be absorbed by the body. the drug level be 50 mg/L? ___________________
b. reach a therapeutic level.
c. exert a response.
d. be removed by the body.

5. The nurse recognizes that drugs given by which

route will be altered by the first-pass effect? (Select
all that apply.)
a. Oral
b. Sublingual
c. Subcutaneous
d. Intravenous
e. Rectal

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23
24  CHAPTER 2 Pharmacologic Principles

Match each field of study with the corresponding job Critical Thinking and Application
description of a person working in that field.
10. _____ Pharmaceutics Answer the following questions on a separate sheet of
paper.
11. _____ Pharmacokinetics
12. _____ Pharmacodynamics 18. Mr. C. is to receive a drug that can be given by in-
jection, either intramuscularly or subcutaneously.
13. _____ Pharmacogenomics Mr. C.’s condition dictates that the drug needs to be
14. _____ Pharmacotherapeutics absorbed quickly. Which route of administration will
the prescriber order? How can the nurse further in-
15. _____ Pharmacognosy crease absorption?
16. _____ Toxicology
19. Ms. D. had a thyroidectomy four years ago, and
17. _____ Pharmacoeconomics has been taking the thyroid hormone levothyroxine
(Synthroid) since the surgery. She visits her primary
a. Lisa is researching botanical and zoologic sources of care provider for periodic labwork to check her hor-
drugs to treat multiple sclerosis. She is part of a uni- mone levels. This is an example of which type of
versity research team that is currently experimenting drug therapy: acute, maintenance, supplemental, or
with varying the biochemical composition and thera- palliative? Explain your answer.
peutic effects of several possible new drugs.
b. Jeffrey works for a pharmaceutical corporation. One 20. E.S. has a prescription for an extended-release,
of its new drugs looks very promising, and Jeffrey’s enteric-coated tablet. The next day, his wife calls to
company is experimenting with dosage forms for ask about crushing the tablet. “He just cannot swal-
this investigational new drug. He is responsible for low that big pill.” What is the nurse’s best answer?
measuring the relationship between the physiochem-
ical properties of the dosage form and the clinical
therapeutic response. Case Study
c. Micah is performing a cost-benefit analysis to com-
pare the effectiveness of two blood pressure medica- Read the scenario and answer the following questions
tions for a health insurance company. on a separate sheet of paper.
d. Devon researches various poisons and is particu-
larly concerned with the detection and treatment of A 65-year-old man with liver cirrhosis is admitted to the
the effects of drugs and other chemicals in certain medical-surgical unit with nausea and vomiting. He also
mammals. has a diagnosis of heart failure. You note that his serum
e. Diane and Phil have spent the last 3 years gather- albumin (protein) level is low. The physician has written
ing family histories, legal case reports, and current admission orders, and you are trying to make the patient
clinical data to identify possible genetic factors that comfortable. He is to take nothing by mouth except for
influence individuals’ responses to meperidine and clear liquids. An intravenous infusion of dextrose 5% in
related drugs. water at 50 mL/hr has been ordered, and the nurses have
f. David works on a study that is gathering data on the had difficulty inserting his intravenous (IV) line.
use of two different drugs for the treatment of rheu-
matoid arthritis. 1. One of the drugs ordered is known to reach a maxi-
g. Leslie’s laboratory monitors drug distribution rates mum level in the body of 200 mg/L and has a half-
between various body compartments, from absorp- life of 2 hours. If this maximum level of 200 mg/L is
tion through excretion. Recently, her laboratory was reached at 4 pm, then what will the drug’s level in the
able to suggest a positive change in the dosage regi- body be at 10 pm?
men for an injectable drug, bringing her firm a pres-
tigious award. 2. Describe how factors identified in the patient’s his-
h. Gregory’s research unit recently recommended two tory would affect the following:
new contraindications for the use of a newly mar- a. Absorption
keted drug after discovering previously unknown b. Distribution
biochemical and physiologic interactions of this drug c. Metabolism
with another unrelated drug. d. Excretion

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 2 Pharmacologic Principles  25

3. Placement of a peripherally inserted central catheter 4. This patient is also receiving digoxin (Lanoxin) for
is ordered. The physician writes an order for a dose heart failure. This drug is known to have a low thera-
of an IVPB antibiotic to be given as soon as IV ac- peutic index. Explain this concept, and what will be
cess is established. What is the reason for this order? done to monitor it.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
This page intentionally left blank
 CHAPTER 3 Lifespan Considerations  27

CHAPTER 3
Lifespan Considerations

Chapter Review and NCLEX® 5. When giving medications to older adults, the nurse
Examination Preparation will keep in mind the changes that occur due to ag-
ing. Which statements regarding changes in the older
Select the best answer for each question. patient are true? (Select all that apply.)
a. Fat content is increased.
1. Which physiologic factor is most responsible for the b. Gastric pH is less acidic because of reduced hy-
differences in the pharmacokinetic and pharmacody- drochloric acid production.
namic behavior of drugs in neonates and adults? c. Protein albumin binding sites are reduced be-
a. Infant’s stature cause of decreased serum protein.
b. Infant’s smaller weight d. Total body water content increases as body com-
c. Immaturity of neonatal organs position changes.
d. Adult’s longer exposure to toxins e. The absorptive surface area of the gastrointesti-
nal tract is increased due to flattening and blunt-
2. A woman who has just discovered that she is preg- ing of the villi.
nant is asking the nurse about taking medications.
The nurse keeps in mind that the greatest risk for 6. A child is to receive a medication that is dosed as
drug-induced developmental defects occurs during 8 mg/kg. The child weighs 40 kg. What is the dose
which trimester of pregnancy? of medication that the nurse will administer to this
a. First child? ____________________
b. Second
c. Third 7. A toddler is to receive a daily dose of digoxin
d. The risk is the same throughout pregnancy. (Lanoxin) 2 mcg/kg/day IV. The toddler weighs
23 pounds. Calculate the amount of medica-
3. Most drug references provide recommended pediat- tion in milligrams that the toddler will receive.
ric dosages based on which of the following? ___________________________
a. Total body water content
b. Fat-to-lean mass ratio 8. The medication in Question 7 is available in a vial of
c. Height 0.1 mg/mL. Calculate how much solution the nurse
d. Body weight will draw up into the syringe, and then mark the sy-
ringe with your answer. ________________
4. The nurse recognizes that drug dosages in older
adults are based on which factor(s)?
a. More on age than on height or weight
b. On body weight and organ function
c. On the total body water content
d. On the strength of the drug

0.2 0.4 0.6 0.8 1 mL

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 27
28  CHAPTER 3 Lifespan Considerations

Match each pregnancy safety category with its corre- Case Study
sponding description.
9. _____ Category A Read the scenario and answer the following questions
on a separate sheet of paper.
10. _____ Category B
11. _____ Category C You are performing telephone triage in a pediatric clinic.
A mother calls about her 28-month-old toddler, who has
12. _____ Category D had chickenpox for 2 days. She wants to give aspirin be-
13. _____ Category X cause the toddler’s fever is 101° F (38.3° C) but is unsure
because her toddler “hates to take pills.”
a. Possible fetal risk in humans is reported; however,
consideration of potential benefit versus risk may, in 1. Should the mother use aspirin for this fever? Refer
selected cases, warrant use of these drugs in preg- to Chapter 44 as needed for developmental consider-
nant women. ations for the use of aspirin.
b. Studies indicate no risk to animal fetuses; informa-
tion for humans is not available. 2. The mother states that her husband is going to the
c. Fetal abnormalities are reported, and positive evi- drugstore for some medicine. What advice will you
dence of fetal risk in humans is available from ani- give her regarding the dosage form of an antipyretic
mal and/or human studies. for her toddler?
d. Studies indicate no risk to the human fetus.
e. Adverse effects are reported in animal fetuses; infor- 3. When the husband returns from the store, he shows
mation for humans is not available. the mother the bottle of generic acetaminophen
liquid suspension formula for children that was rec-
ommended by the store’s pharmacist. He wonders,
though, why the pharmacist would need to know the
Critical Thinking and Application
toddler’s weight before suggesting this medication.
Explain.
Answer the following questions on a separate sheet of
paper.
4. The toddler receives a dose of 1 teaspoon per the di-
rections for a child of his weight of 28 pounds. Later,
14. The nurse works at a community clinic frequented
when his 5-year-old sister needs a dose, she receives
by a number of older patients. Mrs. M. comes to the
1.5 teaspoons because she weighs 45 pounds. If the
clinic complaining of dizziness and nausea. As the
drug contains 160 mg per teaspoon, then how many
nurse takes her medication history, she shows the
milligrams of medication did the 5-year-old child
nurse her “pill box.” Inside the nurse sees almost a
receive in her dose?
dozen different pills, all to be taken at noon. How
could this happen? How could she possibly need so
5. What should the parents look for when evaluating
many medications at the same time?
the children’s response to a dose of acetaminophen?
15. The physician confirms that Mrs. M.’s “new symp-
toms,” as she refers to them, are a result of polyphar-
macy. She protests, telling the nurse, “Honey, I’ve
got news for the doctor. I’ve had to take lots of drugs
at the same time all my life. It never bothered me
before. Why would it now when I’m even more used
to it?” Explain at least three physiologic changes that
occur with aging and the way in which these changes
affect pharmacokinetics and pharmacodynamics.

16. A 14-year-old girl has been diagnosed with type 1

diabetes mellitus, and the nurse is preparing to teach
her how to test her own blood glucose levels with a
glucometer. Describe some strategies that would be
effective for this teaching session.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 4 Cultural, Legal, and Ethical Considerations  29

CHAPTER 4
Cultural, Legal, and Ethical Considerations

Chapter Review and NCLEX® 6. The nurse is performing an admission assessment.

Examination Preparation Which finding is considered part of the cultural
assessment?
Select the best answer for each question. a. The patient uses aspirin as needed for pain.
b. The patient has a history of hypertension.
1. When reviewing drug classifications, the nurse c. The patient is allergic to shellfish.
knows that drugs classified as category C-I, which d. The patient does not eat pork products for reli-
are to be dispensed “only with an approved proto- gious reasons.
col,” include which drugs?
a. Codeine, cocaine, and meperidine (Demerol) 7. While reviewing a newsletter about medications,
b. Heroin, LSD, and marijuana the nurse notices that one drug has a new black box
c. Phenobarbital, chloral hydrate, and warning from the Food and Drug Administration
benzodiazepines (FDA). What does this warning entail? (Select all
d. Cough preparations and diarrhea-control drugs that apply.)
a. The drug is about to be recalled by the FDA.
2. When a health care provider is writing a prescrip- b. Serious adverse effects have been reported with
tion for a drug, he or she is not permitted to mark a the use of this drug.
refill on the prescription if the drug falls into which c. The drug can still be prescribed, but the warn-
category? ing is present to make sure that the prescriber is
a. C-II aware of the potential risks.
b. C-III d. The drug manufacturer has refused to recall the
c. C-IV medication, despite documented problems.
d. C-V e. The drug cannot be prescribed.

3. The nurse is aware that the ethical principle of “Do 8. The nurse is assessing an unresponsive patient when
no harm” is known by which name? a visitor enters the room. The visitor asks, “Oh, what
a. Autonomy happened to him? He was fine yesterday!” Which is
b. Beneficence the most appropriate response from the nurse?
c. Confidentiality a. “Sorry, but I am not allowed to tell you.”
d. Nonmaleficence b. “He had a stroke yesterday while in church, and
there is little hope for him to recover.”
4. Which legal act required drug manufacturers to es- c. “You will need to speak to his physician about
tablish the safety and efficacy of a new drug before his condition.”
its approval for use? d. “Before I can give any information about him,
a. Federal Food and Drugs Act of 1906 I need to ask who you are. Let’s go outside the
b. Federal Food, Drug, and Cosmetic Act of 1938 room and talk.”
c. Kefauver-Harris Amendment of 1962
d. Durham-Humphrey Amendment of 1951 9. The nurse is to administer ranitidine (Zantac) 150
mg IV. The available medication is ranitidine 25 mg/
5. Which is the correct definition for placebo?
mL. How many milliliters will the nurse administer?
a. An investigational drug used in a new drug
__________________________
study
b. An inert substance that is not a drug
c. A legend drug that requires a prescription
d. A substance that is not approved as a drug but is
used as an herbal product

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29
30  CHAPTER 4 Cultural, Legal, and Ethical Considerations

10. Mark the syringe with the amount of medication the nurse will draw up for Question 9.

10
1 2 3 4 5 6 7 8 9 mL

Match each investigational drug study phase with its Critical Thinking and Application
corresponding description.
11. _____ Phase I Answer the following questions on a separate sheet of
paper.
12. _____ Phase II
13. _____ Phase III 19. During morning report, a nurse has been asked to
work on a transplant unit for the day. The nurse has
14. _____ Phase IV personal objections to working on that unit for reli-
gious reasons. What is the best course of action for
a. A study using small numbers of volunteers who
the nurse in this situation?
have the disease or disorder that the drug is meant to
diagnose or treat. Subjects are monitored for drug ef-
20. Identify a cultural group in the area in which you
fectiveness and adverse effects.
live, and explore the health belief practices for that
b. Postmarketing studies conducted by drug companies
group.
to obtain further proof of the drug’s therapeutic and
a. Are there any barriers to adequate health care?
adverse effects.
b. What is the attitude toward Western medicines
c. A study that involves a large number of patients at
and health treatments?
research centers designed to monitor for infrequent
c. What questions should you ask in your cultural
adverse effects and to identify any associated risks.
assessment?
Double-blind, placebo-controlled studies eliminate
patient and researcher bias.
d. A study that uses small numbers of healthy
volunteers, as opposed to volunteers with the Case Study
target ailment, to determine dosage range and
pharmacokinetics. Read the scenario and answer the following questions
on a separate sheet of paper.
Match each cultural group with its corresponding cul-
tural practice. You work in an outpatient treatment clinic for patients
with human immunodeficiency virus (HIV) infection.
15. _____ Asian During a recent staff meeting, the medical director dis-
16. _____ Hispanic cussed a new drug that has shown good results in clini-
cal trials in another country. This drug has not yet been
17. _____ Native American tested in the United States. She stated that she hopes to
18. _____ African American start clinical trials of that drug in the HIV clinic.
The following week, you are asked to start a new
a. Some may seek a balance between the body and drug regimen for four patients with HIV infection. One
mind through the use of “cold” remedies or foods for of the drugs is new to you, and when you ask about it, the
“hot” illnesses, and vice versa. medical director replies, “Oh, that’s the new drug I men-
b. Some may use folk medicine, protective bracelets, tioned last week! One of my colleagues in that country
and laying on of hands. sent me some samples, so we’re going to try it here. The
c. Some believe that opposing forces lead to illness Food and Drug Administration has already started tri-
or health, depending on which force is dominant in als here in the United States. We will be comparing how
the individual and whether the forces are balanced. these four patients do compared with four other patients
Balance produces healthy states. who are in the same stages of HIV infection. The patients
d. Some believe in the need for a balance among body, won’t even know about this change.”
mind, and environment to maintain health and har-
mony with nature.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 4 Cultural, Legal, and Ethical Considerations  31

1. Should you give the drugs as requested? If not, what 4. When you meet with potential study patients, several
needs be done to correct the situation? mention that they fear others will find out about their
illness if they participate in the study. What will you
2. What ethical principle(s) guide your decision? tell these patients?

3. One of the potential study patients, brought in by

his brother, seems reluctant to answer questions
and says he “doesn’t need any drugs.” Upon further
questioning, you find out that he would prefer to take
some home remedies that his mother has made for
him. How will you handle this situation?

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
This page intentionally left blank
 CHAPTER 5 Medication Errors: Preventing and Responding  33

CHAPTER 5
Medication Errors: Preventing
and Responding
Chapter Review and NCLEX® Digoxin 125 mcg PO
Examination Preparation now

Provide the best answer for each question. Lasix 40 mg IV qd

1. A(n) _________________ is defined as any prevent-

able adverse drug event that involves inappropriate d/c all meds
medication use by a patient or health care profes-
sional. It may or may not cause harm to the patient.
NPH insulin 12 u subcut
2. A(n) _________________ reaction is defined as any every morning before
abnormal and unexpected response to a medication, breakfast
other than an allergic reaction, that is peculiar to an Floxin Otic 1 gtt AD bid
individual patient.

3. A(n) _________________ is an immunologic reac- Lactulose 30 mL PO

tion resulting from an unusual sensitivity of a patient q.o.d.
to a particular medication.

4. A(n) _________________ is a type of adverse drug 11. The medication order reads: “Metoprolol 25 mg PO
event that is defined as any unexpected, unintended, twice a day for high blood pressure. Hold if systolic
or excessive response to a medication given at thera- blood pressure is less than 95 mm Hg.” Today the
peutic dosages. pharmacy supplied 50-mg tablets because there were
no 25-mg tablets in stock.
5. A(n) _________________ is an undesirable occur- a. How many tablets will the nurse administer per
rence related to administration of or failure to ad- dose? ________________________
minister a prescribed medication. b. The nurse gives the patient the entire tablet.
How many milligrams does the patient receive?
6. True or false: High-alert medications are involved in ________________________
more errors than other drugs. Explain your answer. c. What will the nurse do next? _______________
______________________________________
7. True or false: All adverse drug events are caused by
medication errors. Explain your answer. 12. The order reads: “Give levothyroxine (Synthroid) 50
mcg PO every morning.” Which of these correctly
8. Identify six ways to avoid medication errors. depicts the dose in milligrams?
a. .05 mg
9. Name at least four of the classes of medications that b. 0.05 mg
are considered “high-alert” drugs. c. 0.050 mg
d. 50000 mg
10. The National Coordinating Council for Medication
Error Reporting and Prevention recommends that 13. The order reads: “Give furosemide 50 mg per gas-
certain terms be written out in full instead of being trostomy tube every morning.” The medication is
abbreviated. Write out the full meaning of each ab- available in liquid form, 10 mg/1 mL. Calculate
breviated word or phrase that appears in bold in the how much medication the nurse will administer.
following list. ________________________

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 33
34  CHAPTER 5 Medication Errors: Preventing and Responding

14. Mark the medication cup with the answer you ob- Case Study
tained for Question 13.
Read the scenario and answer the following questions
on a separate sheet of paper.

A nursing student discovers that she has given her patient

two aspirin tablets instead of the one-tablet daily dose
that was ordered for antiplatelet effects. She is upset and
talks to her fellow students, who tell her to keep quiet
8 dr about it. “One extra aspirin won’t hurt your patient,” they
1 oz 30 mL tell her.

1. What should the nursing student do first? Describe

4 dr
1/2
oz 15 mL other appropriate actions after this.
10 mL
2 dr 2. How could the student have prevented this error?
1t 5 mL
1 dr 4 mL
3. Should the patient be told about it? Explain your
answer.

4. If the patient was not hurt by this incident, then is it

considered a medication error? Explain.

5. The student has decided to inform her instructor. The

instructor helps the student complete a hospital in-
cident report, and a report to the U.S. Pharmacopeia
Medication Errors Reporting Program (USPMERP).
Explain the reason for this report. Will the student’s
name be reported to the USPMERP?

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 CHAPTER 6 Patient Education and Drug Therapy  35

CHAPTER 6
Patient Education and Drug Therapy

Chapter Review and NCLEX® 4. A nurse has completed an education session on

Examination Preparation self-administration of insulin injections. Which
statement(s) describe(s) successful learning in the af-
Select the best answer for each question. fective domain? (Select all that apply.)
a. The patient states, “I am feeling more confident
1. A nurse is preparing for an education session on safe about insulin self-injection.”
medication administration. Which is the best exam- b. The patient states, “It is important to check my
ple of a learning activity that involves the cognitive blood sugar before I take the insulin.”
domain? c. The patient states, “Insulin works to lower my
a. Teaching a patient how to self-administer nasal blood sugar levels.”
spray d. The patient measures the correct amount of in-
b. Teaching a patient how to measure the pulse be- sulin in the syringe for the injection.
fore taking digoxin e. The patient injects himself with insulin using
c. Discussing which foods to avoid while taking the correct technique.
oral anticoagulants
d. Teaching a family member how to give an 5. A patient has been instructed to take 25 mg of di-
injection phenhydramine (Benadryl) oral syrup twice a day
as treatment for a severe case of poison ivy. The
2. The nurse is developing a discharge plan regarding a medication comes in a bottle that contains 12.5 mg/5
patient’s medications. When is the most ideal time to mL. The nurse will be teaching the patient how
begin discharge planning? to measure a dose of the medication. How many
a. When family members are present milliliters will the nurse measure for each dose?
b. Just before the patient leaves the hospital _________________
c. When the patient has been medicated for pain
d. As soon as possible when the patient is ready 6. During a teaching session, the nurse demonstrates
how to draw up insulin into a syringe. The patient
3. The nurse is providing discharge teaching for a pa- then provides a return demonstration and draws up
tient who has a new colostomy following a partial 17 units of insulin. Mark on the syringe the correct
colectomy. The patient is very upset and anxious be- dose of 17 units.
cause of the colostomy. Which statement about this
level of anxiety is true?
a. It may be an obstacle to learning at this time.
b. It means that a family member needs to be
taught instead of the patient.
c. It will have no effect on the patient’s ability to
learn.
d. It may result in the patient having an increased
motivation to learn.

100
10 20 30 40 50 60 70 80 90 units

5 15 25 35 45 55 65 75 85 95

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2007, 2004, 2002, 1999, 1996 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 35
Exploring the Variety of Random
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