Today we're going to talk about expected actions
and outcomes, and we're talking about
pharmacology, which again, is a very big
part of NCLEX. My name is Diana
Shenefield. So let's dive into this. We're going
to talk about a little bit of overview. And again,
as I just mentioned, pharmacology is a big part
of NCLEX. It's so important that you
know common drugs. And so we're going to talk a
little bit about what is expected.
Again, I want you to read your learning outcomes.
If at any point in time you
don't feel like that you've met those outcomes
or you're confused about those
outcomes, make sure you go back to your
pharmacology book and review. So we're going to start
out with a question just to kind of get your
mind thinking about the topic that
we're going to talk about. A patient with
disseminated herpes zoster is given IV
hydrocortisone. We know that's probably
Solu-Cortef. Which lab value does the
nurse expect to be elevated as a result of
this therapy? Again, there are certain
drugs that you're going to need to know.
There are certain disease processes that are
common. And so you're going to want to be able
to put this together. So, what do
Calcium, glucose, magnesium, or potassium?
Hopefully, you picked glucose. Glucose and
steroids always go together. So whenever you
have a patient that is on a steroid,
always be thinking about glucose. Second,
a patient with a ventricular septal
repair is receiving dopamine, which we
know, works on the heart,
postoperatively. Which response is expected?
Again, you may not know exactly
every single drug, but there should be hints
in the question, and there should
certain things about certain drugs that
ring true to you. So should they
have a decreased heart rate? Should they
have a decreased urine output? Should they
have increased cardiac output? Or decreased
cardiac contractility? So if you're thinking
about a patient that just had heart repair,
what are we going to want? Hopefully,
you picked C, increased cardiac output.
So again, you're going to want to review
those common outcomes for certain medications.
So, when you're looking at
your drugs, you need to know what's expected.
We call that the therapeutic
What do I want to have happened when this
patient takes the medication that I'm
giving them? What's the whole purpose? If
you don't know the purpose for a
medication that you're giving, you need
to question the physician, you need to
question the patient. There needs to be a purpose.
What are your expected outcomes?
We know that there are different outcomes.
We have side effects, we have adverse
effects, but what is the whole reason? Is
it to change the way the patient is
breathing? Is it to change their pulse rate?
Is to help the infection go away?
It's really important that when you're
studying your medications that you're
also looking at what is the purpose, and
make sure you're reading through those
uses, so that when your patient is on
those drugs or when you're answering
questions about those drugs that you
understand why they're taking it,
what signs and symptoms are you trying
So expected outcomes. Again, not only do I
need to understand them but I need to
make sure that my patient understands them as
well. That's where my education
comes in. I want my patient to be compliant.
And for them to be compliant,
they have to know why. Why am I taking this
medicine? Why am I going to see as
the outcome for that? Again, they only know
that for me teaching them, and
that's a huge part of my job by giving medications.
So, what do I need to review
when I'm looking at expected outcomes? Well,
one of the things I need to review
is my routes of administration. I need to
remember that oral meds have to pass
through the gut before they are metabolized.
So what does that mean as
far as how fast it's going to work? I need
to understand first pass effect.
Remember that's when a lot of the drug is
metabolized through the liver and has become
inactive, really important to understand that.
Sublingual and buccal, remembering, am I putting
it in the cheek or under the tongue?
Is that faster than swallowing? Yes, because
of the capillaries. How about
liquids or swallowing a pill, which one is
metabolized faster? Or extended release?
What happens if a patient chose an extended
release or breaks open extended
release capsule? If they don't know what the
consequences are to that, they're
not going to abide by that and they may think
it's no big deal. I need to educate
them on that and I need to understand that
as well. And then remembering that IV
is the fastest route of administration. So
when I go back and I ask a patient
that I've given a pain med too, if I've given
an IV, how soon can I expect results?
If I've given them a pill, how soon should
I expect results and when can I
tell the patient that they should be
These are all things that you need to review.
So in closing, make sure you know
your drugs. Now I know people are going to say,
there is no way I can know every
drug in the drug book. And you're right,
there is no way. But there is common
drugs, in that antibiotics
and medicines for blood pressure.
So again, what is it about that
drug that you're giving it to that
patient? What is your expected outcome so
that you can document against that
and you can also teach that. So again, look
at your pharmacology book and
answer those questions in your NCLEX book and you'll do
fine on the test. This is Diana Shenefield. Good luck.