*MUST BE TYPED*

STUDENT NAME____________________________ NUR 340L DRUG INFORMATION FORM PATIENT WEIGHT (KG): ________________

DRUG NAME ORDERED VS. WHY IS YOUR LIST SIDE NURSING WHAT WILL YOU HOW DO YOU
AND RECOMMENDED PATIENT EFFECTS/TOXIC CONSIDERATIONS OR TEACH THE MEASURE
CLASSIFICATION DOSE TAKING THIS EFFECTS PRECAUTIONS PRIOR PATIENT/FAMILY? EFFECTIVENESS OF THIS
*(See footnote) DRUG? TO ADMINISTRATION? DRUG?

(i.e., What does the (Even if your patient did

RN need to not take it and/or you
consider/assess prior did not administer it)
to administration that
is applicable to this
patient?)
Ordered Dose:

Recommended
Dose:

Is this dose
appropriate for
your patient?

*Ordered dose: Include dose, route, frequency. Recommended dose: Calculate the recommended dose- based on weight. mg/kg/day or mg/kg/dose
*MUST BE TYPED*

DRUG NAME ORDERED VS. WHY IS YOUR LIST SIDE NURSING WHAT WILL YOU HOW DO YOU
AND RECOMMENDED PATIENT EFFECTS/TOXIC CONSIDERATIONS OR TEACH THE MEASURE
CLASSIFICATION DOSE TAKING THIS EFFECTS PRECAUTIONS PRIOR PATIENT/FAMILY? EFFECTIVENESS OF THIS
*(See footnote) DRUG? TO ADMINISTRATION? DRUG?

(i.e., What does the (Even if your patient did

RN need to not take it and/or you
consider/assess prior did not administer it)
to administration that
is applicable to this
patient?)
Ordered Dose:

Recommended
Dose:

Is this dose
appropriate for
your patient?

DRUG NAME ORDERED VS. WHY IS THE LIST SIDE NURSING WHAT WILL YOU HOW DO YOU
AND RECOMMENDED PATIENT EFFECTS/TOXIC CONSIDERATIONS OR TEACH THE MEASURE
*MUST BE TYPED*

CLASSIFICATION DOSE TAKING THIS EFFECTS PRECAUTIONS PRIOR PATIENT/FAMILY? EFFECTIVENESS OF THIS
*(See footnote) DRUG? TO ADMINISTRATION? DRUG?

(i.e., What does the (Even if your patient did

RN need to not take it and/or you
consider/assess prior did not administer it)
to administration that
is applicable to this
patient?)
Ordered Dose:

Recommended
Dose:

Is this dose
appropriate for
your patient?

ACADEMIC INTEGRITY POLICY: I HAVE ABIDED BY THE ACADEMIC INTEGRITY POLICY ON THIS ASSIGNMENT.
_______________________________ _______________________________
Student Signature Date