NURSE-3101 Lecture Notes - Lecture 6: Lorazepam, Propranolol, Nursing Process

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15 Sep 2016
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Bloom’s Taxonomy: A Helpful Guide for Students
Perri-Anne Concialdi, MSN, RN, CNS
Student nurses—especially those just entering the collegiate arena from high school—
often complain that they have always done well on tests, that is, until now. They report they are
studying but not achieving the results they are used to. As faculty, we recognize that this can be
frustrating for students, and a bit of education about Bloom’s taxonomy might help!
First of all, who is Bloom? In the 1950’s Benjamin Bloom and a group of educational
psychologists developed a classification of levels of intellectual behavior important in learning.
Bloom found that the great majority of test questions students encounter require them to
think only at the lowest possible level. Bloom identified six levels within the cognitive domain,
from simple recall or recognition of facts, as the lowest level, through increasingly more
complex and abstract mental levels, to the highest order which is classified as evaluation.
So, if you have previously done well on tests it is possible that you were only asked to
recall certain facts or pieces of information and now you are being tested at a different—and
higher—level. In fact, study methods that you once used successfully, such as making flash cards
to help you remember facts, may now be failing you. It is important to understand—you are not
the failure—your study method may be failing you.
Understanding Bloom’s taxonomy can help students understand why nursing tests really
are harder than many other tests they have ever taken before! Take advantage of the practice
quizzes and ATI tests that are available in many of the courses. Remember…you must practice
your skills of blood pressure monitoring and IV starts. You must also practice your skill of test-
Bloom’s Taxonomy - Part I
Let’s look at the six levels of Bloom’s taxonomy.
Level 1 is: KNOWLEDGE.
This is the basic level of recalling certain knowledge. This level is important and certain
information must be memorized and always available for recall (yes…not only for the test at
hand). Important KNOWLEDGE that must be committed into our memory banks includes:
normal vital signs, normal assessment values, important lab values and basic medication facts.
The following are Level I questions:
1. Which of the following blood levels represents a therapeutic range for lithium?
a. 0.1-0.5 mEq/L
b. 0.4-0.8 mEq/L
c. 0.5-1.5 mEq/L
d. 1.0-2.5 mEq/L
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2. Which medication below is classified as a beta-blocker?
a. propanolol
b. furosemide
c. acetylsalicylic acid
d. acetaminophen
Both questions are asking for factual information—simple recall. 0.5-1.5mEq/L is a
therapeutic range for lithium. Beta blockers are cardiac medications and propanolol is a common
Frequently, students may try to recall and memorize everything. That feat is impossible
in nursing. There is too much information and information is always changing. You are likely to
find more KNOWLEDGE level questions during your first semester when you are learning the
important building blocks of your nursing foundation—vital signs, assessment information,
medication administration, body systems, etc. This is the information you need to be able to
Level 2 involves: COMPREHENSION.
This is a higher level of thinking because now we must understand the information and interpret
some data. Note how the above questions can be taken to this “higher level.”
3. Which sign or symptom is the nurse likely to assess if the client’s lithium level is
a. flight of ideas
b. C/O severe constipation
c. ataxia
d. C/O extreme lethargy
4. The nurse must obtain an apical pulse prior to administering which medication below?
a. meperidine
b. metoprolol
c. milk of magnesia
d. methylphenidate
Notice that we are now selecting facts to help us answer the questions. In question 3, we
know that 0.2 mEq/L is a sub-therapeutic level. Lithium is used to treat mania. Flight of ideas is
a symptom of mania. If the blood level is not therapeutic, symptoms of mania have probably not
yet abated.
In question 4, we are looking at the rule of when an apical pulse needs to be assessed.
Apical pulses are checked prior to administering beta blockers, a class of cardiac medications;
metoprolol is a beta-blocker.
Bloom’s level 3 is: APPLICATION.
This is where we, as nurses, use or demonstrate the information. We have rationale for our
actions. There is a reason why we do what we do. Let’s take a look at some level 3 questions.
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5. The patient is ordered lithium carbonate 450mg b.i.d. PO. The nurse should hold the
lithium carbonate if which of the following levels is present?
a. lithium blood level 0.3 mEq/L
b. sodium level – 135 mEq/L
c. lithium blood level – 1.8 mEq/L
d. sodium level –145 mEq/L
6. The patient is ordered metoprolol 50mg daily PO. Which assessment data below requires
the nurse to hold the medication?
a. BP96/54, Apical48, R14, T98.4
b. BP--100/66, Apical—66, R—26, shallow, T—98.8
c. BP—158/98, Apical—114, R—20, T—101.1
d. BP—98/72, Apical-82, irregular, R—16, T—99.1
Nurses should hold lithium when blood levels are too high or toxic. None of the sodium
levels are abnormal. The 0.3 mEq/L lithium level is sub-therapeutic which would not require a
nurse to hold the dose.
Metoprolol is a beta blocker and these medications are held if bradycardia is present. An
apical of 48 demonstrates bradycardia. Though some of the other data above is outside of normal
limits, only bradycardia would require holding this medication.
In the following pages, we will discuss the remaining three levels of Bloom’s taxonomy.
In the meantime begin to challenge yourself while studying for tests and quizzes. Ask yourself:
“What facts are important to memorize?” Nurses must know normal assessment data in
order to differentiate abnormal data. Star data that your instructor is emphasizing as
important and commit this to memory.
“Do I know all of the terminology?” Students must learn to define terminology when they
are reading. If a term is not familiar to you—look it up then and there. Try to make sense
out of terms by identifying prefixes, suffixes and root words.
• Once you know the facts, ask yourself: “What is the nurse likely to observe with this
• Finally ask yourself, “How will knowing this affect my nursing care?” The nurse needs to
be aware of rationale—why we do what we do. When there are Nursing Care Plans in
your textbook, cover up the rationale. Read the Nursing Diagnosis, Outcome(s) and
Interventions. Then ask yourself why that intervention is appropriate. Check your
answers by then reading the rationale.
As nurses our patients will come to us verbalizing and displaying different signs and
symptoms. Some of the signs and symptoms will be relevant to the current condition and others
will not. A good nurse will make sense of the data and intervene safely and appropriately.
Asking you higher level questions now will make you all better nurses in the future.
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