Using Astin's I-E-O model as a framework, this problem of practice study examined nursing student inputs for success in medication calculation competency and used an elective medication calculation course taught with a student-ready critical care pedagogy as an environmental modification to determine changes in student outcomes of medication calculation competency, awareness of academic resources, and use of academic help-seeking behaviors. A historical data set was examined for potential indicators of failing the first attempt of the required medication calculation exam with several significant findings. Subsequent logistic regression analysis revealed that high-school GPA, first-semester college GPA, and ATI Critical Thinking exam scores were significantly associated with likelihood to pass the first attempt. The resulting formula from this model had low accuracy for predicting which students would fail the first attempt but high accuracy for identifying studently likely to pass the first attempt. This model can help guide conversations with students to encourage enrollment in the elective medication calculation course for students who are more likely to need additional support to meet this competency. After taking the elective course, the first-time pass rate on the medication calculation exam was 100% for the enrolled students which was a significant improvement when compared to the historical data set. Additionally, a post-course survey provided information about students' awareness of resources within the nursing program and indicated that students perceived they were more willing to engage in academic help-seeking behaviors after taking the course. These results reveal that the elective course is beneficial for students in gaining medication calculation competency and that using a student-ready critical care pedagogy can also provide other benefits to support prelicensure nursing student success. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]