NCLEX-RN - High-Yield Pharmacology & Priority Nursing Care Flashcards

Question 1

High-Yield Antidote Pairings (Part 1)

Accepted Answer

- **Warfarin** $\rightarrow$ Vitamin K (Phytonadione)
- **Heparin / Enoxaparin** $\rightarrow$ Protamine Sulfate
- **Opioids** $\rightarrow$ Naloxone
- **Acetaminophen** $\rightarrow$ N-acetylcysteine

Question 2

High-Yield Antidote Pairings (Part 2)

Accepted Answer

- **Digoxin** $\rightarrow$ Digoxin Immune Fab (Digibind)
- **Benzodiazepines** $\rightarrow$ Flumazenil
- **Cholinergics / Organophosphates** $\rightarrow$ Atropine
- **Iron** $\rightarrow$ Deferoxamine

Question 3

Critical Therapeutic Drug Monitoring Ranges

Accepted Answer

- **Digoxin**: 0.5–2.0 ng/mL
- **Lithium**: 0.6–1.2 mEq/L
- **Theophylline**: 10–20 mcg/mL
- **Phenytoin**: 10–20 mcg/mL
- **Vancomycin (trough)**: 10–20 mcg/mL

Question 4

ACE Inhibitors (-pril) Adverse Effects & Nursing Priorities

Accepted Answer

- **Key Adverse Effects**: Dry persistent Cough, Angioedema (life-threatening airway compromise), Hyperkalemia, First-dose Hypotension.
- **Nursing Action**: Assess baseline BP and potassium. Teach client to change positions slowly.
- **Black Box**: Teratogenic (contraindicated in pregnancy).

Question 5

Digoxin Toxicity Signs & Nursing Interventions

Accepted Answer

- **Early Signs**: Nausea, vomiting, anorexia, abdominal pain.
- **Late Signs**: Visual disturbances (yellow/green halos, blurred vision), dysrhythmias.
- **Nursing Priority**: Measure apical pulse for 1 full minute before administration; hold if $< 60$ bpm in adults ($< 90$ in infants).
- **Note**: Hypokalemia ($< 3.5$ mEq/L) dramatically increases digoxin toxicity risk.

Question 6

Insulin Types & Peak Action Times

Accepted Answer

- **Rapid-acting** (Lispro, Aspart): Peak 30–90 min. Give with meal on tray.
- **Short-acting** (Regular): Peak 2–4 hrs. *Only insulin safe for IV administration.*
- **Intermediate** (NPH): Peak 4–12 hrs. Cloudy; draw up *Clear to Cloudy* (Regular before NPH).
- **Long-acting** (Glargine, Detemir): No peak (24-hr duration). *Never mix with other insulins.*

Question 7

Anticoagulants: Heparin vs. Warfarin Monitoring

Accepted Answer

- **Heparin (Unfractionated)**: Monitor **aPTT**. Therapeutic level is 1.5–2.5 $	imes$ baseline (approx. 60–80 seconds).
- **Warfarin**: Monitor **PT/INR**. Therapeutic INR is 2.0–3.0 (2.5–3.5 for mechanical heart valves).

Question 8

Nursing Delegation: What CANNOT be Delegated? (EAT Acronym)

Accepted Answer

The RN **cannot** delegate **EAT**:
- **E**valuation (evaluating care outcomes)
- **A**ssessment (initial or comprehensive physical assessments)
- **T**eaching (initial education/planning)

*Additionally*: Unstable clients, blood product administration, and IV push medications must remain with the RN.

Question 9

Scope of Practice: Licensed Practical Nurse (LPN/LVN)

Accepted Answer

- **Client Profile**: Stable clients with predictable outcomes.
- **Permissible Tasks**: Focused assessments, oral/SC/IM medication administration, enteral feedings, sterile dressing changes, urinary catheter insertion, and reinforcing teaching previously provided by the RN.

Question 10

Scope of Practice: Unlicensed Assistive Personnel (UAP)

Accepted Answer

- **Client Profile**: Stable clients only.
- **Permissible Tasks**: Routine standardized skills—ADLs (bathing, dressing), vital signs on stable clients, ambulation, transfers, measuring intake & output (I&O), feeding clients *without* swallowing dysfunction, and basic hygiene care.

Question 11

Priority Frameworks: ABCs vs. Maslow's Hierarchy

Accepted Answer

- **ABCs**: Airway $\rightarrow$ Breathing $\rightarrow$ Circulation. (Exception: CPR follows C-A-B).
- **Maslow's**: Physiological needs (oxygen, fluids, nutrition, elimination, body temp) take priority over psychosocial needs (pain, anxiety, self-esteem).

Question 12

NCLEX Priority Rule: Acute vs. Chronic & Unstable vs. Stable

Accepted Answer

Always prioritize:
1. **Unstable** over Stable
2. **Acute** over Chronic
3. **Unexpected** symptoms over Expected disease-process symptoms

*Example*: A client 2 hours post-op with tachycardia (125 bpm) takes priority over a chronic COPD client with a expected $SpO_2$ of $89\%$.

Question 13

NGN Clinical Judgment Measurement Model: 6 Steps

Accepted Answer

1. **Recognize Cues**: What data is most important?
2. **Analyze Cues**: What do the findings mean?
3. **Prioritize Hypotheses**: Which client issue is most urgent?
4. **Generate Solutions**: What interventions address the priority problem?
5. **Take Action**: Implement the highest-priority interventions.
6. **Evaluate Outcomes**: Did the client respond as expected?

Question 14

Lithium Toxicity & Essential Nursing Care

Accepted Answer

- **Therapeutic Range**: 0.6–1.2 mEq/L.
- **Toxicity Symptoms**: Early ($> 1.5$): Nausea, diarrhea, fine tremors. Late ($> 2.0$): Ataxia, giddiness, coarse hand tremors, seizures.
- **Key Teaching**: Maintain adequate sodium and fluid intake (2–3 L/day). **Hyponatremia** and dehydration cause lithium retention and acute toxicity.

Question 15

Potassium Electrolyte Imbalances & Priority Care

Accepted Answer

- **Hyperkalemia** ($> 5.0$ mEq/L): Muscle weakness, tall peaked T-waves, risk of cardiac arrest. *Tx*: Calcium gluconate (cardioprotective), Insulin + Dextrose, Kayexalate.
- **Hypokalemia** ($< 3.5$ mEq/L): Muscle cramps, U-waves, ST depression.
- *Rule*: **NEVER** administer Potassium IV push (fatal).

Question 16

Beta-Blockers (-lol): Assessment & Safety Rules

Accepted Answer

- **Mechanisms**: Decreases Heart Rate and Blood Pressure.
- **Pre-admin Checks**: Hold if HR $< 60$ bpm or Systolic BP $< 90$ mmHg.
- **Safety Warning**: Non-selective beta-blockers (e.g., Propranolol) cause bronchospasm and are **contraindicated** in clients with Asthma or severe COPD.

Question 17

Monoamine Oxidase Inhibitors (MAOIs) & Tyramine Interaction

Accepted Answer

- **Examples**: Phenelzine, Tranylcypromine, Isocarboxazid.
- **Key Concern**: Ingestion of high-tyramine foods causes a massive release of catecholamines, resulting in **Hypertensive Crisis**.
- **Avoid**: Aged cheeses, cured/processed meats, red wine, tap beer, soy sauce, pickled foods.

Question 18

Signs of Opioid Toxicity & Emergency Intervention

Accepted Answer

- **Opioid Triad**: Respiratory depression ($< 10$–12 breaths/min), Pinpoint pupils (miosis), Unconsciousness/Coma.
- **Priority Action**: Administer **Naloxone** (Narcan) IV/Intranasal.
- **Crucial Note**: Naloxone has a shorter half-life than most opioids; monitor closely for recurrent respiratory depression.

Question 19

Blood Transfusion Reaction: Acute Priorities

Accepted Answer

- **Signs**: Fever, chills, low back pain (acute hemolytic reaction), urticaria, dyspnea.
- **Immediate Steps**:
  1. **STOP** the transfusion immediately.
  2. Disconnect tubing at hub and flush/maintain IV line with normal saline ($0.9\%$ NaCl) using *new* tubing.
  3. Notify HCP and blood bank.
  4. Monitor vital signs and return blood bag/tubing to laboratory.

Question 20

Potassium-Sparing vs. Potassium-Wasting Diuretics

Accepted Answer

- **Potassium-Wasting**: Furosemide, Hydrochlorothiazide. Monitor for hypokalemia, encourage high-potassium diet (bananas, oranges, potatoes).
- **Potassium-Sparing**: Spironolactone. Monitor for hyperkalemia, instruct client to avoid salt substitutes containing potassium.

NCLEX-RN - High-Yield Pharmacology & Priority Nursing Care

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