NCLEX-RN - High-Yield Pharmacology & Safe Medication Administration Flashcards

Question 1

Common Teratogenic Drug Classes

Accepted Answer

Drugs strictly contraindicated during pregnancy due to birth defect risks:
- **ACE Inhibitors / ARBs** (fetal renal dysfunction)
- **Warfarin** (fetal hemorrhage/malformations)
- **Statins** (HMG-CoA reductase inhibitors)
- **Isotretinoin** (severe congenital malformations; requires iPLEDGE program)
- **Tetracyclines** (bone growth retardation and teeth discoloration)

Question 2

Dosage Calculation: Desired over Have Formula

Accepted Answer

$	ext{Dose} = \frac{	ext{Desired}}{	ext{Have}} 	imes 	ext{Volume}$

Used to calculate liquid or solid medication quantities where **Desired** is the prescribed dose, **Have** is the concentration available on hand, and **Volume** is the unit liquid measure (mL, tablet, etc.).

Question 3

IV Flow Rate Formula (gtt/min)

Accepted Answer

$	ext{Flow Rate (gtt/min)} = \frac{	ext{Total Volume (mL)}}{	ext{Total Time (min)}} 	imes 	ext{Drop Factor (gtt/mL)}$

**Key Rule:** Always round manual IV drip rates to the nearest whole drop per minute.

Question 4

IV Infusion Rate Formula (mL/hr)

Accepted Answer

$	ext{Infusion Rate (mL/hr)} = \frac{	ext{Total Volume (mL)}}{	ext{Total Time (hr)}}$

Used when programming an electronic IV infusion pump.

Question 5

Weight-Based Dosage Calculation Steps

Accepted Answer

1. Convert weight from pounds to kilograms: $	ext{Weight (kg)} = \frac{	ext{Weight (lbs)}}{2.2}$
2. Calculate total dose: $	ext{Total Dose} = 	ext{Prescribed Dose per kg} 	imes 	ext{Weight (kg)}$
3. Calculate administration volume using the desired over have formula.

Question 6

ACE Inhibitors: Naming, Adverse Effects & Nursing Priorities

Accepted Answer

**Suffix:** `-pril` (e.g., Lisinopril, Enalapril)

**Adverse Effects:** Persistent dry cough, hyperkalemia ($	ext{K}^+ > 5.0	ext{ mEq/L}$), angioedema (life-threatening airway swelling), and orthostatic hypotension.

**Nursing Priority:** Monitor blood pressure and serum potassium. Teach patient to change positions slowly and report swelling of lips/tongue.

Question 7

Angiotensin II Receptor Blockers (ARBs)

Accepted Answer

**Suffix:** `-sartan` (e.g., Losartan, Valsartan)

**Indication:** Alternative for patients who cannot tolerate ACE inhibitor-induced dry cough.

**Key Risk:** Hyperkalemia and hypotension. Does **not** cause the characteristic dry cough associated with ACE inhibitors.

Question 8

Beta-Blockers: Mechanism & Priority Assessment

Accepted Answer

**Suffix:** `-olol` (e.g., Metoprolol, Propranolol)

**Mechanism:** Decreases heart rate, myocardial contractility, and blood pressure.

**Priority Assessment:** Hold medication if $	ext{HR} < 60	ext{ bpm}$ or $	ext{SBP} < 90	ext{ mmHg}$.

**Caution:** Non-selective beta-blockers (Propranolol) cause bronchospasm; contraindicated in patients with asthma or COPD.

Question 9

Heparin vs. Warfarin: Lab Monitoring & Antidotes

Accepted Answer

**Heparin (Parenteral):**
- **Lab:** aPTT (Target therapeutic range: 1.5–2.5 $	imes$ control, approx. 46–70 seconds)
- **Antidote:** Protamine Sulfate

**Warfarin (Oral):**
- **Lab:** PT/INR (Target INR: 2.0–3.0 for most clinical indications)
- **Antidote:** Vitamin K (Phytonadione)

Question 10

Low Molecular Weight Heparin (Enoxaparin) Safety

Accepted Answer

**Route:** Subcutaneous injection into the abdomen ($\ge 2$ inches away from umbilicus).

**Critical Rules:**
- Do **not** expel the prefilled air bubble prior to injection.
- Do **not** rub the site post-administration (prevents hematoma formation and severe bruising).

Question 11

Digoxin: Therapeutic Index & Toxicity Signs

Accepted Answer

**Therapeutic Range:** $0.5 - 2.0	ext{ ng/mL}$

**Signs of Toxicity:** Early gastrointestinal distress (nausea, vomiting, anorexia), fatigue/confusion, and visual changes (yellow-green halos, blurred vision).

**Nursing Interventions:** Check apical pulse for 1 full minute; hold if $	ext{HR} < 60	ext{ bpm}$. **Hypokalemia** increases the risk of digoxin toxicity.

Question 12

Essential Medication Antidotes Summary

Accepted Answer

- **Acetaminophen:** N-acetylcysteine
- **Opioids:** Naloxone
- **Benzodiazepines:** Flumazenil
- **Magnesium Sulfate:** Calcium Gluconate
- **Cholinergics/Organophosphates:** Atropine

Question 13

Insulin Types: Onset & Peak Timing

Accepted Answer

- **Rapid-Acting (Lispro/Aspart):** Onset 15 min | Peak 1–2 hr (Administer with meals)
- **Short-Acting (Regular):** Onset 30–60 min | Peak 2–4 hr (Only insulin safe for IV administration)
- **Intermediate (NPH):** Onset 1–2 hr | Peak 4–12 hr (Cloudy; draw clear before cloudy)
- **Long-Acting (Glargine/Detemir):** Onset 1–2 hr | No Peak (Do NOT mix with other insulins)

Question 14

High-Alert Medication Safety Rules

Accepted Answer

Medications that pose a heightened risk of causing significant patient harm if misused (e.g., Insulin, Heparin, IV Potassium Chloride, Opioids, Chemotherapy).

**Nursing Safety Rule:** Requires an **independent double-check** by two licensed registered nurses prior to administration.

Question 15

Potassium Chloride (KCl) IV Administration Protocol

Accepted Answer

**NEVER:** Administer via IV Push, IM, or SubQ (causes immediate fatal cardiac arrest).

**IV Infusion Standard:** Administer via infusion pump at a rate not exceeding $10 - 20	ext{ mEq/hr}$ with continuous cardiac monitoring.

**Assessment:** Verify adequate renal function (urine output $\ge 30	ext{ mL/hr}$) prior to administration.

Question 16

Aminoglycosides & Vancomycin: Monitoring Toxicity

Accepted Answer

**Major Toxicities:**
1. **Nephrotoxicity:** Monitor Serum Creatinine ($> 1.2	ext{ mg/dL}$) and BUN ($> 20	ext{ mg/dL}$).
2. **Ototoxicity:** Assess for tinnitus, vertigo, and hearing loss.

**Lab Timing:** Draw **trough levels** 30 minutes before the next dose to prevent drug accumulation.

Question 17

Lithium: Therapeutic Range & Toxicity Risk Factors

Accepted Answer

**Therapeutic Index:** $0.6 - 1.2	ext{ mEq/L}$ (Toxic at $> 1.5	ext{ mEq/L}$).

**Signs of Toxicity:** Coarse hand tremors, persistent diarrhea, vomiting, ataxia, confusion.

**Patient Education:** Maintain consistent fluid intake ($2 - 3	ext{ L/day}$) and sodium levels. **Hyponatremia** causes kidneys to reabsorb lithium, triggering toxicity.

Question 18

Fluoroquinolones (e.g., Ciprofloxacin): Black Box Warning

Accepted Answer

**Suffix:** `-floxacin`

**Black Box Warning:** Risk of tendonitis and **tendon rupture** (most commonly the Achilles tendon), peripheral neuropathy, and CNS toxicity.

**Nursing Priority:** Instruct patient to immediately report new heel/joint pain and refrain from exercise until evaluated.

Question 19

Sublingual Nitroglycerin Protocol for Acute Angina

Accepted Answer

**Administration:** Place 1 tablet under the tongue every 5 minutes for up to 3 doses.

**Emergency Protocol:** Call 911/EMS if chest pain is unresolved or worsening 5 minutes after taking the **first** dose.

**Storage:** Keep in original heat- and light-sensitive dark glass container.

Question 20

Calcium Channel Blockers: Grapefruit Interaction

Accepted Answer

**Examples:** Diltiazem, Verapamil, Amlodipine (`-dipine`)

**Mechanism:** Decreases blood pressure and heart rate via arterial vasodilation.

**Critical Interaction:** Avoid **grapefruit juice**, which inhibits CYP3A4 metabolism, drastically increasing serum drug concentration and causing severe bradycardia and hypotension.

NCLEX-RN - High-Yield Pharmacology & Safe Medication Administration

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