NCLEX-RN - High-Yield Pharmacology, Dosage Calculations & Patient Safety Flashcards

Question 1

Formula - Manual IV Drip Rate (gtt/min)

Accepted Answer

What is the formula for calculating the manual IV flow rate in drops per minute ($gtt/min$)?

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

Question 2

Formula - IV Pump Infusion Rate (mL/hr)

Accepted Answer

What is the formula for calculating the infusion rate for an electronic IV pump in $mL/hr$?

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

Question 3

Dosage Calculation - IV Drip Rate Practice

Accepted Answer

Order: Administer $1,000 	ext{ mL}$ $0.9\% 	ext{ NaCl}$ over $8 	ext{ hours}$ using tubing with a drop factor of $15 	ext{ gtt/mL}$. Calculate the drip rate in $gtt/min$.

**Calculation:**
1. Convert hours to minutes: $8 	ext{ hr} 	imes 60 = 480 	ext{ min}$
2. Apply formula:
$$	ext{Rate} = \frac{1000 	ext{ mL} 	imes 15 	ext{ gtt/mL}}{480 	ext{ min}} = \frac{15000}{480} = 31.25 \approx 31 	ext{ gtt/min}$$

Question 4

Antidote - Warfarin

Accepted Answer

What is the antidote for **Warfarin** toxicity?

**Vitamin K** (Phytonadione).
*Monitor:* **INR** (Therapeutic range: $2.0 - 3.0$ for standard anticoagulation).

Question 5

Antidote - Heparin

Accepted Answer

What is the antidote for **Heparin** (unfractionated) toxicity?

**Protamine Sulfate**.
*Monitor:* **aPTT** (Therapeutic range: $1.5 - 2.5 	imes$ baseline control, typically $60 - 80 	ext{ seconds}$).

Question 6

Antidote - Opioids

Accepted Answer

What is the reversal agent for **Opioid** overdose (e.g., Morphine, Hydromorphone)?

**Naloxone** (Narcan).
*Key Note:* Naloxone's duration of action is often shorter than the opioid's duration; assess for recurrent **respiratory depression** ($<10-12 	ext{ breaths/min}$) and prepare to repeat doses.

Question 7

Antidote - Acetaminophen

Accepted Answer

What is the antidote for **Acetaminophen** (Tylenol) overdose?

**N-acetylcysteine** (Mucomyst).
*Key Note:* Most effective when administered within 8 hours of ingestion to prevent severe hepatotoxicity.

Question 8

Antidote - Digoxin

Accepted Answer

What is the reversal agent for severe **Digoxin** toxicity?

**Digoxin Immune Fab** (Digibind).
*Key Signs of Toxicity:* Visual changes (yellow-green halos, blurred vision), bradycardia, nausea, and vomiting.

Question 9

Antidote - Benzodiazepines

Accepted Answer

What is the antidote for **Benzodiazepine** overdose (e.g., Lorazepam, Diazepam)?

**Flumazenil**.
*Caution:* Can precipitate acute withdrawal seizures in chronic benzodiazepine users.

Question 10

Therapeutic Range - Digoxin

Accepted Answer

What is the therapeutic serum concentration range for **Digoxin**?

**$0.5 - 2.0 	ext{ ng/mL}$**
*Nursing Alert:* Always measure the **apical pulse for 1 full minute** before administration. Hold medication if pulse is $<60 	ext{ bpm}$ in adults, $<70 	ext{ bpm}$ in children, or $<90 	ext{ bpm}$ in infants.

Question 11

Therapeutic Range - Lithium

Accepted Answer

What is the therapeutic serum concentration range for **Lithium**?

**$0.6 - 1.2 	ext{ mEq/L}$** (acute mania: up to $1.5 	ext{ mEq/L}$).
*Toxicity Signs:* Course hand tremors, confusion, ataxia, persistent GI upset.
*Key Patient Teaching:* Maintain adequate **sodium and fluid intake** (low sodium increases lithium toxicity risk).

Question 12

Delegation - Scope of the Registered Nurse (RN)

Accepted Answer

What clinical activities CANNOT be delegated by the RN and must be performed exclusively by the RN?

Remember **EAT**:
* **E**valuation of care plans & client outcomes
* **A**ssessment (initial/comprehensive assessment)
* **T**eaching (initial client education/discharge teaching)

*Also:* Triage, blood transfusions, complex clinical judgments, and unstable clients.

Question 13

Delegation - Scope of the Licensed Practical Nurse (LPN/LVN)

Accepted Answer

What tasks are within the scope of practice for an **LPN/LVN**?

* Care for **stable/predictable** clients
* Administer routine oral, SQ, IM, and non-IV medications (varies by state)
* Perform focused re-assessments and routine wound care/trach care
* Enteral feedings and urinary catheter insertion
* Reinforce education previously provided by the RN

Question 14

Delegation - Scope of Unlicensed Assistive Personnel (UAP)

Accepted Answer

What tasks can be safely delegated to **UAP/CNA**?

* **Routine ADLs**: Bathing, dressing, grooming, feeding non-dysphagic clients
* **Basic skills**: Vital signs on **stable** clients, intake and output (I&O)
* **Hygiene & Mobility**: Ambulation, repositioning, transfers
* *Never delegate:* Assessment, teaching, medication administration, or invasive procedures.

Question 15

Patient Prioritization - Core Principles

Accepted Answer

How should a nurse prioritize client care using NCLEX rules?

1. **ABCs**: Airway $\rightarrow$ Breathing $\rightarrow$ Circulation
2. **Acute over Chronic**: New-onset symptoms take priority over long-standing conditions
3. **Unstable over Stable**: Unpredictable physiological status over predictable findings
4. **Maslow's Hierarchy**: Physiological needs before safety/psychosocial needs

Question 16

Infection Control - Airborne Precautions

Accepted Answer

Which major diseases require **Airborne Precautions** and what PPE/room is required?

**Mnemonic (MTV):**
* **M**easles (Rubeola)
* **T**uberculosis (TB)
* **V**aricella (Chickenpox / Disseminated Zoster)

**Requirements:** Private negative-pressure room (AIIR), **N95 respirator** (or higher) fitted for healthcare personnel, door kept closed.

Question 17

Infection Control - Droplet Precautions

Accepted Answer

Which major pathogens require **Droplet Precautions** and what PPE is required?

**Key Pathogens:** Influenza, Pertussis, Bacterial Meningitis, Mumps, Rubella, RSV (contact + droplet).

**Requirements:** Private room (or cohort with same infection), **Surgical mask** upon room entry, face shield/goggles if splash risk exists.

Question 18

Infection Control - Clostridioides difficile (C. diff) Safety Protocol

Accepted Answer

What specific precautions and hand hygiene protocols must be followed for **C. diff**?

* **Precautions:** Contact Precautions (Gown + Gloves)
* **Hand Hygiene:** Must wash hands with **soap and water** ONLY! Alcohol-based hand rubs do NOT destroy C. diff spores.
* **Equipment:** Dedicated non-critical patient care items; clean surfaces with sporicidal disinfectant (bleach).

Question 19

High-Alert Meds - IV Potassium Chloride (KCl)

Accepted Answer

What is the most critical safety rule regarding **IV Potassium Chloride (KCl)** administration?

* **NEVER administer via IV Push or Direct Bolus** (causes fatal cardiac arrest).
* Must always be diluted and administered via an **infusion pump**.
* Maximum peripheral infusion rate is typically $10 	ext{ mEq/hr}$ (up to $20 	ext{ mEq/hr}$ in intensive care with continuous ECG monitoring).

Question 20

High-Alert Meds - Insulin Administration Rules

Accepted Answer

Which insulin type is the ONLY one safe for **IV push or continuous IV infusion**?

**Regular Insulin** (Short-acting).

*Intermediate (NPH) and Long-acting insulins (Glargine, Detemir) must NEVER be given IV and are strictly subcutaneous.*

NCLEX-RN - High-Yield Pharmacology, Dosage Calculations & Patient Safety

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