NCLEX-RN - Clinical Pharmacology & Patient Safety Protocols Flashcards

Question 1

ABC Prioritization Rule

Accepted Answer

A foundational NCLEX framework prioritizing **Airway**, **Breathing**, and **Circulation** over all other patient needs in emergency or acute triage situations.

Question 2

Maslow's Hierarchy in Nursing Triage

Accepted Answer

Prioritizes basic physiological needs (oxygen, water, elimination, temperature control) over safety, psychological, or social needs. Physiological stability always comes first unless an unsafe environment directly threatens life.

Question 3

Digoxin (Lanoxin) - Mechanism & Clinical Indication

Accepted Answer

A **cardiac glycoside** that increases myocardial contractility (positive inotrope) and decreases heart rate (negative chronotrope). Used primarily in heart failure and atrial fibrillation.

Question 4

Digoxin Toxicity - Signs, Risk Factors & Antidote

Accepted Answer

**Signs:** Nausea, vomiting, confusion, bradycardia, and visual disturbances (yellow-green halos).
**Risk Factor:** Hypokalemia ($K^+ < 3.5	ext{ mEq/L}$) significantly increases risk.
**Action:** Hold dose if apical pulse $< 60	ext{ bpm}$ in adults.
**Antidote:** Digoxin Immune Fab (Digibind).

Question 5

Heparin Sodium - Monitoring & Antidote

Accepted Answer

**Monitoring:** Activated Partial Thromboplastin Time (aPTT). Therapeutic range is typically $1.5 - 2.5 	imes$ baseline (approx. 60–80 seconds).
**Antidote:** Protamine Sulfate.

Question 6

Warfarin (Coumadin) - Monitoring & Antidote

Accepted Answer

**Monitoring:** PT / INR. Target INR is generally $2.0 - 3.0$ ($2.5 - 3.5$ for mechanical heart valves).
**Antidote:** Vitamin $K_1$ (Phytonadione) and Prothrombin Complex Concentrate (PCC) or Fresh Frozen Plasma (FFP).

Question 7

Enoxaparin (Lovenox) - Administration Protocol

Accepted Answer

A Low Molecular Weight Heparin (LMWH) administered subcutaneously in the anterolateral or posterolateral abdominal wall ($2	ext{ inches}$ from the umbilicus). **Do not expel the pre-filled air bubble** before injection; it seals the medication in the tissue.

Question 8

Rapid-Acting Insulin - Profiles & Nursing Alert

Accepted Answer

**Examples:** Lispro, Aspart, Glulisine.
**Onset:** 10–30 minutes | **Peak:** 30 minutes–3 hours | **Duration:** 3–5 hours.
**Alert:** Ensure the patient's meal tray is delivered and present *before* administration to prevent acute hypoglycemia.

Question 9

Regular Insulin - Profile & Administration Route

Accepted Answer

**Onset:** 30–60 minutes | **Peak:** 2–5 hours | **Duration:** 5–8 hours.
**Key Point:** This is the **only** insulin type that can be administered via intravenous (IV) push or continuous IV infusion (e.g., for Diabetic Ketoacidosis).

Question 10

Insulin Mixing Procedure (NPH + Regular)

Accepted Answer

Remember **"Clear before Cloudy"** (RN = Regular to NPH).
1. Inject air into NPH (cloudy).
2. Inject air into Regular (clear).
3. Draw up Regular (clear).
4. Draw up NPH (cloudy).

Question 11

Long-Acting Insulin (Glargine / Detemir) Rule

Accepted Answer

**Onset:** 1–2 hours | **Peak:** None (steady level) | **Duration:** 24 hours.
**Rule:** **Never mix** long-acting insulins in the same syringe with any other insulin.

Question 12

Opioid Toxicity - Clinical Triad & Antidote

Accepted Answer

**Triad:** Respiratory depression ($< 12	ext{ breaths/min}$), pinpoint pupils (miosis), and altered level of consciousness.
**Antidote:** Naloxone (Narcan).
*Note:* Naloxone's half-life is shorter than most opioids; monitor for recurrent respiratory depression and prepare to re-administer.

Question 13

Lithium Carbonate - Therapeutic Range & Toxicity Risks

Accepted Answer

**Therapeutic Range:** $0.6 - 1.2	ext{ mEq/L}$.
**Toxicity ($> 1.5	ext{ mEq/L}$):** Tremors, ataxia, confusion, coarse hand tremors, severe diarrhea.
**Risk:** Hyponatremia or dehydration increases lithium reabsorption in renal tubules, inducing severe toxicity. Maintain stable fluid and sodium intake.

Question 14

Monoamine Oxidase Inhibitors (MAOIs) - Dietary Restriction

Accepted Answer

**Examples:** Phenelzine, Tranylcypromine, Isocarboxazid.
**Constraint:** Avoid foods rich in **tyramine** (aged cheeses, cured meats, red wine, soy sauce, broad beans) to prevent a life-threatening **hypertensive crisis**.

Question 15

Serotonin Syndrome - Presentation & Prevention

Accepted Answer

Occurs when combining serotonergic agents (e.g., SSRIs, MAOIs, St. John's Wort).
**Symptoms:** Hyperreflexia, clonus, tremors, autonomic instability (hyperthermia, tachycardia), and agitation.
**Prevention:** Require a 2–14 day wash-out period between switching antidepressant classes.

Question 16

Vancomycin - Complications & Trough Levels

Accepted Answer

**Adverse Effects:** Nephrotoxicity and Ototoxicity.
**Red Man Syndrome:** Rapid IV infusion causes histamine release resulting in facial/neck flushing and hypotension. Infuse over at least $60	ext{ minutes}$.
**Monitoring:** Draw serum **trough levels** immediately before the next scheduled dose.

Question 17

Acetaminophen Toxicity & Antidote

Accepted Answer

Overdose ($> 3	ext{–}4	ext{ g/day}$) leads to severe, potentially fatal **hepatotoxicity**.
**Antidote:** $N$-Acetylcysteine (Mucomyst), which restores hepatic glutathione reserves.

Question 18

Weight-Based Dosage Calculation Formula

Accepted Answer

To convert weight: $	ext{Weight (kg)} = \frac{	ext{Weight (lbs)}}{2.2}$

To calculate total dosage:
$$	ext{Total Dose} = 	ext{Weight (kg)} 	imes 	ext{Prescribed Dose per kg}$$

Question 19

IV Infiltration vs. Extravasation

Accepted Answer

**Infiltration:** Non-vesicant fluid leaks into tissue $\rightarrow$ swelling, coolness, pallor at the site.
**Extravasation:** Vesicant drug (e.g., norepinephrine, chemotherapy) leaks into tissue $\rightarrow$ severe pain, blistering, tissue necrosis.
**Immediate Action for Both:** Stop infusion immediately and disconnect IV tubing.

Question 20

The Rights of Medication Administration

Accepted Answer

Core safety protocol checks:
1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Time
6. Right Documentation
*(Plus Right Reason, Right Response, and Right to Refuse)*

NCLEX-RN - Clinical Pharmacology & Patient Safety Protocols

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