NCLEX-RN - High-Yield Pharmacology & Nursing Prioritization Flashcards

Question 1

ACE Inhibitors: Naming & Key Adverse Effects

Accepted Answer

Identified by the suffix **`-pril`** (e.g., Lisinopril, Enalapril).

- **Mechanism**: Inhibits Conversion of Angiotensin I to Angiotensin II.
- **Adverse Effects**: Persistent dry cough, Hyperkalemia ($K^+ > 5.0	ext{ mEq/L}$), Orthostatic Hypotension, and Angioedema (life-threatening airway emergency).

Question 2

Beta-Blockers: Mechanism & Nursing Considerations

Accepted Answer

Identified by the suffix **`-lol`** (e.g., Metoprolol, Propranolol).

- **Mechanism**: Decreases heart rate ($HR$) and blood pressure ($BP$).
- **Critical Nursing Rule**: Hold if $HR < 60	ext{ bpm}$ or SBP $< 90	ext{ mmHg}$.
- **Contraindications**: Non-selective beta-blockers (e.g., Propranolol) cause bronchospasm and are contraindicated in clients with asthma or COPD.

Question 3

Digoxin Toxicity: Signs, Symptoms & Lab Monitoring

Accepted Answer

- **Therapeutic Index**: $0.5 - 2.0	ext{ ng/mL}$.
- **Early Signs**: Anorexia, nausea, vomiting, fatigue, confusion.
- **Visual Signs**: Yellow-green halos, blurred vision.
- **Risk Factor**: **Hypokalemia** ($K^+ < 3.5	ext{ mEq/L}$) drastically increases the risk of digoxin toxicity. Always check potassium and apical pulse ($1	ext{ min}$) before administration.

Question 4

Lithium Carbonate: Therapeutic Range & Toxicity

Accepted Answer

- **Therapeutic Range**: $0.6 - 1.2	ext{ mEq/L}$.
- **Toxicity Threshold**: $> 1.5	ext{ mEq/L}$.
- **Signs of Toxicity**: Severe diarrhea, vomiting, coarse hand tremors, ataxia, confusion.
- **Patient Teaching**: Maintain consistent fluid ($2 - 3	ext{ L/day}$) and **Sodium ($Na^+$)** intake. Hyponatremia leads to decreased lithium clearance and toxicity.

Question 5

Critical Lab Values: Serum Potassium ($K^+$)

Accepted Answer

- **Normal Range**: $3.5 - 5.0	ext{ mEq/L}$.
- **Hypokalemia** ($< 3.5$): Muscle weakness, U-waves on ECG, dangerous dysrhythmias. Risk with loop diuretics.
- **Hyperkalemia** ($> 5.0$): Peaked T-waves, widened QRS, ventricular fibrillation. Treat with IV Calcium Gluconate (cardioprotection), IV Insulin + Dextrose, or Sodium Polystyrene Sulfonate (Kayexalate).

Question 6

Critical Lab Values: Serum Sodium ($Na^+$)

Accepted Answer

- **Normal Range**: $135 - 145	ext{ mEq/L}$.
- **Hyponatremia** ($< 135$): Muscle cramps, confusion, lethargy, seizures. Rapid correction risks Osmotic Demyelination Syndrome.
- **Hypernatremia** ($> 145$): Extreme thirst, dry sticky mucous membranes, swollen tongue, hyperreflexia.

Question 7

Anticoagulation: Warfarin & INR Monitoring

Accepted Answer

- **Target INR (Standard)**: $2.0 - 3.0$ (Mechanical heart valves: $2.5 - 3.5$).
- **Antidote**: Vitamin K (Phytonadione).
- **Patient Teaching**: Maintain consistent intake of vitamin K-rich foods (green leafy vegetables). Avoid alcohol and NSAIDs.

Question 8

Anticoagulation: IV Heparin & aPTT Monitoring

Accepted Answer

- **Therapeutic aPTT**: $1.5 - 2.5 	imes$ the control value (around $60 - 80	ext{ seconds}$). Normal aPTT is $30 - 40	ext{ seconds}$.
- **Antidote**: Protamine Sulfate.
- **Complication**: Heparin-Induced Thrombocytopenia (HIT)—suspect if platelet count drops by $>50\%$ within $5 - 10	ext{ days}$ of initiation.

Question 9

Critical Lab Values: Renal Function Tests (BUN & Creatinine)

Accepted Answer

- **Serum Creatinine**: $0.6 - 1.2	ext{ mg/dL}$ (Most sensitive indicator of kidney function).
- **Blood Urea Nitrogen (BUN)**: $10 - 20	ext{ mg/dL}$.
- **Clinical Note**: Elevated BUN with normal Creatinine typically indicates dehydration or excessive protein intake.

Question 10

IV Flow Rate Calculation Formula ($	ext{gtt/min}$)

Accepted Answer

To calculate IV drip rates when using manual gravity tubing:

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

*Always round to the nearest whole number.*

Question 11

IV Calculation Example: Infusion Flow Rate

Accepted Answer

**Problem**: Administer $1000	ext{ mL}$ $0.9\%	ext{ NaCl}$ over $8	ext{ hours}$ with a drop factor of $15	ext{ gtt/mL}$.

$$	ext{Flow Rate} = \frac{1000	ext{ mL} 	imes 15	ext{ gtt/mL}}{8 	imes 60	ext{ min}} = \frac{15000}{480} = 31.25 \approx 31	ext{ gtt/min}$$

Question 12

Nursing Prioritization: Airway, Breathing, Circulation (ABC)

Accepted Answer

1. **Airway**: Obstruction, stridor, anaphylaxis, neck trauma.
2. **Breathing**: Respiratory rate $< 10$ or $> 30$, severe dyspnea, $SpO_2 < 90\%$, tension pneumothorax.
3. **Circulation**: Hypotension, active hemorrhage, absent pulses, shock.

*Exception*: In Cardiac Arrest, follow **C-A-B** (Compressions first).

Question 13

Prioritization Framework: Stable vs. Unstable Clients

Accepted Answer

- **UNSTABLE (First Priority)**: Acute onset/unexpected changes, unstable vitals, newly diagnosed, post-op $<24	ext{ hours}$, altered mental status.
- **STABLE (Lower Priority)**: Chronic long-term conditions, expected symptoms for disease process, post-op $>24	ext{ hours}$, ready for discharge.

Question 14

Nursing Prioritization: Maslow's Hierarchy of Needs

Accepted Answer

Prioritize client needs in the following order:
1. **Physiological**: Oxygen, fluid, nutrition, elimination, body temperature, rest.
2. **Safety & Security**: Protection from injury/fall risk, physical safety.
3. **Love & Belonging**: Social support systems.
4. **Self-Esteem & Self-Actualization**: Body image, personal growth.

Question 15

Statins (HMG-CoA Reductase Inhibitors): Adverse Effects

Accepted Answer

- **Suffix**: `-statin` (e.g., Atorvastatin, Simvastatin).
- **Adverse Effects**: **Rhabdomyolysis** (severe muscle weakness, pain, and dark/tea-colored urine) and Hepatotoxicity.
- **Nursing Actions**: Monitor Liver Function Tests (LFTs) and Creatine Kinase (CK) levels. Take doses in the evening.

Question 16

Calcium Channel Blockers (CCBs): Nursing Care

Accepted Answer

- **Examples**: Diltiazem, Verapamil, Amlodipine (`-dipine`).
- **Mechanism**: Relaxes vascular smooth muscle and slows cardiac conduction.
- **Side Effects**: Peripheral edema, severe constipation, bradycardia, dizziness.
- **Client Teaching**: Avoid **Grapefruit juice** (causes severe drug toxicity).

Question 17

Vancomycin: Trough Levels & Red Man Syndrome

Accepted Answer

- **Trough Level**: Check $15 - 30	ext{ minutes}$ prior to the next dose (Target: $10 - 20	ext{ mcg/mL}$).
- **Toxicity**: Nephrotoxicity (monitor BUN/Creatinine) and Ototoxicity (tinnitus, hearing loss).
- **Red Man Syndrome**: Severe flushing, rash, and hypotension caused by **rapid infusion**. *Action*: Slow the infusion rate down to run over at least $60	ext{ minutes}$.

Question 18

Pharmacology: Insulin Types & Peak Action Times

Accepted Answer

- **Rapid-Acting** (Lispro, Aspart): Peak $0.5 - 1.5	ext{ hours}$ (Must give with meal present!).
- **Short-Acting** (Regular): Peak $2 - 4	ext{ hours}$ (Only type given IV).
- **Intermediate** (NPH): Peak $4 - 12	ext{ hours}$ (Cloudy, can mix with Regular).
- **Long-Acting** (Glargine, Detemir): **No Peak**, duration $24	ext{ hours}$ (Never mix with other insulins).

Question 19

Opioid Toxicity: Clinical Triad & Emergency Reversal

Accepted Answer

- **Classic Triad**: Respiratory depression ($RR < 10	ext{ breaths/min}$), pinpoint pupils (miosis), and depressed level of consciousness.
- **Antidote**: **Naloxone (Narcan)**.
- **Crucial Warning**: Naloxone's half-life is shorter than most opioids. Monitor closely for re-sedation and repeat doses as necessary.

Question 20

Diuretics: Potassium-Wasting vs. Potassium-Sparing

Accepted Answer

- **Potassium-Wasting**: Loop (Furosemide) and Thiazide (HCTZ). Promote excretion of $K^+$. Risk of hypokalemia and ototoxicity (Furosemide given IV push too fast).
- **Potassium-Sparing**: Spironolactone. Retains $K^+$. Risk of hyperkalemia; instruct client to avoid salt substitutes containing potassium.

NCLEX-RN - High-Yield Pharmacology & Nursing Prioritization

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