NCLEX-RN - High-Yield Nursing Pharmacology & Patient Safety Flashcards

Question 1

Priority Framework: ABCs vs. Maslow's Hierarchy

Accepted Answer

Systematically prioritize patient needs. **ABCs** (Airway, Breathing, Circulation) take precedence over all non-life-threatening concerns. **Maslow's Hierarchy** orders needs from basic physiological needs (oxygen, fluids, nutrition) up through safety, love/belonging, esteem, and self-actualization.

Question 2

ACE Inhibitors: Mechanism & Key Adverse Effects

Accepted Answer

Medications ending in **-pril** (e.g., Lisinopril, Enalapril). They inhibit the conversion of Angiotensin I to Angiotensin II.

• **Key Side Effects**: Persistent **dry cough**, **hyperkalemia** ($K^+ > 5.0	ext{ mEq/L}$), severe hypotension, and life-threatening **angioedema** (swelling of lips, tongue, throat).

Question 3

Beta-Blockers: Nursing Considerations & Contraindications

Accepted Answer

Medications ending in **-olol** (e.g., Metoprolol, Propranolol). They decrease heart rate and blood pressure.

• **Nursing Care**: Assess HR and BP prior to administration. Hold if $	ext{HR} < 60	ext{ bpm}$ or $	ext{SBP} < 90	ext{ mmHg}$.
• **Contraindication**: Non-selective beta-blockers (e.g., Propranolol) are contraindicated in patients with **asthma or COPD** due to risk of bronchospasm.

Question 4

Critical Antidote Pairings (Part 1)

Accepted Answer

• **Warfarin (Coumadin)** $\rightarrow$ Vitamin K (Phytonadione)
• **Heparin & LMWH (Enoxaparin)** $\rightarrow$ Protamine Sulfate
• **Opioids (e.g., Morphine, Hydromorphone)** $\rightarrow$ Naloxone (Narcan)
• **Acetaminophen (Tylenol)** $\rightarrow$ N-Acetylcysteine (Mucomyst)

Question 5

Critical Antidote Pairings (Part 2)

Accepted Answer

• **Benzodiazepines (e.g., Lorazepam, Diazepam)** $\rightarrow$ Flumazenil
• **Digoxin** $\rightarrow$ Digoxin Immune Fab (Digibind)
• **Magnesium Sulfate** $\rightarrow$ Calcium Gluconate
• **Cholinergic Crisis (Organophosphates/Pyridostigmine)** $\rightarrow$ Atropine

Question 6

High-Yield Therapeutic Serum Drug Levels

Accepted Answer

• **Digoxin**: $0.5 - 2.0	ext{ ng/mL}$
• **Lithium**: $0.6 - 1.2	ext{ mEq/L}$
• **Theophylline**: $10 - 20	ext{ mcg/mL}$
• **Phenytoin**: $10 - 20	ext{ mcg/mL}$
• **Vancomycin (Trough)**: $10 - 20	ext{ mcg/mL}$

Question 7

Insulin Profiles: Onset, Peak, and Duration

Accepted Answer

• **Rapid-acting** (Lispro, Aspart): Onset $15	ext{ min}$, Peak $1	ext{ hr}$, Duration $3-4	ext{ hr}$ (Give with meals).
• **Short-acting** (Regular): Onset $30-60	ext{ min}$, Peak $2-4	ext{ hr}$, Duration $5-8	ext{ hr}$ (**Only** insulin given IV).
• **Intermediate** (NPH): Onset $1-2	ext{ hr}$, Peak $4-12	ext{ hr}$, Duration $14-24	ext{ hr}$ (Cloudy; draw clear-to-cloudy).
• **Long-acting** (Glargine, Detemir): Onset $3-4	ext{ hr}$, No Peak, Duration $24	ext{ hr}$ (Never mix with other insulins).

Question 8

Anticoagulant Monitoring: Heparin vs. Warfarin

Accepted Answer

• **Heparin**: Monitored via **aPTT**. Therapeutic range is $1.5 - 2.5 	imes$ control (approx. $60 - 80	ext{ seconds}$). Watch for Heparin-Induced Thrombocytopenia (HIT).
• **Warfarin**: Monitored via **PT/INR**. Therapeutic INR is $2.0 - 3.0$ (or $2.5 - 3.5$ for mechanical heart valves).

Question 9

Potassium (K+) Imbalances & Cardiac Manifestations

Accepted Answer

Normal Serum Potassium: $3.5 - 5.0	ext{ mEq/L}$

• **Hyperkalemia** ($>5.0	ext{ mEq/L}$): Tall peaked T-waves, widened QRS. Treatment: IV Calcium Gluconate (cardioprotective), Insulin + Dextrose, Sodium Polystyrene Sulfonate.
• **Hypokalemia** ($<3.5	ext{ mEq/L}$): Flattened T-waves, prominent U-waves, muscle cramps. Significantly increases risk of **Digoxin toxicity**.

Question 10

IV Drip Rate Calculation Formula

Accepted Answer

To calculate IV flow rate in drops per minute ($	ext{gtt/min}$):

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

*Example*: Infuse $1000	ext{ mL}$ over $8	ext{ hours}$ ($480	ext{ min}$) with a tubing drop factor of $15	ext{ gtt/mL}$:

$$	ext{Drip Rate} = \frac{1000 	imes 15}{480} = 31.25 \approx 31	ext{ gtt/min}$$

Question 11

Weight-Based Medication Dosage Calculation

Accepted Answer

1. Convert patient weight from pounds to kilograms ($1	ext{ kg} = 2.2	ext{ lbs}$):
$$	ext{Weight (kg)} = \frac{	ext{Weight (lbs)}}{2.2}$$
2. Multiply target dosage per kg by weight in kg:
$$	ext{Total Dose} = 	ext{Dosage per kg} 	imes 	ext{Weight (kg)}$$

Question 12

Digoxin Toxicity: Risk Factors & Signs/Symptoms

Accepted Answer

• **Early Signs**: Anorexia, nausea, vomiting, abdominal pain.
• **Late Signs**: Visual disturbances (green-yellow halos, blurred vision), bradycardia, heart blocks.
• **Major Risk Factor**: **Hypokalemia** ($K^+ < 3.5	ext{ mEq/L}$) enhances digoxin binding to the $	ext{Na}^+/	ext{K}^+$ ATPase pump, drastically increasing toxicity risk.

Question 13

Potassium-Sparing vs. Loop Diuretics

Accepted Answer

• **Loop Diuretics** (e.g., Furosemide, Bumetanide): Inhibit $	ext{Na-K-2Cl}$ absorption in loop of Henle. Causes severe potassium wasting (risk of **hypokalemia**) and potential **ototoxicity** if administered too rapidly IV.
• **Potassium-Sparing Diuretics** (e.g., Spironolactone): Aldosterone antagonist. Retains potassium (risk of **hyperkalemia**). Patient should avoid salt substitutes containing potassium.

Question 14

Transmission-Based Precautions: Airborne vs. Droplet vs. Contact

Accepted Answer

• **Airborne**: N95 respirator, negative pressure isolation room. (*MTV*: Measles, Tuberculosis, Varicella/Zoster).
• **Droplet**: Surgical mask, private room. (*SPIDERMAN*: Sepsis, Pneumonia, Influenza, Diphtheria, Epiglottitis, Rubella, Mumps).
• **Contact**: Gown and gloves. (*C. diff, MRSA, VRE, Scabies*). *Note*: Soap and water required for C. diff (alcohol rub is ineffective).

Question 15

Vancomycin: Nursing Considerations & Red Man Syndrome

Accepted Answer

• **Trough Levels**: Draw immediately prior to the next scheduled dose (Target: $10 - 20	ext{ mcg/mL}$).
• **Toxicity**: Risk of nephrotoxicity (monitor BUN/Creatinine) and ototoxicity.
• **Red Man Syndrome**: Flushing, erythema, pruritus, and hypotension caused by rapid IV infusion. *Management*: Slow the infusion rate to run over at least $60	ext{ minutes}$ (do not stop drug completely).

Question 16

Monoamine Oxidase Inhibitors (MAOIs) & Tyramine Interaction

Accepted Answer

Examples: Phenelzine, Tranylcypromine, Isocarboxazid.

• **Dietary Restriction**: Must avoid **tyramine-rich foods** (aged cheeses, cured/processed meats, red wine, draft beer, soy sauce, pickled foods).
• **Complication**: Ingesting tyramine while on MAOIs triggers a massive catecholamine release, resulting in a **Hypertensive Crisis** (headache, nausea, $	ext{BP} > 180/120	ext{ mmHg}$).

Question 17

Prioritization Strategy: Expected vs. Unexpected Findings

Accepted Answer

• **Unexpected/Unstable findings** ALWAYS take priority over expected, stable, or chronic findings.
• **Expected (Lower Priority)**: Mild incisional pain 1 day post-op, elevated WBC in a patient with diagnosed pneumonia.
• **Unexpected (High Priority)**: Sudden acute dyspnea, sudden severe 'thunderclap' headache, absent bowel sounds with rigid abdomen, new neurological deficit.

Question 18

Lithium Toxicity: Risk Factors & Patient Teaching

Accepted Answer

• **Therapeutic Range**: $0.6 - 1.2	ext{ mEq/L}$.
• **Toxicity Risk Factors**: **Hyponatremia**, dehydration, and NSAID use decrease lithium clearance, increasing serum toxicity.
• **Teaching**: Maintain consistent fluid intake ($2 - 3	ext{ L/day}$) and normal sodium intake. Avoid OTC NSAIDs; use acetaminophen for pain.

Question 19

Delegation Principles: RN, LPN/LVN, and UAP

Accepted Answer

• **RN Only**: Initial assessment, clinical evaluation, patient teaching, unstable clients, IV push medications, blood transfusion initiation.
• **LPN/LVN**: Stable clients, reassessments, routine oral/IM/SQ medications, sterile dressing changes, tracheostomy care, tube feedings.
• **UAP**: Standard unassigned tasks on stable clients (vital signs, hygiene, ambulation, feeding, measuring intake/output).

Question 20

SBAR Standardized Communication Tool

Accepted Answer

Framework for urgent interprofessional handoff:

• **S (Situation)**: Name, patient, unit, and immediate chief complaint.
• **B (Background)**: Relevant clinical context, admitting diagnosis, baseline status.
• **A (Assessment)**: Current vital signs, physical exam findings, trends.
• **R (Recommendation)**: Suggested action or specific request (e.g., request stat ECG, physician bedside evaluation).

NCLEX-RN - High-Yield Nursing Pharmacology & Patient Safety

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