NCLEX-RN - Fundamentals of Pharmacological Therapies & High-Alert Medications Flashcards

Question 1

IV Flow Rate Formula (mL/hr)

Accepted Answer

Used to set volumetric infusion pumps:

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

Question 2

High-Alert Medication Verification Protocol

Accepted Answer

A critical safety process required before administering high-alert medications (e.g., insulin, heparin, opioids, potassium chloride) involving an independent secondary verification by two licensed registered nurses (RNs).

Question 3

Dosage Calculation: Weight-Based Daily Dose Formula

Accepted Answer

Formula to calculate weight-based medication dosages:

$	ext{Daily Dose (mg)} = 	ext{Weight (kg)} 	imes 	ext{Prescribed Rate (mg/kg/day)}$

To find single-dose amounts, divide the total daily dose by the number of administration intervals per day.

Question 4

IV Drip Rate Formula (gtt/min)

Accepted Answer

Used when administering IV fluids manually via gravity tubing:

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

Question 5

ACE Inhibitors (e.g., Lisinopril, Enalapril)

Accepted Answer

Antihypertensives that prevent conversion of Angiotensin I to II.
- **Key Side Effects**: Persistent dry cough, hyperkalemia ($[K^+] > 5.0	ext{ mEq/L}$), angioedema.
- **Nursing Priority**: Monitor blood pressure and potassium levels; discontinue immediately if lip or tongue swelling occurs.

Question 6

ARBs (Angiotensin II Receptor Blockers) (e.g., Losartan, Valsartan)

Accepted Answer

Antihypertensives used when patients cannot tolerate ACE inhibitor-induced cough.
- **Key Side Effects**: Hyperkalemia, hypotension, renal impairment.
- **Nursing Priority**: Monitor renal function and blood pressure; contraindicated in pregnancy.

Question 7

Antidote: Unfractionated Heparin

Accepted Answer

**Protamine Sulfate**.
- Neutralizes heparin molecules.
- **Monitoring**: Measure Activated Partial Thromboplastin Time (aPTT). Target therapeutic range is $1.5 - 2.5 	imes 	ext{baseline}$ (typically $60 - 80	ext{ seconds}$).Stop infusion if severe bleeding occurs.

Question 8

Antidote: Warfarin (Coumadin)

Accepted Answer

**Vitamin K (Phytonadione)** for standard reversal; **Prothrombin Complex Concentrate (PCC)** or Fresh Frozen Plasma (FFP) for acute/life-threatening bleeding.
- **Monitoring**: Measure PT/INR (Therapeutic INR target: $2.0 - 3.0$ for most conditions).

Question 9

Antidote: Opioids (e.g., Morphine, Fentanyl, Hydromorphone)

Accepted Answer

**Naloxone (Narcan)**.
- Competitive opioid receptor antagonist.
- **Nursing Priority**: Monitor respiratory rate closely. Because Naloxone's half-life is shorter than most opioids, re-sedation and respiratory depression can recur.

Question 10

Antidote: Digoxin Toxicity

Accepted Answer

**Digoxin Immune Fab (Digibind)**.
- **Therapeutic Range**: $0.5 - 2.0	ext{ ng/mL}$.
- **Signs of Toxicity**: Bradycardia, visual changes (yellow-green halos/blurriness), nausea/vomiting, hyperkalemia.
- **Pre-admin Check**: Always assess apical pulse for 1 full minute; hold if $	ext{HR} < 60	ext{ bpm}$.

Question 11

Antidote: Acetaminophen (Tylenol) Toxicity

Accepted Answer

**N-Acetylcysteine (Mucomyst)**.
- Restores hepatic glutathione stores to reduce hepatotoxicity.
- **Nursing Priority**: Most effective when administered within $8 - 10	ext{ hours}$ of acute overdose.

Question 12

Insulin: Rapid-Acting (Lispro, Aspart, Glulisine)

Accepted Answer

- **Onset**: $15	ext{ minutes}$
- **Peak**: $1 - 2	ext{ hours}$
- **Duration**: $3 - 4	ext{ hours}$
- **Nursing Priority**: Administer within $15	ext{ minutes}$ of meals. Ensure the patient's food tray is present at the bedside to prevent hypoglycemia.

Question 13

Insulin: Short-Acting (Regular Insulin)

Accepted Answer

- **Onset**: $30 - 60	ext{ minutes}$
- **Peak**: $2 - 4	ext{ hours}$
- **Duration**: $5 - 8	ext{ hours}$
- **Nursing Consideration**: The **only** insulin type that can be given via Intravenous (IV) push or continuous infusion (e.g., in DKA).

Question 14

Insulin: Intermediate-Acting (NPH)

Accepted Answer

- **Onset**: $1 - 2	ext{ hours}$
- **Peak**: $4 - 12	ext{ hours}$
- **Duration**: $14 - 24	ext{ hours}$
- **Appearance**: Cloudy suspension.
- **Mixing Rule**: Draw Regular insulin first, then NPH ("Clear before Cloudy").

Question 15

Insulin: Long-Acting (Glargine, Detemir)

Accepted Answer

- **Onset**: $1 - 2	ext{ hours}$
- **Peak**: Peakless (steady continuous dose)
- **Duration**: $24	ext{ hours}$
- **Nursing Priority**: Never mix long-acting insulin in the same syringe with any other insulin type.

Question 16

High-Alert Medication: Intravenous Potassium Chloride (KCl)

Accepted Answer

Electrolyte replacement for severe hypokalemia.
- **CRITICAL SAFETY**: **NEVER** administer via IV push or bolus (causes immediate cardiac arrest).
- **Infusion Limit**: Max $10	ext{ mEq/hr}$ via peripheral line; max $20	ext{ mEq/hr}$ via central line with continuous ECG monitoring.

Question 17

High-Alert Medication: Magnesium Sulfate

Accepted Answer

Used for seizure prophylaxis in preeclampsia and management of Torsades de Pointes.
- **Signs of Toxicity**: Loss of deep tendon reflexes (DTRs), respiratory rate $< 12/	ext{min}$, oliguria ($< 30	ext{ mL/hr}$).
- **Antidote**: **Calcium Gluconate**.

Question 18

Beta-Blockers (e.g., Metoprolol, Propranolol)

Accepted Answer

Block $\beta_1$ (and non-selective $\beta_2$) receptors, reducing heart rate and blood pressure.
- **Nursing Considerations**: Hold if $	ext{HR} < 60	ext{ bpm}$ or $	ext{SBP} < 90	ext{ mmHg}$.
- **Safety Alert**: Non-selective beta-blockers (e.g., Propranolol) cause bronchoconstriction and are contraindicated in patients with asthma or severe COPD.

Question 19

Calcium Channel Blockers (e.g., Diltiazem, Amlodipine, Verapamil)

Accepted Answer

Inhibit calcium movement into vascular smooth muscle and cardiac cells, causing vasodilation and decreased heart rate.
- **Side Effects**: Bradycardia, peripheral edema, constipation, hypotension.
- **Patient Teaching**: Avoid grapefruit juice as it significantly increases drug absorption and toxicity risk.

Question 20

Narrow Therapeutic Index: Lithium Carbonate

Accepted Answer

- **Therapeutic Level**: $0.6 - 1.2	ext{ mEq/L}$
- **Toxicity Threshold**: $> 1.5	ext{ mEq/L}$ (tremors, ataxia, confusion, seizures).
- **Risk Factor**: Hyponatremia ($[Na^+] < 135	ext{ mEq/L}$) or dehydration causes the kidneys to reabsorb lithium, dramatically increasing toxicity risk.

Question 21

Direct Oral Anticoagulants (DOACs)

Accepted Answer

Direct Thrombin Inhibitors (Dabigatran) and Factor Xa Inhibitors (Rivaroxaban, Apixaban).
- **Advantages**: Fixed dosing, no routine blood monitoring needed.
- **Antidotes**: **Idarucizumab** for Dabigatran; **Andexanet alfa** for Factor Xa inhibitors.

NCLEX-RN - Fundamentals of Pharmacological Therapies & High-Alert Medications

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