National Council Licensure Examination for Registered Nurses (NCLEX-RN) Physiological Integrity: Pharmacological and Parenteral Therapies Syllabus

Physiological Integrity: Pharmacological and Parenteral Therapies syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Physiological Integrity: Pharmacological and Parenteral Therapies in National Council Licensure Examination for Registered Nurses (NCLEX-RN), not a summary of it.

1. 1

   Medication Administration and Safety

   4 topics

   • Rights of safe medication administration
     • Right client, drug, dose, route, time, documentation
     • High-alert medications and double checks
   • Routes and techniques of administration
     • Oral, topical, inhaled, and rectal routes
     • Subcutaneous, intramuscular, and intradermal injection
   • Dosage calculation and conversions
     • Weight-based and pediatric dosing
     • IV flow rate and drip factor calculations
   • Medication reconciliation and error prevention
2. 2

   Pharmacological Pain and Drug Interactions

   4 topics

   • Pain management and analgesics
     • Opioid and non-opioid agents
     • Patient-controlled analgesia and opioid reversal
   • Expected actions and therapeutic effects
   • Adverse effects, contraindications, and interactions
     • Drug-drug and drug-food interactions
     • Toxicities and antidotes
   • Therapeutic drug monitoring
3. 3

   Parenteral and Intravenous Therapies

   4 topics

   • IV access and site management
     • Peripheral and central venous access
     • Infiltration, phlebitis, and complication recognition
   • IV fluids and electrolyte replacement
     • Isotonic, hypotonic, and hypertonic solutions
   • Blood and blood product administration
     • Compatibility, consent, and transfusion reactions
   • Total parenteral nutrition administration
4. 4

   Pharmacology by Body System

   4 topics

   • Cardiovascular and anticoagulant agents
     • Antihypertensives, antiarrhythmics, diuretics
     • Anticoagulants and thrombolytics
   • Endocrine and antidiabetic agents
     • Insulin types and oral hypoglycemics
   • Anti-infective and immunologic agents
   • Neurologic and psychiatric agents
     • Antipsychotics, antidepressants, anxiolytics

Physiological Integrity: Pharmacological and Parenteral Therapies flashcards for National Council Licensure Examination for Registered Nurses (NCLEX-RN)

24 of 51 cards from the Physiological Integrity: Pharmacological and Parenteral Therapies deck — real questions with worked answers.

1. What are the classic "six rights" of safe medication administration?

   Right patient, right drug, right dose, right route, right time, and right documentation. (Often expanded to include right reason, right response, and right to refuse.)

2. What are the two acceptable patient identifiers required before administering any medication?

   Two unique identifiers such as the patient's full name and date of birth (or medical record number)—never the room number. Verify against the MAR and patient's ID band.

3. What is the formula for calculating a basic medication dose (tablets or volume to give)?

   Desired dose / Dose on hand × Quantity (volume) = Amount to administer. (D/H × Q.)

4. What is the formula for calculating IV infusion rate in mL/hr?

   mL/hr = Total volume (mL) ÷ Total time (hr).

5. What is the formula for calculating IV drip rate in gtt/min using a drop factor?

   gtt/min = (Total volume mL × drop factor gtt/mL) ÷ Total time in minutes.

6. How do you convert kilograms to pounds and pounds to kilograms?

   1 kg = 2.2 lb. To get kg, divide pounds by 2.2; to get pounds, multiply kg by 2.2.

7. How many milligrams are in 1 gram, and how many micrograms in 1 milligram?

   1 g = 1000 mg; 1 mg = 1000 mcg. (Move 3 decimal places.)

8. How many milliliters are in 1 teaspoon, 1 tablespoon, and 1 ounce?

   1 tsp = 5 mL; 1 tbsp = 15 mL; 1 oz = 30 mL.

9. What is medication reconciliation and when must it be performed?

   Comparing a patient's complete current medication list against new orders to avoid omissions, duplications, dosing errors, and interactions. Performed at admission, transfer, and discharge.

10. What are "high-alert" medications and how should they be handled?

    Drugs with heightened risk of significant harm if used in error (e.g., insulin, heparin/anticoagulants, opioids, concentrated electrolytes like KCl, chemotherapy). They require independent double-checks before administration.

11. List five of the standard "Do Not Use" abbreviations to prevent medication errors.

    U/u (use "unit"), IU (use "international unit"), Q.D./Q.O.D. (use "daily"/"every other day"), trailing zero (X.0 mg), and lack of leading zero (.X mg→use 0.X mg); also MS/MSO4/MgSO4.

12. What is the correct nursing response after discovering a medication error?

    First assess and stabilize the patient, notify the provider, then complete an incident/occurrence report. Document the patient's condition factually in the chart (do not reference the incident report in the chart).

13. What angle is used for intramuscular, subcutaneous, and intradermal injections?

    IM = 90 degrees; subcutaneous = 45-90 degrees; intradermal = 5-15 degrees (just under the skin, forming a bleb/wheal).

14. What is the preferred IM injection site for adults and for infants, and the maximum volume per IM site?

    Adults: ventrogluteal (preferred, avoids nerves/vessels) or deltoid; infants/young children: vastus lateralis. Max ~3 mL per adult IM site (deltoid ~1 mL).

15. What is the Z-track technique and why is it used for IM injections?

    Pulling the skin laterally before injection and releasing it after withdrawal seals the medication in the muscle, preventing leakage and irritation of subcutaneous tissue. Used for irritating/staining drugs like iron dextran.

16. What is the WHO three-step analgesic ladder for pain management?

    Step 1: non-opioids (acetaminophen, NSAIDs) ± adjuvants; Step 2: weak opioids (codeine, tramadol) for mild-moderate pain; Step 3: strong opioids (morphine) for moderate-severe pain. Escalate as pain increases.

17. What is the priority assessment before and after giving an opioid analgesic?

    Assess respiratory rate (hold if <12/min in adults), level of sedation, blood pressure, and pain level. Respiratory depression is the most life-threatening adverse effect.

18. What is the antidote (reversal agent) for opioid overdose and for benzodiazepine overdose?

    Opioids: naloxone (Narcan); benzodiazepines: flumazenil. Both are short-acting and may require repeat dosing.

19. What is the maximum recommended adult daily dose of acetaminophen and its toxicity concern?

    Generally 4 g/day (lower, ~3 g, with liver disease or alcohol use). Overdose causes hepatotoxicity; antidote is acetylcysteine (Mucomyst).

20. What is the difference between a therapeutic effect, a side effect, and an adverse effect?

    Therapeutic effect = intended beneficial response; side effect = predictable, usually mild secondary effect; adverse effect = unintended, harmful, often serious reaction requiring intervention.

21. What is the difference between pharmacokinetics and pharmacodynamics?

    Pharmacokinetics = what the body does to the drug (absorption, distribution, metabolism, excretion). Pharmacodynamics = what the drug does to the body (mechanism of action and effects).

22. What is the difference between an agonist and an antagonist drug?

    An agonist binds a receptor and activates it to produce a response; an antagonist binds the receptor and blocks/prevents the response (no activation).

23. What is the difference between a drug's peak and trough levels in therapeutic drug monitoring?

    Peak = highest serum concentration (drawn after administration/absorption) to assess toxicity risk; trough = lowest concentration (drawn just before the next dose) to ensure a therapeutic minimum.

24. What is the therapeutic serum range and toxicity sign for digoxin?

    Therapeutic: 0.5-2.0 ng/mL. Early toxicity signs: anorexia, nausea/vomiting, visual disturbances (yellow-green halos), bradycardia, dysrhythmias. Hold for apical pulse <60. Hypokalemia increases toxicity risk.

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