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

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).

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).

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.

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.

What is the therapeutic serum range for lithium and its key nursing teaching?

Therapeutic: 0.6-1.2 mEq/L (toxic >1.5). Teach consistent sodium and fluid intake; sodium/fluid loss raises lithium levels. Signs of toxicity: tremor, diarrhea, confusion, ataxia.

What therapeutic lab values are used to monitor warfarin and heparin?

Warfarin: PT/INR (therapeutic INR usually 2-3). Heparin: aPTT (therapeutic 1.5-2.5× control) and anti-Xa levels.

What is the antidote for warfarin and for heparin overdose?

Warfarin: vitamin K (phytonadione). Heparin: protamine sulfate.

What are the signs of IV infiltration versus phlebitis at a peripheral IV site?

Infiltration: cool, pale, swollen, taut skin with slowed/stopped flow (fluid in tissue). Phlebitis: warm, red, tender, possibly a palpable cord along the vein (inflammation). Both require stopping the infusion and removing the catheter.

What is extravasation and what is the immediate nursing action?

Leakage of a vesicant (tissue-damaging) drug into surrounding tissue. Stop the infusion immediately, leave the catheter in place to aspirate the drug, notify the provider, and follow antidote/protocol; mark the area and elevate.

How often should peripheral IV sites and IV tubing be assessed/changed per general standards?

Assess site at least every shift/hourly per policy; rotate peripheral sites and change dressings per institutional policy (often 72-96 hr). Change tubing per policy (continuous ~96 hr, lipid/blood tubing more frequently).

What is the difference between an isotonic, hypotonic, and hypertonic IV solution?

Isotonic (e.g., 0.9% NaCl, LR): stays in vascular space, expands volume. Hypotonic (e.g., 0.45% NaCl): moves water into cells, treats cellular dehydration. Hypertonic (e.g., 3% NaCl, D10): pulls fluid out of cells into vasculature.

Give an example of an isotonic, a hypotonic, and a hypertonic IV fluid.

Isotonic: 0.9% NaCl (normal saline), lactated Ringer's, D5W (in bag). Hypotonic: 0.45% NaCl. Hypertonic: 3% NaCl, D5 0.9% NaCl, D10W, D5LR.

What are the critical safety rules for administering IV potassium chloride?

Never give IV push/bolus (causes fatal cardiac arrest). Always dilute and infuse slowly (usually ≤10 mEq/hr peripherally), use an infusion pump, and ensure adequate urine output before giving.

What are the ECG/clinical signs of hyperkalemia versus hypokalemia?

Hyperkalemia: peaked T waves, widened QRS, bradycardia, muscle weakness. Hypokalemia: flattened T waves, U waves, ST depression, dysrhythmias, muscle cramps/weakness.

What type of IV solution and tubing must be used to administer packed red blood cells?

Only 0.9% normal saline (isotonic) with blood; never dextrose (hemolysis) or LR (calcium clots). Use Y-type tubing with an in-line filter and an 18-20 gauge catheter.

What are the nursing steps for monitoring during a blood transfusion?

Verify with two RNs (patient ID, blood type, unit number, expiration). Take baseline vitals, start slowly, stay with the patient for the first 15 minutes (when most reactions occur), and recheck vitals per policy. Complete each unit within 4 hours.

What is the immediate nursing action if a transfusion (hemolytic) reaction is suspected?

Stop the transfusion immediately, keep the IV line open with normal saline using new tubing, notify the provider and blood bank, monitor vitals, and send the blood bag and a blood/urine sample for analysis.

What are the signs of an acute hemolytic transfusion reaction?

Fever, chills, low back/flank pain, hypotension, tachycardia, dyspnea, chest pain, hemoglobinuria (red/brown urine), and a sense of impending doom—from ABO incompatibility.

What route of administration is required for total parenteral nutrition (TPN) and why?

A central venous catheter (e.g., PICC or central line), because TPN is hypertonic (high dextrose/osmolarity) and would damage peripheral veins. It must be infused via a pump with a filter.

What are key nursing care priorities for a patient receiving TPN?

Monitor blood glucose regularly (risk of hyper/hypoglycemia), use strict aseptic technique (infection risk), never abruptly stop (taper to prevent rebound hypoglycemia), monitor electrolytes/weight, and use a dedicated line.

What is the mechanism and key teaching for ACE inhibitors ("-pril" drugs)?

Block conversion of angiotensin I to II, lowering blood pressure. Teach about dry cough, risk of hyperkalemia and angioedema, first-dose hypotension; contraindicated in pregnancy.

What is the key difference in action between beta-blockers and calcium channel blockers?

Beta-blockers ("-olol") block beta receptors to lower HR, BP, and contractility (hold for HR <60). Calcium channel blockers ("-dipine", diltiazem, verapamil) block calcium to relax vessels and lower BP; some also slow heart rate.

What is the mechanism of statins and their major adverse effects to monitor?

HMG-CoA reductase inhibitors lower LDL cholesterol. Monitor for myopathy/rhabdomyolysis (muscle pain, elevated CK) and hepatotoxicity (monitor LFTs). Take in the evening; avoid grapefruit juice.

What is the onset, peak, and key safety concern for rapid-acting insulin (e.g., lispro, aspart)?

Onset ~15 minutes, peak ~30-90 minutes, duration 3-5 hours. Give right before/with a meal; food must be available to prevent hypoglycemia.

What are the signs of hypoglycemia and the "rule of 15" for treatment?

Signs: shakiness, sweating, tachycardia, confusion, hunger, irritability. Rule of 15: give 15 g fast-acting carbohydrate, recheck glucose in 15 minutes, repeat if still <70 mg/dL. If unconscious: IV dextrose or glucagon.

What is the mechanism and major safety concern of metformin?

Decreases hepatic glucose production and increases insulin sensitivity (does not cause hypoglycemia alone). Risk of lactic acidosis; hold before/after IV contrast and in renal impairment. Monitor renal function.

Why must many antibiotics (e.g., penicillins, cephalosporins) be given for the full prescribed course, and what is the priority assessment before the first dose?

To fully eradicate the organism and prevent antibiotic resistance. Priority: assess for drug allergies (e.g., penicillin) and obtain ordered culture specimens before the first dose.

What is "red man syndrome" with vancomycin and how is it prevented?

Flushing, erythema, and pruritus of the face/neck/upper body caused by infusing vancomycin too rapidly (histamine release). Prevent by infusing slowly (over at least 60 minutes); monitor trough levels for nephrotoxicity/ototoxicity.

What are the key adverse effects to monitor with aminoglycosides (e.g., gentamicin)?

Nephrotoxicity and ototoxicity (irreversible hearing loss/vestibular damage). Monitor peak and trough levels, renal function (BUN/creatinine), and hearing.

What is serotonin syndrome and which drug class is most associated with it?

A potentially life-threatening reaction (agitation, hyperthermia, tachycardia, hyperreflexia, tremor, diaphoresis) from excess serotonin—associated with SSRIs/SNRIs, especially when combined with MAOIs or other serotonergic drugs.

What dietary restriction is critical for patients taking MAOIs and why?

Avoid tyramine-rich foods (aged cheeses, cured/smoked meats, fermented foods, red wine, soy sauce). Tyramine with MAOIs can trigger a hypertensive crisis (severe headache, elevated BP, palpitations).