Introduction

Pharmacology is one of the most challenging yet essential areas for NCLEX preparation. Understanding medications, their uses, mechanisms, and nursing considerations can make a difference in clinical decision-making. This guide provides an in-depth look at commonly tested medications and includes examples of when nurses may use them in practice, along with key nursing actions.

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

Mechanism: Decrease heart rate and blood pressure by blocking beta-adrenergic receptors.

Uses: Hypertension, angina, heart failure, and post-myocardial infarction.

Example in Practice:

• A nurse is caring for a patient with hypertension and a heart rate of 72 bpm. The provider prescribes metoprolol to control the patient’s blood pressure.

Nursing Actions:

• Assess heart rate and blood pressure before administration. Hold the dose if the heart rate is below 60 bpm.

• Monitor for signs of hypotension or bronchospasm, especially in patients with asthma or COPD.

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

Mechanism: Inhibit calcium ion influx into cardiac and smooth muscle, promoting vasodilation and reducing cardiac workload.

Uses: Hypertension, angina, atrial fibrillation.

Example in Practice:

• A patient with stable angina complains of chest pain on exertion. The provider prescribes amlodipine to improve blood flow and reduce symptoms.

Nursing Actions:

• Monitor for peripheral edema, hypotension, or bradycardia.

• Teach patients to avoid grapefruit juice, which can increase medication levels.

3. Cardiac Glycosides (e.g., Digoxin)

Mechanism: Increases cardiac contractility and slows conduction through the AV node.

Uses: Heart failure and atrial fibrillation.

Example in Practice:

• A patient with heart failure is admitted with worsening shortness of breath. Digoxin is prescribed to improve cardiac output.

Nursing Actions:

• Monitor for digoxin toxicity (e.g., nausea, vomiting, visual changes).

• Check apical pulse for one full minute before administering; hold if the heart rate is below 60 bpm.

• Assess potassium levels, as hypokalemia increases toxicity risk.

4. Antidepressants (e.g., Fluoxetine, Sertraline)

Mechanism: Increase serotonin levels in the brain by inhibiting serotonin reuptake.

Uses: Depression, anxiety disorders, obsessive-compulsive disorder.

Example in Practice:

• A patient reports feeling anxious and unable to focus. Sertraline is prescribed to manage anxiety symptoms.

Nursing Actions:

• Monitor for side effects, such as insomnia or sexual dysfunction.

• Watch for increased suicidal ideation, especially during the first few weeks of therapy.

5. Anticoagulants (e.g., Warfarin, Heparin)

Mechanism: Prevent clot formation by interfering with the clotting cascade.

Uses: Deep vein thrombosis (DVT), pulmonary embolism (PE), atrial fibrillation.

Example in Practice:

• A post-surgical patient is at high risk for developing DVT. Heparin is prescribed as a prophylactic measure.

Nursing Actions:

• For warfarin, monitor INR (therapeutic range is 2-3).

• For heparin, monitor aPTT and platelet counts. Watch for signs of bleeding, including bruising and hematuria.

6. Antibiotics (e.g., Amoxicillin, Gentamicin, Doxycycline)

Mechanism: Destroy bacteria or inhibit their growth.

Uses: Treat bacterial infections, such as pneumonia, UTIs, and skin infections.

Example in Practice:

• A child with strep throat is prescribed amoxicillin.

Nursing Actions:

• Assess for allergies before administration.

• Teach patients to complete the full course of antibiotics to prevent resistance.

• Monitor for side effects, such as diarrhea or signs of a superinfection.

7. Diuretics (e.g., Furosemide, Spironolactone)

Mechanism: Promote the excretion of sodium and water through the kidneys.

Uses: Edema, heart failure, hypertension.

Example in Practice:

• A patient with congestive heart failure presents with peripheral edema and shortness of breath. Furosemide is prescribed to reduce fluid overload.

Nursing Actions:

• Monitor for dehydration and electrolyte imbalances, especially hypokalemia with loop diuretics.

• Encourage morning dosing to prevent nocturia.

8. Insulin (e.g., Lispro, Regular, NPH, Glargine)

Mechanism: Facilitates glucose uptake by cells to lower blood sugar levels.

Uses: Diabetes mellitus (Type 1 and Type 2).

Example in Practice:

• A diabetic patient with a blood sugar level of 250 mg/dL is prescribed rapid-acting lispro before meals.

Nursing Actions:

• Monitor blood glucose levels before administration.

• Ensure the patient eats within 15 minutes after administering rapid-acting insulin.

• Rotate injection sites to prevent lipodystrophy.

9. Analgesics (e.g., Morphine, Acetaminophen)

Mechanism: Relieve pain by interacting with pain receptors or reducing inflammation.

Uses: Acute and chronic pain, post-surgical pain.

Example in Practice:

• A post-operative patient rates their pain as 8/10. The provider prescribes morphine.

Nursing Actions:

• Assess pain levels before and after administration.

• Monitor for respiratory depression and constipation.

• Teach patients to avoid alcohol while on opioids.

10. Bronchodilators (e.g., Albuterol, Ipratropium)

Mechanism: Relax bronchial smooth muscle to improve airflow.

Uses: Asthma, chronic obstructive pulmonary disease (COPD).

Example in Practice:

• A patient with asthma experiences wheezing and shortness of breath. The provider orders albuterol via inhaler.

Nursing Actions:

• Educate patients on proper inhaler technique.

• Monitor for side effects, such as tachycardia and tremors.

Sample NCLEX Questions

1. A patient on warfarin has an INR of 4.5. What is the most appropriate nursing action?

a. Administer the next dose as scheduled

b. Administer vitamin K

c. Hold the next dose and notify the provider

d. Increase dietary intake of green leafy vegetables

Answer: c. Hold the next dose and notify the provider.

2. A nurse is about to administer furosemide to a patient. Which finding requires intervention?

a. Potassium level of 3.0 mEq/L

b. Blood pressure of 140/80 mmHg

c. Heart rate of 72 bpm

d. Peripheral edema

Answer: a. Potassium level of 3.0 mEq/L.

3. A patient prescribed digoxin reports nausea and blurred vision. What is the priority nursing action?

a. Administer the next dose as prescribed

b. Assess digoxin levels and notify the provider

c. Encourage the patient to drink fluids

d. Monitor blood pressure and heart rate

Answer: b. Assess digoxin levels and notify the provider.

4. A diabetic patient receives lispro insulin before breakfast but becomes busy and skips the meal. What is the nurse’s priority action?

a. Encourage the patient to eat immediately

b. Administer glucagon

c. Reassess blood glucose levels

d. Monitor for signs of hypoglycemia

Answer: d. Monitor for signs of hypoglycemia.

Conclusion

Mastering pharmacology is vital for NCLEX success and effective nursing practice. Understanding when and how to use these medications, along with appropriate nursing considerations, ensures safe and patient-centered care. Make pharmacology a strength, not a stress, as you prepare for the NCLEX and beyond