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RN Pharmacology for Nursing

REVIEW MODULE EDITION 8.0

Contributors
Honey C. Holman, MSN, RN

Debborah Williams, MSN, RN

Sheryl Sommer, PhD, RN, CNE

Consultants
Janean Johnson, MSN, RN, CNE
Tracey Bousquet, BSN, RN
Brenda S. Ball, MEd, BSN, RN
Penny Fauber, PhD, MS, BSN, RN
Cindy Morris, DNP, RN, IBCLC
Jenni L. Hoffman, DNP,
LaKeisha Wheless, MSN, RN FNP-C, CLNC, FAANP
Mendy G. McMichael, DNP, RN Jessica L. Johnson, DNP, MSN, BSN, RN

Pamela Roland, MSN, MBA, RN Lisa Kongable, MA, ARNP, PMHCNS, CNE

Peggy Leehy, MSN, RN Melanie P. Schrader, PhD, RN

Robin Hertel, EdS, MSN, RN, CMSRN Virginia Tufano, EdD, MSN, RN

INTELLECTUAL PROPERTY NOTICE

ATI Nursing is a division of Assessment Technologies Institute®, LLC.

Copyright © 2019 Assessment Technologies Institute, LLC. All rights reserved.

The reproduction of this work in any electronic, mechanical, or other means, now known or hereafter
invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the
content in this publication, including, for example, the cover, all of the page headers, images, illustrations,
graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual
property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by
third parties who have licensed their materials to Assessment Technologies Institute, LLC.

RN PHARMACOLOGY FOR NURSING I

07/24/15 April 19, 2019 9:51 AM rm_rn_2019_pharm_FRONT-MATTER 07/24

Director of content review: Kristen Lawler

Director of development: Derek Prater

Project management: Tiffany Pavlik, Shannon Tierney

Coordination of content review: Honey C. Holman, Debborah Williams

Copy editing: Kelly Von Lunen, Bethany Phillips, Kya Rodgers, Joshua Hoeven

Layout: Spring Lenox, Maureen Bradshaw, Bethany Phillips

Illustrations: Randi Hardy

Online media: Brant Stacy, Ron Hanson, Britney Fuller, Barry Wilson

Cover design: Jason Buck

Interior book design: Spring Lenox

IMPORTANT NOTICE TO THE READER

Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for
informational and educational purposes only and may be modified or updated by the publisher at any time. This
publication is not providing medical advice and is not intended to be a substitute for professional medical advice,
diagnosis, or treatment. The publisher has designed this publication to provide accurate information regarding the
subject matter covered; however, the publisher is not responsible for errors, omissions, or for any outcomes related to
the use of the contents of this book and makes no guarantee and assumes no responsibility or liability for the use of the
products and procedures described or the correctness, sufficiency, or completeness of stated information, opinions, or
recommendations. The publisher does not recommend or endorse any specific tests, providers, products, procedures,
processes, opinions, or other information that may be mentioned in this publication. Treatments and side effects described
in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect
that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by
the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice,
and government regulations often change the accepted standard in this field. When consideration is being given to use
of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the
drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations
on dose, precautions, and contraindications and determining the appropriate usage for the product. Any references
in this book to procedures to be employed when rendering emergency care to the sick and injured are provided solely
as a general guide. Other or additional safety measures may be required under particular circumstances. This book
is not intended as a statement of the standards of care required in any particular situation, because circumstances
and a patient’s physical condition can vary widely from one emergency to another. Nor is it intended that this book
shall in any way advise personnel concerning legal authority to perform the activities or procedures discussed. Such
specific determination should be made only with the aid of legal counsel. Some images in this book feature models.
These models do not necessarily endorse, represent, or participate in the activities represented in the images. THE
PUBLISHER MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, WITH
RESPECT TO THE CONTENT HEREIN. THIS PUBLICATION IS PROVIDED AS-IS, AND THE PUBLISHER AND ITS AFFILIATES
SHALL NOT BE LIABLE FOR ANY ACTUAL, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY
DAMAGES RESULTING, IN WHOLE OR IN PART, FROM THE READER’S USE OF, OR RELIANCE UPON, SUCH CONTENT.

II CONTENT MASTERY SERIES

07/24/15 April 19, 2019 9:51 AM rm_rn_2019_pharm_FRONT-MATTER

User’s Guide
Welcome to the Assessment Technologies Institute® RN ACTIVE LEARNING SCENARIOS
Pharmacology for Nursing Review Module Edition 8.0. The AND APPLICATION EXERCISES
mission of ATI’s Content Mastery Series® Review Modules
Each chapter includes opportunities for you to test your
is to provide user-friendly compendiums of nursing
knowledge and to practice applying that knowledge. Active
knowledge that will:
Learning Scenario exercises pose a nursing scenario
● Help you locate important information quickly.
and then direct you to use an ATI Active Learning
● Assist in your learning efforts.

Template (included at the back of this book) to record

● Provide exercises for applying your nursing knowledge.
the important knowledge a nurse should apply to the
● Facilitate your entry into the nursing profession as a
scenario. An example is then provided to which you can
newly licensed nurse.
compare your completed Active Learning Template. The
This newest edition of the Review Modules has been Application Exercises include NCLEX-style questions, such
redesigned to optimize your learning experience. We’ve as multiple-choice and multiple-select items, providing
fit more content into less space and have done so in a you with opportunities to practice answering the kinds of
way that will make it even easier for you to find and questions you might expect to see on ATI assessments or
understand the information you need. the NCLEX. After the Application Exercises, an answer key
is provided, along with rationales.

ORGANIZATION NCLEX® CONNECTIONS

This Review Module is organized into units covering To prepare for the NCLEX-RN, it is important to
pharmacological principles (Unit 1) and medications understand how the content in this Review Module
affecting the body systems and physiological processes is connected to the NCLEX-RN test plan. You can find
(Units 2 to 13). Chapters within these units conform to one information on the detailed test plan at the National
of two organizing principles for presenting the content. Council of State Boards of Nursing’s website, www.ncsbn.
● Nursing concepts org. When reviewing content in this Review Module,
● Medications regularly ask yourself, “How does this content fit into
the test plan, and what types of questions related to this
Nursing concepts chapters begin with an overview
content should I expect?”
describing the central concept and its relevance to nursing.
Subordinate themes are covered in outline form to To help you in this process, we’ve included NCLEX
demonstrate relationships and present the information in Connections at the beginning of each unit and with each
a clear, succinct manner. question in the Application Exercises Answer Keys. The
NCLEX Connections at the beginning of each unit point
Medications chapters include an overview describing a
out areas of the detailed test plan that relate to the content
disorder or group of disorders. Medications used to treat
within that unit. The NCLEX Connections attached to the
these disorders are grouped according to classification.
Application Exercises Answer Keys demonstrate how each
A specific medication can be selected as a prototype or
exercise fits within the detailed content outline.
example of the characteristics of medications in this
These NCLEX Connections will help you understand how
classification. These sections include information about
the detailed content outline is organized, starting with
how the medication works and its therapeutic uses.
major client needs categories and subcategories and
Next, you will find information about complications,
followed by related content areas and tasks. The major
contraindications/precautions, and interactions, as well as
client needs categories are:
nursing interventions and client education to help prevent ● Safe and Effective Care Environment
and/or manage these issues. Finally, the chapter includes ◯ Management of Care

information on nursing administration of the medication ◯ Safety and Infection Control

and evaluation of the medication’s effectiveness. ● Health Promotion and Maintenance

● Psychosocial Integrity
● Physiological Integrity
◯ Basic Care and Comfort

◯ Pharmacological and Parenteral Therapies

◯ Reduction of Risk Potential

◯ Physiological Adaptation

An NCLEX Connection might, for example, alert you that

content within a unit is related to:
● Pharmacological and Parenteral Therapies
◯ Adverse Effects/Contraindications/Side Effects/

Interactions
■ Identify a contraindication to the administration of

a medication to the client.

RN PHARMACOLOGY FOR NURSING USER’S GUIDE III

07/24/15 April 19, 2019 9:51 AM rm_rn_2019_pharm_FRONT-MATTER

QSEN COMPETENCIES ICONS

As you use the Review Modules, you will note the Icons are used throughout the Review Module to draw
integration of the Quality and Safety Education for your attention to particular areas. Keep an eye out for
Nurses (QSEN) competencies throughout the chapters. these icons.
These competencies are integral components of the
curriculum of many nursing programs in the United States This icon is used for NCLEX Connections.
and prepare you to provide safe, high-quality care as a
newly licensed nurse. Icons appear to draw your attention This icon indicates gerontological considerations,
to the six QSEN competencies. or knowledge specific to the care of older
adult clients.
Safety: The minimization of risk factors that could
cause injury or harm while promoting quality care This icon is used for content related to safety
and maintaining a secure environment for clients, self, and is a QSEN competency. When you see this
and others. icon, take note of safety concerns or steps that
nurses can take to ensure client safety and a
Patient-Centered Care: The provision of caring and
safe environment.
compassionate, culturally sensitive care that addresses
clients’ physiological, psychological, sociological, spiritual, This icon is a QSEN competency that indicates
and cultural needs, preferences, and values. the importance of a holistic approach to
providing care.
Evidence-Based Practice: The use of current knowledge
from research and other credible sources, on which to base This icon, a QSEN competency, points out the
clinical judgment and client care. integration of research into clinical practice.

Informatics: The use of information technology as a This icon is a QSEN competency and highlights
communication and information-gathering tool that the use of information technology to support
supports clinical decision-making and scientifically based nursing practice.
nursing practice.
This icon is used to focus on the QSEN
Quality Improvement: Care related and organizational competency of integrating planning processes to
processes that involve the development and meet clients’ needs.
implementation of a plan to improve health care services
This icon highlights the QSEN competency of care
and better meet clients’ needs.
delivery using an interprofessional approach.
Teamwork and Collaboration: The delivery of client care
This icon appears at the top-right of pages
in partnership with multidisciplinary members of the
and indicates availability of an online media
health care team to achieve continuity of care and positive
supplement, such as a graphic, animation, or
client outcomes.
video. If you have an electronic copy of the
Review Module, this icon will appear alongside
clickable links to media supplements. If you have
a hard copy version of the Review Module, visit
www.atitesting.com for details on how to access
these features.

FEEDBACK
ATI welcomes feedback regarding this Review Module.
Please provide comments to [email protected].

As needed updates to the Review Modules are identified,

changes to the text are made for subsequent printings
of the book and for subsequent releases of the electronic
version. For the printed books, print runs are based
on when existing stock is depleted. For the electronic
versions, a number of factors influence the update
schedule. As such, ATI encourages faculty and students to
refer to the Review Module addendums for information on
what updates have been made. These addendums, which
are available in the Help/FAQs on the student site and the
Resources/eBooks & Active Learning on the faculty site,
are updated regularly and always include the most current
information on updates to the Review Modules.

IV USER’S GUIDE CONTENT MASTERY SERIES

07/24/15 April 19, 2019 9:14 AM rm_rn_2019_pharm_TOC

Table of Contents
NCLEX® Connections 1

UNIT 1 Pharmacological Principles 3

CHAPTER 1 Pharmacokinetics and Routes of Administration 3

CHAPTER 2 Safe Medication Administration and Error Reduction 11

CHAPTER 3 Dosage Calculation 19

CHAPTER 4 Intravenous Therapy 35

CHAPTER 5 Adverse Effects, Interactions, and Contraindications 39

CHAPTER 6 Individual Considerations of Medication Administration 45

NCLEX® Connections 49

UNIT 2 Medications Affecting the Nervous System 51

CHAPTER 7 Anxiety and Trauma- and Stressor-Related Disorders 51

CHAPTER 8 Depressive Disorders 57

CHAPTER 9 Bipolar Disorders 67

CHAPTER 10 Psychotic Disorders 73

CHAPTER 11 Medications for Children and Adolescents Who Have Mental Health Issues 81

CHAPTER 12 Substance Use Disorders 91

CHAPTER 13 Chronic Neurologic Disorders 97

CHAPTER 14 Eye and Ear Disorders 109

Eye disorders 109

Ear disorders 113

CHAPTER 15 Miscellaneous Central Nervous System Medications 117

CHAPTER 16 Sedative-Hypnotics 123

RN PHARMACOLOGY FOR NURSING TABLE OF CONTENTS V

07/24/15 April 19, 2019 9:14 AM rm_rn_2019_pharm_TOC 07/24

NCLEX® Connections 129

UNIT 3 Medications Affecting the Respiratory

System 131
CHAPTER 17 Airflow Disorders 131

CHAPTER 18 Upper Respiratory Disorders 139

NCLEX® Connections 145

UNIT 4 Medications Affecting the Cardiovascular

System 147
CHAPTER 19 Medications Affecting Urinary Output 147

CHAPTER 20 Medications Affecting Blood Pressure 155

CHAPTER 21 Cardiac Glycosides and Heart Failure 167

CHAPTER 22 Angina 173

CHAPTER 23 Medications Affecting Cardiac Rhythm 177

CHAPTER 24 Antilipemic Agents 185

NCLEX® Connections 191

UNIT 5 Medications Affecting the Hematologic

System 193
CHAPTER 25 Medications Affecting Coagulation 193

CHAPTER 26 Growth Factors 205

CHAPTER 27 Blood and Blood Products 211

VI TABLE OF CONTENTS CONTENT MASTERY SERIES

07/24/15 April 19, 2019 9:14 AM rm_rn_2019_pharm_TOC

NCLEX® Connections 217

UNIT 6 Medications Affecting the Gastrointestinal

System and Nutrition 219
CHAPTER 28 Peptic Ulcer Disease 219

CHAPTER 29 Gastrointestinal Disorders 225

CHAPTER 30 Vitamins and Minerals 235

NCLEX® Connections 243

UNIT 7 Medications Affecting the Reproductive

System 245
CHAPTER 31 Medications Affecting the Reproductive Tract 245

CHAPTER 32 Medications Affecting Labor and Delivery 255

NCLEX® Connections 263

UNIT 8 Medications for Joint and Bone

Conditions 265
CHAPTER 33 Connective Tissue Disorders 265

CHAPTER 34 Bone Disorders 275

NCLEX® Connections 281

UNIT 9 Medications for Pain and Inflammation 283

CHAPTER 35 Non-Opioid Analgesics 283

CHAPTER 36 Opioid Agonists and Antagonists 287

CHAPTER 37 Adjuvant Medications for Pain 293

CHAPTER 38 Miscellaneous Pain Medications 299

RN PHARMACOLOGY FOR NURSING TABLE OF CONTENTS VII

07/24/15 April 19, 2019 9:14 AM rm_rn_2019_pharm_TOC 07/24

NCLEX® Connections 307

UNIT 10 Medications Affecting the Endocrine

System 309
CHAPTER 39 Diabetes Mellitus 309

CHAPTER 40 Endocrine Disorders 319

NCLEX® Connections 329

UNIT 11 Medications Affecting the Immune System 331

CHAPTER 41 Immunizations 331

CHAPTER 42 Chemotherapy Agents 337

Cytotoxic chemotherapy agents 337

Noncytotoxic chemotherapy agents 347

NCLEX® Connections 355

UNIT 12 Medications for Infection 357

CHAPTER 43 Principles of Antimicrobial Therapy 357

CHAPTER 44 Antibiotics Affecting the Bacterial Cell Wall 361

CHAPTER 45 Antibiotics Affecting Protein Synthesis 367

CHAPTER 46 Urinary Tract Infections 373

CHAPTER 47 Mycobacterial, Fungal, and Parasitic Infections 379

CHAPTER 48 Viral Infections, HIV, and AIDS 385

VIII TABLE OF CONTENTS CONTENT MASTERY SERIES

07/24/15 April 19, 2019 9:14 AM rm_rn_2019_pharm_TOC

NCLEX® Connections 393

UNIT 13 Other Medications 395

CHAPTER 49 Complementary, Alternative, and Integrative Therapies 395

References 401

Active Learning Templates A1

Basic Concept A1

Diagnostic Procedure A3

Growth and Development A5

Medication A7

Nursing Skill A9

System Disorder A11

Therapeutic Procedure A13

Concept Analysis A15

RN PHARMACOLOGY FOR NURSING TABLE OF CONTENTS IX

07/24/15 April 19, 2019 9:14 AM rm_rn_2019_pharm_TOC

X TABLE OF CONTENTS CONTENT MASTERY SERIES

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