Medication Helps and Hints for NCLEX RN

Mixed Insulins

  • It is possible to mix two types of insulins in the same syringe. They are often called 70/30 mixes.

  • A 70/30 mix usually contains 70% N insulin and 30% R insulin unless stated otherwise.

  • Remember: N (NPH) is in the numerator, so in a 70/30 mix, N is 70%.

  • To calculate the amount of N and R insulin in a mixed dose:

    • Multiply the total units by 0.70 to find the units of N insulin.

    • Multiply the total units by 0.30 to find the units of R insulin.

    • Example:

      • Healthcare provider orders 50 units of 70/30 insulin.
      • N insulin: 50 units×0.70=35 units50 \text{ units} \times 0.70 = 35 \text{ units}
      • R insulin: 50 units×0.30=15 units50 \text{ units} \times 0.30 = 15 \text{ units}
      • Always verify that the sum of the N and R units equals the total ordered units: 35+15=50 units35 + 15 = 50 \text{ units}

Drawing Up Mixed Insulins

  • Pressurize: Injecting air into a vial.

  • Draw up: Pulling medication out of a vial.

Steps for Drawing Up Mixed Insulins:

  1. Pressurize the N (NPH) insulin vial.
  2. Pressurize the R (Regular) insulin vial.
  3. Immediately draw up the R insulin.
  4. Draw up the N insulin.
  • Mnemonic: N-R-R-N (Pressurize N, Pressurize R, Draw up R, Draw up N).

Injections: IM vs. Subcutaneous (SubQ)

  • Choosing the correct gauge and length of the needle based on the route of injection.

  • Intramuscular (IM) Injections

    • The 'I' in IM looks like the number '1'.

    • Select the answer choice with a '1' in both the gauge and length.

    • Example: 21 gauge, 1-inch needle.

  • Subcutaneous Injections

    • The 'S' in SubQ looks like the number '5'.
    • Select the answer choice with a '5' in both the gauge and length.
    • Example: 25 gauge, 5/8-inch needle.

Anticoagulants: Heparin vs. Warfarin (Coumadin)

Heparin

  • Route: IV or SubQ.

  • Onset: Works immediately.

  • Duration: Cannot be on it for longer than 21 days.

  • Monitoring: Monitored by the PTT.

  • Antidote: Protamine sulfate.

  • Pregnancy: Cannot give to pregnant patients

Warfarin (Coumadin)

  • Route: PO (oral) only.

  • Onset: Takes days to work.

  • Duration: Can be taken for life.

  • Monitoring: Monitored by the PT/INR.

  • Antidote: Vitamin K.

  • Pregnancy: Cannot give to pregnant patients.

Mnemonics involving PTT and PT/INR

  • Heparin: H-E-P-A-R-I-N (7 letters) → 10 - 7 = 3 → PTT

  • Warfarin: W-A-R-F-A-R-I-N (8 letters) → 10 - 8 = 2 → PT/INR

Diuretics: Potassium Sparing vs. Potassium Wasting

  • The NCLEX primarily tests whether a diuretic spares or wastes potassium.

  • If the diuretic name ends in "-tone", it spares potassium.

    • Examples: spironolactone, aldactone.

  • If the diuretic name ends in anything other than "-tone", it wastes potassium.

    • Examples: furosemide, bumetanide.

Muscle Relaxants (e.g. Baclofen)

  • Abuse Potential: Muscle relaxants are increasingly abused, often in conjunction with prescription pain medications.

  • Important Considerations:

    1. Drowsiness.
    2. Muscle weakness.
    3. Avoid driving.
    4. Avoid alcohol.
    5. Do not be responsible for childcare of children under the age of 12 while taking muscle relaxants. Government says at age 12, a child can be alone at home. At age 11, they cannot. It's child abuse or neglect.