Pharmacological and Parenteral Therapies: Rights, Calculations, and Monitoring
What you must understand
Know the rights of medication administration (right client, drug, dose, route, time, documentation, reason, and the client's right to refuse), the three checks, and the use of two identifiers. Know high-alert medications (insulin, heparin, opioids, potassium, chemotherapy), independent double checks, and look-alike/sound-alike names. Know IV therapy basics: isotonic, hypotonic, and hypertonic solutions; flow rate calculation; infiltration versus phlebitis versus extravasation; and central line care.
Know key monitoring parameters: digoxin (apical pulse before administration; hold if below 60 in adults and notify), warfarin (INR), heparin (aPTT and platelets for HIT), insulin (blood glucose and hypoglycemia signs), potassium (never IV push; always diluted and infused at a controlled rate), and opioids (respiratory rate and sedation). Know the antidotes commonly tested: naloxone for opioids, protamine for heparin, vitamin K for warfarin, and acetylcysteine for acetaminophen.
Traps to watch
- Never give potassium by IV push; it can be fatal.
- Hold-and-notify parameters are commonly the point of the question.
- Infiltration is cool, pale, and swollen; phlebitis is warm, red, and painful along the vein.
- Do not crush extended-release formulations unless the order specifies.
Rule of thumb
Before any dose: verify the parameter that makes the drug safe for this client. If the parameter is outside the safe range, hold the drug and notify the provider.
Worked example
An order reads digoxin 0.25 mg PO daily. The LPN takes an apical pulse for a full minute and counts 52. The correct action is to withhold the dose, document the assessment, and notify the provider, because an adult apical pulse below 60 is a hold parameter for digoxin.