Pharmacological and Parenteral Therapies
Pharmacological and Parenteral Therapies
This domain tests safe medication administration, dosage calculation, IV therapy, blood transfusion, high-alert medications, and monitoring for adverse effects. The exam prioritizes client identification, independent double-checks, and early recognition of harm.
Safe administration and calculations
- Follow the rights: right client, drug, dose, route, time, reason, and documentation; the client also has the right to refuse.
- Perform three checks: when removing the medication, when preparing it, and at the bedside.
- Use two client identifiers and an independent double-check for high-alert drugs such as insulin, heparin, opioids, and chemotherapy.
- Dose = (desired dose ÷ available dose) × volume. IV rate (mL/h) = total volume ÷ total hours.
- Pediatric doses are weight-based (mg/kg) and must not exceed the adult maximum.
IV therapy and blood transfusion
- Assess the IV site for phlebitis, infiltration, and infection; label and change tubing per policy.
- Blood: verify consent, perform two-person bedside verification, take baseline vital signs, start slowly, and stay with the client for the first 15 minutes.
- If a transfusion reaction occurs, stop the transfusion, keep the line open with normal saline, notify the provider, and return the bag and tubing.
- TPN requires a dedicated line; do not stop it abruptly because of hypoglycemia risk.
Worked example
A child weighing 20 kg is prescribed 15 mg/kg of a medication. The dose is 15 × 20 = 300 mg. The available concentration is 100 mg/mL, so the volume is 300 ÷ 100 = 3 mL. The PN checks that 300 mg does not exceed the maximum pediatric dose, verifies the calculation with a second nurse, and administers the medication using two identifiers.
Traps that cost marks
- Mixing long-acting insulin glargine with other insulins.
- Starting a blood transfusion quickly or leaving the client during the first 15 minutes.
- Holding warfarin without checking the INR.
- Giving furosemide or digoxin without monitoring potassium.
- Treating a calculated dose as correct without checking the maximum dose.