Physiological Integrity: Pharmacological and Parenteral Therapies
What this domain tests
Pharmacological and Parenteral Therapies tests safe medication administration, dosage calculation, IV therapy, blood transfusion, high-alert medications, adverse effects, and client education. The exam expects the RN to apply the rights of administration and to recognize when to withhold and clarify.
Core rules
- Verify the right client, drug, dose, route, time, reason, and documentation; use two identifiers.
- Calculate carefully and label units. Use dimensional analysis or ratio-proportion; check pediatric and weight-based doses against safe ranges.
- High-alert drugs (insulin, heparin, opioids, chemotherapy, concentrated electrolytes) require independent double-checks and standardized concentrations.
- For blood transfusion, verify with a second nurse, use normal saline, start slowly, stay with the client, and stop immediately for a reaction.
- Teach adverse effects and when to call; document administration and response.
Worked example
Order: 500 mg of a drug by mouth. Available: 250 mg/5 mL. Calculation: 500 mg ÷ 250 mg = 2; 2 × 5 mL = 10 mL. The nurse measures 10 mL, checks the order and client identity, and documents. Reasoning: the dose is not 5 mL; the available concentration contains 250 mg in each 5 mL, so 500 mg requires two 5-mL units.
Traps
- Misplacing decimals or omitting units.
- Giving a drug before resolving an unclear order.
- Hanging blood with dextrose or adding medication to the blood bag.
- Checking only the label, not the client's allergies and indication.