Pharmacological and Parenteral Therapies
Medication safety and parenteral care
Pharmacology questions combine the rights of medication administration with client monitoring. Verify the right client, drug, dose, route, time, reason, and documentation; use two identifiers and an independent double-check for high-alert drugs such as insulin, heparin, and opioids per policy. Calculate carefully, check the dose against weight or renal function when relevant, and question unclear orders. Know common adverse effects, holding parameters, interactions, and teaching. For example, assess the apical pulse before giving digoxin and hold for a rate below the ordered parameter, usually 60 beats per minute in adults, while notifying the provider. Do not skip a dose based on a laboratory value without a protocol or order.
Parenteral therapy requires aseptic technique, patency checks, and rate control. For intravenous fluids, monitor site, rate, intake and output, and signs of overload. For blood products, use the correct tubing and normal saline, begin slowly, stay with the client for the first 15 minutes, and stop the transfusion for a reaction. Total parenteral nutrition requires dedicated line care and gradual rate changes per policy. Medication reconciliation prevents omissions and duplicates. Older adults and children have higher risk from dosing errors and adverse effects. Controlled substances require accurate counting and wasting with a witness.
Trap and worked example
Traps include giving a drug because it is 'ordered' despite a wrong dose, checking only one identifier, and treating a transfusion reaction by slowing the rate. Worked example: an order reads 10 units of insulin, but the client's usual dose is 4 units and the glucose is normal. The nurse does not give the dose; the nurse clarifies the order and documents. Rule of thumb: when in doubt, stop and verify.