Pharmacological and Parenteral Therapies
What this domain tests
Safe administration, calculation, monitoring, and rescue. The rights of medication administration (client, drug, dose, route, time, documentation, reason, and the client's right to refuse) anchor every item. High-alert medications - insulin, heparin, opioids, potassium, chemotherapy, and concentrated electrolytes - require independent double-checks. Potassium is never given IV push and never given undiluted; it is always infused with a pump, diluted, and with cardiac monitoring at high rates.
Skills to own
Dimensional analysis or desired-over-have-times-quantity for dosing; weight-based pediatric dosing with a safe-range check; IV flow-rate calculation; interpreting peak and trough levels; recognizing anaphylaxis and transfusion reactions (stop the infusion, keep the line patent with normal saline, notify the provider and blood bank).
Antidotes and levels
Protamine for heparin; vitamin K (phytonadione) for warfarin; naloxone for opioids; flumazenil for benzodiazepines; acetylcysteine for acetaminophen; digoxin immune Fab for digoxin toxicity; calcium gluconate for magnesium sulfate toxicity. Insulin timing matters: rapid-acting analogs act in about 15 minutes and are given with meals; regular insulin about 30 minutes before meals; glargine is peakless and never mixed with other insulins.
Traps
Holding a medication without notifying the provider; giving a dose that 'looks high' without recalculating; mixing glargine; giving potassium by IV push; checking a trough after the drug is given; forgetting to assess apical pulse before digoxin or blood pressure before an antihypertensive.
Worked rule
When a prescribed dose falls outside the safe range, stop, recalculate, and clarify with the prescriber before giving anything.