Pharmacological and Parenteral Therapies
What this domain tests
This domain asks you to administer medications and fluids safely and to recognize and respond to adverse effects. You do not need to memorize every drug, but you must know the high-alert medications, key monitoring parameters, and the rights of administration.
Concepts to master
- Rights of administration: right client (two identifiers), drug, dose, route, time, documentation, and reason; plus the right to refuse.
- High-alert drugs: insulin, heparin, opioids, and concentrated electrolytes. Insulin and heparin require an independent double-check; never "eyeball" a dose.
- IV therapy: calculate flow rates, know isotonic versus hypotonic versus hypertonic fluids, and monitor for infiltration, phlebitis, and fluid overload.
- Therapeutic drug monitoring: draw trough levels before the next dose and peak levels after administration per protocol; monitor for toxicity (for example, vancomycin, digoxin, aminoglycosides).
- Anticoagulants: monitor aPTT for heparin and INR for warfarin; know antidotes (protamine, vitamin K).
- Adverse-effect recognition: anaphylaxis, hypoglycemia, bleeding, and respiratory depression from opioids.
Traps
When a client shows signs of a reaction, the first action is usually to stop the infusion or hold the drug and assess - not to chart and call later. Do not crush extended-release tablets. Do not give potassium by IV push. Verify calculations and question any dose that seems unusual.
Rule of thumb
Before giving any drug, run the three checks plus two identifiers, and know the one thing you must monitor after administration (blood pressure, glucose, INR, respiratory rate).
Worked example: A client on IV heparin has an aPTT far above the therapeutic range and new gum bleeding. The nurse stops the infusion, assesses for bleeding, notifies the provider, and anticipates protamine sulfate - the antidote.