Physiological Integrity: Pharmacological and Parenteral Therapies
Pharmacological and Parenteral Therapies
This domain tests safe medication administration, dosage calculation, IV therapy, blood products, and parenteral nutrition. Accuracy depends on unit conversion, verification, and monitoring for adverse effects.
Core rules
- Follow the rights of medication administration and perform three checks against the order, label, and client identifiers.
- High-alert medications (insulin, heparin, opioids, chemotherapy) require independent double-checks and standardized concentrations.
- Calculate doses with dimensional analysis and round only at the end. Convert pounds to kilograms by dividing by 2.2.
- IV flow rate (gtt/min) = (volume in mL × drop factor) ÷ time in minutes.
- Blood transfusion: two-nurse verification, baseline vitals, start slowly, stay with the client for the first 15 minutes, and stop the transfusion if a reaction is suspected.
- Monitor peak and trough levels for vancomycin and aminoglycosides; draw troughs before the next dose.
Worked example
An order is 1,000 mL over 8 hours with a 15 gtt/mL drop factor. Convert 8 hours to 480 minutes. Then (1,000 × 15) ÷ 480 = 15,000 ÷ 480 = 31.25, rounded to 31 gtt/min. If the order were 500 mg and the vial is 250 mg/5 mL, then (500 ÷ 250) × 5 = 10 mL. Showing the unit cancellation prevents the common error of inverting the ratio.
Traps that cost marks
Rounding before the final step; confusing milligrams and micrograms; giving IV push medications rapidly; infusing blood with dextrose-containing solutions; checking compatibility after hanging the drug.