Chapter 6 of 715% of exam

Pharmacological and Parenteral Therapies

Pharmacological and Parenteral Therapies tests safe medication administration, dosage calculation, monitoring for therapeutic and adverse effects, and management of high-alert drugs. The nurse applies the rights of medication administration and drug-class knowledge to protect the client.

Safe Medication Administration

The nurse follows the rights of medication administration and verifies identity and allergies before giving any drug. Safe practice prevents errors.

Apply the rights

Verify the right client, drug, dose, route, time, and documentation.

Honor allergies

Hold any drug the client is allergic to and notify the prescriber.

Verify identity

Use two identifiers before administering medications.

Document accurately

Record administration promptly and never chart a drug before giving it.

Dosage Calculation

Accurate calculation prevents underdosing and overdosing. The nurse uses the desired-over-available method and double-checks high-risk calculations.

Use desired over available

Divide the ordered dose by the dose on hand and multiply by the quantity.

Double-check high-alert drugs

Have a second nurse verify insulin, heparin, and pediatric doses.

Convert units carefully

Ensure consistent units before calculating to avoid tenfold errors.

Question unusual doses

Verify any dose that seems too high or requires many tablets or vials.

Drug Classes and Monitoring

The nurse monitors laboratory values and vital signs specific to each drug class to ensure safety and efficacy. Class-specific parameters guide administration.

Monitor anticoagulants

Use PT and INR for warfarin and aPTT for heparin; protamine reverses heparin and vitamin K reverses warfarin.

Check cardiac drugs

Hold digoxin for an apical rate below 60 and assess heart rate and blood pressure before beta-blockers.

Watch diuretics

Loop diuretics such as furosemide can cause hypokalemia; monitor potassium.

Monitor nephrotoxic antibiotics

Check renal function and peak and trough levels with aminoglycosides.

Adverse Effects and Toxicity

The nurse recognizes adverse effects, toxicity, and required teaching for common medications. Early recognition prevents harm.

Recognize opioid effects

Assess respiratory rate and sedation and initiate a bowel regimen to prevent constipation.

Detect lithium toxicity

Vomiting, coarse tremors, and confusion signal toxicity due to the narrow therapeutic range.

Teach ACE inhibitor cough

A persistent dry cough is common, and angioedema is a rare emergency.

Taper corticosteroids

Do not stop long-term steroids abruptly; taper to prevent adrenal insufficiency.

Parenteral and High-Alert Therapies

The nurse safely administers IV therapies, including high-alert electrolytes, and manages timing-sensitive drugs. Special precautions prevent fatal errors.

Never IV push potassium

Dilute IV potassium and infuse slowly with a pump; rapid administration can be fatal.

Time insulin with food

Ensure rapid-acting insulin such as lispro is followed by food within about 15 minutes.

Give blood with saline

Infuse blood products with normal saline only and verify with a second nurse.

Teach food and drug interactions

Avoid tyramine with MAOIs and separate tetracycline from dairy and antacids.

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Physiological Adaptation and Reduction of Risk

Last updated: July 2026