第 6 章，共 7 章15% 占考试比重
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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