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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is planning care for a group of clients receiving pharmacological and parenteral therapies. Which of the following actions demonstrate safe and effective nursing practice? (Select all that apply.)

  1. Flush a central venous access device with 1010 mL of sterile 0.9%0.9\% sodium chloride before and after administering an intravenous push medication.Answer
  2. B
    Program the infusion pump to deliver 22 grams of intravenous vancomycin in 500500 mL of 0.9%0.9\% sodium chloride at a rate of 500500 mL/hr.
  3. C
    Administer a secondary intravenous infusion of ceftriaxone through the same intravenous line as a continuous lactated Ringer's infusion.
  4. Dedicate a single lumen of a multi-lumen central venous catheter exclusively for the administration of total parenteral nutrition.Answer
  5. E
    Assess the client's airway patency before stopping the infusion when a client receiving intravenous penicillin reports sudden facial swelling.
  6. Review the client's most recent serum potassium level prior to initiating a continuous intravenous infusion of potassium chloride.Answer

Answer

The correct actions represent adherence to evidence-based safety guidelines: flushing a central line with an appropriately sized syringe (1010 mL), dedicating a single catheter lumen strictly for total parenteral nutrition, and verifying baseline electrolyte values before administering potassium chloride.
Safe parenteral therapy relies on proactive risk management. Using a 1010 mL syringe to flush a central line prevents catheter rupture caused by high pressure. Dedicating a single lumen for total parenteral nutrition prevents dangerous drug interactions and minimizes central line-associated bloodstream infections. Finally, verifying serum potassium levels before initiating a potassium chloride infusion is a mandatory safety check to prevent fatal cardiac dysrhythmias.

Step-by-Step Solution

1
Evaluate the central line flushing technique.
Using a 1010 mL syringe with 0.9%0.9\% sodium chloride is identified as the correct standard.
Smaller syringes create excessive pressure that can rupture central venous catheters.
2
Analyze the vancomycin dosage calculation and infusion rate.
The rate of 500500 mL/hr is identified as dangerously fast for a 22-gram dose.
Vancomycin must be infused over at least 120120 minutes for a 22-gram dose to prevent Red Man Syndrome.
3
Assess the compatibility of ceftriaxone and lactated Ringer's.
This combination is identified as strictly contraindicated.
Ceftriaxone forms fatal precipitates when mixed with calcium, which is present in lactated Ringer's solution.
4
Evaluate the management of total parenteral nutrition (TPN).
Dedicating a specific central line lumen for TPN is recognized as correct.
TPN has a high infection risk and is incompatible with many medications.
5
Prioritize interventions for a client experiencing an allergic reaction.
Assessing the airway before stopping the penicillin infusion is identified as the incorrect sequence.
The absolute first priority is to stop the offending medication to prevent further systemic allergen exposure.
6
Determine the safety prerequisite for potassium administration.
Checking the most recent serum potassium level is identified as a necessary action.
Potassium is a high-alert medication; giving it without knowing current levels risks fatal hyperkalemia.

Key Concept

Safe administration of parenteral therapies requires strict adherence to infusion rate guidelines, rigorous compatibility checks, prioritization of source control during adverse reactions, and diligent pre-administration laboratory monitoring.
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Topics

Pharmacological and Parenteral Therapies

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