Podcast
Questions and Answers
An LPN is caring for a patient with a peripherally inserted central catheter (PICC) line. Which of the following actions is within the LPN's scope of practice, according to the provided guidelines?
An LPN is caring for a patient with a peripherally inserted central catheter (PICC) line. Which of the following actions is within the LPN's scope of practice, according to the provided guidelines?
- Maintaining the central venous infusion of approved fluids and checking the dressing. (correct)
- Initiating the administration of chemotherapeutic agents through the PICC line.
- Discontinuing the PICC line based on the patient's improved condition.
- Administering a rapid intravenous bolus of medication.
A physician orders vancomycin $1$ gram IV q12h for a patient with a MRSA infection. The patient's creatinine level is elevated. What is the most appropriate initial action for the nurse?
A physician orders vancomycin $1$ gram IV q12h for a patient with a MRSA infection. The patient's creatinine level is elevated. What is the most appropriate initial action for the nurse?
- Check peak and trough levels after the first dose.
- Administer the vancomycin as prescribed, as it is a standard dose for MRSA.
- Immediately contact the physician to question the drug dose.
- Consult with the pharmacist to determine if the elevated creatinine affects drug dosing. (correct)
An LPN is working under the supervision of an RN in a long-term care facility. Which of the following intravenous fluids can the LPN initiate via a peripheral route, according to the state's Board of Nursing?
An LPN is working under the supervision of an RN in a long-term care facility. Which of the following intravenous fluids can the LPN initiate via a peripheral route, according to the state's Board of Nursing?
- 5% Dextrose in 0.45% Sodium Chloride (D5 1/2 NS). (correct)
- Total Parenteral Nutrition (TPN).
- Albumin 25%.
- Packed Red Blood Cells (PRBCs).
A patient receiving IV antibiotics has orders for peak and trough levels. When should the nurse obtain the trough level?
A patient receiving IV antibiotics has orders for peak and trough levels. When should the nurse obtain the trough level?
An LPN is preparing to administer an intravenous piggyback (IVPB) medication. Which of the following medications, according to the Board of Nursing guidelines, is the LPN permitted to administer via IVPB?
An LPN is preparing to administer an intravenous piggyback (IVPB) medication. Which of the following medications, according to the Board of Nursing guidelines, is the LPN permitted to administer via IVPB?
A drug that initiates a physiological change in the body is best described as which of the following?
A drug that initiates a physiological change in the body is best described as which of the following?
After a drug is processed by the body, the amount of the drug that is available for use is referred to as:
After a drug is processed by the body, the amount of the drug that is available for use is referred to as:
In the context of IV fluid administration, what does the abbreviation 'KVO' signify?
In the context of IV fluid administration, what does the abbreviation 'KVO' signify?
When administering multiple IV medications, staggering the administration times addresses which potential issue?
When administering multiple IV medications, staggering the administration times addresses which potential issue?
Which of the following best describes 'therapeutic drug administration'?
Which of the following best describes 'therapeutic drug administration'?
Which of the following is the MOST critical nursing action if a visible precipitate is observed in an IV solution during administration?
Which of the following is the MOST critical nursing action if a visible precipitate is observed in an IV solution during administration?
A patient receiving an IV antibiotic develops a sudden onset of hives, difficulty breathing, and a drop in blood pressure. This is most likely indicative of what condition?
A patient receiving an IV antibiotic develops a sudden onset of hives, difficulty breathing, and a drop in blood pressure. This is most likely indicative of what condition?
A medication order reads, 'Administer 1 gram of Ceftriaxone IVPB every 12 hours.' Which of the following rights of IV administration does 'IVPB' directly relate to?
A medication order reads, 'Administer 1 gram of Ceftriaxone IVPB every 12 hours.' Which of the following rights of IV administration does 'IVPB' directly relate to?
A patient is prescribed two drugs that, when combined, result in a greater therapeutic effect than either drug would produce alone. This is an example of what type of drug interaction?
A patient is prescribed two drugs that, when combined, result in a greater therapeutic effect than either drug would produce alone. This is an example of what type of drug interaction?
A patient reports experiencing ringing in their ears (tinnitus) after starting a new medication. This could be a sign of which type of organ-specific toxicity?
A patient reports experiencing ringing in their ears (tinnitus) after starting a new medication. This could be a sign of which type of organ-specific toxicity?
A patient is receiving an antibiotic via continuous IV infusion. Why is it important to draw serum drug levels?
A patient is receiving an antibiotic via continuous IV infusion. Why is it important to draw serum drug levels?
Which of the following best describes chemical incompatibilities between IV drugs?
Which of the following best describes chemical incompatibilities between IV drugs?
Before administering an IV antibiotic, a nurse checks the IV site and notes that there is no backflow and resistance is met when flushing. What is the MOST appropriate nursing action?
Before administering an IV antibiotic, a nurse checks the IV site and notes that there is no backflow and resistance is met when flushing. What is the MOST appropriate nursing action?
A patient develops a secondary infection during antibiotic treatment that is resistant to the initial antibiotic. This is best described as which of the following?
A patient develops a secondary infection during antibiotic treatment that is resistant to the initial antibiotic. This is best described as which of the following?
A patient receiving vancomycin IV develops redness and itching after 15 minutes of the infusion. What is MOST appropriate initial nursing action?
A patient receiving vancomycin IV develops redness and itching after 15 minutes of the infusion. What is MOST appropriate initial nursing action?
An LPN is asked to administer medication via IV push. According to the guidelines, what action should the LPN take?
An LPN is asked to administer medication via IV push. According to the guidelines, what action should the LPN take?
An LPN is working in a clinic and needs to start an IV for a patient. Which of the following actions is within the LPN's scope of practice?
An LPN is working in a clinic and needs to start an IV for a patient. Which of the following actions is within the LPN's scope of practice?
An LPN is caring for a patient with a peripheral IV. Which of the following tasks falls within the LPN's scope of practice?
An LPN is caring for a patient with a peripheral IV. Which of the following tasks falls within the LPN's scope of practice?
An LPN is working under the supervision of an RN. The RN asks the LPN to administer a medication via IV piggyback (IVPB). Which of the following scenarios would necessitate the LPN to verify the permissibility of this task?
An LPN is working under the supervision of an RN. The RN asks the LPN to administer a medication via IV piggyback (IVPB). Which of the following scenarios would necessitate the LPN to verify the permissibility of this task?
An LPN is working in a healthcare setting. In which of the following scenarios would it be MOST appropriate for the LPN to refuse to perform an IV-related task?
An LPN is working in a healthcare setting. In which of the following scenarios would it be MOST appropriate for the LPN to refuse to perform an IV-related task?
A patient is prescribed a medication with a known bioavailability of 60%. What does this percentage indicate regarding the drug's pharmacokinetics?
A patient is prescribed a medication with a known bioavailability of 60%. What does this percentage indicate regarding the drug's pharmacokinetics?
A new drug is designed to bind strongly to a specific receptor site to prevent the action of a naturally occurring neurotransmitter. This drug would be classified as which of the following?
A new drug is designed to bind strongly to a specific receptor site to prevent the action of a naturally occurring neurotransmitter. This drug would be classified as which of the following?
A patient with a compromised venous access requires continuous low-dose IV fluid administration to prevent the IV site from clotting. Which of the following abbreviations best describes this order?
A patient with a compromised venous access requires continuous low-dose IV fluid administration to prevent the IV site from clotting. Which of the following abbreviations best describes this order?
During a diagnostic workup, a physician orders a test to evaluate the function of a patient's adrenal gland. Understanding medication uses, the nurse anticipates the use of a medication for which of the following purposes?
During a diagnostic workup, a physician orders a test to evaluate the function of a patient's adrenal gland. Understanding medication uses, the nurse anticipates the use of a medication for which of the following purposes?
A patient is prescribed an antibiotic prior to dental surgery to prevent a potential infection. This type of drug administration is best described as:
A patient is prescribed an antibiotic prior to dental surgery to prevent a potential infection. This type of drug administration is best described as:
A physician orders an IV contrast dye to visualize the blood vessels during an angiography. The use of this medication falls under which of the following categories?
A physician orders an IV contrast dye to visualize the blood vessels during an angiography. The use of this medication falls under which of the following categories?
A patient is receiving an IV antibiotic for a systemic infection. The physician orders a 'sensitivity test.' What is the purpose of this test in relation to the patient's treatment?
A patient is receiving an IV antibiotic for a systemic infection. The physician orders a 'sensitivity test.' What is the purpose of this test in relation to the patient's treatment?
Which of the following actions reflects a nurse's understanding of medication administration responsibilities?
Which of the following actions reflects a nurse's understanding of medication administration responsibilities?
A patient receiving multiple IV medications suddenly develops shortness of breath, hives, and a drop in blood pressure. What is the priority nursing intervention?
A patient receiving multiple IV medications suddenly develops shortness of breath, hives, and a drop in blood pressure. What is the priority nursing intervention?
A patient is prescribed an IV medication known to cause ototoxicity. Which assessment finding would be most concerning?
A patient is prescribed an IV medication known to cause ototoxicity. Which assessment finding would be most concerning?
A nurse is preparing to administer two medications via IV infusion. To ensure compatibility, what should the nurse verify?
A nurse is preparing to administer two medications via IV infusion. To ensure compatibility, what should the nurse verify?
An LPN is caring for a patient receiving vancomycin IV. Which laboratory value should the nurse monitor to assess for potential nephrotoxicity?
An LPN is caring for a patient receiving vancomycin IV. Which laboratory value should the nurse monitor to assess for potential nephrotoxicity?
A patient is receiving an IV antibiotic when the nurse notices redness, swelling, and pain at the insertion site. What is the MOST appropriate initial action?
A patient is receiving an IV antibiotic when the nurse notices redness, swelling, and pain at the insertion site. What is the MOST appropriate initial action?
A patient with a known penicillin allergy is prescribed cefazolin (a cephalosporin) IV. What is the MOST important action for the nurse?
A patient with a known penicillin allergy is prescribed cefazolin (a cephalosporin) IV. What is the MOST important action for the nurse?
A patient is prescribed an IV medication that is known to cause photosensitivity. What instruction should the nurse include in the patient's discharge teaching?
A patient is prescribed an IV medication that is known to cause photosensitivity. What instruction should the nurse include in the patient's discharge teaching?
The nurse is administering an IV antibiotic to a patient when she notices the patient is developing urticaria. Which action should the nurse take first?
The nurse is administering an IV antibiotic to a patient when she notices the patient is developing urticaria. Which action should the nurse take first?
A patient on IV antibiotics develops persistent diarrhea. What condition should the nurse suspect?
A patient on IV antibiotics develops persistent diarrhea. What condition should the nurse suspect?
A patient receiving IV fluids complains of sudden chills and muscle aches. What is the MOST likely cause?
A patient receiving IV fluids complains of sudden chills and muscle aches. What is the MOST likely cause?
Which action demonstrates the nurse's understanding of appropriate patient advocacy in medication administration?
Which action demonstrates the nurse's understanding of appropriate patient advocacy in medication administration?
A patient is receiving an IV medication when the nurse observes a new onset of facial flushing, anxiety, and a rapid heart rate. What is the initial nursing intervention?
A patient is receiving an IV medication when the nurse observes a new onset of facial flushing, anxiety, and a rapid heart rate. What is the initial nursing intervention?
The provider orders an IV medication to be administered immediately. What is the nurse's priority action before administering the medication?
The provider orders an IV medication to be administered immediately. What is the nurse's priority action before administering the medication?
A patient receiving multiple IV medications develops a synergistic drug interaction. What does this mean?
A patient receiving multiple IV medications develops a synergistic drug interaction. What does this mean?
A patient is prescribed two IV medications that are incompatible when mixed. What is an appropriate nursing intervention to ensure safe administration?
A patient is prescribed two IV medications that are incompatible when mixed. What is an appropriate nursing intervention to ensure safe administration?
A patient receiving gentamicin has an order for peak and trough levels. If the gentamicin is scheduled for 0900, when should the trough level be obtained?
A patient receiving gentamicin has an order for peak and trough levels. If the gentamicin is scheduled for 0900, when should the trough level be obtained?
An LPN is caring for a patient with impaired kidney function. Which of the following actions is MOST important for the LPN to anticipate regarding medication administration?
An LPN is caring for a patient with impaired kidney function. Which of the following actions is MOST important for the LPN to anticipate regarding medication administration?
An LPN is asked to administer a medication via IV push. According to the guidelines, what is the LPN's MOST appropriate action?
An LPN is asked to administer a medication via IV push. According to the guidelines, what is the LPN's MOST appropriate action?
An LPN is about to administer magnesium sulfate IV. What is the MOST important piece of information the LPN needs to verify?
An LPN is about to administer magnesium sulfate IV. What is the MOST important piece of information the LPN needs to verify?
An elderly patient with a history of liver cirrhosis is prescribed a new medication. What is the most important consideration for the LPN regarding the patient's medication regimen?
An elderly patient with a history of liver cirrhosis is prescribed a new medication. What is the most important consideration for the LPN regarding the patient's medication regimen?
A patient is receiving furosemide, a loop diuretic, and complains of new-onset ringing in the ears. Which type of drug reaction does this MOST likely indicate?
A patient is receiving furosemide, a loop diuretic, and complains of new-onset ringing in the ears. Which type of drug reaction does this MOST likely indicate?
A patient is prescribed both a hypnotic medication and consumes alcohol. This combination could lead to what type of drug interaction?
A patient is prescribed both a hypnotic medication and consumes alcohol. This combination could lead to what type of drug interaction?
A patient with a known opioid dependency is given naloxone (Narcan) to reverse respiratory depression. What type of drug interaction is this?
A patient with a known opioid dependency is given naloxone (Narcan) to reverse respiratory depression. What type of drug interaction is this?
An LPN is working under the supervision of an RN. In which of the following scenarios is the LPN operating outside their scope of practice regarding IV therapy?
An LPN is working under the supervision of an RN. In which of the following scenarios is the LPN operating outside their scope of practice regarding IV therapy?
An LPN is preparing to administer IV fluids to a patient. Which of the following actions requires immediate intervention by the supervising RN?
An LPN is preparing to administer IV fluids to a patient. Which of the following actions requires immediate intervention by the supervising RN?
A patient is to receive potassium intravenously. What is the maximum concentration of potassium that an LPN can administer per 1000 mL of IV fluid?
A patient is to receive potassium intravenously. What is the maximum concentration of potassium that an LPN can administer per 1000 mL of IV fluid?
An LPN is working in a physician's office where the physician will be on-site. Under what condition is the LPN authorized to perform IV therapy in this setting?
An LPN is working in a physician's office where the physician will be on-site. Under what condition is the LPN authorized to perform IV therapy in this setting?
How can an LPN best ensure they are practicing within their legal scope when administering IV therapy?
How can an LPN best ensure they are practicing within their legal scope when administering IV therapy?
A patient develops a severe allergic reaction to a bee sting. This reaction is best described as:
A patient develops a severe allergic reaction to a bee sting. This reaction is best described as:
An LPN calculates a medication dosage using the formula: desired dose/dose on hand x vehicle. If the desired dose is 150 mg, the dose on hand is 200 mg, and the vehicle is 5 mL, what is the correct amount to administer?
An LPN calculates a medication dosage using the formula: desired dose/dose on hand x vehicle. If the desired dose is 150 mg, the dose on hand is 200 mg, and the vehicle is 5 mL, what is the correct amount to administer?
A patient is prescribed an IV antibiotic with a scheduled administration time of 0900. Considering the 'Right Time' principle, what is an acceptable administration window for this medication in a standard hospital setting?
A patient is prescribed an IV antibiotic with a scheduled administration time of 0900. Considering the 'Right Time' principle, what is an acceptable administration window for this medication in a standard hospital setting?
A doctor orders 750mg of a medication, but the average dose listed in the drug book is 500mg. What is the MOST appropriate nursing action?
A doctor orders 750mg of a medication, but the average dose listed in the drug book is 500mg. What is the MOST appropriate nursing action?
An LPN receives an order to administer an IV antibiotic via IV push. What is the most appropriate action for the LPN?
An LPN receives an order to administer an IV antibiotic via IV push. What is the most appropriate action for the LPN?
A nurse is preparing to administer an IV antibiotic. What is the BEST resource to consult for the recommended infusion time?
A nurse is preparing to administer an IV antibiotic. What is the BEST resource to consult for the recommended infusion time?
Before administering an IV antibiotic, a nurse reviews the patient's medication history. What is the primary reason for this action?
Before administering an IV antibiotic, a nurse reviews the patient's medication history. What is the primary reason for this action?
A nurse assesses an IV site and notes a lack of backflow and resistance when flushing. What is the most appropriate nursing action?
A nurse assesses an IV site and notes a lack of backflow and resistance when flushing. What is the most appropriate nursing action?
A patient with a known penicillin allergy is prescribed amoxicillin. Despite the documented allergy, the medication is dispensed by the pharmacy. What is the nurse's BEST course of action?
A patient with a known penicillin allergy is prescribed amoxicillin. Despite the documented allergy, the medication is dispensed by the pharmacy. What is the nurse's BEST course of action?
A patient is receiving an IV antibiotic for a wound infection. Which assessment finding would BEST indicate a therapeutic effect of the medication?
A patient is receiving an IV antibiotic for a wound infection. Which assessment finding would BEST indicate a therapeutic effect of the medication?
A patient receiving an IV antibiotic reports nausea. What is the most appropriate initial nursing intervention?
A patient receiving an IV antibiotic reports nausea. What is the most appropriate initial nursing intervention?
Which statement BEST describes the importance of verifying drug compatibility before administering IV medications?
Which statement BEST describes the importance of verifying drug compatibility before administering IV medications?
A patient is scheduled to receive vancomycin. Prior to administration, the nurse reviews the order and notes the patient also has an order for normal saline to run continuously. What step is MOST important?
A patient is scheduled to receive vancomycin. Prior to administration, the nurse reviews the order and notes the patient also has an order for normal saline to run continuously. What step is MOST important?
A patient receiving an IV antibiotic complains of pain at the insertion site along with some visible redness. What is the MOST appropriate initial nursing intervention?
A patient receiving an IV antibiotic complains of pain at the insertion site along with some visible redness. What is the MOST appropriate initial nursing intervention?
Which scenario requires the nurse to immediately verify the IV antibiotic order with the prescribing physician?
Which scenario requires the nurse to immediately verify the IV antibiotic order with the prescribing physician?
A patient is receiving gentamicin IV for a severe infection. Which of the following assessments is MOST important for the nurse to monitor related to potential adverse effects of this medication?
A patient is receiving gentamicin IV for a severe infection. Which of the following assessments is MOST important for the nurse to monitor related to potential adverse effects of this medication?
A nurse is preparing to administer an IV antibiotic to a patient with a history of multiple drug allergies. What is the MOST critical action to take before initiating the infusion?
A nurse is preparing to administer an IV antibiotic to a patient with a history of multiple drug allergies. What is the MOST critical action to take before initiating the infusion?
Flashcards
Pre-Drug Administration Tests
Pre-Drug Administration Tests
Evaluates kidney and liver function to ensure safe drug administration and prevent toxicity.
Peak and Trough Levels
Peak and Trough Levels
Measure drug concentration at its highest (peak) and lowest (trough) levels to maintain therapeutic range and avoid toxicity.
State Board of Nursing
State Board of Nursing
LPNs must follow the regulations and guidelines set by their state's Board of Nursing.
Common IV Flush Solutions
Common IV Flush Solutions
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LPN IV Supervision
LPN IV Supervision
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Pharmacokinetics
Pharmacokinetics
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Absorption (Drugs)
Absorption (Drugs)
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Distribution (Drugs)
Distribution (Drugs)
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Bioavailability
Bioavailability
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Target Cells
Target Cells
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Antagonist (Drug)
Antagonist (Drug)
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Agonist (Drug)
Agonist (Drug)
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Diagnostic Testing (Drugs)
Diagnostic Testing (Drugs)
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Prophylactic Drug Administration
Prophylactic Drug Administration
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Therapeutic Drug Administration
Therapeutic Drug Administration
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Rights of IV Administration
Rights of IV Administration
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Therapeutic Incompatibilities
Therapeutic Incompatibilities
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Anaphylaxis
Anaphylaxis
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Synergistic Drug Interactions
Synergistic Drug Interactions
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Superinfection
Superinfection
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Absorption (Pharmacokinetics)
Absorption (Pharmacokinetics)
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Distribution (Pharmacokinetics)
Distribution (Pharmacokinetics)
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Drug Action
Drug Action
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Target Sites (Drugs)
Target Sites (Drugs)
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IV Piggyback (IVPB)
IV Piggyback (IVPB)
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Prophylactic Drug
Prophylactic Drug
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Prophylactic Antibiotics
Prophylactic Antibiotics
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Therapeutic Antibiotics
Therapeutic Antibiotics
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Right Infusion Time
Right Infusion Time
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Right Compatibilities
Right Compatibilities
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Drug Incompatibilities Check
Drug Incompatibilities Check
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Right Method and Mode
Right Method and Mode
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Average Medication Dose
Average Medication Dose
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Questioning Dosage
Questioning Dosage
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Advocate for Patient Safety
Advocate for Patient Safety
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Route of Administration
Route of Administration
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Infusion Time
Infusion Time
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Expected Action
Expected Action
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Therapeutic Effects Monitoring
Therapeutic Effects Monitoring
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Medication Incompatibilities
Medication Incompatibilities
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IV Site Assessment
IV Site Assessment
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Staggered Infusion Times
Staggered Infusion Times
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Precipitate Formation
Precipitate Formation
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Factors Affecting Compatibility
Factors Affecting Compatibility
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Tachycardia
Tachycardia
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Toxicity
Toxicity
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Nephrotoxicity
Nephrotoxicity
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Neurotoxicity
Neurotoxicity
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Ototoxicity
Ototoxicity
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Hepatotoxicity
Hepatotoxicity
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Urticaria
Urticaria
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Erythema
Erythema
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Pruritus
Pruritus
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Therapeutic Responses
Therapeutic Responses
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Microorganism Overgrowth
Microorganism Overgrowth
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Scope of Practice
Scope of Practice
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LPN Peripheral IV Patency
LPN Peripheral IV Patency
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LPN IV Fluid Administration
LPN IV Fluid Administration
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LPN IV Initiation (Peripheral)
LPN IV Initiation (Peripheral)
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LPN IV Push Meds: Not Allowed
LPN IV Push Meds: Not Allowed
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LPNs and Pediatric IVs
LPNs and Pediatric IVs
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Drug Dosage Calculations
Drug Dosage Calculations
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Synergistic Interaction
Synergistic Interaction
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Antagonistic Interaction
Antagonistic Interaction
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Anaphylaxis (Drug Reaction)
Anaphylaxis (Drug Reaction)
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Dosage Adjustments
Dosage Adjustments
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Maintaining Patency (IV)
Maintaining Patency (IV)
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Commonly Used IV Fluids
Commonly Used IV Fluids
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IV Piggyback Medications (LPN)
IV Piggyback Medications (LPN)
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Prohibited IV Procedures (LPN)
Prohibited IV Procedures (LPN)
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IV Push Medications (LPN)
IV Push Medications (LPN)
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Supervision (IV Therapy)
Supervision (IV Therapy)
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Study Notes
Pharmacokinetics and Drug Movement
- Pharmacokinetics studies how a drug moves throughout the body.
- Absorption is how a drug enters the bloodstream from its administration site.
- Example: Oral drugs absorb into the bloodstream from the stomach and small intestine.
- Distribution is the process of drug transport throughout the body, mainly via the bloodstream.
- Bioavailability represents the proportion of the drug that reaches systemic circulation after administration.
- Factors such as absorption, metabolism, and excretion determine it.
- Expressed as a percentage.
- A bioavailability of 50% means 50% of the dose reaches the bloodstream.
- Drug companies conduct extensive testing to determine bioavailability.
Drug Action and Target Sites
- Drug action is the mechanism by which a drug exerts its therapeutic effect.
- Target sites are the specific cells or tissues where a drug interacts.
- Example: Insulin targets cells to regulate blood sugar.
Agonists and Antagonists
- Agonist: A drug that initiates a change or response in the body.
- Antagonist: A drug that blocks or inhibits the action of another drug or substance.
IV Therapy Abbreviations
- CBC: Central Venous Catheter
- IVPB: IV Piggyback
- IV: Intravenous
- KVO: Keep Vein Open
- LR: Lactated Ringers
- ONC: Over the Needle
- TKO: To Keep Open
- meq: Milliequivalents
Uses of Medications
- Diagnostic Testing:
- Sensitivity Testing: Determines a drug's effectiveness against a specific pathogen.
- Function of Glands: Assesses the function of various glands.
- Radiologic Studies: Used in imaging procedures like colonoscopies, cystograms, CAT scans, nuclear scans, angiographies, and myelograms
Nursing Responsibilities
- Nurses must understand the:
- Purpose of the medication
- Mechanism of action
- Side effects
- Expected actions
Types of Drug Administration
- Prophylactic: Prevents a condition.
- Example: Antibiotics before surgery to prevent infection.
- Therapeutic: Treats an existing condition.
- Example: Antibiotics to treat a bacterial infection.
The Rights of IV Administration
- Traditional Rights:
- Right Patient
- Right Time
- Right Drug
- Right Dose
- Right Route
- Right Documentation
- Additional Rights of IV Therapy:
- Right Infusion Time: Administer medications within a specific time frame.
- Typically within 30 minutes before or after the scheduled time.
- Nursing homes may allow a 1-hour window before or after.
- Right Compatibilities: Verify medication compatibility before mixing in an IV line by checking drug books.
- Right Infusion Time: Administer medications within a specific time frame.
Drug Compatibility and Administration
- Always check for drug incompatibilities, verifying if the medication is compatible with normal saline.
- Ensure the correct method and mode of administration.
- Example: IV antibiotics ordered IVP (intravenous push) should not be continuous infusions.
- Safe IV Antibiotic Administration: Always use the correct techniques.
Dosage and Route of Administration
- Average Dose: Find the average dose in the drug book; it's recommended for an average-sized person.
- Questioning Dosage: Clarify any significant differences from the average dose with the doctor.
- Example: Question an 800 mg order if the average dose is 500 mg.
- Advocate for Patient Safety: Ensure correct dosage and route.
- Route of Administration: Follow the prescribed route (PO, IM, IV).
- LPN Scope of Practice: LPNs cannot administer IV push medications, except for saline flushes; IV antibiotics must be given via IV piggyback.
Infusion Time and Expected Action
- Infusion Time: Administer medication at the correct rate, as indicated in the drug guide or on the label.
- Expected Action: Understand the medication's intended therapeutic effect.
- Therapeutic Effects: Monitor to ensure the medication works as intended.
Safety Measures and Nursing Responsibilities
- Common Side Effects: Be aware of common side effects.
- Incompatibilities: Never mix incompatible medications.
- Verify Orders: Always verify the doctor's order against the medication label and drug book.
- Allergies: Ask the patient about allergies before administration, even if previously asked.
- Medication Knowledge: Never administer a medication without knowing its purpose.
- IV Site Assessment: Assess the IV site for patency every two hours; check for backflow and ensure free flushing.
- Never Force Flushing: Do not force an IV flush if it doesn't flush, to avoid dislodging a clot.
Monitoring and Administration
- Complications: Monitor for complications.
- Flow Rate: Administer medications at the correct flow rate.
- Therapeutic Effects: Monitor for therapeutic effects.
- Vital Signs: Monitor vital signs for any changes.
- Standards of Care: Follow standards of care for IV administration by LPNs.
- Previous History: Ask about the patient's history with IV antibiotics or medications.
- Methods of Administration: Intermittent and continuous.
- Intermittent Administration: Used for patients with a hip lock or IV port.
- Administer the medication through a primary set.
Key Points to Remember
- Always verify drug compatibility, dosage, and route of administration.
- Advocate for patient safety by questioning orders and ensuring correct administration.
- Monitor for therapeutic effects and complications.
- Follow standards of care for IV administration by LPNs.
- Be aware of your scope of practice and limitations.
- Always ask about allergies and previous medication history.
- Never administer a medication without knowing what it is for.
- Assess the IV site for patency regularly.
- Never force flushing an IV site.
Infusion Compatibility
- Staggered Infusion Times: Ensure infusion times are staggered for incompatible medications.
- Precipitate Formation: Stop the infusion immediately and change the primary line, fluids, and tubing if a precipitate forms.
- Factors Affecting Compatibility:
- pH of Fluids
- Types of Medications
- Preservatives
Drug Interactions and Adverse Reactions
- Anaphylaxis: A severe, life-threatening hypersensitivity reaction.
- Considered an emergency, monitor respiratory status closely.
- Sensitivity to Light: Some medications cause sensitivity to light.
- Synergistic Drug Interactions: Interaction produces a greater effect than the sum of individual actions.
- Example: Hypnotic with alcohol.
- Can be dangerous.
- Antagonistic Drug Interactions: Opposed to an action, the opposite of an agonist.
- Agonist: Initiates a physiological response when combined with a receptor,
- Tachycardia: Heart rate over 100 bpm.
- Toxicity: The state of being poisoned.
- Nephrotoxicity: Toxic to the kidneys.
- Monitor BUN, creatinine, and urine output.
- Assess kidney function and associated structures.
- Neurotoxicity: Toxic to the nervous system.
- May cause paresthesias and neurological changes.
- Ototoxicity: Toxic to the ears.
- Monitor for tinnitus and vertigo.
- Hepatotoxicity: Toxic to the liver.
- Monitor liver function tests and look for jaundice.
- Urticaria: Hives.
- Erythema: Redness.
- Pruritus: Itching.
Nursing Responsibilities
- Scope of Practice: Only administer medications allowed by your state's scope of practice.
- Therapeutic and Non-Therapeutic Responses:
- Assess for both.
- Example: Improvement in infection from an IV antibiotic.
- Non-therapeutic responses include side effects like GI upset.
- Ongoing assessment is crucial.
- Life-Threatening Adverse Reactions:
- Investigate patient complaints.
- Notify physician/charge nurse.
- Initiate emergency procedures if necessary.
- Never leave the patient unattended during an emergency.
- Patient Allergies:
- Document all allergies and possible cross-allergies.
- Example: Penicillin and cephalosporins.
- Untoward Reactions and Side Effects:
- Allergic Reactions: Notify physician/charge nurse immediately for signs like rash, pruritus, or edema.
- Photosensitivity: Monitor for photosensitivity reactions.
- Drug-Induced Fever: Watch for drug-induced fever.
- GI Effects: Most drugs have GI side effects.
Microorganism Overgrowth vs. Superinfection
- Microorganism Overgrowth: Clinical signs/symptoms when normally low numbers of bacteria in the stomach, duodenum, jejunum, and ileum significantly increase.
- Superinfection: A second infection superimposed on an earlier one.
- Example: Yeast infection after antibiotic therapy.
Organ-Specific Toxicities
- Nephrotoxicity: Toxic to the kidneys.
- Neurotoxicity: Toxic to the nervous system.
- Ototoxicity: Toxic to the ears.
- Hepatotoxicity: Toxic to the liver.
Drug Dosages and Calculations
- Perform various drug calculations, such as milligrams per kilogram, weight-based dosing, and 24-hour dosage calculations.
Table of Drug Interactions and Adverse Reactions
- Synergistic: Effect greater than the sum of individual actions.
- Example: Hypnotic + Alcohol
- Antagonistic: Opposed action.
- Example: Narcan + Opioids
- Anaphylaxis: Severe allergic reaction.
- Example: Bee sting allergy
- Nephrotoxicity: Toxic to the kidneys.
- Example: Aminoglycosides
- Neurotoxicity: Toxic to the nervous system.
- Example: Chemotherapy drugs
- Ototoxicity: Toxic to the ears.
- Example: Loop diuretics
- Hepatotoxicity: Toxic to the liver.
- Example: Acetaminophen overdose
Medication Calculations and Considerations
- Dosage Calculations: LPNs use calculations to ensure accurate medication administration.
- Kidney and Liver Function: Tests are crucial to determine how medications are metabolized and excreted.
- Dosage Adjustments: Impaired liver or kidney function can affect medication dosages, requiring adjustments by a physician.
- Peak and Trough Levels: Used to determine drug dosage, especially for antibiotics like gentamicin.
- Blood Levels: Pharmacists monitor blood levels and adjust dosages based on peak and trough results.
Scope of Practice for IV Therapy
- Board of Nursing Website: Provides specific guidelines for LPNs regarding IV therapy.
- IV Therapy Education and Training: LPNs must complete IV therapy education and training from an accredited nursing program.
- Documentation: Evidence of IV therapy education and training must be documented on the official transcript.
- LPN Scope of Practice: LPNs who have completed IV training can perform specific IV therapy procedures.
LPN IV Therapy Procedures
- Maintaining Patency: LPNs can maintain patency of peripheral intermittent vascular devices using non-therapeutic flush solutions.
- Peripheral IVs: LPNs can maintain peripherally inserted central catheters (PICCs) and administer board-approved IV fluids via the peripheral route.
- Fluid and Dressing Management: LPNs can check flow rates, monitor fluids, and change dressings for peripheral IVs.
- Initiating IV Fluids and Medications: LPNs can initiate the administration of board-approved IV fluids and medications via the peripheral route.
- Excluded IV Therapy Procedures:
- Cannot administer IV fluids or medications via central lines, including midline central venous catheters, midclavicular catheters, or PICCs.
Board-Approved IV Fluids:
- Normal saline (NS)
- Lactated Ringer's (LR)
- D5W (5% dextrose in water)
- D5 1/4 NS (5% dextrose in 1/4 normal saline)
- D5 1/2 NS (5% dextrose in 1/2 normal saline)
- Magnesium sulfate (2-5 grams per 1000 mL)
- Potassium (maximum 40 mEq per 1000 mL)
- Multi-vitamin additives (for peripheral infusion only)
Medications: Administered via IV piggyback
- Antibiotics
- Antifungals
- Antivirals
- H2 receptor blockers (e.g., Zantac)
- Proton pump inhibitors (e.g., Protonix)
- Antiemetics
Prohibited IV Therapy Procedures:
- Central Line Administration: Cannot initiate, regulate, or administer medications via a central line.
- IV Push Medications: Cannot administer IV push medications, including:
- IV boluses
- IV piggybacks (except those approved by the board)
- Parenteral nutrition agents (except vitamins)
- Blood products
- Plasma expanders
- Chemotherapy medications
- Pediatric Patients: LPNs cannot perform advanced IV therapy procedures on patients under two years of age.
- Home Setting: LPNs cannot perform IV therapy in the home setting.
Supervision and Delegation
- Supervision: LPNs performing IV therapy must be supervised by a registered nurse (RN) who is physically present on the premises where the patient is receiving care.
- Physician and Dentist Supervision: Physicians and dentists can provide supervision in their medical or dental offices.
- Delegation: All other settings require supervision and delegation by an RN.
Key Medications for LPNs to Know
- Primary IV Fluids: LPNs should know the primary IV fluids they can administer.
- Magnesium Sulfate and Potassium: LPNs should know the specific dosages for magnesium sulfate and potassium.
- Multivitamins: LPNs should know that multivitamins can only be given for peripheral infusions.
- IV Piggyback Medications: LPNs should know the medications that can be administered via IV piggyback.
Importance of Knowing Scope of Practice
- Responsibility: It is the LPN's responsibility to know their scope of practice and the medications they can and cannot administer.
Summary Table: LPN IV Therapy Scope of Practice
| Procedure | Allowed | Not Allowed |
|---|---|---|
| Maintaining Patency of Peripheral IVs | Yes | |
| Administering Board-Approved IV Fluids | Yes (peripheral route only) | Central line administration |
| Initiating IV Fluids and Medications | Yes (peripheral route only) | Central line administration |
| IV Push Medications | No | All IV push medications, including boluses, piggybacks (except those approved by the board), parenteral nutrition agents (except vitamins), blood products, plasma expanders, and chemotherapy medications |
| Pediatric Patients (under 2 years old) | No (advanced IV therapy procedures) | |
| Home Setting | No |
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