NCLEX Review Guide: Parenteral Medications & Reconstitution

Types of Parenteral Routes

• Intramuscular (IM): Administered into muscle tissue for systemic absorption, typically deltoid, vastus lateralis, or ventrogluteal sites
• Subcutaneous (SubQ): Injected into fatty tissue layer beneath skin, commonly used for insulin, heparin, and vaccines
• Intradermal (ID): Shallow injection into dermis layer, primarily for allergy testing and tuberculin skin tests
• Intravenous (IV): Direct administration into bloodstream for immediate systemic effect

Step-by-Step Reconstitution

1. Verify medication order and check expiration dates on both powder and diluent
2. Calculate the amount of diluent needed based on desired concentration
3. Clean vial tops with alcohol swabs and allow to air dry
4. Draw up the calculated amount of diluent using aseptic technique
5. Inject diluent slowly into powder vial to prevent foaming
6. Gently swirl or roll vial between palms - never shake vigorously
7. Label reconstituted medication with date, time, concentration, and your initials

IV Compatibility & Administration

• Compatibility: Ability of two or more medications to be mixed without chemical reaction or precipitation
• Always check compatibility charts before mixing medications in same IV line
• Flush IV lines with normal saline between incompatible medications
• Monitor for signs of infiltration, extravasation, and phlebitis during IV administration

Essential Calculations

• Always double-check math calculations with another nurse when possible
• Use dimensional analysis for complex dosage calculations
• Read reconstitution directions carefully - some require multiple steps or specific diluent volumes