NCLEX Review Guide: Fundamentals, Medication & IV Therapy, Blood Transfusion / Central Line Care

Six Rights of Medication Administration

• Right Patient: Always verify patient identity using two identifiers (name and DOB/medical record number) before medication administration
• Right Drug: Check medication name three times - when removing from storage, preparing, and before administration
• Right Dose: Calculate and verify dosage using appropriate formulas and double-check high-risk medications
• Right Route: Ensure medication is given via correct pathway (PO, IV, IM, SQ) as ordered by physician
• Right Time: Administer medications within 30 minutes of scheduled time unless otherwise specified
• Right Documentation: Record medication administration immediately after giving, including time, dose, route, and patient response

IV Therapy Fundamentals

• Isotonic solutions (0.9% NS, LR) maintain fluid balance and are used for fluid replacement and maintenance
• Hypotonic solutions (0.45% NS) move fluid into cells and are used for cellular dehydration
• Hypertonic solutions (3% NS, D5W) pull fluid from cells and are used for fluid overload or cerebral edema
• Monitor IV site every hour for signs of infiltration (coolness, swelling, pallor) or phlebitis (warmth, redness, pain)

Pre-Transfusion Procedures

1. Verify physician order and obtain informed consent from patient
2. Check blood type and crossmatch results with two nurses using two patient identifiers
3. Obtain baseline vital signs (temperature, pulse, respirations, blood pressure)
4. Start IV with 18-gauge needle or larger using 0.9% normal saline
5. Inspect blood product for clots, unusual color, or expired date

Transfusion Reactions

• Hemolytic reaction: Most serious - fever, chills, back pain, dark urine; stop transfusion and maintain kidney function
• Febrile reaction: Most common - fever, chills; may premedicate with acetaminophen for future transfusions
• Allergic reaction: Hives, itching, bronchospasm; administer antihistamines and corticosteroids as ordered
• Circulatory overload: Dyspnea, crackles, hypertension; slow or stop transfusion and administer diuretics

Central Line Management

• Sterile technique must be maintained for all central line procedures including dressing changes and blood draws
• CVC dressing changes should be performed every 7 days for transparent dressings or when soiled, loose, or damp
• Flush lumens with saline before and after medication administration and with heparin if indicated by facility policy
• Monitor insertion site daily for signs of infection: redness, swelling, drainage, or increased temperature

1. Perform hand hygiene and don sterile gloves and mask
2. Remove old dressing using non-sterile gloves, then apply sterile gloves
3. Cleanse insertion site with chlorhexidine using circular motion from center outward
4. Allow antiseptic to dry completely before applying new sterile dressing
5. Secure all lumens and label dressing with date and nurse initials

Common Pitfalls