Skip to content

Get the app

Study guide · Physiological Integrity

Pharmacological and Parenteral Therapies

13 to 19% of the exam · 17 activity statements

Pharmacological and Parenteral Therapies covers how the nurse checks, prepares, gives, calculates and evaluates medications, intravenous fluids, blood products and parenteral nutrition, and how medications are stored, counted and disposed of. NCLEX items test whether you catch an unsafe prescription before it reaches the client, review the right data before a dose, calculate accurately, recognize a dangerous response early and act on it in the right order.

A study feature written by ExamDragon, not part of the real exam. Each heading is one of the Related Activity Statements NCSBN lists for this category (17 of them), in our words; NCSBN's wording is in its Test Plan.

At a glance

Physiological Integrity
13 to 19%

of the exam (NCSBN's range)

Activity statements
17
Key terms
15

What this guide covers, statement by statement

  1. Check that a medication order is correct and suitable for the client
  2. Prepare and give medications following the rights of administration
  3. Work out the dose calculations medications require
  4. Watch IV infusions and look after the site
  5. Handle and give controlled substances as regulations require
  6. Check relevant data, such as labs and allergies, before giving medication
  7. Adjust a medication dose using assessment findings and ordered limits
  8. Give blood products and monitor how the client reacts
  9. Use or look after central venous access devices
  10. Teach the client about their medications
  11. Assess how the client responds to a medication
  12. Give parenteral nutrition and monitor the client's response
  13. Give medications to manage pain
  14. Take part in reconciling the client's medications
  15. Store and keep medications safe and secure
  16. Handle and give high-alert medications safely
  17. Get rid of medications safely

1Check that a medication order is correct and suitable for the client

  • A complete prescription names the client, the date and time, the drug, the dose, the route, the frequency (and duration where it applies) and carries the prescriber's signature or authentication.
  • Compare the prescription with the client: age, weight, allergies, diagnosis, kidney and liver function, current medications and the usual safe dose range for that drug.
  • Error-prone notation is a reason to clarify: "U" for units, "QD" or "QOD", a trailing zero (5.0 mg) or a missing leading zero (.5 mg).
  • The nurse who gives a medication is accountable for it: if a prescription is unclear, incomplete or outside the safe range, hold the dose and contact the prescriber **before** giving it.
  • Verbal or telephone prescriptions are used only when necessary; write them down, read them back to the prescriber, and have them signed within the time set by policy.
  • Do not carry out a prescription you believe is unsafe even if the prescriber insists; follow the chain of command and document.
  1. In practiceA client who weighs 50 kg (110 lb) has a new prescription for a medication at a dose twice the usual adult range written in the drug reference. The nurse holds the dose, calls the prescriber to clarify with the reference range at hand, and documents the conversation. A dose outside the safe range is never given just because it was written.
  2. Where questions turnGiving a dose as written because the prescriber is the expert, when the nurse is independently accountable for checking it.
Practise this activity

2Prepare and give medications following the rights of administration

  • The rights of medication administration: right client, drug, dose, route, time and documentation, plus right reason, right response and the client's right to refuse.
  • Identify the client with two identifiers (for example full name and date of birth) against the medication administration record; a room or bed number is never an identifier.
  • Do three checks: when taking the medication from storage, when preparing it, and at the bedside before giving it; scan the barcode where the system exists, but scanning does not replace the checks.
  • Prepare medications for one client at a time, give only what you prepared yourself, and never leave medications at the bedside unless a prescription and policy allow it.
  • Do not crush extended-release, enteric-coated or sublingual tablets; ask the pharmacist for another form when a client cannot swallow.
  • Document right after giving a dose, never before; if a client refuses, explore why, do not force it, notify the prescriber when it matters, and document the refusal.
  1. In practiceA client asks why the tablet looks different from the one taken at home. The nurse stops, rechecks the prescription and the medication record, and confirms with the pharmacy that it is a different manufacturer of the same drug before giving it. A client's question about a medication is a cue to recheck, not to reassure.
  2. Where questions turnAccepting a client's answer to "Are you Mr. Lee?" or a room number as identification instead of two identifiers checked against the record.
Practise this activity

3Work out the dose calculations medications require

  • Dimensional analysis: set up the units so that everything you do not want cancels and the unit you want is left, for example mg ordered x (mL / mg available) = mL to give.
  • Weight-based dosing: convert pounds to kilograms first (1 kg = 2.2 lb), multiply by the dose per kg, then check the result against the safe range before preparing.
  • Infusion pump rate (mL/h) = total volume (mL) / time (h); for a dose ordered per hour, mL/h = dose per hour / concentration (dose per mL).
  • Gravity drip rate (gtt/min) = volume (mL) x drop factor (gtt/mL) / time (min); round to a whole drop.
  • Worked example: 25,000 units of heparin in 500 mL is 50 units/mL; a prescription of 1,000 units/h runs at 1,000 / 50 = 20 mL/h.
  • Ask whether the answer makes sense: a dose of 8 tablets or 15 mL of an injection is a signal to recalculate and have another nurse check it.
  1. In practiceA child who weighs 44 lb has a prescription for 15 mg/kg of a medication; the label reads 160 mg per 5 mL. The nurse converts 44 lb to 20 kg, calculates 300 mg, then 300 mg x 5 mL / 160 mg = 9.4 mL, and confirms 300 mg is inside the safe range in the drug reference. Converting weight first and checking the range prevents the commonest pediatric dosing errors.
  2. Where questions turnUsing the weight in pounds in a per kg formula, which gives a dose 2.2 times too high.
Practise this activity

4Watch IV infusions and look after the site

  • Check the infusion against the prescription at the start of each shift and at every bag change: the solution, additives, rate, pump settings and the time it was hung.
  • Inspect the site often (per policy, and more often for infants, older adults, vesicants and confused clients): look, touch and compare with the other limb.
  • Infiltration: swelling, coolness, pallor and slowing of the infusion; stop the infusion, remove the catheter, elevate the limb and apply a compress as policy directs for that solution.
  • Phlebitis: redness, warmth, tenderness or a cord along the vein; remove the catheter, apply a warm compress, restart in the other arm and document using the phlebitis scale.
  • Extravasation of a vesicant is an emergency: stop the infusion **immediately**, follow the policy for that drug (some call for aspiration through the catheter and an antidote) and notify the prescriber.
  • Never speed up an infusion to catch up on volume that ran behind; recalculate from the remaining volume and time or ask the prescriber.
  1. In practiceA client receiving 0.9% sodium chloride at 100 mL/h says the arm feels tight; the site is puffy, pale and cool and the pump alarms for occlusion. The nurse stops the infusion, removes the catheter, elevates the arm and restarts the line in the other arm. These are signs of infiltration, and the line cannot be saved by flushing.
  2. Where questions turnFlushing a swollen, cool site to clear an occlusion alarm instead of stopping the infusion and removing the catheter.
Practise this activity

5Handle and give controlled substances as regulations require

  • Controlled substances are kept locked (automated dispensing cabinet or a double-locked area) and every dose removed is accounted for.
  • Counts are done by two licensed nurses together, commonly at shift change: one leaving and one coming on, both sign.
  • Wasting part of a dose needs a licensed witness who watches the waste and co-signs; never sign for a waste you did not see.
  • A count that does not match is reported **immediately** to the charge nurse or pharmacy, before either nurse leaves the unit.
  • Signs that a colleague may be diverting drugs include frequent wastes, clients reporting poor pain relief on that nurse's shift and frequent breaks; report concerns through the chain of command.
  • Keep keys and access codes to yourself; sharing a log-in makes every removal under that name unaccountable.
  1. In practiceA nurse gives 2 mg of an opioid from a 4 mg vial and asks a colleague to sign for the 2 mg waste later because the colleague is busy. The colleague declines to sign without having watched and comes to witness the waste in real time. Both document the waste at the time it happens.
  2. Where questions turnCo-signing a waste or a count after the fact to be helpful, which makes the witness responsible for a discrepancy they never saw.
Practise this activity

6Check relevant data, such as labs and allergies, before giving medication

  • Check allergies and the type of reaction before every first dose; a client allergic to one drug may react to a related one (for example a penicillin and some cephalosporins).
  • Know the data to review for common drugs: apical pulse for 1 full minute before digoxin (hold below 60/min in an adult and report), blood pressure before antihypertensives, respiratory rate and sedation level before opioids.
  • Review relevant lab values with their ranges (ranges vary by laboratory): potassium 3.5 to 5.0 mEq/L before diuretics and digoxin, INR (about 0.8 to 1.1 without anticoagulation; usually 2 to 3 on warfarin) before warfarin, aPTT before heparin, glucose before insulin.
  • Look for interactions: two drugs that both cause bleeding, sedation, low blood pressure or high potassium; grapefruit juice with some statins and calcium channel blockers; foods high in tyramine with monoamine oxidase inhibitors.
  • Check kidney function (creatinine about 0.6 to 1.2 mg/dL) before drugs cleared by the kidney and before iodinated contrast for a client taking metformin.
  • When a finding is outside the parameter, hold the dose and notify the prescriber; giving it and reporting later is too late.
  1. In practiceBefore giving furosemide and digoxin, the nurse sees a potassium of 3.1 mEq/L (3.5 to 5.0 mEq/L) and an apical pulse of 58/min. The nurse holds both doses and notifies the prescriber. Low potassium increases the risk of digoxin toxicity, and a pulse below 60/min is a hold parameter.
  2. Where questions turnGiving digoxin after a radial pulse check, or giving a diuretic without checking the potassium first.
Practise this activity

7Adjust a medication dose using assessment findings and ordered limits

  • Titrate only within the parameters in the prescription or protocol: the starting dose, the size of each change, how often, the target and the maximum.
  • Assess the target measure before each change and again after it at the interval the protocol sets (for vasoactive drugs, often every few minutes).
  • Use an infusion pump with the drug library for every titrated infusion, and have another nurse check high-alert infusions when policy requires it.
  • If the target is not reached at the maximum dose, or the client shows an adverse effect, stop increasing and notify the prescriber.
  • Examples: an insulin infusion adjusted by capillary glucose per protocol; a nitroglycerin infusion increased for chest pain as long as systolic pressure stays above the ordered limit.
  • Document each change with the assessment that led to it.
  1. In practiceA client on a nitroglycerin infusion still has chest pain rated 4 of 10, and the protocol allows an increase every 5 minutes while systolic pressure stays above 90 mm Hg. The nurse checks the pressure (112/70 mm Hg), increases the rate by the ordered step and rechecks pain and pressure 5 minutes later. If the pressure fell below 90 mm Hg, the nurse would stop increasing and notify the prescriber.
  2. Where questions turnMaking a larger or faster change than the protocol allows because the client still has symptoms.
Practise this activity

8Give blood products and monitor how the client reacts

  • Before the transfusion: confirm a signed consent, a current type and screen or crossmatch, a large enough catheter (commonly 20 gauge or larger in an adult) and baseline vital signs including temperature.
  • Two licensed staff (or as policy defines) verify at the bedside together: the client's two identifiers and band, the blood bank number, ABO group and Rh type, the product, and the expiry.
  • Prime and run blood only with 0.9% sodium chloride through blood tubing with a filter; never add medications to the bag or the line.
  • Start slowly, stay with the client for the first 15 minutes (when most severe reactions show), recheck vital signs per policy, and finish within 4 hours of starting.
  • For any reaction (fever, chills, back pain, itching, hives, dyspnea, hypotension), **stop the transfusion first**, keep the vein open with new tubing and 0.9% sodium chloride, assess, then notify the prescriber and blood bank.
  • Return the bag and tubing to the blood bank and collect the specimens policy requires; dyspnea, crackles and high blood pressure in an older client suggest circulatory overload.
  1. In practiceTen minutes into a transfusion of packed red blood cells, a client reports low back pain and chills, with temperature up from 98.6 F (37 C) to 100.8 F (38.2 C). The nurse stops the transfusion, disconnects the blood tubing and runs 0.9% sodium chloride through new tubing, then notifies the prescriber and blood bank. Back pain and fever early in a transfusion suggest an acute hemolytic reaction.
  2. Where questions turnSlowing the transfusion or giving an antipyretic and continuing, instead of stopping it before anything else.
Practise this activity

9Use or look after central venous access devices

  • Confirm tip placement (usually by chest x-ray) before first use of a newly placed central line or PICC.
  • Scrub the hub with an antiseptic (such as chlorhexidine with alcohol) and let it dry before every access; use a 10 mL or larger syringe to flush, since smaller syringes create higher pressure.
  • Change dressings with sterile technique per policy (commonly a transparent dressing every 7 days, gauze every 2 days, or sooner if wet, loose or soiled); assess the site for redness, drainage and tenderness.
  • Air embolism (sudden dyspnea, chest pain, hypotension, a churning heart sound): clamp the catheter, place the client on the **left side with the head down** (left side Trendelenburg), give oxygen and call for help.
  • For removal, position the client flat or head down and have the client hold the breath or bear down as the catheter comes out; apply an occlusive dressing and check the tip is intact.
  • Ask daily whether the line is still needed; every day a central line stays in raises the risk of a bloodstream infection.
  1. In practiceDuring a tubing change on a subclavian line, the client suddenly becomes short of breath with an SpO2 of 86% and chest pain. The nurse clamps the catheter, turns the client onto the left side with the head of the bed lowered, gives oxygen and calls the rapid response team. The position traps air in the right atrium away from the pulmonary artery.
  2. Where questions turnRaising the head of the bed for dyspnea when air embolism is suspected, instead of left side head down.
Practise this activity

10Teach the client about their medications

  • Teach the name and purpose, how and when to take it, what to expect, the common side effects, and the warning signs to report.
  • Use plain language and teach-back ("Tell me how you will take this at home"); ask about literacy, language and vision first, and use a professional interpreter when needed.
  • Anticoagulants: report bleeding, use a soft toothbrush and electric razor, keep vitamin K intake consistent on warfarin, and tell every provider and dentist.
  • Common teaching points: rise slowly with antihypertensives; take levothyroxine on an empty stomach in the morning; do not stop corticosteroids, antiepileptics or beta blockers abruptly.
  • Ask about over-the-counter drugs, herbal products and alcohol, which can interact with prescriptions (for example St. John's wort, NSAIDs).
  • Include the family or caregiver when the client agrees, and give written instructions to take home.
  1. In practiceA client starting warfarin says green salads will be avoided completely from now on. The nurse explains that vitamin K foods do not need to be cut out, but should be eaten in steady amounts so the INR stays stable, and asks the client to repeat the plan. Large swings in vitamin K intake are what change the warfarin effect.
  2. Where questions turnTelling a client on warfarin to avoid all green vegetables, rather than keeping vitamin K intake consistent.
Practise this activity

11Assess how the client responds to a medication

  • Know the expected effect and when it should appear (onset and peak), and reassess at that time: for example pain 15 to 30 minutes after an IV analgesic, 30 to 60 minutes after an oral one.
  • Watch for adverse effects and toxicity, especially with a narrow therapeutic range: digoxin (nausea, visual changes, dysrhythmias), lithium (tremor, diarrhea, confusion), aminoglycosides (hearing loss, rising creatinine).
  • Anaphylaxis (stridor, wheezing, hypotension, swelling of the face or throat) after a dose: stop the drug, call for help, maintain the airway and give epinephrine per protocol.
  • Use drug levels with their ranges (vary by laboratory) as the prescription directs: a trough is drawn just before the next dose, a peak at the time set for that drug.
  • Evaluate response by measurable data: blood pressure, glucose, urine output, INR, pain score, sleep, mood.
  • Report a lack of effect as well as an adverse effect, and document both.
  1. In practiceTwenty minutes after the first dose of IV ceftriaxone, a client has hives, wheezing and a blood pressure of 84/50 mm Hg. The nurse stops the infusion, calls for help, keeps the airway open and gives epinephrine per protocol. Anaphylaxis is treated **first** with epinephrine, not with an antihistamine alone.
  2. Where questions turnReassessing pain at a time that does not match the drug's onset, or treating anaphylaxis with an antihistamine before epinephrine.
Practise this activity

12Give parenteral nutrition and monitor the client's response

  • Parenteral nutrition with a high dextrose concentration goes through a central line, on a pump, on a dedicated lumen; nothing else is added or infused through that lumen.
  • Check the bag against the prescription with the label, and inspect lipid-containing mixtures for separation or oiling out; do not use one that looks wrong.
  • Monitor capillary glucose often (commonly every 4 to 6 hours, more often at first; typical fasting range 70 to 99 mg/dL, or 3.9 to 5.5 mmol/L), daily weight, intake and output, and electrolytes.
  • Do **not** stop parenteral nutrition abruptly: rebound hypoglycemia can follow; if the bag runs out or the line is lost, hang 10% dextrose at the same rate per policy and notify the prescriber.
  • Do not speed up a bag that is running behind; hyperglycemia and fluid overload follow.
  • Watch for refeeding syndrome in a malnourished client (falling phosphate, potassium and magnesium) and for line infection (fever, chills).
  1. In practiceA client's parenteral nutrition bag will be empty in 30 minutes, and pharmacy says the next bag needs another 2 hours. The nurse hangs 10% dextrose at the same rate as policy directs and checks capillary glucose. Stopping the infusion would risk hypoglycemia.
  2. Where questions turnStopping parenteral nutrition when the bag runs out, or speeding it up to catch up on the daily volume.
Practise this activity

13Give medications to manage pain

  • Assess pain with a valid scale for the client (numeric, faces, or a behavioral scale for a client who cannot report), and believe the client's report.
  • Use a multimodal plan: scheduled nonopioids (acetaminophen, NSAIDs when safe), nondrug measures, and opioids when needed.
  • Before an opioid, check the respiratory rate and sedation level; sedation comes before respiratory depression, so an increasingly sleepy client needs the next dose held and the prescriber notified.
  • For opioid-induced respiratory depression (shallow breathing, low respiratory rate, difficult to rouse), stimulate the client, support breathing, give naloxone per protocol and recheck often, since its effect can wear off before the opioid's.
  • Only the client presses the patient-controlled analgesia button; family members pressing it for a sleeping client can cause an overdose.
  • Prevent opioid constipation with a scheduled bowel regimen; watch the total daily acetaminophen dose from all products.
  1. In practiceA postoperative client on morphine by patient-controlled analgesia is difficult to rouse, with a respiratory rate of 8/min and SpO2 of 88%. The nurse stops the pump, stimulates the client, gives oxygen and naloxone per protocol, and keeps checking because naloxone can wear off before the morphine does. Sedation and a falling respiratory rate are the warning signs.
  2. Where questions turnLetting a family member press the patient-controlled analgesia button, or giving the next opioid dose to a sleepy client because the pain score was high earlier.
Practise this activity

14Take part in reconciling the client's medications

  • Medication reconciliation compares the client's current medications with new prescriptions at every transition: admission, transfer between units and discharge.
  • The list includes prescriptions, over-the-counter drugs, vitamins, herbal products, inhalers, eye drops, patches and the dose and last time taken.
  • Use more than one source: the client, family, the pharmacy, the primary care record and the client's own bottles.
  • Look for omissions, duplications (two drugs of the same class), dose differences and interactions, and bring each to the prescriber to resolve.
  • At discharge, give the client one clear list of what to start, stop and continue, and ask the client to repeat it back.
  1. In practiceOn admission, a client lists three medications, but the daughter brings a bag holding a fourth: an over-the-counter NSAID taken daily. The client is also prescribed warfarin. The nurse adds the NSAID to the list and tells the prescriber about the bleeding risk of the two together.
  2. Where questions turnRecording only the client's prescription drugs and missing over-the-counter and herbal products.
Practise this activity

15Store and keep medications safe and secure

  • Store medications as labeled: unopened insulin and many vaccines in the refrigerator; protect light-sensitive drugs; never store food with medications.
  • Date a multidose vial when it is opened and discard it by the date policy sets; a single-dose vial is used once.
  • Label every syringe or container you prepare and do not give immediately, and never give a medication someone else prepared.
  • Prevent mix-ups between look-alike, sound-alike drugs with separate storage, tall man lettering and a barcode check.
  • Keep medication carts and rooms locked; never leave a medication unattended or at the bedside unless policy allows it.
  • Report a medication error or near miss through the incident system so the process can be fixed; the report is not placed in the client's record.
  1. In practiceA nurse finds an unlabeled syringe of clear fluid on the medication cart at the start of the shift. The nurse discards it per policy and does not give it, even though a colleague thinks it is the 0900 antibiotic. An unlabeled medication cannot be verified and is never given.
  2. Where questions turnGiving a medication prepared by another nurse, or one whose label is missing, because a colleague says what it is.
Practise this activity

16Handle and give high-alert medications safely

  • High-alert medications (insulin, heparin and other anticoagulants, opioids, concentrated electrolytes such as potassium chloride, magnesium sulfate, chemotherapy) cause the most harm when given wrong.
  • Use an independent double check by a second nurse when policy requires it: each calculates and checks alone, then they compare.
  • Potassium chloride is **never** given IV push or as an undiluted bolus; it is given diluted, on a pump, at a rate within policy, with adequate urine output confirmed.
  • Insulin: measure with an insulin syringe in units, check glucose first, write "units" in full; only regular insulin is commonly given IV in this setting, by pump and protocol.
  • Know the reversal agents: naloxone for opioids, protamine sulfate for heparin, vitamin K (phytonadione) for warfarin; check aPTT for unfractionated heparin and platelet counts (about 150,000 to 400,000/mm3) for heparin-induced thrombocytopenia.
  • Magnesium sulfate: check deep tendon reflexes, respiratory rate and urine output; loss of reflexes or slowed breathing means stop the infusion and report, with calcium gluconate available.
  1. In practiceA prescription reads potassium chloride 20 mEq IV now, and a vial of concentrated potassium chloride is found in the cabinet. The nurse does not draw it up for injection; the nurse obtains the premixed diluted bag from pharmacy, checks the potassium level and urine output, and runs it on a pump at the rate policy allows. Concentrated potassium given IV push can stop the heart.
  2. Where questions turnGiving potassium chloride IV push or adding it to a hanging bag without mixing, instead of a premixed diluted infusion on a pump.
Practise this activity

17Get rid of medications safely

  • Sharps go **immediately** into a puncture-resistant sharps container at the point of use; never recap a used needle by hand.
  • Hazardous drugs (for example chemotherapy) and their supplies go into the designated hazardous waste container, handled with the protective equipment policy sets.
  • Controlled substance waste is done with a licensed witness and documented by both, using the facility's approved method.
  • Teach clients that a drug take-back site or program is the best way to dispose of unused medications at home.
  • If no take-back option exists, mix most medications with something unappealing (used coffee grounds, cat litter) in a sealed bag in the household trash and remove personal details from the bottle; flush only drugs on the FDA's flush list, such as some opioids.
  • Used fentanyl patches still hold drug: fold the sticky sides together and dispose of them as directed, out of reach of children and pets.
  1. In practiceA home care client asks what to do with leftover oxycodone tablets after surgery. The nurse tells the client about a pharmacy take-back kiosk nearby and explains the instructions on the FDA flush list for when no take-back is available. Leftover opioids at home are a common source of misuse and accidental poisoning.
  2. Where questions turnTelling a client to throw unused opioids loose in the trash, or recapping a used needle before disposal.
Practise this activity

Key terms

Rights of medication administration
Right client, drug, dose, route, time and documentation, with reason, response and the right to refuse.
Dimensional analysis
A calculation method that sets up units as fractions so unwanted units cancel and the wanted unit is left.
Drop factor
The number of drops per mL a gravity tubing delivers (for example 10, 15, 20 or 60 gtt/mL).
High-alert medication
A drug that carries a high risk of serious harm when given in error, such as insulin, heparin, opioids and potassium chloride.
Independent double check
Two nurses each verify a medication and calculation separately, then compare results.
Therapeutic range
The blood level of a drug that gives benefit without toxicity; narrow for drugs such as digoxin and lithium.
Trough level
The lowest blood level of a drug, drawn just before the next dose.
Infiltration
Leakage of a nonvesicant IV solution into the tissue around the catheter.
Extravasation
Leakage of a vesicant into the tissue, which can cause blistering and tissue death.
Acute hemolytic reaction
Destruction of transfused red cells, usually from ABO incompatibility, with fever, back pain, hypotension and dark urine.
Circulatory overload
Fluid overload from a transfusion or infusion, with dyspnea, crackles, high blood pressure and distended neck veins.
Air embolism
Air entering the venous system through a central line; treated with clamping, left side head down positioning and oxygen.
Refeeding syndrome
Dangerous falls in phosphate, potassium and magnesium when a malnourished client starts nutrition.
Medication reconciliation
Comparing all of a client's medications with new prescriptions at admission, transfer and discharge.
Reversal agent
A drug that counters another: naloxone for opioids, protamine sulfate for heparin, vitamin K for warfarin.

After this guide: After this guide you should be able to verify a prescription and the client data before a dose, calculate oral, weight-based and infusion doses, give high-alert drugs, blood and parenteral nutrition safely, recognize a dangerous response and take the **first** action, and store, count and dispose of medications correctly.

Practise Pharmacological and Parenteral Therapies