Rights Of Medication Administration - NCLEX Pn

1. In a long-term care facility, an LPN is preparing to give insulin lispro subcutaneously before breakfast to a 79-year-old male with type 2 diabetes. The order reads: insulin lispro sliding scale subcutaneous before meals; blood glucose 201–250 mg/dL = 4 units. The client's fingerstick blood glucose is 228 mg/dL, but breakfast trays are delayed and will arrive in about 45 minutes. Which action should the nurse take to ensure the right time is followed?
   Answer: Hold the insulin until the meal is available, then administer it immediately before the client eats. This question tests the rights of medication administration, particularly focusing on the right time for rapid-acting insulin administration. The specific rights involved are the right client, medication, dose, route, time, and documentation, with emphasis on the right time. The correct answer (B) accurately follows these rights by holding the insulin until the meal is available and then administering it immediately before eating, as insulin lispro is rapid-acting and peaks in 30-90 minutes. Option A risks hypoglycemia by giving insulin 45 minutes before food arrival; option C delays insulin too long and compromises glycemic control; option D inappropriately suggests changing to long-acting insulin for meal coverage. The principle of ensuring client safety through accurate medication administration requires coordinating rapid-acting insulin with meal availability to prevent hypoglycemia while maintaining glycemic control. A key strategy is to always verify meal availability before administering rapid-acting insulin and to hold the dose if meals are significantly delayed.
2. In a hospital, an LPN is preparing to administer heparin 5,000 units subcutaneously every 8 hours for venous thromboembolism prophylaxis to a 74-year-old postoperative client; the medication label reads heparin 10,000 units/mL, and the order requires 0.5 mL. Which action should the nurse take to ensure the right dose is given?
   Answer: Draw up 0.5 mL using an appropriate syringe and have the dose verified per facility policy before administration This question tests the rights of medication administration. The specific rights involved are right dose and right route. The correct answer, drawing up 0.5 mL using an appropriate syringe and having the dose verified per facility policy, accurately follows these rights for precise anticoagulation. Option A fails by delegating without oversight; option C fails by rounding incorrectly; option D fails by changing route. The principle of ensuring client safety through accurate medication administration requires verification of high-alert drugs like heparin. This prevents bleeding complications. A strategy for double-checking medication orders and client details is to use independent double-checks for calculations.
3. In a pediatric inpatient unit, an LPN is preparing to administer an oral antibiotic to a 7-year-old child; the order reads azithromycin 200 mg by mouth once daily, and the child's armband is missing after a bath. Which action should the nurse take to ensure the right client receives the medication?
   Answer: Use two identifiers and replace the missing identification band before administering the medication This question tests the rights of medication administration. The specific rights involved are right client and right documentation. The correct answer, using two identifiers and replacing the missing identification band before administering, accurately follows these rights for proper verification. Option A fails by relying on parent only; option C fails by delaying identification; option D fails by assuming refusal. The principle of ensuring client safety through accurate medication administration requires identification bands for pediatric safety. This avoids wrong-patient errors. A strategy for double-checking medication orders and client details is to replace bands immediately and confirm identifiers.
4. On a home health visit, an LPN reviews medications with a 70-year-old woman with hypertension; the prescription label reads lisinopril 10 mg by mouth daily, but the client says, "I take it only when my blood pressure feels high." Which observation indicates the client needs further teaching about their medication?
   Answer: The client states she takes lisinopril only when she feels her blood pressure is high This question tests the rights of medication administration. The specific rights involved are right time and right dose. The correct answer, the client taking lisinopril only when she feels her blood pressure is high, accurately identifies the need for teaching as it violates consistent daily administration. Option A fails as proper storage is correct; option C fails as knowing name and dose is appropriate; option D fails as reporting side effects is correct. The principle of ensuring client safety through accurate medication administration includes adhering to prescribed schedules for blood pressure control. This prevents hypertensive crises from inconsistent use. A strategy for double-checking medication orders and client details is to assess client compliance and understanding during home visits.
5. In a long-term care facility, an LPN is preparing to give digoxin 0.125 mg by mouth daily at 0900 to an 83-year-old woman with heart failure; the medication administration record lists the drug, but the blister pack label shows digoxin 0.25 mg. Which action should the nurse take to ensure the right medication is given?
   Answer: Hold the dose and clarify the discrepancy with the pharmacy and provider per facility policy before administering This question tests the rights of medication administration. The specific rights involved are right dose and right medication. The correct answer, holding the dose and clarifying the discrepancy with the pharmacy and provider, accurately follows these rights by resolving the mismatch between order and label. Option A fails by giving the wrong dose, violating right dose; option C fails by altering the tablet without verification, missing right dose; option D fails by teaching after administration, ignoring the error. The principle of ensuring client safety through accurate medication administration involves verifying labels against orders to prevent cardiac toxicity from digoxin overdose. This safeguards elderly patients from adverse effects. A strategy for double-checking medication orders and client details is to compare the medication blister pack, order, and administration record three times.
6. During shift change in a long-term care facility, an LPN is reconciling medications for a 90-year-old woman with dementia; the medication administration record shows haloperidol 0.5 mg by mouth at bedtime, but the night nurse reports giving haloperidol 1 mg at bedtime for the last two nights due to agitation without a new order. What is the nurse's priority when administering medication?
   Answer: Verify the right dose by comparing the current provider order to what was administered and report the discrepancy per facility policy This question tests the rights of medication administration. The specific rights involved are right dose and right documentation. The correct answer, verifying the right dose by comparing the current provider order to what was administered and reporting the discrepancy, accurately follows these rights by addressing the error. Option A fails by continuing the wrong dose; option C fails by not reporting; option D fails by falsifying records. The principle of ensuring client safety through accurate medication administration requires reporting variances to prevent ongoing errors. This protects vulnerable elderly from harm. A strategy for double-checking medication orders and client details is to review administration records during shifts.
7. In a pediatric clinic, an LPN is to administer amoxicillin 25 mg/kg/day by mouth in two divided doses for a 4-year-old female who weighs 16 kg and has acute otitis media. The prescription label reads: amoxicillin 200 mg by mouth twice daily for 10 days. Which action should the nurse take to ensure the right dose is given?
   Answer: Calculate the daily dose based on weight and compare it with the labeled dose before administering the first dose. This question tests the rights of medication administration, particularly focusing on verifying the right dose for a pediatric client using weight-based calculations. The specific rights involved are the right client, medication, dose, route, time, and documentation, with emphasis on the right dose. The correct answer (B) accurately follows these rights by calculating the expected dose (25 mg/kg/day × 16 kg = 400 mg/day, or 200 mg twice daily) and comparing it with the labeled dose before administration. Option A fails to verify the dose independently; option C inappropriately changes the route without authorization; option D delays verification until after administration, potentially risking an incorrect dose. The principle of ensuring client safety through accurate medication administration is especially critical in pediatrics where doses are weight-based and calculation errors can have serious consequences. A key strategy for pediatric medication administration is to always independently calculate weight-based doses and verify them against the prescription before giving any medication.
8. In a hospital scenario, an LPN is assigned to administer a new prescription for metoprolol tartrate 25 mg by mouth twice daily to a 60-year-old man with hypertension; the client states he is allergic to "beta-blockers" but cannot describe the reaction. Which action should the nurse take to ensure the right medication is given?
   Answer: Hold the medication and notify the provider of the reported allergy before administering the first dose This question tests the rights of medication administration. The specific rights involved are right medication and right client. The correct answer, holding the medication and notifying the provider of the reported allergy, accurately follows these rights by clarifying the allergy before administration. Option B fails by administering without verification, violating right medication; option C fails by assuming refusal, missing right medication; option D fails by teaching after, ignoring the allergy. The principle of ensuring client safety through accurate medication administration involves investigating vague allergies to prevent reactions. This ensures appropriate drug selection. A strategy for double-checking medication orders and client details is to review allergy history and order compatibility.
9. In a hospital medical-surgical unit, an LPN is preparing to give a first dose of lisinopril 10 mg by mouth now for a 58-year-old male with hypertension and type 2 diabetes. The client states, "I had swelling of my lips after a blood pressure pill years ago," and the chart lists an allergy to angiotensin-converting enzyme inhibitors. Which action should the nurse take to ensure the right medication is given?
   Answer: Hold the lisinopril and notify the registered nurse or provider about the reported allergy before giving the dose. This question tests the rights of medication administration, specifically focusing on ensuring the right medication is given to the right client. The specific rights involved are the right client, medication, dose, route, time, and documentation, with emphasis on the right medication in the context of a documented allergy. The correct answer (B) accurately follows these rights by holding the medication and notifying the appropriate healthcare provider, as lisinopril is an ACE inhibitor and the client has a documented allergy to this drug class with a history of angioedema (lip swelling). Option A fails to meet the right medication principle by attempting to administer a contraindicated drug; option C ignores the allergy concern and focuses only on blood pressure; option D violates safety by administering first and checking the allergy afterward. The principle of ensuring client safety through accurate medication administration requires nurses to verify allergies before giving any medication, especially when the client reports previous adverse reactions. A key strategy is to always check allergies in the medication administration record and listen carefully when clients report previous reactions to medications.
10. At a long-term care facility during shift change, an LPN is reconciling medications for an 82-year-old female with atrial fibrillation and osteoarthritis. The medication administration record lists warfarin 5 mg by mouth daily at 1700, but the new provider order written today states warfarin 2.5 mg by mouth daily at 1700. The nurse is preparing the 1700 dose. The nurse should verify which aspect of the medication order?
    Answer: The right dose by clarifying the discrepancy with the registered nurse or provider before administering warfarin. This question tests the rights of medication administration, particularly focusing on verifying the right dose when there is a discrepancy between orders. The specific rights involved are the right client, medication, dose, route, time, and documentation, with emphasis on the right dose. The correct answer (A) accurately follows these rights by requiring clarification of the dose discrepancy between the MAR (5 mg) and the new provider order (2.5 mg) before administration. Option B incorrectly focuses on route verification when no route issue exists; option C violates proper documentation timing by suggesting signing before administration; option D addresses timing but ignores the critical dose discrepancy. The principle of ensuring client safety through accurate medication administration requires nurses to resolve any discrepancies in medication orders before proceeding with administration. A strategy for double-checking medication orders includes comparing the MAR with the most recent provider orders and seeking clarification when differences are identified.
11. In a hospital, an LPN is preparing to administer potassium chloride 20 mEq by mouth daily to a 66-year-old man receiving furosemide; the client says, "Those pills are too big, so I crush them and mix them in applesauce," and the available form is an extended-release tablet. What is the nurse's priority when administering medication?
    Answer: Hold administration and notify the provider/pharmacy because extended-release tablets should not be crushed This question tests the rights of medication administration. The specific rights involved are right route and right medication. The correct answer, holding administration and notifying the provider/pharmacy because extended-release tablets should not be crushed, accurately follows these rights by preventing improper release. Option A fails by encouraging crushing; option C fails by ignoring the issue; option D fails by documenting without correction. The principle of ensuring client safety through accurate medication administration involves maintaining drug formulations for controlled release. This avoids toxicity from rapid absorption. A strategy for double-checking medication orders and client details is to check medication forms against client preferences and orders.
12. In a hospital, an LPN is preparing to administer insulin lispro 6 units subcutaneously with lunch to a 58-year-old woman with type 2 diabetes; the lunch tray has not arrived and the current blood glucose is 92 mg/dL. What is the nurse's priority when administering medication?
    Answer: Hold the insulin until the meal is available and follow facility policy for timing rapid-acting insulin with food This question tests the rights of medication administration. The specific rights involved are right time and right dose. The correct answer, holding the insulin until the meal is available and following facility policy for timing, accurately follows these rights by coordinating with food intake to prevent hypoglycemia. Option A fails by giving without food; option C fails by changing route; option D fails by teaching after ignoring timing. The principle of ensuring client safety through accurate medication administration involves timing insulin with meals for glucose balance. This reduces hypoglycemic risks in diabetics. A strategy for double-checking medication orders and client details is to check blood glucose and meal status before administration.
13. In a hospital rehabilitation unit, an LPN is administering scheduled medications to a 76-year-old male with Parkinson disease. The order reads: carbidopa-levodopa 25/100 mg by mouth at 0800, 1200, 1600, and 2000. It is now 1200, but the client is off the unit in physical therapy and will return at 1300. Which action should the nurse take to ensure the right time is maintained?
    Answer: Administer the 1200 dose at 1300 when the client returns and document the reason for the delayed administration. This question tests the rights of medication administration, particularly focusing on maintaining the right time when scheduled doses are delayed. The specific rights involved are the right client, medication, dose, route, time, and documentation. The correct answer (A) accurately follows these rights by administering the delayed dose when the client returns and documenting the reason for the delay, which maintains therapeutic blood levels of carbidopa-levodopa crucial for Parkinson's symptom control. Option B risks subtherapeutic levels by skipping a dose; option C could cause adverse effects by doubling the dose; option D inappropriately delegates medication administration to non-nursing staff. The principle of ensuring client safety through accurate medication administration recognizes that while timing is important, maintaining therapeutic drug levels for chronic conditions takes precedence over exact timing when reasonable delays occur. A strategy for managing delayed doses includes administering the medication as soon as possible after the scheduled time, documenting the actual administration time and reason for delay, and monitoring for any adverse effects.
14. In a long-term care facility, an LPN is preparing to give digoxin 0.125 mg by mouth daily to a 90-year-old female with heart failure. The medication administration record has two residents with the same last name on the same hallway. Which action should the nurse take to ensure the right client is identified before administering the medication?
    Answer: Ask the client to state their full name and date of birth and compare these with the identification band and medication administration record. This question tests the rights of medication administration, specifically focusing on ensuring the right client receives the medication when there is potential for confusion. The specific rights involved are the right client, medication, dose, route, time, and documentation, with emphasis on the right client. The correct answer (A) accurately follows these rights by using two unique identifiers (full name and date of birth) and comparing them with both the identification band and MAR, which is the standard practice for client identification. Option B relies only on room number, which is not a reliable identifier; option C inappropriately delegates client identification to unlicensed personnel; option D is impractical and doesn't use standard identification procedures. The principle of ensuring client safety through accurate medication administration requires using at least two unique identifiers that don't include room number, as clients can be moved or rooms can have multiple occupants. A key strategy for preventing wrong-client errors is to always check the identification band and ask the client to state their identifiers rather than asking yes/no questions like "Are you Mrs. Smith?"
15. On a home health visit, an LPN sees a 56-year-old man with type 2 diabetes who was prescribed metformin 500 mg by mouth twice daily with meals; the client states, "I take two tablets at bedtime so I don't forget." Which observation indicates the client needs further teaching about their medication?
    Answer: The client states he takes both doses at bedtime instead of twice daily with meals This question tests the rights of medication administration. The specific rights involved are right time and right dose. The correct answer, the client taking both doses at bedtime instead of twice daily with meals, accurately identifies the need for teaching as it violates proper timing and potentially dosing efficacy for metformin. Option A fails as it shows correct adherence, not needing teaching; option C fails as proper storage is correct; option D fails as monitoring is appropriate. The principle of ensuring client safety through accurate medication administration includes educating on correct timing to maintain therapeutic levels and avoid side effects. This ensures optimal drug absorption and glycemic control. A strategy for double-checking medication orders and client details is to review the prescription label and client understanding during each visit.
16. In a hospital setting, an LPN is preparing to administer heparin 5,000 units subcutaneously every 8 hours for deep vein thrombosis prophylaxis to a 45-year-old female post-operative client. The medication drawer contains heparin 10,000 units/mL vials, and the order requires a 0.5 mL dose if using that concentration. Which action should the nurse take to ensure the right medication is given?
    Answer: Verify the medication label against the medication administration record and calculate the volume to draw up before preparing the syringe. This question tests the rights of medication administration, specifically focusing on verifying the right medication and calculating the correct dose. The specific rights involved are the right client, medication, dose, route, time, and documentation. The correct answer (A) accurately follows these rights by verifying the medication label against the MAR and calculating the correct volume (5,000 units ÷ 10,000 units/mL = 0.5 mL) before preparation. Option B inappropriately involves another client in medication verification; option C would result in a double dose (10,000 units instead of 5,000 units); option D prioritizes documentation over medication verification, risking errors. The principle of ensuring client safety through accurate medication administration requires careful verification of medication labels and accurate dose calculations, especially with high-alert medications like heparin. A strategy for preventing medication errors includes using the "five rights" check three times: when removing medication from storage, when preparing it, and at the bedside before administration.
17. During a home health visit, an LPN sees a 74-year-old male with chronic heart failure who was prescribed furosemide 20 mg by mouth every morning. The client says, "I take two of the 20 mg tablets at night so I don't forget." What is the nurse's priority when administering medication?
    Answer: Clarify the prescribed dose and timing with the client and reinforce taking 20 mg in the morning as ordered. This question tests the rights of medication administration, specifically addressing the right dose and right time when a client is not following the prescribed regimen. The specific rights involved are the right client, medication, dose, route, time, and documentation. The correct answer (C) accurately follows these rights by clarifying the prescribed dose and timing with the client and reinforcing the correct administration schedule of 20 mg in the morning. Option A fails to address the timing error and incorrect total daily dose (40 mg instead of 20 mg); option B incorrectly changes the dose without provider authorization; option D inappropriately suggests stopping the medication without provider consultation. The principle of ensuring client safety through accurate medication administration requires nurses to educate clients about proper medication timing and dosing to achieve therapeutic effects while minimizing adverse effects. A strategy for medication reconciliation during home visits includes reviewing what the client actually takes versus what is prescribed and providing education to correct any discrepancies.
18. On a hospital telemetry unit, an LPN is preparing to administer metoprolol tartrate 25 mg by mouth at 0900 to a 67-year-old female with hypertension and a heart rate of 54 beats/min. The order reads: metoprolol tartrate 25 mg by mouth twice daily; hold if heart rate is less than 60 beats/min. What is the nurse's priority when administering medication?
    Answer: Hold the medication and notify the registered nurse according to the hold parameter in the order. This question tests the rights of medication administration, specifically addressing the right dose and following hold parameters based on vital signs. The specific rights involved are the right client, medication, dose, route, time, and documentation. The correct answer (B) accurately follows these rights by holding the medication according to the specific parameter in the order (hold if heart rate less than 60) and notifying the registered nurse, as the client's heart rate is 54 beats/min. Option A violates the hold parameter by administering despite bradycardia; option C inappropriately adjusts the dose without authorization; option D addresses orthostatic precautions but ignores the hold parameter. The principle of ensuring client safety through accurate medication administration requires nurses to follow all parameters and restrictions specified in medication orders, as these protect clients from adverse effects. A strategy for safe medication administration includes checking all relevant vital signs against hold parameters before administering medications that affect cardiovascular function.
19. In a pediatric setting, an LPN is preparing to administer ibuprofen 10 mg/kg by mouth every 6 hours as needed for pain to a 10-year-old child weighing 30 kg; the bottle available is ibuprofen 100 mg/5 mL. The nurse should verify which aspect of the medication order?
    Answer: Right dose by calculating the milligram dose from the child's weight and measuring the correct volume This question tests the rights of medication administration. The specific rights involved are right dose and right route. The correct answer, right dose by calculating the milligram dose from the child's weight and measuring the correct volume, accurately follows these rights for precise administration. Option A fails by over-administering; option C fails by changing route; option D fails by documenting prematurely. The principle of ensuring client safety through accurate medication administration requires weight-based calculations for pain relief without toxicity. This protects children from adverse effects. A strategy for double-checking medication orders and client details is to use a calculator and verify measurements.
20. On a hospital unit, an LPN is about to give a new medication, sulfamethoxazole-trimethoprim 1 tablet by mouth twice daily, to a 34-year-old woman with a urinary tract infection; the client states she has a "sulfa" allergy that caused a rash. Which action should the nurse take to ensure the right medication is given?
    Answer: Hold the medication and notify the provider of the reported sulfa allergy before administering This question tests the rights of medication administration. The specific rights involved are right medication and right client. The correct answer, holding the medication and notifying the provider of the reported sulfa allergy, accurately follows these rights by preventing allergic reactions. Option A fails by minimizing the allergy; option C fails by ignoring the allergy; option D fails by insufficient verification. The principle of ensuring client safety through accurate medication administration involves allergy checks to avoid adverse events. This ensures safe antibiotic use. A strategy for double-checking medication orders and client details is to confirm client statements with records before dosing.

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