Rights Of Medication Administration
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NCLEX-PN › Rights Of Medication Administration
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?
Instruct the client to continue crushing the tablet but take it with more applesauce
Document the client’s preference and administer the crushed tablet as requested
Ask the client to drink a full glass of water after crushing and taking the tablet
Hold administration and notify the provider/pharmacy because extended-release tablets should not be crushed
Explanation
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.
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?
Hold the medication and notify the provider of the reported sulfa allergy before administering
Ask the client to drink extra fluids and give the medication as ordered
Verify the medication by comparing it only to the medication administration record once
Administer the medication because a rash is not a serious allergy and document the reaction history later
Explanation
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.
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?
Document the 1 mg dose on the medication administration record as if it were ordered
Continue giving 1 mg at bedtime because it was effective for agitation
Teach staff nonpharmacologic calming techniques and leave the dose unchanged without reporting
Verify the right dose by comparing the current provider order to what was administered and report the discrepancy per facility policy
Explanation
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.
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?
Draw up 0.5 mL using an appropriate syringe and have the dose verified per facility policy before administration
Ask another nurse to give the injection while the LPN prepares the next client’s medications
Administer the medication intramuscularly to reduce bruising at the injection site
Round the dose up to 1 mL to avoid medication waste
Explanation
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.
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?
Ask another client in the room to confirm the vial looks like the heparin used earlier.
Draw up 1 mL to ensure the full dose is delivered and document the higher dose as a variance.
Verify the medication label against the medication administration record and calculate the volume to draw up before preparing the syringe.
Document the administration time first, then check the vial concentration to avoid being late.
Explanation
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.
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?
Give the first dose now and recheck the child’s weight at the next visit to confirm dosing accuracy.
Change the route to intramuscular injection to ensure full absorption in a child.
Calculate the daily dose based on weight and compare it with the labeled dose before administering the first dose.
Administer the medication as labeled because the pharmacy has already calculated the pediatric dose.
Explanation
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.
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?
The right route by confirming that warfarin is intended to be given by mouth rather than subcutaneously.
The right time by giving the 5 mg dose at 1600 so it is completed before dinner trays arrive.
The right dose by clarifying the discrepancy with the registered nurse or provider before administering warfarin.
The right documentation by signing the medication administration record now to avoid missing the 1700 charting window.
Explanation
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.
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?
Administer the 1200 dose at 1300 when the client returns and document the reason for the delayed administration.
Ask physical therapy staff to administer the medication during the session so it is exactly on time.
Give two tablets at 1600 to make up for the missed 1200 dose.
Skip the 1200 dose and resume with the 1600 dose to avoid giving doses too close together.
Explanation
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.
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?
Ask the client to state their full name and date of birth and compare these with the identification band and medication administration record.
Ask the certified nursing assistant to verify the client’s identity because the assistant knows the residents well.
Confirm the client’s identity by checking the room number against the medication administration record.
Call the family member listed in the chart to confirm the client’s identity before giving digoxin.
Explanation
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?"
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?
Teach the client to rise slowly from bed after taking the medication and then administer the dose.
Hold the medication and notify the registered nurse according to the hold parameter in the order.
Give half the dose (12.5 mg) and document the dose adjustment to reduce bradycardia risk.
Administer the medication because the blood pressure is the primary indicator for antihypertensives.
Explanation
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.