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Fundamentals · chapter 11 · Medication Administration

Fundamental Principles of Medication Administration

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Medication safety categories

    These safety measures fall into four categories: ensuring correct identification of the patient, checking the medication order for errors, maintaining a safe environment, and monitoring for adverse reactions.

  2. Interdisciplinary team checkpoints

    By using an interdisciplinary team approach, safety measures may be assessed at multiple checkpoints and by several professionals, thereby reducing the opportunity for medication errors to occur.

  3. Two patient identifiers

    According to TJC’s National Patient Safety Goals, at least two patient identifiers are required to correctly identify the patient.

  4. Room number exclusion

    It is important to note that room number is not a unique identifier and should not be used to confirm the patient’s identity.

  5. Clarifying incomplete orders

    If any part of the medication order is missing, there are any questions about the order, or the writing is illegible, the nurse must contact the prescriber to clarify and correct the order.

  6. Allergy verification

    When verifying the medication order for errors, assessing patient allergies is a key safety consideration. If the patient has a documented allergy to the drug ordered, the nurse should provide notification of the allergy to the provider, who will consider alternative drugs and/or treatments.

  7. Medication indication rationale

    When administering medications, it is important to know and understand what medication the patient is taking, why they are taking it, to question the provider if it is unclear as to why a drug is ordered, and to explain to patients what they are taking and why.

  8. PRN indication requirement

    For example, medications ordered on a PRN basis must contain an indication for when to administer the medication.

  9. Medication error reporting

    If an actual or potential drug administration error occurs, it is important to report the situation immediately according to the agency’s policy.

  10. Allergic reaction notification

    The nurse should notify the provider immediately if the patient develops any symptoms of an allergic reaction.

  11. Anaphylaxis emergency response

    The nurse should discontinue the drug and urgently notify the provider if anaphylaxis is suspected. The nurse will also initiate emergency protocols according to agency policy.

  12. Core medication rights

    The five core “rights” of medication administration include the following: right patient, right drug, right route, right time, and right dose.

  13. Three medication checkpoints

    These three checkpoints are when obtaining the medication, when preparing the medication, and when administering the medications at the bedside.

  14. Barcode verification

    By scanning barcodes on the patient’s armband and medication labels, the electronic system can confirm that the right patient receives the right dose of the right medication according to the right frequency.

Terms to know

drug indication
A drug indication refers to the use of the drug for a particular disease or condition.
adverse reaction
An unwanted and undesirable effect related to a drug is called an adverse reaction.
allergic reaction
An allergic reaction occurs when the immune system responds to a substance, including a drug.
anaphylaxis
Anaphylaxis is a rare, life-threatening reaction that causes symptoms such as difficulty breathing, nausea, vomiting, diarrhea, dizziness, tachycardia, hypotension, seizure, and loss of consciousness.
drug toxicity
The degree to which a drug can be poisonous or harmful to the body is called drug toxicity.
tolerance
A tolerance refers to a decrease in the effectiveness of the drug over time due to repeated use.
drug interaction
A drug interaction is when a drug reacts with another drug, food, supplement, or the patient’s medical condition.
paradoxical effect
A paradoxical effect occurs when the effect of a drug is opposite from the intended effect.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A nurse is preparing to administer a scheduled medication to a patient who is unconscious and cannot state their name or date of birth. Which action should the nurse take to verify the patient’s identity?

    1. Ask another patient in the room to confirm the patient’s identity.
    2. Use the patient’s room number because the patient cannot speak.
    3. Administer the medication if the medication administration record matches the bed assignment.
    4. Verify the patient’s identity using a photo ID according to policy.

    Answer: Verify the patient’s identity using a photo ID according to policy.

    When the patient cannot verbalize identity, the nurse must use another acceptable identifier method, such as a photo ID. Room number is not a unique identifier and should not be used to confirm identity.

  2. A nurse is reviewing medication orders before administration. Which situations require the nurse to contact the prescriber to clarify and correct the order before giving the medication? Select all that apply.

    1. The order is missing the route of administration.
    2. Proceeding because the patient states this is a usual home medication.
    3. The nurse has questions about the order.
    4. The handwriting on the order is illegible.
    5. Asking another nurse to guess the intended order so administration is not delayed.

    Answer: The order is missing the route of administration., The nurse has questions about the order., The handwriting on the order is illegible.

    The nurse must ensure the medication order is complete and clear before administration. Missing information, questions about the order, or illegible writing require clarification with the prescriber rather than guessing or relying on patient familiarity.

  3. A nurse is preparing medications during a busy shift. Which actions help maintain a safe medication administration environment? Select all that apply.

    1. Leave medications at the bedside for the patient to take later without a provider order.
    2. Place prepared patient medications in a clothing pocket while walking to the room.
    3. Return medications to the cabinet if there is a delay in administration.
    4. Gather medications for one patient at a time.
    5. Clearly label all prepared medications.

    Answer: Return medications to the cabinet if there is a delay in administration., Gather medications for one patient at a time., Clearly label all prepared medications.

    Safe medication practice includes preparing medications for one patient at a time, labeling prepared medications, and returning them to storage if administration is delayed. Medications should not be placed in clothing pockets or left at the bedside unless ordered by the provider.

  4. While scanning medications, a nurse notices the medication label does not match the medication order and stops before giving the drug. What is the nurse’s best next action?

    1. Document only if the patient later develops an adverse reaction.
    2. Report the potential medication administration error immediately according to agency policy.
    3. Ask the patient whether they are willing to take the medication anyway.
    4. Ignore the event because the patient did not receive the medication.

    Answer: Report the potential medication administration error immediately according to agency policy.

    A potential medication error should be reported, even if the medication was not administered. Reporting potential errors supports education and helps reduce the risk of a future actual error.

  5. A patient develops intense itching and a red, raised rash shortly after IV contrast dye is started. Which action should the nurse take first?

    1. Stop the infusion and alert the provider about a suspected allergic reaction.
    2. Increase the infusion rate to complete the diagnostic procedure faster.
    3. Wait one hour because serious drug allergy symptoms cannot occur quickly.
    4. Continue the infusion and document the rash as a predictable side effect.

    Answer: Stop the infusion and alert the provider about a suspected allergic reaction.

    Rapid onset of itching and rash after a medication or contrast dye suggests an allergic reaction. The nurse should stop the infusion and notify the provider, then continue monitoring for progression such as signs of anaphylaxis.

  6. At the three medication administration checkpoints, the nurse compares the medication label with the medication order. Which items should the nurse confirm? Select all that apply.

    1. Right patient
    2. Right drug
    3. Right room number
    4. Right dose
    5. Right route

    Answer: Right patient, Right drug, Right dose, Right route

    The medication label should be compared with the order at the checkpoints to confirm the core rights, including patient, drug, route, time, and dose. Room number is not a unique patient identifier and is not one of the medication administration rights.

Where every quote comes from

Section 11.2 Fundamental Principles of Medication Administration of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.