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Fundamentals · chapter 11 · Medication Administration

Medication Orders

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. Order types overview

    When administering medications, it is important for the nurse to be aware of the various types of medication orders that may be written. Common types of medication orders include routine orders, one-time orders, standing orders, STAT orders (to be completed now), PRN (as needed) orders, and titration orders.

  2. Using order types

    Identifying the order type helps the nurse to prepare for medication administration by knowing which medications to administer, when to administer them, as well as specific indications for administration.

  3. Purpose of standing orders

    Standing orders are written to address protocols in which the nurse can intervene in a timely manner without having to wait on the provider to write orders, or there are general guidelines for treating a certain condition.

  4. PRN indication limits

    It is important to note that a PRN medication may only be administered for the ordered indication. For instance, an order that reads “Acetaminophen 500 mg PO PRN headache” cannot be administered for mild arthritic pain.

  5. Titration in critical care

    A titration order is an order in which the medication dose is either progressively increased or decreased by the nurse in response to the patient’s status. Titration orders are typically used for patients in critical care as defined by agency policy.

  6. Incomplete orders

    When reviewing a medication order, the nurse must ensure all essential components are included in the prescription before administering the medication. If any component of the medication order is missing, the nurse must contact the prescribing provider to clarify and correct the order.

  7. Drug name categories

    Drugs are provided with three categories of names: (1) a chemical name, (2) a generic name, and (3) a brand name. The chemical name provides a detailed description of the drug's molecular structure and chemical composition.

  8. Generic name preference

    The generic name, which is the standard name assigned by the United States Adopted Names (USAN) Council, is universally accepted and provides a simpler, more concise designation for the drug (Merck Co., 2023). It is typically used by healthcare professionals and is preferred in clinical settings to reduce confusion.

  9. Avoid abbreviated drug names

    The drug name must be clearly specified to prevent errors in medication administration. The name should be written in full and should not be abbreviated in order to avoid confusion with other medications that may have similar abbreviations.

  10. Metric system accuracy

    The metric system is the most widely used international system of measurement and is considered to be the most accurate of the three systems of measurement. It is a decimal-based system based on units of ten.

  11. Measurement system choice

    According to the Institute for Safe Medication Practices (ISMP, 2021), household and apothecary measurements should only be used to provide directions for mixing dry ingredients to prepare a topical product. In all other circumstances, the metric system should be used.

  12. Zero safety rules

    Drug dosages should not be written with trailing zeros. For example, 1 milligram should be written as 1 mg instead of 1.0 mg to reduce the risk of the dosage being mistaken for 10 mg.

  13. Ordered route required

    A drug may only be administered via the ordered route. In the event the medication cannot be administered via the route ordered, the nurse must notify the provider.

  14. Verbal order process

    When taking a verbal order, the nurse must restate the order back to the provider to ensure the message was received correctly. The nurse must immediately document the verbal order in the patient’s chart, and the provider must review and sign the order according to the agency’s policy.

Terms to know

medication order
A medication order is a prescription ordered within clinical practice.
routine order
A routine order is a medication order that is continuously followed until canceled.
one-time order
A one-time order is an order for a medication to be administered just one time.
standing order
A standing order is a standardized order that may be implemented under certain circumstances.
STAT order
A STAT order is a one-time order that is administered as urgently as possible.
PRN order
A PRN order is a medication order to be administered as needed.
titration order
A titration order is an order in which the medication dose is either progressively increased or decreased by the nurse in response to the patient’s status.
route of the drug
The route of the drug is the method by which the drug should be administered.

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 patient has an order for “Acetaminophen 500 mg PO PRN headache.” The patient reports mild arthritic pain but denies a headache. What is the nurse’s best action?

    1. Administer the medication because it is ordered PRN for pain-related symptoms.
    2. Give the medication only if the patient rates the arthritic pain as severe.
    3. Administer the medication and document arthritic pain as the reason.
    4. Do not administer the medication for arthritic pain and contact the provider if medication is needed.

    Answer: Do not administer the medication for arthritic pain and contact the provider if medication is needed.

    The correct action is to withhold the PRN medication because it is ordered only for headache. PRN medications may only be given for the ordered indication, so giving it for arthritic pain would not follow the order.

  2. A nurse is checking whether a medication order is complete before administration. Which components must be included in all medication orders? Select all that apply.

    1. Drug dose, route, and frequency
    2. Patient’s room number
    3. Date and time the medication order was written
    4. Patient’s full name and date of birth
    5. Name of the drug

    Answer: Drug dose, route, and frequency, Date and time the medication order was written, Patient’s full name and date of birth, Name of the drug

    A complete medication order must include the patient identifiers, drug name, dose, route, frequency, and the date and time written. A room number is not listed as a required component and should not replace the required patient information.

  3. A medication is ordered PO, but the nurse determines the patient cannot receive the medication by that route. What should the nurse do first?

    1. Document that the medication was refused and skip the dose.
    2. Hold the medication and notify the provider for further instructions.
    3. Ask another nurse to choose the safest alternate route.
    4. Administer the medication by another route that is available.

    Answer: Hold the medication and notify the provider for further instructions.

    The nurse may not change the medication route independently. If the ordered route cannot be used, the nurse must notify the provider and wait for an approved, clearly specified alternative route before administration.

  4. The nurse is reviewing medication doses written in several new orders. Which dose formats follow the safety guidance in the section? Select all that apply.

    1. 500 mg
    2. 1.0 mg
    3. .5 mg
    4. 0.5 mg
    5. 1 mg

    Answer: 500 mg, 0.5 mg, 1 mg

    Doses should not use trailing zeros, so 1 mg is safer than 1.0 mg. A dose less than one unit must include a leading zero, so 0.5 mg is correct and .5 mg is unsafe; 500 mg does not involve a decimal-zero issue.

  5. A postoperative patient develops nausea. The unit has a standardized protocol that allows the nurse to administer medications for nausea without waiting for the provider to write a new order. What type of medication order is the nurse using?

    1. Routine order
    2. One-time order
    3. Standing order
    4. Titration order

    Answer: Standing order

    A standing order is a standardized order that can be implemented under certain circumstances. The section specifically notes that surgical procedures often use standing orders for symptoms such as nausea or vomiting.

  6. A provider is unable to enter an order and gives the nurse a verbal medication order. Which nursing actions are appropriate? Select all that apply.

    1. Restate the order back to the provider.
    2. Wait to document the order until after the medication is administered.
    3. Have the provider review and sign the order according to agency policy.
    4. Immediately document the verbal order in the patient’s chart.
    5. Follow state and organizational policies for verbal order components.

    Answer: Restate the order back to the provider., Have the provider review and sign the order according to agency policy., Immediately document the verbal order in the patient’s chart., Follow state and organizational policies for verbal order components.

    When receiving a verbal order, the nurse must read back or restate the order, document it immediately, and follow applicable policies. The provider must review and sign according to agency policy; delaying documentation until after administration is not supported by the section.

Where every quote comes from

Section 11.1 Medication Orders 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.