Medication Safety
Which action best reflects the 'Right Patient'?
Using two identifiers such as name and date of birth before medication administration.
Which route has the fastest absorption?
IV route
What is the first-pass effect? Why is it important?
It reduces the bioavailability of some drugs by metabolizing them in the liver before systemic circulation.
example: Lidocaine, Nitroglycerin, Morphine
May require higher doses or alternative route, such as Sublingual, transdermal, or IV
Situation: Redness + cloudy drainage under dressing. What is your FIRST action?
Notify provider and monitor chart for new orders.
What is the correct immediate action after giving an injection?
Activate the safety device and place the needle directly into a sharps container — never recap.
A nurse prepares a medication but delays documentation for several hours. What is the main legal risk?
Late documentation can suggest care was delayed or not given and may be viewed as falsification in court.
Which “Right” is violated if a nurse gives a medication without explaining its purpose?
Right Education.
Which insulin has the fastest onset?
Rapid-acting insulin, such as lispro, Humalog, aspart, NovoLog.
Patient receives rapid-acting insulin but the meal tray is delayed. What is the immediate risk?
Hypoglycemia due to insulin peaking without food
Who is legally responsible for a medication error, even if another nurse prepared or handed the medication to them?
The nurse who administers the medication.
**Never administer medication that has been prepared by another nurse.
Before using a PICC line, which assessment is MOST important?
Inspecting the site for redness, swelling, pain, or drainage.
A patient refuses a scheduled medication. What is the BEST response?
Respect the refusal, explore concerns, notify provider, and document.
Before administering a Metoprolol, which assessment is required?
You would need to know it is a beta-blocker.
Heart rate and blood pressure must be checked.
A patient reports burning during IV antibiotic administration through a central line. What is your FIRST action?
Stop the infusion immediately.
Which task can be delegated to a UAP (unlicensed assistive personnel)?
Vital signs, hygiene assistance, and ADLs — but not medication administration, assessments, or teaching.
The MAR requires 25 mg metoprolol, but only 50 mg tablets are available. What must the nurse do?
Split the tablet (if safe) or follow pharmacy policy to ensure the correct 25 mg dose.
Patient begins coughing violently during insertion. What is the FIRST priority?
Airway Stop immediately—possible airway entry.
Which insulin type must NEVER be mixed with other insulins?
Long-acting insulins (e.g., glargine).
You administer a dose of epinephrine to a patient that is having a severe (anaphylactic) reaction to a medication. Their vitals signs are 145/86 blood pressure, 132 Heart Rate, 24 Respiration. What do you do next?
Document the vital signs and be prepared to administer a second dose in 5-15 minutes, if needed.
If a patient is on antihypertensives, what should the nurse always check before giving the dose?
Blood pressure — hold if too low per provider parameters.
A nurse answers a call light of a patient. The patient complains of blurred vision, weakness is diaphoretic (sweaty), with tremors (shaking). What is important to know about these symptoms?
Hypoglycemia, Does the patient have a diagnosis of diabetes mellitus and is she insulin dependent?
Interventions: check blood sugar, if low below 70, offer 40 grams of carbohydrates, monitor closely until she returns to baseline.
When encountering two medications that look or sound alike, what is the safest process?
Perform a full label read-back, compare to MAR, and complete a second RN double-check if required.
When should a nurse document medication administration?
Immediately after giving the medication—never before
A patient says, “I don’t think I take that medication.” What should the nurse do first?
Stop and recheck the MAR and order before administration.
A nurse retrieves a medication, but the dose on the label is smudged and unreadable. What is the priority action?
Do not administer; replace the medication with a readable label and return the unreadable to pharmacy.