Pharmacology and Medication Administration
Core concepts
Medication safety centers on the rights of administration (right patient, drug, dose, route, time, documentation, reason, and to refuse), the importance of checking allergies, and the nurse's legal duty to question unclear or unsafe orders. Know high-alert medications (insulin, heparin, opioids, chemotherapy, concentrated electrolytes) and their safeguards: independent double-checks, smart pumps, and standardized concentrations. Understand pharmacokinetics (absorption, distribution, metabolism, excretion) and key concepts like half-life, therapeutic index, peak and trough levels, and first-pass effect. For common drug classes, link mechanism to monitoring: aminoglycosides (peak/trough, ototoxicity, nephrotoxicity), digoxin (apical pulse before dose, therapeutic range, toxicity signs), warfarin (INR), heparin (aPTT, antidote protamine), opioids (respiratory depression, naloxone).
Traps in questions
The exam loves hold parameters: know to hold digoxin for apical pulse below 60, hold metformin before contrast, and hold ACE inhibitors for hypotension or rising potassium. Another trap is route or timing errors-giving a sustained-release tablet crushed, or an IV push too fast. Watch for questions that ask the first action: for a wrong medication already given, assess the patient first, then notify the provider and complete an incident report (never document the error in the chart narrative as blame). Pediatric and weight-based dosing (mg/kg) frequently appear; always verify the safe dose range.
Rule of thumb
Assess before you administer, and reassess before you repeat. For any "which action first" medication question, choose patient assessment over paperwork or notification.
Worked example
An order reads digoxin 0.25 mg PO daily. The nurse finds an apical pulse of 54. Correct action: hold the dose, document the assessment, and notify the prescriber-do not give and do not simply recheck later without reporting.