Pharmacology and Medication Administration
Rights, Calculations, and High-Alert Drugs
Medication questions combine the rights of administration, safe calculation, and drug-specific monitoring. Verify the right patient, drug, dose, route, time, and documentation, and add right reason and right response. Calculate pediatric doses by weight in kilograms and confirm they fall within safe ranges. Know high-alert medications: insulin, heparin, opioids, and chemotherapy require independent double-checks. Know antidotes and reversal agents - naloxone for opioids, protamine for heparin, vitamin K for warfarin, and acetylcysteine for acetaminophen. Understand therapeutic ranges for drugs such as digoxin, lithium, and vancomycin, and monitor the organ that clears the drug.
Traps to Watch
Questions often test whether you hold a medication. Hold digoxin for a pulse below 60 in adults or per protocol, hold insulin for hypoglycemia, and hold anticoagulants before procedures per orders. Never crush enteric-coated or extended-release tablets without verification. Watch unit conversions - milligrams to micrograms, pounds to kilograms. Also, the first action when an error occurs is to assess the patient, then report through the facility system; do not hide or delay.
Rule of Thumb
If a dose looks wrong, it probably is - stop, recalculate, and clarify with the prescriber. Use the smallest number of steps in calculations and always label units.
Worked Example
An order reads 0.25 mg of digoxin. The pulse is 52. The nurse holds the dose, documents the pulse, and notifies the prescriber, because bradycardia is a reason to withhold digoxin under standard protocols.