Medication Administration and Pharmacological Assisting
What the exam expects
Medication questions test the rights of administration and your scope. Know the right resident (verified with two identifiers - name and date of birth, never the room number), right medication, right dose, right route, right time, right documentation, and the resident's right to refuse. Work only within what your state and facility authorize; unlicensed assistive personnel typically give medications only under nurse delegation and only after training. Follow the MAR exactly: never transcribe, never alter a dose, never give a medication because a family member says the resident takes it at home, and never accept a verbal dose change. Report any error or near miss immediately - the nurse and prescriber need to know, and the resident may need monitoring.
Practical points
Observe for effects and side effects: check the pulse before a digoxin dose if instructed, watch for bleeding with anticoagulants, for low blood sugar with insulin (shakiness, sweating, confusion), for dehydration with diuretics, and record intake and output. Do not crush enteric-coated or sustained-release tablets without an order. Never leave medications at the bedside; stay until the resident swallows. Eye drops go into the conjunctival sac without touching the dropper to the eye. For an inhaler, shake, have the resident exhale, press and inhale, then hold the breath about 10 seconds. Controlled substances are counted at shift change with a witness, and any discrepancy is reported at once. For PRN medications, document the effect afterward.
Traps
Choices that chart a medication before it is given, that crush a tablet to speed swallowing without an order, that leave pills on the bedside table, or that give a drug to a resident who is refusing are all wrong. A refusal is not an error - but it must be documented and reported.
Rule of thumb
No order, no medication. When in doubt about any of the rights - the drug, the dose, the resident - stop, verify with the nurse, and document what happened.