Medication Administration and Pharmacology
Medication Administration and Pharmacology
This domain tests safe prescribing and administration: the medication rights, high-alert medications, dose calculation, adverse effects, interactions, and monitoring parameters. The exam expects you to verify the order against the patient and the laboratory data, not just pour the pill.
Core rules
- Verify patient, drug, dose, route, time, and documentation; also confirm reason, allergies, and patient-specific parameters (renal function, potassium, glucose, INR).
- High-alert drugs include insulin, heparin, opioids, concentrated electrolytes, chemotherapy, and neuromuscular blockers. Use independent double checks and standardized concentrations.
- Write and read doses with a leading zero (0.5 mg) and never a trailing zero (5.0 mg); avoid U for units.
- IV push rate matters: too fast can cause hypotension, arrhythmia, or seizures (for example phenytoin).
- Distinguish adverse drug reaction (harm) from side effect (predictable effect) and from medication error (preventable process failure).
- Know antidotes: naloxone for opioids, protamine for heparin, vitamin K for warfarin, N-acetylcysteine for acetaminophen, flumazenil for benzodiazepines.
Worked example
An order reads insulin regular sliding scale: BG 200–250 give 4U. The nurse should clarify the U and confirm the concentration is U-100 before drawing up. If the patient’s glucose is 230 mg/dL and the order is active, give 4 units subcutaneously, document the glucose, and reassess in 2 hours per protocol. If the patient is NPO for surgery and the order lacks a hold parameter, call the provider rather than guessing.
Traps
- Accepting U or a trailing zero because the order looks clear.
- Holding an antihypertensive without checking the ordered parameters.
- Giving potassium IV push-never acceptable outside a controlled protocol.
- Documenting a medication before it is actually given.