Before administering insulin, what additional safety step is required?

Independent double-check by another licensed nurse. Insulin is a high-alert medication that requires an independent double-check by another licensed nurse before administration. This includes verifying the insulin type, dose, and patient blood glucose level. This practice helps catch errors before they reach the patient.

An LPN prepares to give a medication and realizes it looks different from what the patient usually receives. What should the LPN do?

Hold the medication and verify with pharmacy before giving. If a medication appears different than expected, the nurse should hold it and verify with the pharmacy before administration. The change could indicate the right medication from a different manufacturer, but could also indicate an error. Always verify when something seems unusual.

An LPN accidentally gives the wrong dose of a medication. The patient shows no adverse effects. What should the LPN do FIRST?

Assess the patient and notify the provider. The immediate priority after a medication error is to assess the patient for any adverse effects and notify the provider. Even if no symptoms are present, the provider needs to know so appropriate monitoring can be ordered. Incident reports and documentation come after patient safety is ensured.

3.5 Safe Medication Administration | NCLEX-PN (Practical Nurse) | Free Exam Prep

Safe Medication Administration

Medication errors are a leading cause of preventable patient harm. The LPN/LVN must follow systematic procedures to ensure every medication is administered safely.

The Rights of Medication Administration

Traditional "5 Rights" plus additional safety rights:

Right	Verification
Right Patient	Two identifiers (name + DOB or MRN)
Right Drug	Compare label to order, check for allergies
Right Dose	Calculate if needed, verify appropriateness
Right Route	Verify route matches order and form
Right Time	Within acceptable window of scheduled time
Right Documentation	Document after administration
Right Reason	Understand why patient is receiving medication
Right Response	Monitor for expected and adverse effects
Right to Refuse	Patient can decline; document and report

Before Medication Administration

Three Checks:

When removing from storage
When preparing/pouring medication
At the patient's bedside before administration

Verify at each check:

Drug name matches order
Dose is correct
Expiration date is valid
Medication appearance is normal

High-Alert Medications

Medications that can cause significant harm if given incorrectly:

Category	Examples
Anticoagulants	Heparin, warfarin, enoxaparin
Insulins	All types
Opioids	Morphine, fentanyl, hydromorphone
Sedatives	Benzodiazepines, propofol
Chemotherapy	All cytotoxic agents
Electrolytes	Potassium chloride, sodium chloride >0.9%
Neuromuscular blockers	Succinylcholine, vecuronium

High-alert medication safety practices:

Independent double-check by second nurse
Use of tall-man lettering (e.g., DOPamine vs. DOBUTamine)
Limited access storage
Standardized concentrations
Smart pump programming

Look-Alike/Sound-Alike (LASA) Medications

Common LASA pairs that cause confusion:

Drug	Confused With
Metformin	Metronidazole
Hydroxyzine	Hydralazine
Prednisone	Prednisolone
Clonidine	Klonopin
Tramadol	Trazodone
Celebrex	Celexa

Prevention strategies:

Read labels carefully, do not assume
Use both brand and generic names
Verify indication for the medication
Question if something doesn't make sense

Allergies and Adverse Reactions

Always verify allergies before administration:

Check allergy band
Verify in medical record
Ask patient directly

Types of reactions:

Reaction	Description	Action
Side effect	Known, expected effect	Monitor, may continue
Adverse reaction	Unintended, harmful effect	Report, may discontinue
Allergic reaction	Immune response	Stop medication, treat symptoms
Anaphylaxis	Severe, life-threatening	Emergency response, epinephrine

Safe Medication Practices

Do	Don't
Verify orders are complete and legible	Administer unclear orders
Calculate doses independently	Assume calculations are correct
Check compatibility before mixing	Mix medications without verification
Label all syringes	Leave syringes unlabeled
Administer medications you prepared	Give medications prepared by others
Question orders that seem inappropriate	Assume the prescriber is always right

When to Question an Order

Contact prescriber or pharmacist if:

Order is unclear or incomplete
Dose seems unusually high or low
Route seems inappropriate
Patient has documented allergy
Drug interaction is suspected
Order doesn't match diagnosis

Document:

That you questioned the order
Response received
Action taken

Medication Errors

If an error occurs:

Assess the patient immediately
Notify the provider and supervising RN
Monitor for adverse effects
Document accurately in the medical record
Complete an incident report (per facility policy)
Do not document "incident report filed" in the chart

Types of errors:

Error Type	Example
Omission	Missed dose
Wrong dose	10 mg instead of 1 mg
Wrong drug	Similar name confusion
Wrong route	IV instead of IM
Wrong time	Given 4 hours late
Wrong patient	Patient misidentified

Controlled Substance Safety

Requirements for controlled substances:

Count at shift change
Dual signature for waste
Secure storage
Accurate documentation
Report discrepancies immediately

Signs of diversion:

Frequent "wasted" medications
Patients reporting inadequate pain relief
Unusual patterns of medication administration
Tampering with medication packaging

On the NCLEX-PN

Expect questions about:

The rights of medication administration
High-alert medication precautions
Appropriate response to medication errors
When to question medication orders

NCLEX-PN

1Introduction to the NCLEX-PN

2Chapter 2: Coordinated Care

3Chapter 3: Safety and Infection Prevention and Control

4Chapter 4: Health Promotion and Maintenance

5Chapter 5: Psychosocial Integrity

6Basic Care and Comfort

7Pharmacological and Parenteral Therapies

8Reduction of Risk Potential

9Physiological Adaptation

Key Takeaways