Safe Medication Administration Flashcards

A practical nurse is preparing to administer a nasogastric (NG) tube medication to a client who is also receiving a continuous enteral feed. The medication monograph states it should be given on an empty stomach. Which sequence of actions is MOST appropriate?

Answer: Stop the feed 30–60 minutes before administration, flush the tube, give the medication, flush again, then restart the feed after the required interval

Medications requiring an empty stomach must not be given concurrently with enteral feeds. The correct practice is to pause the feed for the required time before and after administration, flush the tube with water before and after the medication to prevent tube occlusion and drug-feed interactions, and only resume feeding after the specified hold period. Mixing medication into the feed bag risks incompatibility, inaccurate dosing, and altered absorption. Many medications designated 'empty stomach' are also modified-release and must not be crushed.

A client with a known penicillin allergy is prescribed cephalexin 500 mg PO for a wound infection. The prescriber documents awareness of the allergy and confirms the order. What is the practical nurse's BEST action?

Answer: Clarify with the prescriber the clinical rationale, document the conversation, ensure emergency equipment is available, monitor the client closely after administration, and follow agency policy on cross-reactive allergy orders

Cephalosporins share a beta-lactam ring structure with penicillins, and cross-reactivity — while estimated at 1–2% — is a real risk. Even when a prescriber knowingly orders a cross-reactive drug, the nurse's professional responsibility does not end at 'the doctor said so.' The nurse must clarify the rationale, document the informed decision, ensure resuscitation equipment is accessible, administer with enhanced monitoring, and follow organizational policy. Simply administering without these steps or refusing without escalation both represent incomplete professional practice.

During a medication reconciliation on admission, a client reports taking warfarin 5 mg daily at home. The admission orders read warfarin 2.5 mg daily. The client insists their home dose is 5 mg and becomes agitated when the nurse attempts to give 2.5 mg. What is the MOST appropriate nursing action?

Answer: Administer 2.5 mg as ordered, document the discrepancy, and immediately contact the prescriber to reconcile the difference before the next dose

Nurses must administer medications as prescribed — not as reported by the client — because verbal reports may be inaccurate or reflect a dose that has since been adjusted. However, a discrepancy of this magnitude with a narrow-therapeutic-index drug like warfarin carries serious bleeding risk and must be resolved urgently. The nurse administers the ordered dose (which is safer than the higher unverified dose), documents the discrepancy in detail, and contacts the prescriber immediately so the correct dose can be confirmed or adjusted before the next scheduled administration. Withholding without contact delays necessary anticoagulation.

A practical nurse is preparing 0.4 mg of morphine sulfate IV for a post-operative client. The available vial reads 'Morphine Sulfate 1 mg/mL.' After drawing up 0.4 mL, the nurse notices a second vial on the same tray labeled 'Hydromorphone 2 mg/mL.' What is the MOST important immediate action?

Answer: Label the syringe immediately, remove the hydromorphone vial from the work area, then perform a final label check before administration

Hydromorphone is 5–10 times more potent than morphine and is a high-alert medication involved in numerous fatal errors. The immediate priority when a look-alike/sound-alike (LASA) drug is present on the same tray is to remove the distractor from the workspace, label the prepared syringe immediately to prevent it from being confused with another, and perform a final independent label verification against the original vial before administration. Discarding both vials is wasteful and unnecessary if the correct drug was drawn. Proceeding without labelling the syringe or removing the LASA drug violates safe medication preparation principles.

A practical nurse administers a scheduled oral dose of metoprolol tartrate 50 mg to a client. Fifteen minutes later, the client's heart rate is 42 bpm and blood pressure is 88/54 mmHg. The client is drowsy but arousable. Which intervention reflects the MOST appropriate initial response?

Answer: Notify the prescriber immediately, withhold further doses, initiate continuous cardiac monitoring, and prepare for potential reversal with atropine or glucagon per order

These findings indicate beta-blocker toxicity with hemodynamic compromise (bradycardia + hypotension + altered level of consciousness). The nurse must immediately notify the prescriber, hold further doses, and initiate continuous monitoring. Glucagon is the specific antidote for beta-blocker overdose as it bypasses the blocked receptor; atropine may be ordered for symptomatic bradycardia. Reassessing in 30 minutes is dangerous — the client already shows signs of compromise. Trendelenburg and fluid bolus alone do not address the underlying pharmacological cause. Epinephrine is not a routine beta-blocker reversal agent and could cause rebound hypertension.

A practical nurse is administering insulin using a pen device shared on the unit for multiple clients. A colleague mentions this is acceptable because individual pen needles are changed between clients. What is the MOST accurate response by the nurse?

Answer: The practice is unsafe — insulin pens are single-client devices; reusing the pen body between clients risks backflow contamination of the medication reservoir regardless of needle changes

Insulin pens — including the pen body and medication cartridge — are single-patient-use devices. When a needle is attached and the pen is used, blood can be drawn back into the cartridge through capillary action (backflow), contaminating the medication reservoir with bloodborne pathogens (HIV, hepatitis B, hepatitis C). Changing the needle does not eliminate this risk because the contamination is in the cartridge, not just the needle. Health Canada, ISMP Canada, and all provincial nursing regulatory bodies explicitly prohibit sharing insulin pen devices between clients. This has been associated with real-world bloodborne pathogen transmission events.