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MEDICATION ADMINISTRATION — EXAM PRACTICE QUESTIONS 200 Questions with Verified Answers & Detailed Rationales Based on NCLEX, Nursing Fundamentals, & Clinical Pharmacology Standards EXAM OVERVIEW Medication administration is a core competency in nursing and healthcare practice. This exam covers the six rights of medication administration, dosage calculations, routes of administration, pharmacokinetics, safety protocols, medication errors, legal/ethical considerations, and patient education. Key References:
- The Six Rights of Medication Administration
- Safe Medication Administration Guidelines
- NCLEX-RN Examination Standards
SECTION 1: THE RIGHTS OF MEDICATION ADMINISTRATION Questions 1– 25
Q1. The nurse is preparing to administer medications. What should be the first action taken to confirm the right patient?
- A) Ask the patient to state their date of birth
- B) Compare the name on the medication administration record (MAR) with the name on the patient's identification armband
- C) Ask the patient to state their name and address
- D) Check the patient's chart for a photograph Rationale: The most reliable method for confirming patient identity is to compare the MAR with the patient's identification armband. Asking patients to state their name and date of birth is also recommended, but the armband provides the most definitive verification.
Q2. When should the six rights of medication administration be verified during the medication administration process?
- A) Only before preparing the medication
- B) Only immediately before administering the medication
- C) At three different checkpoints: before preparing, before administering, and after administration
- D) At the end of the shift Rationale: The six rights should be checked at three checkpoints: when removing the medication from storage, when preparing it, and at the patient's bedside before administration.
Q3. Which of the following is NOT one of the traditional six rights of medication administration?
- A) Right patient
- B) Right dose
- C) Right route
- D) Right documentation
Q6. The nurse verifies the medication order against the MAR three times. This practice ensures which right?
- A) Right patient
- B) Right medication
- C) Right dose
- D) Right route Rationale: Verifying the medication order against the MAR ensures the correct medication is being administered.
Q7. A patient asks what a medication is for before taking it. The nurse explains the indication. Which right is being addressed?
- A) Right dose
- B) Right reason/indication
- C) Right time
- D) Right route Rationale: Patients have the right to know why they are receiving a medication. This is sometimes called the "right reason" or "right indication."
Q8. Which action demonstrates the right dose?
- A) Calculating the dose based on the patient's weight and verifying the calculation
- B) Giving the medication at the correct time
- C) Administering the medication via the correct route
- D) Documenting the administration Rationale: The right dose requires accurate calculation and verification, especially for weight- based or high-alert medications.
Q9. The nurse is preparing to administer an IM injection. The provider ordered the medication to be given IV. What should the nurse do?
- A) Administer it IM as planned
- B) Administer it IV and document
- C) Clarify the order with the provider
- D) Administer it orally Rationale: Administering a medication via the wrong route can be dangerous or fatal. The nurse must clarify the order with the provider.
Q10. Which of the following is an example of the right documentation?
- A) Recording the administration after the shift ends
- B) Documenting the medication, dose, route, time, and your signature immediately after administration
- C) Writing "given" without details
Q13. The nurse is preparing medications for two patients with similar names. What is the best practice to avoid error?
- A) Administer one medication at a time
- B) Use two patient identifiers and avoid distractions
- C) Have another nurse check the medications
- D) Administer both patients' medications together Rationale: Using two patient identifiers and minimizing distractions are essential to prevent errors with similar patient names.
Q14. Which of the following is an example of the right route?
- A) Administering a tablet orally
- B) Giving an IM injection in the deltoid
- C) Both A and B are correct
- D) Neither A nor B is correct Rationale: The right route means administering the medication via the prescribed route, whether oral, IM, IV, topical, etc.
Q15. The nurse administers a medication 45 minutes after the scheduled time. This is:
- A) Acceptable within the standard window
- B) Outside the standard 30-minute window and should be documented
- C) Only acceptable for non-critical medications
- D) Not an error if the patient is asleep Rationale: Most facilities allow a 30-minute window before or after the scheduled time. Beyond that, it should be documented as late and the reason noted.
Q16. The "right response" in medication administration refers to:
- A) The patient's verbal response
- B) Evaluating the therapeutic effect of the medication
- C) The patient's satisfaction with the medication
- D) The nurse's response to an adverse reaction Rationale: The right response involves monitoring and documenting the patient's response to the medication.
Q17. A nurse gives a patient the wrong medication and the patient experiences no harm. This is considered:
- A) A sentinel event
- B) A near miss or medication error
- C) Acceptable practice
- D) Not reportable
Q20. Which of the following is NOT a right of medication administration?
- A) Right patient
- B) Right medication
- C) Right dose
- D) Right cost Rationale: Cost is not a right of medication administration. The traditional rights focus on safety and accuracy.
Q21. A nurse administers a medication via the wrong route. The patient experiences no immediate harm. The nurse should:
- A) Ignore the error
- B) Report the error immediately and monitor the patient
- C) Document the correct route
- D) Wait to see if symptoms develop Rationale: All medication errors must be reported immediately, even if no harm occurs.
Q22. Which of the following best describes the "right time" in medication administration?
- A) Administering the medication exactly at the prescribed time
- B) Administering the medication within an acceptable time window (usually 30 minutes before or after)
- C) Administering the medication at any time during the shift
- D) Administering the medication when the patient requests it Rationale: The right time means administering within the facility's acceptable time window.
Q23. A patient is unable to swallow pills. The nurse should:
- A) Crush the medication without checking
- B) Check if the medication can be crushed and administer via an alternative route if appropriate
- C) Skip the dose
- D) Administer it rectally without an order Rationale: Some medications should not be crushed (e.g., sustained-release, enteric-coated). The nurse must check before altering the formulation.
Q24. The nurse is documenting medication administration and realizes a dose was missed. What should the nurse do?
- A) Document the missed dose and notify the provider
- B) Document that it was given
- C) Administer a double dose next time
- D) Ignore the missed dose
Rationale: IV administration delivers medication directly into the bloodstream, providing the fastest onset of action.
Q27. A patient is prescribed a medication that is destroyed by gastric acid. Which route would be most appropriate?
- A) Oral
- B) Parenteral (IV or IM)
- C) Topical
- D) Sublingual Rationale: Medications destroyed by gastric acid must be administered via parenteral routes to bypass the digestive system.
Q28. The nurse is administering ear drops. This is an example of which route?
- A) Oral administration
- B) Parenteral administration
- C) Topical administration
- D) Enteral administration Rationale: Ear drops are applied to the surface of the body (the ear canal) and are considered a topical medication.
Q29. Which route of administration is most commonly used for medication administration?
- A) Oral
- B) Intravenous
- C) Intramuscular
- D) Subcutaneous Rationale: The oral route is the most common and convenient route for medication administration.
Q30. A medication is administered under the tongue. This route is called:
- A) Buccal
- B) Sublingual
- C) Oral
- D) Topical Rationale: Sublingual administration involves placing medication under the tongue for rapid absorption.
Q31. A medication is administered between the cheek and gum. This route is called:
Q34. The nurse is administering an injection into the dermis layer of the skin. This route is called:
- A) Subcutaneous
- B) Intramuscular
- C) Intravenous
- D) Intradermal Rationale: Intradermal injections are given into the dermis, just below the epidermis.
Q35. A patient is prescribed a medication that must be given via a central line. This route is:
- A) Peripheral IV
- B) Central venous access
- C) IM
- D) Subcutaneous Rationale: Central lines (such as PICC lines or central venous catheters) are used for medications that are irritating to peripheral veins or require long-term access.
Q36. The nurse is administering a medication via a nasogastric tube. This is considered which route?
- B) Enteral
- C) Topical
- D) Inhalation Rationale: Enteral administration includes medications given through the gastrointestinal tract, including via NG tubes.
Q37. A patient is using a metered-dose inhaler. This is which route of administration?
- A) Oral
- B) Inhalation
- C) Topical
- D) Parenteral Rationale: Inhalation delivers medication directly to the respiratory tract.
Q38. Which route of administration avoids first-pass metabolism?
- A) Oral
- B) IV
- C) Enteral
- D) Rectal Rationale: IV administration delivers medication directly into the bloodstream, bypassing the liver's first-pass metabolism.
- C) Rectal
- D) Vaginal Rationale: Suppositories are administered rectally for local or systemic effects.
Q42. Which route of administration has the slowest onset of action?
- A) Oral
- B) IV
- C) IM
- D) Sublingual Rationale: Oral medications must be absorbed through the GI tract, which takes longer than parenteral routes.
Q43. The nurse is administering medication via a vaginal suppository. This route is:
- A) Rectal
- B) Vaginal
- C) Topical
- D) Oral Rationale: Vaginal suppositories are administered for local or systemic effects via the vaginal route.
Q44. A patient is receiving medication through a patient-controlled analgesia (PCA) pump. This is which route?
- A) Oral
- B) Intravenous
- C) Subcutaneous
- D) Epidural Rationale: PCA pumps typically deliver medication intravenously.
Q45. The nurse is administering an intrathecal injection. This medication is given into the:
- A) Muscle
- B) Vein
- C) Skin
- D) Space around the spinal cord Rationale: Intrathecal injections are given into the subarachnoid space around the spinal cord.
Q46. Which of the following is an advantage of the oral route?
- A) Rapid onset
- B) Bypasses first-pass metabolism
