Lesson 25 — Medication Administration

Half B · HLT420B·Kinn's Ch 15·General Patient Care (18.7%)

Source

All procedural steps, PURPOSE rationales, and topic content below are verbatim from MedCerts HLT420B Storyline modules. Quiz items have been normalized to multiple-choice format with verbatim source rationales. Reference textbook: Niedzwiecki & Pepper, Kinn's The Clinical Medical Assistant, 15th ed., Chapter 15. No outside material added.

Learning Objectives — NHA-aligned
Module L25-01 · Procedural skill

Oral and Ampule Medications

Goal: To verify the rules of medication administration and safely dispense, administer, and document the administration of an oral medication.

Equipment
  • Patient's health record
  • Written provider's order, including the drug name, strength, dose, and route of administration
  • Container of ordered medication
  • Calibrated medication cup
  • Water, if appropriate
  • PDR, online drug reference, or package insert
  1. Read the order and clarify any questions with the provider.
  2. If you are unfamiliar with HydroDiuril, refer to the Physician's Desk Reference (PDR), online drug reference, or package insert to determine the purpose of the drug, common side effects, typical dose, and any pertinent precautions or contraindications. Be prepared to answer any questions the patient may have about the medication. Use the Seven Rights to prevent errors. This step completes the Right Medication rule of medication administration.
  3. Perform calculations needed to match the provider's order. Confirm the answer with the provider if you have any questions.
  4. Assemble the equipment and sanitize your hands.
  5. Prepare the medication in a well-lit, quiet area.
  6. Compare the order with the label on the container of medicine when you remove it from storage. Check the expiration date on the container and dispose of the medication if it has expired.
    Purpose

    To compare the medication label and the provider's order the first of three times.

  7. Compare the order with the label on the container of medicine just before dispensing the ordered dose. Make sure the strength on the label matches the order or that you dispense the correctly calculated dose.
    Purpose

    To compare the medication label and the provider's order the second of three times. This completes the Right Medication and the Right Dose of the rules of medication administration.

  8. Gently tap the prescribed dose into the lid of the medication container.
  9. If too many tablets are dispensed onto the lid, pour the extra tablets back into the container.
  10. Do not touch the inside of the lid or the medication. Empty the medication in the container lid into a medicine cup.
    Purpose

    Touching the medication or the inside of the container contaminates the drug.

  11. Mix medication well if required.
  12. When liquid medications are poured, the label should be held in the palm of the hand.
    Purpose

    To protect the label from medication spills. The medication must be discarded if staff members are unable to read the drug label clearly.

  13. Place the medicine cup on a flat surface and, at eye level, pour the medication to the prescribed dose mark on the medicine cup.
    Purpose

    At eye level, the base of the meniscus is where the prescribed dose should be measured.

  14. Recap the container and compare the label with the provider's order before replacing the container in storage.
    Purpose

    To compare the medication label and the provider's order the third of three times.

  15. Take the medication to the patient.
  16. Greet the patient, and identify him or her by name and date of birth (DOB); compare them to the name and DOB on the order.
    Purpose

    To make sure you have the right patient. This completes the Right Patient of the rules of medication administration.

  17. Mention the name of the drug and the reason it is being given. Ask the patient whether she or he has any allergies to the medication.
    Purpose

    To educate the patient about drug treatment and to verify that the patient is not allergic to the prescribed medication.

  18. If necessary, help the patient into a sitting position.
  19. Administer tablets, capsules, or caplets with water. If the patient is receiving liquid medication, offer water after the medication has been taken if appropriate. Make sure the patient swallows the entire dose. This completes the Right Route and the Right Time of the rules of medication administration.
  20. Provide patient education about the purpose of the drug, typical side effects, and dosage and storage recommendations. Consult the provider to clarify information if needed.
    Purpose

    To ensure compliance with home drug therapy and to monitor for side effects.

  21. The patient must remain in the office for 20 to 30 minutes after drug administration as a precaution against untoward effects.
  22. If the patient experiences any discomfort after taking a medication, the provider should be notified immediately and the incident documented completely and accurately.
  23. Sanitize your hands.
    Purpose

    To ensure infection control.

  24. Document the administration of the drug, including the date and time; the drug name, dose, strength, and route of administration; any patient side effects; and patient education provided about the drug. This completes the Right Documentation of the rules of medication administration. Document the date, the time, HydroDiuril 100 mg tab administered PO per Dr. Thau's order. Pt education conducted; pt had no questions. and sign your Name.
Module L25-02 · Procedural skill

Vial and Powder Medications

Goal: To fill a syringe from a multidose vial using sterile technique.

Equipment
  • Patient's health record
  • Written provider's order, including the drug name, strength, dose, and route of administration
  • Multidose vial containing the medication ordered
  • Alcohol wipes
  • Sterile needle and syringe unit
  • PDR, online drug reference, or package insert
  1. Read the order and clarify any questions with the provider.
    Purpose

    The medical assistant should never dispense or administer a drug without making sure the provider's order is legible and the details of the drug are known.

  2. If you are unfamiliar with the medication, refer to the PDR, online drug reference, or package insert to determine the purpose of the drug, common side effects, typical dose, and any pertinent precautions or contraindications. Be prepared to answer any questions the patient may have about the medication. Use the Seven Rights to prevent errors.
  3. Perform calculations needed to match the provider's order. Confirm the answer with the provider if you have any questions.
  4. Dispense the medication in a well-lit, quiet area.
    Purpose

    To prevent distractions and possible errors.

  5. Assemble the equipment and sanitize your hands. Choose the correct syringe and needle unit, depending on the site of administration, patient characteristics, and the amount of medication to be injected.
  6. Compare the order with the label on the vial of medicine when you remove it from storage. Check the quality of the medication and the expiration date on the container and dispose of the medication if it appears contaminated, contains sediment, or has expired.
    Purpose

    To compare the medication label and the provider's order the first of three times.

  7. Compare the order with the label on the vial of medicine just before dispensing the ordered dose. Make sure the strength on the label matches the order or that you dispense the correctly calculated dose.
    Purpose

    To compare the medication label and the provider's order the second of three times.

  8. Gently agitate the medication by rolling the vial between your palms.
    Purpose

    To mix any medication that may have settled.

  9. Clean the rubber stopper of the vial with the alcohol wipe using a circular motion. Place the vial on a secure, flat surface, leaving the alcohol swab over the rubber stopper.
  10. With the needle cover in place, grasp the syringe plunger and draw up an amount of air equal to the amount of medication ordered.
    Purpose

    Not enough replaced air makes it difficult to withdraw the medication; too much replaced air increases the pressure in the vial so that medication is forced into the syringe without the plunger being pulled to withdraw it.

  11. Remove the alcohol swab over the rubber stopper and the needle cover and insert the needle into the center of the rubber stopper. Hold the vial firmly against a flat surface and watch carefully that the needle touches only the cleaned rubber area.
    Purpose

    To maintain the sterility of the needle.

  12. Inject the aspirated air in the syringe into the vial.
  13. Keeping the syringe unit in the vial, pick up and invert them. Slowly pull back on the plunger with the unit at eye level and draw up more medication than ordered into the syringe unit.
    Purpose

    Withdrawing medication rapidly causes air bubbles to form in the syringe. Draw up extra medication so that any bubbles in the syringe can be injected back into the vial while maintaining sterility.

  14. While the needle is still in the vial, check for air bubbles in the syringe.
    Purpose

    Air bubbles displace medication, and the patient will not receive the proper amount of medication.

  15. If air bubbles are present, slip the fingers holding the vial down to grasp the vial and syringe as a single unit.
    Purpose

    This frees your dominant hand.

  16. With your free hand, tap the syringe until the air bubbles dislodge and float into the tip of the syringe.
  17. Inject the air bubbles back into the vial with the extra medication that was withdrawn. At eye level, make sure the accurate amount of medication is in the syringe unit.
  18. Withdraw the needle from the vial and carefully replace the needle cover without letting the needle touch the outside of the cover.
  19. Return the medication to the shelf or the refrigerator, checking the order against the label one more time to complete the three label checks.
    Purpose

    This is the third of the three drug labels and order checks.

  20. Dispose of used alcohol and gauze squares. Sanitize your hands.
    Purpose

    To insure infection control.

Module L25-03 · Conceptual content

Incident Report

Goal: To promptly report a medication error to your supervisor and complete an incident report form according to the facility's policies and procedures.

Equipment
  • Patient's health record
  • Written provider's order, including the drug name, strength, dose, and route of administration
  • PDR, online drug reference, or package insert
  • Facility Medication Error Incident Report Form
Medication Error Incident Report Process

When a medication error occurs, it is essential to promptly report it to your supervisor and complete an incident report form according to the facility's policies and procedures. The incident report must document the details of the error and identify which of the Nine Rights of medication administration were not followed. This provides a record for quality improvement and patient safety monitoring. If unfamiliar with a drug involved in the error, refer to the PDR, online drug reference, or package insert to determine the purpose of the drug, common side effects, typical dose, and any pertinent precautions or contraindications.

Practice quiz · verbatim from MedCerts

Knowledge-check items

Click an answer to lock it in — you'll see the rationale below. Reset any time to re-attempt. Items originally formatted as true/false, fill-in-blank, or drag-and-drop have been normalized to multiple choice; the source format is noted in the eyebrow.

L25-01 · Oral and Ampule Medications

Q1 · L25-01 · normalized from tf
Medicine labels are checked, comparing with the order, how many times during the process of dispensing and administration of oral medications?
Rationale
"To compare the medication label and the provider's order the first of three times," "To compare the medication label and the provider's order the second of three times," and "To compare the medication label and the provider's order the third of three times."

The three label checks occur when the medication is removed from storage, just before dispensing, and before returning the container to storage.

Source: L25-01 Knowledge Check
Q2 · L25-01 · normalized from tf
When is the medication label compared with the provider's order the second of three times?
Rationale
"Compare the order with the label on the container of medicine just before dispensing the ordered dose. Make sure the strength on the label matches the order or that you dispense the correctly calculated dose. PURPOSE: To compare the medication label and the provider's order the second of three times."

The second label check ensures the strength matches the order or the correctly calculated dose is dispensed before administration.

Source: L25-01 Knowledge Check
Q3 · L25-01 · normalized from tf
If the patient experiences any discomfort after taking a medication, what should be done?
Rationale
"If the patient experiences any discomfort after taking a medication, the provider should be notified immediately and the incident documented completely and accurately."

Immediate notification and documentation are essential for patient safety and medical-legal protection.

Source: L25-01 Knowledge Check
Q4 · L25-01 · normalized from tf
To complete the Right Patient rule of medication administration, what identification information must be verified?
Rationale
"Greet the patient, and identify him or her by name and date of birth (DOB); compare them to the name and DOB on the order. PURPOSE: To make sure you have the right patient. This completes the Right Patient of the rules of medication administration."

Both name and DOB must be verified and compared to the order to ensure the correct patient receives the medication.

Source: L25-01 Knowledge Check
Q5 · L25-01 · normalized from tf
When administering a medication, what should always be stated to the patient?
Rationale
"Mention the name of the drug and the reason it is being given. Ask the patient whether she or he has any allergies to the medication. PURPOSE: To educate the patient about drug treatment and to verify that the patient is not allergic to the prescribed medication."

Stating the drug name and reason, plus verifying allergies, educates the patient and prevents adverse reactions.

Source: L25-01 Knowledge Check
Q6 · L25-01 · normalized from fitb
To complete the three label checks when filling a syringe from an ampule, how many times must the provider's order be checked against the label?
Rationale
"Before discarding the ampule in the sharps container, check the provider's order against the label one more time to complete the three label checks."

The three label checks for ampules follow the same pattern as for other medications: when removing from storage, before dispensing, and before final disposal.

Source: L25-01 Knowledge Check
Q7 · L25-01 · normalized from fitb
After a filter needle is used and discarded into the sharps container, what type of needle is used to prevent possible injection of glass particles?
Rationale
"Change the filter needle, safeguarding the sterility of the injection unit, for a needle of the appropriate length and gauge based on the provider's ordered route of administration and patient characteristics. Discard the used filter needle into the sharps container. PURPOSE: A new needle is used to prevent the possible injection of glass particles on or inside the filter needle."

A new needle prevents glass particle injection and ensures optimal medication delivery with a sharp needle.

Source: L25-01 Knowledge Check
Q8 · L25-01 · normalized from fitb
To prevent possible contamination of the medication when preparing an ampule, what action should be taken with the neck of the ampule?
Rationale
"Thoroughly disinfect the neck of the ampule with alcohol squares. PURPOSE: To prevent possible contamination of the medication."

Alcohol disinfection removes bacteria and ensures the medication remains sterile during withdrawal.

Source: L25-01 Knowledge Check

L25-02 · Vial and Powder Medications

Q1 · L25-02 · normalized from dragdrop
What is the purpose of drawing air into the syringe before inserting the needle into the vial?
Rationale
"With the needle cover in place, grasp the syringe plunger and draw up an amount of air equal to the amount of medication ordered. PURPOSE: Not enough replaced air makes it difficult to withdraw the medication; too much replaced air increases the pressure in the vial so that medication is forced into the syringe without the plunger being pulled to withdraw it."

The air replacement maintains proper vial pressure to allow smooth medication withdrawal without excessive pressure buildup.

Source: L25-02 Knowledge Check
Q2 · L25-02
After withdrawal of medication from the vial, which syringe unit is used to administer the medication?
Rationale
"An unused syringe unit should be used to administer the medication to the patient because the needle on the used unit may not be as sharp as that on a new syringe unit."

A new syringe unit ensures a sharp needle for safe, effective medication administration with minimal tissue trauma.

Source: L25-02 Knowledge Check
Q3 · L25-02
Which factors determine the syringe unit to be used for administration?
Rationale
"Assemble the equipment and sanitize your hands. Choose the correct syringe and needle unit, depending on the site of administration, patient characteristics, and the amount of medication to be injected."

All three factors—site, patient characteristics, and volume—determine the appropriate syringe and needle selection for proper administration.

Source: L25-02 Knowledge Check
Q4 · L25-02
After drawing up air equal to the amount of diluent needed to reconstitute medication, what is done with the air?
Rationale
"Inject the aspirated air in the syringe into the diluent vial."

Injecting the air into the diluent vial maintains proper pressure and allows easy withdrawal of the necessary diluent volume.

Source: L25-02 Knowledge Check
Q5 · L25-02
Why is the vial of reconstituted medication rolled between the palms of your hands?
Rationale
"Roll the vial with the drug and diluent mixture between the palms of your hands to mix it thoroughly. Do not shake the vial unless directed to do so on the drug label. When the medication is completely mixed, no residue or crystals are seen on the bottom of the vial."

Rolling thoroughly mixes the reconstituted medication without causing excessive agitation that could denature the drug or create bubbles.

Source: L25-02 Knowledge Check
Q6 · L25-02
What is the purpose of checking for air bubbles in the syringe while the needle is still in the vial?
Rationale
"While the needle is still in the vial, check for air bubbles in the syringe. PURPOSE: Air bubbles displace medication, and the patient will not receive the proper amount of medication."

Detecting and removing air bubbles while the needle remains in the vial allows them to be expelled back into the vial while maintaining sterility and accurate dosing.

Source: L25-02 Knowledge Check
Q7 · L25-02
When should the medication label be checked the third time to complete the three label checks?
Rationale
"Return the medication to the shelf or the refrigerator, checking the order against the label one more time to complete the three label checks. PURPOSE: This is the third of the three drug labels and order checks."

The final label check before returning medication to storage ensures the correct medication was used and confirms proper storage location.

Source: L25-02 Knowledge Check

L25-03 · Incident Report

Q1 · L25-03
In the incident involving administering Spiriva instead of Ventolin HF, which Right of medication administration was violated?
Rationale
"Dr. Thau writes the following order: Administer Ventolin HF, 2 puffs, to Simon Alesiam STAT. You administer 2 puffs of Spiriva, thinking it is the same drug."

The error involved administering the wrong medication (Spiriva instead of Ventolin HF), which violates the Right Medication rule.

Source: L25-03 Knowledge Check
Q2 · L25-03
When completing a medication error incident report, what information about the patient must be documented?
Rationale

The incident report form requires comprehensive patient identification including name, address, phone number, email, age, date of birth, sex, and patient ID to ensure proper documentation and follow-up of the medication error.

Source: L25-03 Knowledge Check
Q3 · L25-03
What information about the employee involved in the medication error must be documented on the incident report?
Rationale

The incident report form requires both the employee's name and title to be documented to ensure accountability and proper documentation of the medication error.

Source: L25-03 Knowledge Check
Q4 · L25-03
In the incident scenario, what date and time must be documented on the medication error incident report?
Rationale

The incident report must document the date and time of the incident (1-10-XXXX; 09:50 AM) to create an accurate record of when the medication error occurred.

Source: L25-03 Knowledge Check
Q5 · L25-03
What type of medication error occurred in the scenario where Spiriva was given instead of Ventolin HF?
Rationale

The error involved administering the wrong medication—Spiriva instead of the ordered Ventolin HF—which is classified as a 'wrong medication given' type of error.

Source: L25-03 Knowledge Check