NCLEX Medication Administration: Six Rights & Safety Protocols

Medication administration is one of the most critical responsibilities for nurses—and one of the most heavily tested topics on the NCLEX. The exam evaluates whether you can safely administer medications, prevent errors, and follow proper protocols. This guide covers the **Six Rights**, essential medication safety steps, and high-yield content you must know for drug administration questions.

Why Medication Safety Matters on the NCLEX

Medication errors can lead to serious harm, and the NCLEX ensures that new nurses are prepared to administer drugs safely. You must demonstrate strong clinical judgment, accurate calculations, and strict adherence to safety principles.

Understanding the Six Rights of Medication Administration

The “Six Rights” form the foundation of safe drug administration. Every NCLEX medication question touches on at least one of these.

• 1. Right Patient
  • Always identify the patient using TWO identifiers:
  • Name
  • Date of birth
  • Never use room number as an identifier.
• 2. Right Medication
  • Compare the medication label with the MAR three times:
  • When pulling
  • When preparing
  • Before giving
• 3. Right Dose
  • Double-check calculations, especially for:
  • Pediatrics
  • High-alert medications
  • IV drugs
  • If something seems wrong, clarify before administering.
• 4. Right Route
  • Verify whether the medication is ordered orally, IV, IM, subcutaneously, or via NG tube.
  • Never change the route without an order.
• 5. Right Time
  • Medications must be given at the correct time interval.
  • Critical medications (antibiotics, insulin, anticoagulants) require extra accuracy.
• 6. Right Documentation
  • Chart immediately after giving—not before.
  • Document:
  • Dose
  • Route
  • Time
  • Patient response

High-Alert Medication Protocols

NCLEX focuses heavily on high-risk drugs such as:

• Insulin
• Heparin
• Opioids
• Potassium chloride
• Chemotherapy agents

Key safety rules:

• Use two-nurse verification
• Never give IV potassium as a bolus
• Monitor closely for side effects

Additional Medication Administration Safety Protocols

• 1. Check Allergies Every Time
  Look for: rash, swelling, anaphylaxis history.
• 2. Assess Before Administering
  Examples:
  • Check HR before digoxin
  • Check BP before antihypertensives
  • Check blood sugar before insulin
• 3. Evaluate After Giving
  Monitor for adverse effects, therapeutic responses, and unexpected changes.
• 4. Use the “Do Not Crush” List
  Extended-release (ER), sustained-release (SR), and enteric-coated drugs should never be crushed.

Common NCLEX Medication Question Examples

• A potassium IV is ordered at 20 mEq/hr. The nurse should:
  ✔ Use an infusion pump and NEVER give IV push.
• A patient with an allergy band requests morphine. What should the nurse do?
  ✔ Verify the allergy and contact the provider.
• Before giving digoxin, the nurse finds an apical pulse of 52 bpm.
  ✔ Hold the medication and notify the provider.

Final Thoughts

Understanding the **Six Rights** and safety protocols is essential for every nursing student. NCLEX medication questions test your ability to think critically, follow procedures, and protect your patient at every step. With consistent practice and strong foundational knowledge, you can confidently answer medication safety questions on exam day.