NCLEX Review Guide: Medication & IV Therapy Fundamentals

Six Rights of Medication Administration

• Right Patient: Use two patient identifiers (name and DOB) before administering any medication
• Right Drug: Verify medication name against MAR three times - when removing from storage, preparing, and before administration
• Right Dose: Calculate and double-check dosages, especially for high-alert medications like insulin and heparin
• Right Route: Ensure proper administration method (PO, IV, IM, SQ) matches physician order
• Right Time: Administer within 30 minutes before or after scheduled time for routine medications
• Right Documentation: Record administration immediately after giving medication, never pre-chart

IV Site Assessment & Management

• Infiltration Signs: Coolness, swelling, pallor, and pain at IV site - stop infusion immediately
• Phlebitis Signs: Redness, warmth, pain, and cord-like vein - discontinue IV and apply warm compress
• Assess IV site every 1-2 hours for signs of complications and patency
• Change IV tubing every 72-96 hours or per facility policy to prevent infection

Basic Dosage Formula

• Formula: Desired Dose ÷ Dose on Hand × Quantity = Amount to Give
• Always convert to same units before calculating (mg to mg, g to g)
• Use dimensional analysis for complex conversions involving multiple steps

IV Flow Rate Calculations

1. Gravity Flow Rate: (Total Volume × Drop Factor) ÷ Time in Minutes = gtt/min
2. Pump Rate: Total Volume ÷ Hours = mL/hr
3. Standard drop factors: Microdrip = 60 gtt/mL, Macrodrip = 10-20 gtt/mL

Check Your Knowledge:

• ☐ Can you list all six rights of medication administration?
• ☐ Do you know the difference between infiltration and phlebitis?
• ☐ Can you calculate basic dosages using the formula method?
• ☐ Do you understand microdrip vs. macrodrip calculations?
• ☐ Can you identify when to stop an IV infusion immediately?