# A nurse is preparing to administer medications to multiple patients on a medical-surgical unit. Which action by the nurse demonstrates the most effective strategy for preventing medication errors?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=319494  
> language: ko  
> subject: Next Gen NCLEX

## 문제

A nurse is preparing to administer medications to multiple patients on a medical-surgical unit. Which action by the nurse demonstrates the most effective strategy for preventing medication errors?

## 보기

1. Double-checking high-risk medications with another nurse only when required by hospital policy
2. Performing the 'five rights' of medication administration for each patient at the bedside before administration **✔ 정답**
3. Preparing all medications for multiple patients simultaneously to improve efficiency
4. Relying on the electronic medication administration record (eMAR) without additional verification steps

**정답: 2**

## 해설

The 'five rights' (right patient, drug, dose, route, time) verified at the bedside is the most effective strategy as it provides a final safety check before administration, preventing errors from prescription or preparation. Other options either rely on policy alone, compromise safety for efficiency, or omit bedside verification.

## 심화 해설

Core Nursing Explanation
**Key Concept Analysis**: This question assesses the nurse's application of the Five Rights of Medication Administration as a fundamental, proactive safety strategy. The core theme is Key Point! **active verification at the point of care** to prevent errors. The five rights (right patient, medication, dose, route, and time) are not a one-time checklist but a dynamic process that culminates at the bedside. This final verification is critical because it catches errors that may have occurred during prescribing, transcribing, dispensing, or preparation phases.

**Answer Rationale**: Option ② is correct because it describes the consistent, independent application of the five rights *at the bedside*. This action ensures the nurse personally verifies all critical information against the patient's identification and the medication order immediately before administration. It is a universal precaution that does not depend on external factors like policy mandates or technology reliability. Bedside verification is the last and most crucial defense in the medication safety chain.

**Distractor Analysis**:

Watch out for confusion! Option ① is incorrect because it makes a critical safety practice (double-checking high-alert medications like insulin, heparin, or opioids) conditional. While policy may dictate when a double-check is mandatory, a safe nurse understands that independent verification and, when in doubt, collaboration with a colleague are always best practices, not just when required.

Option ③ is incorrect and dangerous. Preparing medications for multiple patients at once (batch preparation) is a major source of cross-contamination and mix-up errors. It violates the principle of focusing on one patient at a time and increases the risk of administering the wrong medication to the wrong patient.

Option ④ is incorrect because it represents over-reliance on technology. While an electronic medication administration record (eMAR) is a powerful tool, it is not infallible. Errors can occur in data entry, system updates, or scanning. The nurse's clinical judgment and direct verification at the bedside remain irreplaceable safety steps.

**Related Concepts**: This principle connects to broader concepts of patient safety, Just Culture (focusing on system improvement rather than individual blame for errors), and the use of barrier precautions (like barcode scanning coupled with the five rights) to create a multi-layered defense against errors.

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**: You are assigned to Mr. Johnson, a 68-year-old patient with heart failure (HF) and type 2 diabetes mellitus (DM). His 0900 medications include furosemide 40 mg IV push, metoprolol 25 mg PO, and insulin aspart 8 units subcutaneously before breakfast.

**Nursing Intervention Strategy**:

- **Assessment & Preparation**: Review the eMAR and medication administration record (MAR). Gather medications for **Mr. Johnson only**. For insulin, perform an independent double-check of the dose with another nurse per hospital policy (high-alert medication).

- **Bedside Verification (The Five Rights)**: Go to Mr. Johnson's room with his medications on a clean tray.

- **Right Patient**: Scan his wristband and have him state his name and date of birth. Compare to the eMAR.

- **Right Medication**: For each drug, show Mr. Johnson the labeled vial/package and state the drug name and purpose ("This is your furosemide, a water pill, to help remove extra fluid").

- **Right Dose**: Verify the dose on the package against the eMAR. For IV furosemide, confirm the concentration in the syringe.

- **Right Route**: Furosemide is IV, metoprolol is PO, insulin is subcut. Prepare the correct syringe (IV vs. insulin syringe) for each.

- **Right Time**: Confirm the 0900 administration time. Assess if any conditions warrant holding a medication (e.g., hold metoprolol if heart rate is < 60 bpm or systolic BP is < 100 mmHg).

- **Administration & Education**: Administer medications using correct technique. Educate Mr. Johnson: "This insulin will help manage your blood sugar. I'll check your glucose in about an hour. The furosemide may make you urinate more frequently."

- **Evaluation & Documentation**: Document administration immediately in the eMAR. Monitor for therapeutic effects (increased urine output, stable heart rate) and adverse effects (hypoglycemia, orthostatic hypotension).

Nursing Procedure & Medication Flow
**Step-by-Step for High-Risk IV Push (Furosemide)**:
1. Perform hand hygiene.
2. Prepare medication in a quiet, distraction-free zone.
3. **Two patient identifiers** at bedside.
4. Explain procedure to patient.
5. Assess IV site for patency, signs of infiltration/phlebitis.
6. Administer furosemide **slowly** over 1-2 minutes to avoid ototoxicity.
7. Monitor for sudden diuresis, electrolyte shifts (especially potassium), and orthostatic hypotension.

**Patient Safety and Precautions**:

- **Never** leave medications unattended at the bedside.

- **Never** pre-pull medications from labeled containers (e.g., taking a vial of insulin to another room).

- If a patient questions a medication ("This pill looks different"), **STOP**, re-verify all five rights, and investigate before proceeding.

- Use barcode medication administration (BCMA) if available, but remember it is a tool to *assist* the five rights, not replace them.

A Word from Your Senior Nurse
"Medication administration is one of our highest-risk responsibilities. The 'five rights' are your personal armor. In the rush of a busy shift, it's tempting to cut corners to be 'efficient.' But remember: true efficiency is doing it right the first time, because one error can cost a life. Make bedside verification your non-negotiable ritual. Your vigilant double-check is the final gatekeeper standing between a prescription and your patient's bloodstream. Own that responsibility with pride and precision."

## 핵심 개념

- **Five Rights of Medication Administration** — The five fundamental checks to ensure safe medication administration: Right Patient, Right Drug, Right Dose, Right Route, Right Time. Verified at the bedside.
- **High-Alert Medication** — Medications that bear a heightened risk of causing significant patient harm when used in error (e.g., insulin, heparin, opioids, chemotherapeutic agents). Often require independent double-checks.
- **eMAR (Electronic Medication Administration Record)** — A digital record used to document the prescribing, dispensing, and administration of medications. Used with barcode scanning to enhance safety but requires nurse verification.
- **Barcode Medication Administration** — A safety system where nurses scan a barcode on the patient's wristband and the medication package to electronically verify the five rights before administration.
- **Just Culture** — An organizational culture that focuses on identifying and fixing system flaws that lead to errors, rather than solely blaming individuals, while maintaining accountability for reckless behavior.

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