Pharmacological therapies
Medication safety: the rights, high-alert drugs, and when to hold a dose
The checks that prevent errors, the drugs that need extra care, and the findings that mean you hold a dose and call.
9 min read·core·
Reviewed by a licensed nurse · 22 October 2026
The rights are a checklist, not a slogan
The core rights are right client, right drug, right dose, right route, right time and right documentation. Many facilities add right reason and right response. The exam tests whether you notice the one that is wrong, not whether you can recite the list.
Use two client identifiers, not the room number. Compare the order, the label and the drug at the bedside before you give it.
Check before you give
| Drug | Check first | Concern |
|---|---|---|
| Digoxin | Apical pulse for a full minute | Slow pulse, toxicity |
| Antihypertensive | Blood pressure | Hypotension |
| Insulin | Glucose and meal timing | Hypoglycemia |
| Warfarin | INR | Bleeding |
| Heparin | aPTT (per protocol) | Bleeding |
| Opioid | Respiratory rate and sedation | Respiratory depression |
Hold parameters come from the order, the facility and the drug reference. These are common examples.
High-alert medications
These carry a higher risk of serious harm when used in error.
- ·Insulin: confirm the type, dose and timing with food. Rapid-acting insulin is given with meals.
- ·Heparin and other anticoagulants: watch for bleeding, and know the antidote (protamine sulfate for heparin).
- ·Opioids: assess respiratory rate and level of consciousness, and keep naloxone available.
- ·Concentrated potassium chloride: never given as an undiluted push. It is a cause of cardiac arrest.
Antidotes to know
- ·Heparin: protamine sulfate
- ·Warfarin: vitamin K (phytonadione)
- ·Opioids: naloxone
- ·Acetaminophen overdose: acetylcysteine
- ·Benzodiazepines: flumazenil, used with caution
Check yourself
Did it stick?
1. The nurse is about to give digoxin and finds an apical pulse of 52 beats per minute. What should the nurse do?
2. Which medication is the antidote for heparin?
3. A client taking digoxin has a potassium level of 3.0 mEq/L. Why is this important?
Sources
More in NCLEX-PN
Management of care
Scope of practice and delegation for the practical nurse
Physiological adaptation
Potassium, sodium, calcium and magnesium: what to notice and what to report
Safety and infection control
Pressure injuries and falls: staging, risk and prevention
Pharmacological therapies
Insulin types, timing and hypoglycemia
Educational content for exam preparation. It is not clinical guidance and does not replace your facility's policies, current professional guidelines or the advice of a qualified clinician.