Drug Administration: IV, IM, SC , With Memonics & MCQ | Fundamental of Nursing| Nursing Student

💊 Fundamentals of Nursing – NORCET

Drug Administration

Complete study notes covering 10 Rights, Routes, Medication errors, Types of orders, and high-yield MCQs for NORCET, AIIMS, DSSSB & State Nursing Exams.

📋 10 Rights of Drug Administration

💉 All Routes Covered

❓ 12 MCQs Included

🧠 Mnemonics

💡 Introduction

Drug administration is the process of giving a therapeutic agent (drug/medication) to a patient. It is one of the most critical nursing responsibilities requiring knowledge, skill, and extreme care. Errors in drug administration can lead to serious patient harm, making it a high-priority topic in all nursing exams.

📖

Key Definition

Pharmacology = Study of drugs | Pharmacokinetics = What body does to drug (ADME) | Pharmacodynamics = What drug does to body

🔄 Pharmacokinetics – ADME

Phase	Full Form	Description
A	Absorption	Movement of drug from site of administration into bloodstream
D	Distribution	Drug carried by blood to target tissues and organs
M	Metabolism	Drug broken down (mainly in liver) – also called Biotransformation
E	Excretion	Elimination of drug/metabolites (mainly via kidneys/urine)

🧠

Mnemonic – ADME

Absorption

Distribution

Metabolism

Excretion

✅ The 10 Rights of Drug Administration

Originally 5 Rights, now expanded to 10 Rights for patient safety. These are the MOST important topic for NORCET — memorize all 10!

Right 01

Right Patient

Check patient ID band. Ask patient to state their name. Use 2 identifiers.

Right 02

Right Drug

Verify medication name. Check 3 times. Compare label with MAR.

Right 03

Right Dose

Calculate dose carefully. Use formula: Dose = Desired ÷ On Hand × Vehicle.

Right 04

Right Route

Oral, IV, IM, SC, topical etc. Confirm appropriate route for that drug.

Right 05

Right Time

Give drug at correct time. ±30 min is acceptable window for most drugs.

Right 06

Right Documentation

Record immediately AFTER giving drug. Never document in advance.

Right 07

Right Reason

Understand WHY the drug is ordered. Verify the indication is appropriate.

Right 08

Right Response

Monitor therapeutic effect. Check if drug is achieving the desired outcome.

Right 09

Right to Refuse

Patient has the right to refuse medication. Document refusal appropriately.

Right 10

Right Education

Educate patient about drug name, purpose, side effects, and precautions.

🧠

Mnemonic for 10 Rights – "P D D R T – D R R R E"

Patient

Drug

Dose

Route

Time

Documentation

Reason

Response

Refuse

Education

💉 Routes of Drug Administration

💊

Oral Route (PO)

Most common & safest

• Tablets, capsules, syrups, suspensions
• Slow onset of action
• First-pass metabolism occurs
• Contraindicated: unconscious, vomiting patients
• Sublingual (SL) – under tongue (e.g., GTN)
• Buccal – between cheek and gum

💉

Parenteral Route

Injection – Fastest onset

• IV (Intravenous) – Fastest, 100% bioavailability
• IM (Intramuscular) – Deltoid, Vastus lateralis, Gluteus
• SC (Subcutaneous) – Insulin, Heparin
• ID (Intradermal) – Mantoux/TB test, allergy tests
• Bypasses first-pass metabolism

🌬️

Inhalation Route

Respiratory drugs

• MDI (Metered Dose Inhaler)
• Nebulizer, DPI (Dry Powder Inhaler)
• Rapid onset for lung conditions
• Used in asthma, COPD
• Rinse mouth after corticosteroid inhalers

🧴

Topical Route

Local effect

• Creams, ointments, patches (transdermal)
• Transdermal patch – slow sustained release
• Ophthalmic (eye drops/ointments)
• Otic (ear drops)
• Nasal drops/sprays

🩺

Rectal / Vaginal

Local or systemic

• Suppositories, enemas
• Used when patient cannot take orally
• Rectal – Fever, seizures (Diazepam suppository)
• Vaginal – Pessaries, creams
• Partially avoids first-pass metabolism

🧠

Special Routes

Advanced/critical care

• Intrathecal – Into spinal subarachnoid space
• Epidural – Into epidural space
• Intraosseous (IO) – Into bone marrow (emergency)
• Intracardiac – Directly into heart muscle

📊 Injection Routes – Comparison Table

Parameter	Intradermal (ID)	Subcutaneous (SC)	Intramuscular (IM)	Intravenous (IV)
Needle Angle	10–15°	45° (or 90° if obese)	90°	15–30°
Needle Size	25–27G, ⅜–⅝"	25G, ⅝"	21–23G, 1–3"	20–22G
Volume	0.01–0.1 mL	0.5–1 mL	1–5 mL (max 5 mL)	Variable
Site	Forearm (inner), upper back	Abdomen, thigh, upper arm	Deltoid, Vastus lateralis, Gluteus	Median cubital, cephalic vein
Onset	Slowest	Slow (30–90 min)	Faster (10–20 min)	Fastest (immediate)
Example	Mantoux test, BCG	Insulin, Heparin, Vaccines	Vaccines, Antibiotics	Emergency drugs, Fluids

⚠️

Important: For SC injections of Insulin/Heparin — do NOT aspirate and do NOT massage the site after injection (can cause bruising/hematoma).

🎯 IM Injection Sites – Details

Site	Nerve/Vessel Risk	Best For	Notes
Vastus Lateralis (outer thigh)	Lowest risk	Infants, children, adults	Preferred site for infants <3 years
Ventrogluteal (hip)	Safest IM site overall	Adults	No major nerves/vessels — most preferred for adults
Deltoid (upper arm)	Radial nerve risk	Small volumes, vaccines	Max 1 mL; not for irritating drugs
Dorsogluteal (gluteus maximus)	Sciatic nerve risk	Adults only	Avoid in infants; risk of sciatic nerve injury

🚨

High Yield! The Ventrogluteal site is the SAFEST IM injection site. The Vastus Lateralis is preferred for infants under 3 years. Sciatic nerve injury risk is with Dorsogluteal site.

🔒 Z-Track Technique

The Z-track method is used for IM injections of irritating/staining drugs (e.g., Iron dextran, certain vaccines) to prevent drug leakage into subcutaneous tissue.

1

Pull Skin Laterally

Displace skin 1–1.5 inches to one side using non-dominant hand

2

Insert Needle at 90°

Insert needle fully into the muscle while holding displaced skin

3

Aspirate (if required)

Pull back plunger to check for blood return (blood = reposition)

4

Inject Slowly

Inject medication slowly (10 seconds per mL)

5

Wait 10 Seconds

Hold needle in place for 10 seconds after injecting

6

Release Skin

Withdraw needle and release skin — creates a "Z" seal trapping drug in muscle

⚠️

Do NOT massage the site after Z-track injection — it defeats the purpose of the technique.

📝 Types of Medication Orders

Type of Order	Description	Example
Routine/Standing Order	Given regularly until discontinued	Tab. Metformin 500mg BD × 30 days
PRN Order (Pro Re Nata)	Given as needed, based on patient condition	Tab. Paracetamol 500mg SOS for fever
Stat Order	Given IMMEDIATELY, only once	Inj. Adrenaline 0.5mg IV STAT
Single/One-time Order	Given once at a specific time	Tab. Diazepam 5mg before procedure
Verbal/Telephone Order	Oral order from doctor; nurse writes and reads back	Emergency situations

🧠

Mnemonic – Types of Orders

Routine

PRN

STAT

Single

Verbal

👉 "Really Prepared Students Succeed Very well"

📋 Common Medication Abbreviations

Abbreviation	Latin Meaning	English Meaning
OD	Omni die	Once daily
BD / BID	Bis in die	Twice daily
TID / TDS	Ter in die	Three times daily
QID	Quater in die	Four times daily
HS	Hora somni	At bedtime
AC	Ante cibum	Before meals
PC	Post cibum	After meals
PRN / SOS	Pro re nata	As needed / If necessary
STAT	Statim	Immediately
PO	Per os	By mouth (oral)
SL	Sub lingua	Under the tongue
NPO / NBM	Nil per os	Nothing by mouth

🔢 Dose Calculation Formula

📐

Formula – Desired Over Have

Dose = (Desired Dose ÷ Available Dose) × Volume

Example: Doctor orders 250mg of Amoxicillin. Available: 500mg/5mL
→ Dose = (250 ÷ 500) × 5 = 2.5 mL

💧

IV Drip Rate Formula

Drops/min = (Volume in mL × Drop factor) ÷ Time in minutes

Standard drop factors: Macro drip = 20 drops/mL | Micro drip = 60 drops/mL

⚠️ Medication Errors

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional.

Type of Error	Description
Wrong Drug	Look-alike/sound-alike (LASA) drugs confused
Wrong Dose	Calculation errors, decimal point errors
Wrong Route	IM drug given IV or vice versa
Wrong Time	Drug given too early or too late
Wrong Patient	Failure to verify identity
Omission Error	Ordered drug not given
Transcription Error	Incorrect copying of doctor's order

🚨

High Alert Drugs (NORCET Favourite!): Insulin, Heparin, Concentrated Electrolytes (KCl), Chemotherapy agents, Opioids, Neuromuscular blocking agents. These are known as "High Alert Medications" — errors with these cause significant patient harm.

🔴 Drug Reactions & Adverse Effects

Term	Definition	Example
Side Effect	Predictable, known, unintended effect at therapeutic dose	Drowsiness with antihistamines
Adverse Drug Reaction (ADR)	Harmful, unintended response at normal dose	Rash with Penicillin
Toxicity	Harmful effect due to excessive drug levels	Digoxin toxicity (bradycardia, visual changes)
Anaphylaxis	Severe, life-threatening allergic reaction	Penicillin anaphylaxis (treat with Epinephrine)
Idiosyncratic Reaction	Unpredictable, abnormal response (genetic basis)	Hemolysis with primaquine in G6PD deficiency
Tolerance	Decreased effect with repeated use; needs higher dose	Opioid tolerance
Dependence	Physical/psychological need for drug	Benzodiazepine dependence
Teratogenicity	Drug causing fetal abnormality	Thalidomide, Category X drugs

💚

Anaphylaxis Treatment – NORCET Favourite: First drug = Adrenaline (Epinephrine) 0.5mg IM into outer thigh. Then antihistamines + corticosteroids + IV fluids.

👩‍⚕️ Nurse's Responsibilities in Drug Administration

1

Verify the Order

Check physician's order — drug name, dose, route, frequency, and date. Clarify any unclear orders.

2

Check Three Times (3-Check Rule)

Check medication label: (1) When removing from storage, (2) Before preparing, (3) Before administering.

3

Assess Patient

Check allergies, vital signs (e.g., BP before antihypertensives, pulse before digoxin), and patient's current condition.

4

Educate Patient

Explain drug name, purpose, expected effects, and possible side effects before administration.

5

Administer Correctly

Use correct technique for the route. Maintain asepsis. Never leave medications at bedside unattended.

6

Document Immediately

Record in MAR (Medication Administration Record) immediately after giving — include time, dose, route, and your signature.

7

Evaluate Response

Monitor patient for therapeutic effects and adverse reactions after administration.

🔁 The 3-Check Rule (Label Verification)

Check #	When	Action
1st Check	When retrieving from storage/shelf	Compare label with MAR/prescription
2nd Check	While preparing the drug	Re-verify drug, dose, expiry date
3rd Check	Before administering to patient	Final check at bedside before giving

📝 High-Yield MCQs – Drug Administration (NORCET)

Q1. The original "5 Rights" of drug administration have now been expanded to how many rights?

• A) 7 Rights
• B) 8 Rights
• C) 10 Rights
• D) 12 Rights

💡 Tip: Original 5 = Patient, Drug, Dose, Route, Time. Extended to 10 adding Documentation, Reason, Response, Refuse, Education.

Q2. Which site is the SAFEST for intramuscular injection in adults?

• A) Dorsogluteal
• B) Deltoid
• C) Ventrogluteal
• D) Vastus Lateralis

💡 Tip: Ventrogluteal has NO major nerves or blood vessels nearby. Vastus Lateralis is safest for infants under 3 years.

Q3. The needle angle for intradermal injection is?

• A) 10–15 degrees
• B) 45 degrees
• C) 60 degrees
• D) 90 degrees

💡 Tip: ID = 10–15° | SC = 45° | IM = 90° | IV = 15–30°. A wheal (blister) should form after ID injection — confirms correct placement.

Q4. Which type of medication order means "give immediately, one time only"?

• A) PRN Order
• B) Standing Order
• C) STAT Order
• D) Single Order

💡 Tip: STAT = immediate, one-time. PRN = as needed. Single order = one time at a specific time (not necessarily immediately).

Q5. When administering insulin SC injection, the nurse should:

• A) Aspirate and massage after injection
• B) Aspirate but do not massage
• C) Massage but do not aspirate
• D) Neither aspirate nor massage

💡 Tip: For Insulin and Heparin SC — NO aspiration, NO massage. Massaging causes faster absorption and can alter insulin action and cause bruising.

Q6. Z-track injection technique is used for which type of drugs?

• A) SC drugs
• B) Irritating or staining IM drugs
• C) IV medications
• D) Sublingual drugs

💡 Tip: Z-track is specifically for irritating drugs like Iron Dextran that can stain/damage subcutaneous tissue if they leak back. Always IM.

Q7. Documentation of drug administration should be done:

• A) 30 minutes before giving the drug
• B) Before drawing up the drug
• C) Immediately AFTER administering the drug
• D) At the end of the nurse's shift

💡 Tip: Never document in advance. Always document after giving — this is both a legal and safety principle. Pre-documenting could lead to double-dosing.

Q8. What is the preferred IM injection site for infants below 3 years of age?

• A) Deltoid
• B) Dorsogluteal
• C) Ventrogluteal
• D) Vastus Lateralis

💡 Tip: Deltoid muscle is underdeveloped in infants. Dorsogluteal carries sciatic nerve risk. Vastus Lateralis (outer thigh) is the safest for infants.

Q9. The term "Pharmacokinetics" refers to:

• A) What drug does to the body
• B) Study of drug names and classification
• C) What the body does to the drug (ADME)
• D) Drug-drug interactions

💡 Tip: Pharmacokinetics = ADME (Absorption, Distribution, Metabolism, Excretion) = body's action on drug. Pharmacodynamics = drug's action on body.

Q10. The first line drug in anaphylaxis is:

• A) Hydrocortisone IV
• B) Chlorpheniramine IV
• C) Adrenaline (Epinephrine) 0.5mg IM
• D) Salbutamol nebulization

💡 Tip: Adrenaline (Epinephrine) is ALWAYS first in anaphylaxis. Given 0.5mg IM into outer thigh. Never give IV unless cardiac arrest. Antihistamines are secondary.

Q11. "BD" in a prescription means the drug should be given:

• A) Once daily
• B) Twice daily
• C) Three times daily
• D) Four times daily

💡 Tip: OD = Once | BD/BID = Twice | TID/TDS = Thrice | QID = Four times daily. These Latin abbreviations are very commonly tested.

Q12. Doctor orders 500mg of a drug. Available is 250mg/5mL. How many mL should the nurse administer?

• A) 5 mL
• B) 2.5 mL
• C) 10 mL
• D) 7.5 mL

💡 Formula: (Desired ÷ Available) × Volume = (500 ÷ 250) × 5 = 2 × 5 = 10 mL. Always double-check dose calculations!

⚡ Quick Reference – Drug Administration

Total Rights

10 Rights

ID Needle Angle

10–15°

SC Needle Angle

45° (90° if obese)

IM Needle Angle

90°

Safest IM – Adults

Ventrogluteal

Safest IM – Infants

Vastus Lateralis

Insulin/Heparin SC

No aspirate/massage

Anaphylaxis Drug #1

Adrenaline 0.5mg IM

Label Checks

3 Times

Macro Drip Factor

20 drops/mL

Micro Drip Factor

60 drops/mL

Dose Formula

D ÷ H × V