| Course | NSG 124 Pharmacology |
|---|---|
| Unit | Unit 7 |
| Paper type | High-alert medication file |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 124 Unit 7
Intravenous Magnesium Sulfate on a Labor Unit: A High-Alert Medication File, With the Independent Double-Check Set Out Role by Role
Student Name
Department of Nursing, Herzing University
NSG 124: Pharmacology
Instructor Name
February 26, 2026
Intravenous Magnesium Sulfate on a Labor Unit: A High-Alert Medication File, With the Independent Double-Check Set Out Role by Role
Why It Is High Alert
The Institute for Safe Medication Practices [ISMP] names magnesium sulfate injection among the acute-care drugs whose errors are most likely to hurt patients badly (ISMP, 2018). On a labor unit it is given intravenously to prevent seizures in preeclampsia with severe features, as recommended by obstetric guidance (American College of Obstetricians and Gynecologists [ACOG], 2020). The margin between a protective level and a dangerous one is narrow: too much depresses reflexes, then breathing, then heart conduction. The course pharmacology text describes this progression and the role of calcium gluconate as the antidote (Burchum & Rosenthal, 2022).
What Goes Wrong: Categories of Error
An analysis of obstetric accidents with this drug described errors that fall into a small number of categories (Simpson & Knox, 2004). Programming errors: a maintenance rate entered as a bolus, or the bolus volume entered as an hourly rate. Container errors: a large bag of concentrated drug hung where only a small loading dose was intended, so that a pump error delivers far more than planned. Line errors: the infusion connected to the wrong line, or run without a pump. Monitoring errors: the infusion continued while reflexes, breathing, or urine output declined unnoticed. Handoff errors: the rate or the time the loading dose finished not passed on at shift change.
The Independent Double-Check
Two registered nurses take part. The primary nurse is caring for the patient. The second nurse is not assigned to her and has not been told what the settings should be. Each checks without reference to the other, in this order.
Second nurse, alone: reads the order in the record and writes down, without looking at the pump or the bags, the drug, the concentration expected, the loading dose and the time over which it is to run, the maintenance rate, and the patient's identity.
Second nurse, alone: goes to the bedside, reads each bag label and the pump screen, traces each line from the bag through the pump channel to its connection on the patient, and checks the patient's wristband against the order.
Primary nurse, separately: completes the same list from the order and the bedside before comparing.
Comparison: the two lists are compared item by item at the bedside. Any difference stops the infusion from starting until it is resolved, and the difference is resolved by returning to the order, not by agreeing on one nurse's version.
Repeat: the check is repeated when the loading dose finishes and the pump changes to maintenance, at any rate change, and at every shift handoff.
Storage, Labeling, and Handling
Premixed bags from pharmacy only, with the loading dose supplied as a separate, smaller bag. The drug run on a pump with the drug library on, never by gravity. A dedicated pump channel and a label at the line's connection point near the patient. Calcium gluconate kept in the room, with its location stated at handoff.
Monitoring While It Runs
Patellar reflexes, breaths per minute, pulse oximetry, how alert she is, and hourly urine at the intervals the unit protocol sets, with magnesium levels drawn as ordered. Because magnesium is cleared by the kidneys, falling urine output raises the level even at an unchanged rate. Loss of reflexes or a respiratory rate below the protocol limit means the pump is paused and the provider is paged immediately (ACOG, 2020).
What Is Said at Handoff
Because handoff errors form their own category, the file lists what must be said aloud at every change of nurse, at the bedside with the pump in view: the drug and its concentration as printed on the bag; the maintenance rate on the pump screen, read aloud by the receiving nurse; when the loading dose ran and whether it finished; the latest reflexes, breathing rate, and urine output with their times; the most recent magnesium level and when the next is due; where the calcium gluconate is; and any change in the plan, such as when the infusion is expected to stop after delivery. The receiving nurse then completes the independent double-check described above before the outgoing nurse leaves. A handoff that happens at the desk, away from the pump, cannot catch a programming error, which is why the location is part of the requirement.
Record
The record carries both nurses' names and the time of each double-check, the time the loading dose started and finished, every rate change, each set of monitoring findings, and the handoff. The patient context is composite; protocols and limits belong to the unit's own policy.
References
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia (ACOG Practice Bulletin No. 222). Obstetrics & Gynecology, 135(6), e237-e260. https://doi.org/10.1097/AOG.0000000000003891
Burchum, J. R., & Rosenthal, L. D. (2022). Lehne's pharmacology for nursing care (11th ed.). Elsevier.
Institute for Safe Medication Practices. (2018). ISMP list of high-alert medications in acute care settings. https://www.ismp.org/recommendations/high-alert-medications-acute-list
Simpson, K. R., & Knox, G. E. (2004). Obstetrical accidents involving intravenous magnesium sulfate: Recommendations to promote patient safety. MCN: The American Journal of Maternal/Child Nursing, 29(3), 161-169. https://doi.org/10.1097/00005721-200405000-00006
NSG 124 Unit 7 instructions, in plain terms
Unit 7 asks you to prepare a file on a high-alert medication. Expect to explain why it is high alert, describe categories of error, set out safeguards such as the independent double-check, address storage and labeling, describe monitoring and handoff and state what is recorded. Many versions ask what makes a double-check independent and how detailed monitoring should be. Check whether your section names the drug. An independent double-check means the second nurse works from the order without seeing the first nurse's result. Errors cluster in predictable places, such as rate programming and bag confusion. Monitoring should name signs of toxicity and what to do. Handoff is a known error point. Name the antidote and where it is kept, since toxicity can develop quickly.
Inside the NSG 124 Unit 7 example
The file opens with why the drug is high alert. The error section groups errors by type from published analysis. The double-check section lists steps for each nurse, emphasizing independence. The storage section explains premixed bags and separate loading doses. The monitoring section lists signs of toxicity with thresholds and the antidote, calcium gluconate, kept at the bedside. The handoff section lists items said aloud. The record section lists what is documented. Each safeguard answers a named error category, so the file reads as protection built from known failures rather than general caution. The loading dose, the most error-prone step, gets its own separate check before the maintenance rate starts.
Reading the NSG 124 Unit 7 rubric
Herzing's rubric for a high-alert medication file usually covers the reason for high-alert status, error categories, the double-check, storage, monitoring, handoff and documentation. The independent double-check and the monitoring plan are read most closely, because they are the main safeguards against harm. Error category points reward published sources. Storage criteria look for premixed products and separately supplied loading doses. Monitoring points go to signs of toxicity with thresholds and actions, such as stopping the infusion if reflexes disappear. Handoff earns credit for items said aloud. Documentation should name both nurses and times. The antidote kept at the bedside is usually expected. Simpson and Knox's analysis supports the error categories.
Common NSG 124 Unit 7 mistakes, and how to avoid them
High-alert files in Unit 7 commonly lose points by describing the double-check as one nurse watching the other, which is not independent. Another frequent problem is monitoring without thresholds, such as checking reflexes without saying what result stops the drug. Students often forget the antidote. Error categories are missing or invented. Storage and labeling are skipped. Handoff is not addressed, though handoff errors are a known category. The record lacks both names. Urine output is left out, though magnesium is cleared by the kidneys. Pump programming errors are not mentioned. Finally, tie each safeguard to an error type, because graders reward a file that shows why each step exists.
Get a NSG 124 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your NSG 124 classroom, and say which medication the file has to cover. We write a custom example that argues the classification from a source, writes the two verifications as separate accounts, gives the comparison its own step and closes on policy. First custom sample free, back in 24 to 48 hours.
More NSG 124 papers and BSN samples
- NSG 124 Unit 1: Route and form comparison
- NSG 124 Unit 2: Dose calculation worksheet
- NSG 124 Unit 3: Administration rights walkthrough
- NSG 124 Unit 4: Pre-dose assessment record
- NSG 124 Unit 5: Monitoring and counseling brief
- NSG 124 Unit 6: Adverse effect escalation chart
- NSG 124 Unit 8: Drug classification table
- NSG 126 Unit 7: First year readiness plan
- NSG 221 Unit 7: Condition presentation summary
- NSG 222 Unit 7: Family assessment write-up
- NSG 223 Unit 7: Multi problem patient record
NSG 124 Unit 7 questions, answered
What makes a double-check independent on paper?
That the two accounts can be read on their own. If your write-up describes both people looking at the same syringe at the same moment and agreeing, it has recorded a joint check, whatever it calls itself. Show each person verifying without reference to the other, then show the comparison as a separate step with its own result.
Do I have to have performed a double-check myself?
No, and you should not be writing up one you performed on a real patient. Clinical hours, skills sign-offs and every medication pass on a live patient remain your own work and are logged where your program requires. This file is an academic document built on a composite scenario, and it shows the shape of the record rather than substituting for the work itself.
How much of the file should the double-check take?
Most of it, unless your instructions divide the sections for you. The classification and the error categories set it up, and storage details close it, but the middle is where this unit concentrates its credit. A file spending two pages on labeling and four lines on the check has weighted itself against the criteria.
Where can I find a free NSG 124 Unit 7 sample paper?
The full NSG 124 Unit 7 magnesium sulfate file is on this page free of charge, error categories, double-check, monitoring and handoff. A file for another high-alert drug can be written on request.
What is an independent double-check for high-alert medications?
Two nurses each verify the order, drug, dose, rate and patient separately, without seeing the other's result, then compare. This sample sets out those steps for intravenous magnesium sulfate on a labor unit.