Pharmacology · chapter 2 · Drug Administration
Drug Administration and the Nursing Process
The 13 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Client-centered holistic care
The client (not the nurse) is at the center of the nursing process, which encompasses health, wellness, and illness in a holistic sense, incorporating all aspects of the client—physical, psychological, social, emotional, cultural, and spiritual.
Accurate assessment foundation
Assessment should relate to both actual and potential health problems. All other steps in the nursing process are based on an accurate assessment.
Pre-administration assessment
Before administering any medications to a client, it is important to be thorough in assessing the client to prevent harm and deliver optimal care.
Medication history scope
This includes prescription drugs, over-the-counter (OTC) medications, herbal supplements, illicit drugs, alcohol, nicotine, and caffeine. The nurse should ask specific questions.
Allergies before medication
No medication should be given without first asking the client about allergies and reactions to medications. If a client has been previously exposed to a drug and had a mild reaction, the reaction could be more severe when they are exposed again.
Health literacy and adherence
It is crucial for a client to know why a drug is important to their health and well-being so that they will adhere to a medication regimen. It is also vital that the client understands both the therapeutic effects and side effects of the drug.
Focused medication assessment
When administering medications, the nurse should complete a focused assessment as it relates to the medication to be given. For example, if giving a medication to lower blood pressure, blood pressure should be assessed before giving the drug.
Laboratory values before drugs
Laboratory values should also be assessed prior to giving medication. One diuretic may cause potassium to be excreted from the body, requiring the nurse to withhold the diuretic if the client is hypokalemic, but another may cause potassium to be conserved and should not be given to a client who is already hyperkalemic.
Weight and dosage safety
A client’s weight should be obtained prior to administering some drugs, especially in the pediatric population. An accurate weight will assist the nurse in determining if the dosage is appropriate.
Drug appropriateness problems
Part of the assessment the nurse completes before drug administration is determining if the drug is appropriate for the client (right diagnosis or indication) and identifying any potential problems that might arise if the drug is given (adverse effects).
Collaborative planning goals
When possible, the client, family, and nurse should work together in the planning process to better understand the desired outcomes. Goals are written in such a way that it is clear what type of observable response should be seen (Callahan, 2023).
Medication administration rights
Verify the rights to medication administration (right client, right medication, right indication, right dosage range and rate of administration [if appropriate], right route, right time, and right documentation).
Evaluation of drug response
This ongoing process evaluates the client’s response to the drug—for the therapeutic effect, the development of adverse effects, and teaching needs—and anticipates discharge needs. Therapeutic effectiveness refers to whether the drug did what it was supposed to do.
Terms to know
- nursing process
- The nursing process is a method of critical thinking consisting of five steps that occur continuously while the client is in the nurse’s care.
- Assessment
- Assessment is the process of data collection using a systematic method for collecting information and recognizing various clues as they relate to the client’s status.
- Health literacy
- Health literacy is a general term used to describe an individual’s ability to obtain, understand, and make appropriate decisions based on information to promote their health and wellness (Taylor et al., 2023).
- PRN
- PRN stands for pro re nata, a Latin term meaning “as the circumstances arise.”
- goal
- The goal is defined as the result that the nurse and client wish to see due to the nursing interventions (Callahan, 2023).
- Therapeutic effectiveness
- Therapeutic effectiveness refers to whether the drug did what it was supposed to do.
- Clinical judgment
- Clinical judgment is defined by the NCSBN as “the observed outcome of critical thinking and decision making.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A nurse is preparing to administer metoprolol to a client who experienced a myocardial infarction 3 days ago. The client’s blood pressure is 84/60 mm Hg, heart rate is 48 beats per minute, and the client reports dizziness. What is the nurse’s best action?
- Delay checking any additional data until the next scheduled assessment.
- Do not give the medication because the blood pressure and heart rate are too low.
- Give the medication and reassess the blood pressure and heart rate afterward.
- Administer the medication because it is ordered after myocardial infarction.
Answer: Do not give the medication because the blood pressure and heart rate are too low.
The nurse must recognize cues and analyze whether the medication is safe to administer. In this situation, the section states that the blood pressure and heart rate are too low to give metoprolol; giving it or delaying assessment would ignore abnormal findings and client symptoms.
A nurse is obtaining a medication history before administering a newly prescribed drug. Which actions should the nurse take? Select all that apply.
- Ask specifically about over-the-counter medications.
- Encourage the client or family member to bring the actual medications if possible.
- Ask about herbal supplements.
- Include alcohol, nicotine, and caffeine use in the assessment.
- Exclude illicit drugs unless the client asks whether they matter.
Answer: Ask specifically about over-the-counter medications., Encourage the client or family member to bring the actual medications if possible., Ask about herbal supplements., Include alcohol, nicotine, and caffeine use in the assessment.
The medication assessment should include prescription drugs, OTC drugs, herbal supplements, illicit drugs, alcohol, nicotine, and caffeine, and the nurse should ask specific questions. Excluding illicit drugs unless the client brings them up is unsafe because substance use may affect medication response and risk.
A client tells the nurse, “I am allergic to diphenhydramine because it makes me very drowsy.” Which response best reflects safe nursing assessment?
- Tell the client that drowsiness is impossible with this medication.
- Ignore the report because drowsiness is never clinically relevant.
- Record diphenhydramine as a severe allergy and avoid asking more questions.
- Clarify the reaction and document both the allergy information and the reaction clearly.
Answer: Clarify the reaction and document both the allergy information and the reaction clearly.
The nurse should clarify what reaction occurred because some reported allergies are actually expected side effects. The section specifically uses diphenhydramine-related drowsiness as an example of an expected effect, and it emphasizes documenting allergy and reaction information clearly.
During medication administration, which checks are part of verifying the rights of medication administration as described in the section? Select all that apply.
- Right client
- Right route
- Right documentation
- Right room
- Right indication
Answer: Right client, Right route, Right documentation, Right indication
The section lists right client, right indication, right route, and right documentation among the rights to verify during medication administration. “Right room” is not listed as one of the rights and could lead to unsafe reliance on location rather than client verification.
A nurse is planning care for a hospitalized client with severe postoperative knee pain who has medication ordered for pain control. Which goal is written most appropriately?
- The client will rate their knee pain as 4 or less on a 0 to 10 scale during this shift.
- The nurse will administer pain medication whenever it is available.
- The client will have less pain soon.
- Physical therapy will occur even if pain is uncontrolled.
Answer: The client will rate their knee pain as 4 or less on a 0 to 10 scale during this shift.
Goals should be client-centered, specific, realistic, and describe an observable response. The option using a pain rating of 4 or less during the shift matches the section’s example; the other options are vague, nurse-focused, or disregard the client’s condition.
After administering a medication, the nurse is evaluating the client’s response and planning next steps. Which areas should the nurse evaluate? Select all that apply.
- Whether the drug produced the intended therapeutic effect
- Whether discharge needs should be anticipated
- Whether evaluation can stop because the medication was administered as ordered
- Whether the client has additional teaching needs
- Whether adverse effects developed
Answer: Whether the drug produced the intended therapeutic effect, Whether discharge needs should be anticipated, Whether the client has additional teaching needs, Whether adverse effects developed
Evaluation is ongoing and includes the client’s therapeutic response, adverse effects, teaching needs, and discharge needs. The nurse should not stop evaluating simply because the medication was administered; goals and interventions may need to be modified as the client’s status changes.
Where every quote comes from
Section 2.1 Drug Administration and the Nursing Process of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.