Review for NCLEX-RN® - PHARMACOLOGY &
PARENTERAL THERAPY
PHARMACOLOGY
DRUG ADMINISTRATION
Legal aspects of medication administration
The Joint Commission requires that two patient identifiers (e.g., name, birthday, account number) be
checked prior to administration of any medication.
Components of a legal medication order
• Date and time
• Patient’s name
• Patient’s inpatient ID number
• Drug Name and strength of dose
• Frequency of dose
• Physician’s full signature
Nurse’s legal responsibility
• Interpret each component of the order
• Question the order by communicating with the physician if
The nurse cannot read the order
Any component of the order is erroneous or ambiguous
The nurse had any doubt about the appropriateness of the order
Any order which does to make sense, such as large number of tablets or
capsule. Or a large volume of solution for injection
Controlled Substances
⚫ All controlled substances must be stored in a locked container requiring a key or
computerized access code for entry.
⚫ An inventory record of all controlled substances used is maintained.
⚫ If any part of a dose of a controlled substance is discarded, a second nurse witnesses the
disposal and the record is signed by both nurses. (Agency policies and procedures are always
followed.)
⚫ Agency policies and procedures are followed with regard to the counting of controlled
substances at the end of a shift; any discrepancy in the count is reported immediately.
Before Administration
,⚫ Wash your hands.
⚫ Assess the prescription and compare new medication prescriptions with the current list of
medications (reconciliation).
, ⚫ Ask the client whether he or she has a history of allergies.
⚫ Determine the purpose of the medication.
⚫ Assess the client for existing medical disorders in which the prescribed medication is
contraindicated (e.g., many medications are contraindicated in pregnancy and for breastfeeding
clients).
⚫ Check the client’s age (the older client and the neonate are at greater risk for toxicity than is an
adult client).
⚫ Assess the client’s vital signs and significant laboratory results (e.g., the potassium level in a
client who has been prescribed a loop diuretic).
⚫ Assess the client’s understanding of the purpose of the prescribed medication.
⚫ Identify and address concerns (e.g., social, cultural, religious) that the client has with regard to
taking the medication.
⚫ Use the appropriate resources (e.g., medication formulary, pharmacist) as necessary when
preparing the medication.
During Administration
⚫ Assess the six rights: right medication, right dose, right client, right route, right time, and right
documentation.
⚫ Assess the need for conversion or calculation of a dose when preparing medication for
administration.
⚫ Administer the medication within 30 minutes of the prescribed time.
⚫ Avoid administering medications with antacids, which affect absorption of medication. Also
avoid administering medications with grapefruit juice, which contains an enzyme that inhibits
absorption of many medications.
After Administration
, ⚫ Do not recap needles; discard needles in an appropriate container, using the safety device
provided with the syringe if one is available.
⚫ Dispose of any unused medication in accordance with agency policy: Liquid medication may be
discarded in a sink or flushed down a toilet; tablets or capsules may be flushed down the toilet.
Never discard medication in a trash container.
⚫ Document administration of the medication given at€” including its name, the dose, the date
and time, and your initials at€” immediately after giving the medication.
⚫ Monitor the client for side effects or adverse effects (e.g., allergic reaction) to the medication
and take action if adverse effects occur.
⚫ Evaluate the client for a therapeutic response to the medication.
Administering Oral Medications
⚫ Pour tablets or capsules into the medication container's cap, not your hand. Medications
prepared for unit dosage may be opened at the time of administration in the client's room.
⚫ Scored tablets (those marked to facilitate division) may be divided into halves or quarters.
⚫ Enteric-coated tablets and sustained-released capsules must not be crushed.
⚫ To pour medication accurately using a medicine cup, hold the cup at eye level, then pour to the
line designating the desired measure of medication.
⚫ Volumes of less than 5 mL are measured with the use of a syringe from which the needle has
been removed.
⚫ A calibrated dropper is used to give medicine to a child or to add a small amount of liquid to
water or juice.
⚫ Do not mix liquids with tablets or liquids with liquids in the same container.
Sublingual (under the tongue) and Buccal (between the cheek and the gum):
⚫ Instruct clients to keep the medication in place until it is absorbed.
⚫ Clients should not eat or drink while the tablet is in place.
Liquids, Suspensions, & Elixirs:
⚫ Follow directions for dilution and shaking.
⚫ When administering the medication, the base of the meniscus (lowest fluid line) is at the level of
the desired dose.
Standard precautions require the wearing of gloves when placing a tablet under a patient’s tongue.
The patient should not chew a sublingual tablet and should not drink or swallow until the tablet is
completely dissolved and absorbed.
Nasogastric and Gastrostomy Tubes
Check for proper tube placement.
PARENTERAL THERAPY
PHARMACOLOGY
DRUG ADMINISTRATION
Legal aspects of medication administration
The Joint Commission requires that two patient identifiers (e.g., name, birthday, account number) be
checked prior to administration of any medication.
Components of a legal medication order
• Date and time
• Patient’s name
• Patient’s inpatient ID number
• Drug Name and strength of dose
• Frequency of dose
• Physician’s full signature
Nurse’s legal responsibility
• Interpret each component of the order
• Question the order by communicating with the physician if
The nurse cannot read the order
Any component of the order is erroneous or ambiguous
The nurse had any doubt about the appropriateness of the order
Any order which does to make sense, such as large number of tablets or
capsule. Or a large volume of solution for injection
Controlled Substances
⚫ All controlled substances must be stored in a locked container requiring a key or
computerized access code for entry.
⚫ An inventory record of all controlled substances used is maintained.
⚫ If any part of a dose of a controlled substance is discarded, a second nurse witnesses the
disposal and the record is signed by both nurses. (Agency policies and procedures are always
followed.)
⚫ Agency policies and procedures are followed with regard to the counting of controlled
substances at the end of a shift; any discrepancy in the count is reported immediately.
Before Administration
,⚫ Wash your hands.
⚫ Assess the prescription and compare new medication prescriptions with the current list of
medications (reconciliation).
, ⚫ Ask the client whether he or she has a history of allergies.
⚫ Determine the purpose of the medication.
⚫ Assess the client for existing medical disorders in which the prescribed medication is
contraindicated (e.g., many medications are contraindicated in pregnancy and for breastfeeding
clients).
⚫ Check the client’s age (the older client and the neonate are at greater risk for toxicity than is an
adult client).
⚫ Assess the client’s vital signs and significant laboratory results (e.g., the potassium level in a
client who has been prescribed a loop diuretic).
⚫ Assess the client’s understanding of the purpose of the prescribed medication.
⚫ Identify and address concerns (e.g., social, cultural, religious) that the client has with regard to
taking the medication.
⚫ Use the appropriate resources (e.g., medication formulary, pharmacist) as necessary when
preparing the medication.
During Administration
⚫ Assess the six rights: right medication, right dose, right client, right route, right time, and right
documentation.
⚫ Assess the need for conversion or calculation of a dose when preparing medication for
administration.
⚫ Administer the medication within 30 minutes of the prescribed time.
⚫ Avoid administering medications with antacids, which affect absorption of medication. Also
avoid administering medications with grapefruit juice, which contains an enzyme that inhibits
absorption of many medications.
After Administration
, ⚫ Do not recap needles; discard needles in an appropriate container, using the safety device
provided with the syringe if one is available.
⚫ Dispose of any unused medication in accordance with agency policy: Liquid medication may be
discarded in a sink or flushed down a toilet; tablets or capsules may be flushed down the toilet.
Never discard medication in a trash container.
⚫ Document administration of the medication given at€” including its name, the dose, the date
and time, and your initials at€” immediately after giving the medication.
⚫ Monitor the client for side effects or adverse effects (e.g., allergic reaction) to the medication
and take action if adverse effects occur.
⚫ Evaluate the client for a therapeutic response to the medication.
Administering Oral Medications
⚫ Pour tablets or capsules into the medication container's cap, not your hand. Medications
prepared for unit dosage may be opened at the time of administration in the client's room.
⚫ Scored tablets (those marked to facilitate division) may be divided into halves or quarters.
⚫ Enteric-coated tablets and sustained-released capsules must not be crushed.
⚫ To pour medication accurately using a medicine cup, hold the cup at eye level, then pour to the
line designating the desired measure of medication.
⚫ Volumes of less than 5 mL are measured with the use of a syringe from which the needle has
been removed.
⚫ A calibrated dropper is used to give medicine to a child or to add a small amount of liquid to
water or juice.
⚫ Do not mix liquids with tablets or liquids with liquids in the same container.
Sublingual (under the tongue) and Buccal (between the cheek and the gum):
⚫ Instruct clients to keep the medication in place until it is absorbed.
⚫ Clients should not eat or drink while the tablet is in place.
Liquids, Suspensions, & Elixirs:
⚫ Follow directions for dilution and shaking.
⚫ When administering the medication, the base of the meniscus (lowest fluid line) is at the level of
the desired dose.
Standard precautions require the wearing of gloves when placing a tablet under a patient’s tongue.
The patient should not chew a sublingual tablet and should not drink or swallow until the tablet is
completely dissolved and absorbed.
Nasogastric and Gastrostomy Tubes
Check for proper tube placement.
