Medication Administration

An important function in providing safe and effective care to clients is the administration of medications. Because this is one of the responsibilities of a beginning LPN/LVN, questions about medications are often an important part of the NCLEX-PN^® exam. The LPN/LVN who is minimally competent is knowledgeable about medications and uses the “six rights” when administering medication.

In nursing school, most questions about medication followed the same pattern. You were told the client’s diagnosis, the name of the medication, and then were asked a question. Even if you didn’t know the information about the medication, sometimes you were able to select the correct answer by knowing the diagnosis.

The NCLEX-PN^® exam does not give you any clues from the context of the question. The questions on this exam include the name of the medication, almost always identifying it by both trade and generic names. Most of the time, you will not be given the reason the client is receiving the medication.

Let’s look at some medication questions.

1. The physician orders furosemide and spironolactone for a client. Prior to administering the medication, the LPN/LVN determines that the client’s potassium is 3.2 mEq/L. In addition to notifying the supervising RN, the LPN/LVN should anticipate taking which of the following actions?
   1. Do not administer the furosemide or spironolactone.
   2. Administer the spironolactone only.
   3. Administer the furosemide only.
   4. Administer the furosemide and spironolactone.

This is a typical exam-style medication question. The question concerns the side effects and nursing implications of furosemide (Lasix) and spironolactone (Aldactone).

1. The potassium level is below normal (3.5–5.0 mEq/L). Furosemide is a potassium-wasting diuretic. Spironolactone is a potassium-sparing diuretic. There is no reason to hold the spironolactone because the client has a low potassium level. Eliminate this answer.
2. The spironolactone should be administered.
3. Do not administer the furosemide because it is a potassium-wasting diuretic. The client’s potassium level is already low. Eliminate.
4. Do not administer the furosemide. Eliminate.

The correct answer is (2).

Let’s try this next question.

1. A client returns to the clinic 2 weeks after being started on allopurinol 200 mg PO daily. The LPN/LVN reviews information about this medication with the client. Which of the following statements by the client indicates that the teaching was effective?
   1. “I should take my medication on an empty stomach.”
   2. “I should take my medication with orange juice.”
   3. “I should increase my intake of protein.”
   4. “I should drink at least 8 glasses of water every day.”

To answer this question you need to know information about allopurinol (Zyloprim), an antigout agent that reduces uric acid.

1. Allopurinol is best tolerated with or immediately after meals to reduce gastrointestinal (GI) irritation. Eliminate.
2. Orange juice makes the urine acidic. Allopurinol is more soluble in alkaline urine. Eliminate.
3. It is not necessary to increase the intake of protein when taking allopurinol. Eliminate.
4. Allopurinol can cause renal calculi. The client should drink 3,000 mL/day to reduce the risk of kidney stone formation.

The correct answer is (4). You must know the side effects and nursing implications of medications for the NCLEX-PN^® exam.