Medication Administration

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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 “rights” medication administration.

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, usually identifying it by generic name only. 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 primary health care provider 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 (3.2 mmol/L). In addition to notifying the supervising RN, the LPN/LVN should anticipate taking which of the following actions?
   1. Hold either 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 and spironolactone.

1. “Hold either the furosemide or spironolactone.” The potassium level falls below normal (3.5–5 mEq/L[3.5–5 mmol/L]). Furosemide is a potassium-wasting diuretic, and 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. “Administer the spironolactone only.” The spironolactone should be administered.
3. “Administer the furosemide only.” Do not administer the furosemide because it is a potassium-wasting diuretic. The client’s potassium level is already low. Eliminate.
4. “Administer the furosemide and spironolactone.” 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 daily intake of protein.”
   4. “I should drink at least 8 glasses of water daily.”

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

1. “I should take my medication before eating.” Allopurinol is best tolerated with or immediately after meals to reduce gastrointestinal (GI) irritation. Eliminate.
2. “I should take my medication with orange juice.” Orange juice makes the urine acidic. Allopurinol is more soluble in alkaline urine. Eliminate.
3. “I should increase my daily intake of protein.” It is not necessary to increase the intake of protein when taking allopurinol. Eliminate.
4. “I should drink at least 8 glasses of water daily.”Allopurinol can cause kidney stones. The client should drink 3,000 mL/day to reduce the risk of renal calculi formation.

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