In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of adverse effects, contradictions, side effects and interactions of medications in order to:

  • Identify a contraindication to the administration of a medication to the client
  • Identify actual and potential incompatibilities of prescribed client medications
  • Identify symptoms/evidence of an allergic reaction (e.g., to medications)
  • Assess the client for actual or potential side effects and adverse effects of medications (e.g., prescribed, over-the-counter, herbal supplements, preexisting condition)
  • Provide information to the client on common side effects/adverse effects/potential interactions of medications and inform the client when to notify the primary health care provider
  • Notify the primary health care provider of side effects, adverse effects and contraindications of medications and parenteral therapy
  • Document side effects and adverse effects of medications and parenteral therapy
  • Monitor for anticipated interactions among the client prescribed medications and fluids (e.g., oral, IV, subcutaneous, IM, topical prescriptions)
  • Evaluate and document the client's response to actions taken to counteract side effects and adverse effects of medications and parenteral therapy

The administration of medications involves far more than handing an ordered medication to a client. The administration of medications entails the nurse's application of critical thinking skills, their professional judgment, their application of pathophysiology, and a thorough knowledge of the client and their condition.

When medications are ordered, the nurse must be knowledgeable about the indications, contraindication, side effects, adverse effects and the interactions associated with the medication, as found in a reliable resource such as the Physician's Desk Reference. If, and when, the nurse's knowledge of these things and the nurse's knowledge about the client and their condition are not consistent and congruent with each other, the nurse must question the order and discuss their concerns with the ordering physician or licensed independent practitioner such as a physician's assistant or nurse practitioner.

After a medication has been administered, the nurse is also responsible and accountable for closely monitoring the client for any side effects and adverse actions.

Identifying a Contraindication to the Administration of a Medication to the Client

Like indications, virtually all medications have contraindications against their use. Some of the most commonly occurring contraindications for medications include:

  • Sensitivity or allergy to the medication
  • Pregnancy
  • Lactation
  • Renal disease
  • Hepatic disease

Prior to the administration of medications, the nurse must be fully knowledgeable about the contraindications of the medications, the client's condition and determine whether or not the ordered medication is contraindicated for this client. When a nurse identifies that fact that a medication is contraindicated for a client, the nurse must communicate with the ordering physician in order to clarify this medication order.

Identifying Actual and Potential Incompatibilities of Prescribed Client Medications

Some medications are compatible with other medications and others are not; and some intravenous fluids and medications are compatible with each other, and others are not. Compatible medications can be safely administered in one syringe for an intramuscular medication and non compatible medications cannot be given in the same syringe. At times incompatibility is evidenced with changes such as those related to color changes and the formation of a cloudy solution or obvious precipitate, and at other times incompatibility may not be noticeable. For this reason, nurses must refer to a compatibility or incompatibility chart before they mix medications or medications and solutions.

Identifying Symptoms and Evidence of an Allergic Reaction

Allergic reactions to medications can be minor and they can also be very serious and life threatening, Nurses, therefore, must assess clients and identify any possible allergies to the medications. These allergies can be assessed with the client's medical history and they can also be assessed when a client is getting a medication to which they have never had a prior allergic response to.

All allergies are documented in the nursing assessment and also on the medication administration record in addition to other areas in the medical record, according to the facility's policy and procedure. Many healthcare agencies also use allergy bands and/or bar codes with embedded allergy information to enable nurses to readily identify any allergies to medications.

Commonly occurring medication allergies include allergies to penicillin which can be particularly dangerous and life threatening, allergies to sulfonamides, and allergic reactions to cephalosporin medications. It is estimated that about ten percent of people have had a reaction to penicillin. Some of these reactions are an allergic response to the penicillin, and others are simply a side effect of the penicillin.

The first exposure to penicillin, referred to as the "sensitizing dose", sensitizes and prepares the body to respond to a second exposure or dose. The signs and symptoms of this allergic "sensitizing dose" response include a body wide rash and itching. When this is observed, the nurse must discontinue the medication, notify the physician and document this reaction thoroughly and completely in the medical record.

If a medication is administered after a "sensitizing dose", this second exposure or dose can lead to anaphylaxis, or anaphylactic shock which is a form of distributive shock. The signs and symptoms of anaphylaxis and anaphylactic shock are decreased cardiac output, a drastic and dramatic drop in the client's blood pressure, tachycardia with a bounding pulse, the massive collapse of venules and arterioles in the body's circulatory system, histamine release, the pooling of venous blood, laryngeal edema, respiratory distress, and death unless it is immediately treated.

All allergic responses, including those secondary to medications, must be immediately documented and reported to the doctor and other members of the healthcare team, as indicated and according to the facility's specific policies and procedures. Additionally, the client and family members must be advised of all allergic reactions and adverse reactions to medications so that this information can be passed on to other health care providers during the client's lifetime.

Assessing the Client for Actual or Potential Side Effects and Adverse Effects of Medications

Nurses collect, analyze and document objective and subjective data from clients in reference to any actual or potential side effects and adverse reactions, in addition to the allergies as discussed immediately above, relating to prescribed medications, over the counter preparations, and herbal supplements as part of the client's medical history.

There are times when a client may state that they are allergic to something, including foods and medications, when indeed, they may not be. For this reason, nurses will, therefore, record the client's subjective comments about this "allergy" and also how they know or believe that they are allergic to something or that they have had an adverse reaction to a medication, an herbal supplement. Whenever a questionable allergy is identified by the client, this "allergy" must be further explored before it is given.

Providing Information to the Client on Common Side Effects/Adverse Effects/Potential Interactions of Medications and Informing the Client When to Notify the Primary Health Care Provider

In addition to other patient and family education, clients and family members should be given complete information about all the drugs that they are or will be taking. The contents of this education should minimally include:

  • The name and purpose of the medication
  • The dosage of the medication
  • When and how often the medication should be given
  • The contraindications of the medication
  • The possible side effects of the medication and the signs and symptoms of these side effects
  • The possible adverse effects of the medication and the signs and symptoms of these side effects
  • How the medication can interact with other medications, including prescription and over the counter medications, foods, and supplements
  • Special instructions including things like taking the medication with a meal or taking the medication between meals
  • When to notify the primary health care provider including when a possible allergic response, an adverse action, or a side effect has occurred

Notifying the Primary Health Care Provider of Side Effects, Adverse Effects and Contraindications of Medications and Parenteral Therapy

Nurses who assess that the client has been affected with a side effect or adverse effect to mediations and parenteral therapy must report and record this data immediately and they should hold the medication until a response from the ordering physician gives the nurse further instructions. At times, the medication may be continued and, at other times, the medication may be discontinued and replaced with another medication.

Documenting the Side Effects and Adverse Effects of Medications and Parenteral Therapy

As stated immediately above, nurses who assess that the client has been affected with a side effect or adverse effect to mediations and parenteral therapy must report and record this data immediately.

Monitoring for Anticipated Interactions Among the Client's Prescribed Medications and Fluids

In addition to the nurse's awareness of and knowledge about the interactions that can occur among medications in all routes and forms, the nurse must also be knowledgeable the interactions of medications and fluids. Based on this knowledge, the nurse monitors and assesses clients for all anticipated interactions and intervenes accordingly.

Evaluating and Documenting the Client's Response to Actions Taken to Counteract the Side Effects and Adverse Effects of Medications and Parenteral Therapy

In addition to all the other roles and responsibilities of the nurse in reference to medication and fluid administration, the nurse must evaluate and document all client responses to interventions that were implemented to counteract any side effects and adverse reactions to medications and parenteral therapy. For example, a client who is given a new medication that leads to nausea and vomiting may get an antiemetic medication to counteract these side effects; and a client who has anaphylactic shock to a medication and is given epinephrine and a bronchodilator to preserve life during this life threatening emergency as they are closely reassessed and monitored for their responses to these emergency interventions.


SEE – Pharmacological & Parenteral Therapies Practice Test Questions

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