Expected Actions and Outcomes: NCLEX-RN
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of expected actions and outcomes in order to:
- Obtain information on a client's prescribed medications (e.g., review formulary, consult pharmacist)
- Use clinical decision making/critical thinking when addressing expected effects/outcomes of medications (e.g., oral, intradermal, subcutaneous, IM, topical)
- Evaluate the client's use of medications over time (e.g., prescription, over-the-counter, home remedies)
- Evaluate client response to medication (e.g., therapeutic effects, side effects, adverse reactions)
Some of the reliable resources that nurses can use to access and obtain information about a client's medications are the Physician's Desk Reference (PDR), a nurses' drug handbook published by a reputable publishing company, a nursing textbook, a formulary, a pharmacist and a reliable internet resource.
Using Clinical Decision Making and Critical Thinking When Addressing the Expected Effects and Outcomes of Medications
Critical thinking is an essential skill for registered nurses; nursing care and many other things are much more complex than they have been in the past. Nurses provide care in a time continuous change occurs. Things are not as simple and clear as they used to be. Patient care problems are highly complex and more ambiguous than ever before. For example, in years past the Physician Desk Reference which included all medications that are approved for use was only an inch or so in height; now it is over five inches thick. New medications, and new side effects and outcomes, are now too numerous to immediately recall, therefore, the nurse administering medications must know about their clients and their health care concerns and integrate this knowledge into the complexities of the medications that they are administering to the client by using problem solving, clinical decision making and critical thinking skills. The essential components of critical thinking entail deep thought and deep repeated questioning. When nurses ask themselves questions like "how", "what if", "why" and "what else", they are using critical thinking to explore things that are affecting or possibly affecting the client and they can also discover some innovative solutions and alternatives.
It is essential that all nurses are aware of the possible therapeutic effects, side effects and adverse reactions of medications. Any medication can result in an adverse effects, which can range from mild to severe, therefore observation and evaluation of the patient after administration of medication is vital.
Therapeutic effects are the expected results of medications. The nurse, therefore, must monitor the client to determine the effects of a medication on the client and their physical or psychological status.
Some clients take or are given medications for an acute illness and for a brief period of time; while other clients may take or are given medications for a chronic health disorder for an extended period of time. These medications can include prescription medications, over the counter medications, vitamins, supplements, and alternative medications and treatments like a home remedy, an herb or a naturopathic remedy.
Nurses caring for clients who are taking one or more medications for an extended period of time must:
- Monitor the client's adherence to and compliance with their medication regimen
- Assess and reassess the client in terms of the achievement of the expected outcomes of the medication(s) over time
- Monitor the client for any side effects, interactions and adverse effects
- Monitor and assess the client for any signs of toxicity
- Monitor and assess the client for the presence of any cumulative effects of their medication that has been taken over a period of time
Additionally, the nurse caring for the client over time will periodically perform the medication reconciliation process to insure that the nurse is aware of all medications that the client is taking, some of which may have been ordered by a physician other than the client's primary care doctor and some of which are over the counter or alternative therapies that the client has added. The complete and current list of medications is then reviewed by the nurse and possible interactions are identified and addressed with the client.
Nurses evaluate the client's responses to all of their medications. These responses can include the therapeutic effects, side effects, adverse reactions, and interactions.
Therapeutic effects of a medication include the expected and desired effect of a medication; the side effects of a medication include all the effects of the medication other than the expected and desired therapeutic effect of the medication, some of which can be serious and others of which can be not serious and just an annoyance to the client; an adverse effect to a medication is a serious side effect of the medication that can, at times, be life threatening, as is the case with an anaphylactic response to a medication; and drug interactions can increase or decrease the effects of one or more medication when they are taken together and/or with another substance such as an over the counter medication.
- Adverse Effects/Contraindications/Side Effects/Interactions
- Blood and Blood Products
- Central Venous Access Devices
- Dosage Calculations
- Expected Actions/Outcomes (Currently here)
- Medication Administration
- Parenteral/Intravenous Therapies
- Pharmacological Pain Management
- Total Parenteral Nutrition