Page 1 - Pharmacological Therapies Study Guide for the NCLEX-PN Exam
As an LPN, you will be giving medication and monitoring parenteral therapies, so you’ll need to know quite a bit about things like spotting side effects and calculating dosages. You can provide a great deal of important information to your superiors that will help them make informed medication decisions, but you need to know what and how to observe. Approximately 10% to 16% of the questions on the NCLEX-PN® test relate to this area of nursing, so be sure to find additional information if anything here still puzzles you.
Desired Effects of Medication
When giving medications and monitoring clients after they have received medications, it is extremely important to know the expected outcomes so that you can use them as the barometer during the client assessment.
Prior to administering medications, it is important to determine the client’s expectations of the medication treatment. If the client has unreasonable expectations about a medication’s efficacy, this may be an opportunity to reinforce teaching. For example, while a pain medication may help lessen pain, the client should not expect it to remove the pain completely.
Multiple resources can be used to assist in determining the expected outcomes and adverse reactions to medication. This includes, but is not limited to, knowledge of pharmacology and knowledge of pathophysiology.
Working with Clients
When working with clients, the LPN role and responsibility will include observation before, during, and after medication administration along with identifying opportunities to reinforce teaching.
When observing clients, it is important to remember that clients may be taking multiple medications over long periods of time that they may fail to initially report, such as over-the-counter medications and home remedies in addition to prescription medications. And when a medication is given, the LPN should evaluate the client’s response to the medication to ensure that it has its therapeutic effect without adverse reactions or interactions.
The LPN will have the opportunity to reinforce education to their clients regarding medications. This may include reinforcing teaching on the action of medication and the anticipated therapeutic effects of the medication. In addition, the LPN should ensure the client is aware of potential pharmacological interactions when taking the medication.
Other Effects of Medication
Types of Effects
In addition to the intended effects or therapeutic effects of medications, the LPN should also be on alert for other effects of medications, such as adverse effects or side effects.
One type of effect that the LPN should constantly be monitoring for after administering a medication is an adverse effect to a drug. An adverse effect is an unintended pharmacologic effect of a drug that may or may not be predictable. One example of an adverse effect to a drug is an allergic reaction. Adverse effects almost always require an intervention.
As opposed to an adverse effect, a side effect tends to be more predictable. While still undesired, clients and providers are usually aware of potential side effects to a drug so that they can be alert for them. Side effects usually resolve on their own, but if the side effects are intolerable, the provider may consider changing medications.
A contraindication to a medication is a reason to avoid prescribing a certain drug in a situation or based on a client’s history. This could be a contraindication due to a known allergy or due to a disease process. If a prescribed medication seems to be contraindicated, the LPN should ask to clarify the order prior to administering the medication.
In addition to contraindications, some drugs may have known interactions or incompatibilities with each other. This tends to be caused by related or competing mechanisms of action. Even if there are potential interactions, a provider may still prescribe a medication if the benefit outweighs the risk or negative impact.
While an LPN may not be prescribing medications, it is important that the LPN have a certain amount of medication knowledge so that they can monitor and care for clients accordingly.
In your role as an LPN, medication knowledge is important so that you can identify potential interactions and actual incompatibilities of medications that are ordered or prescribed to a client. Further, this knowledge will help identify a potential contraindication to the administration of a prescribed or over-the-counter medication.
When reviewing a client’s medication list or receiving a new medication order or prescription for a client, if the LPN is concerned about a contraindication or potential interaction, the LPN should notify the primary healthcare provider of potential adverse effects to the client. Prevention of an adverse event is more important than timely administration in most cases.
Working with Clients
When the LPN is working with clients and administering or observing medication administration, there are a number of crucial tasks in the scope of responsibility.
Monitor and Document
Client monitoring and documentation are required. The LPN should document when a medication has been administered, monitor the client for adverse effects or side effects, and notify the healthcare provider of any adverse effects.
Interactions with medications and fluids— Medications can be administered in a variety of delivery methods (oral, IV, subcutaneous, IM, topical), which may impact the potential for interactions. The client should be monitored for interactions.
Adverse effects— The LPN should monitor the client for any potential adverse effects of medications (including prescribed, over-the-counter, and herbal supplements). If any actual adverse effects are noticed, they should be thoroughly documented.
Side effects— The LPN should monitor the client for any side effects to administered medications and the client’s ability to tolerate the severity of these side effects.
Client response to management of effects— The LPN should monitor the client’s ability to manage side effects and/or adverse effects to determine if intervention may be needed.
Allergic reactions— In the event of an allergic reaction, the LPN should note the symptoms of the allergic reaction and ensure that the reaction is documented.
In addition to monitoring the client and documenting, the LPN will be responsible for reinforcing client teaching on possible effects of medications, implementing procedures to counteract adverse effects of medications, and suggest withholding a medication dose if the client experiences an adverse effect.