The route of administration directly affects how quickly a medication works, how long it lasts, and the likelihood of side effects. Therefore, nurses must actively evaluate the patient’s condition, medication properties, and safety risks before giving any drug.
On the NCLEX, questions frequently assess how well a nurse chooses the safest and most effective medication route for a specific clinical situation.
Oral (PO) Route
Description
Patients swallow oral medications, which then absorb through the gastrointestinal tract.
Advantages
- Nurses use this route easily and non-invasively
- Patients often prefer it for long-term therapy
- Providers commonly prescribe it in outpatient care
Nursing Considerations
- Assess the patient’s ability to swallow
- Confirm that the patient remains alert
- Never crush enteric-coated or extended-release tablets
NCLEX Tip
Avoid oral medications in patients who vomit or have a decreased level of consciousness.
Sublingual and Buccal Routes
Description
Patients place medications under the tongue (sublingual) or between the cheek and gum (buccal), where the medication dissolves.
Advantages
- These routes provide rapid absorption
- They bypass the liver’s first-pass metabolism
Nursing Considerations
- Instruct the patient not to swallow the medication
- Ask the patient to avoid food or drink until dissolution
NCLEX Focus
Nurses commonly administer nitroglycerin via the sublingual route.
Topical Route
Description
Nurses apply medications directly to the skin or mucous membranes.
Advantages
- This route provides localized effects
- It limits systemic absorption
Nursing Considerations
- Always wear gloves
- Apply medication to clean, dry skin
- Rotate application sites regularly
NCLEX Safety Point
Always remove old transdermal patches before applying a new one.
Transdermal Route
Description
Medications slowly pass through the skin into systemic circulation.
Advantages
- This route maintains steady medication levels
- It delivers long-lasting effects
Nursing Considerations
- Keep heat sources away from patches
- Date, time, and initial each patch
- Inspect the skin for irritation
NCLEX Reminder
Heat increases medication absorption and can lead to toxicity.
Intradermal (ID) Route
Description
Nurses inject medication into the dermis.
Common Uses
- Allergy testing
- Tuberculin skin testing
Nursing Considerations
- Select a small-gauge needle
- Inject at a shallow angle
NCLEX Tip
Proper technique produces a visible wheal at the injection site.
Subcutaneous (SubQ) Route
Description
Nurses inject medication into fatty tissue beneath the skin.
Common Medications
- Insulin
- Heparin
Nursing Considerations
- Rotate injection sites consistently
- Do not aspirate when administering insulin or heparin
NCLEX Alert
Pinch the skin to prevent accidental intramuscular injection.
Intramuscular (IM) Route
Description
Nurses inject medication deep into muscle tissue.
Advantages
- This route absorbs medication faster than SubQ
- Nurses can administer larger volumes
Nursing Considerations
- Identify anatomical landmarks carefully
- Monitor the site for bleeding
- Select the correct needle size
NCLEX Focus
Nurses prefer the ventrogluteal site for IM injections.
Intravenous (IV) Route
Description
Nurses deliver medication directly into the bloodstream.
Advantages
- This route provides immediate effects
- Nurses maintain precise control over dosage
Nursing Considerations
- Monitor the IV site continuously
- Verify medication compatibility
- Watch closely for adverse reactions
NCLEX Priority
Because IV medications act rapidly, nurses must monitor patients closely.
Inhalation Route
Description
Patients inhale medications directly into the lungs.
Common Uses
- Bronchodilators
- Corticosteroids
Nursing Considerations
- Teach correct inhaler technique
- Instruct patients to rinse their mouth after steroid use
NCLEX Tip
Administer bronchodilators before inhaled corticosteroids.
Rectal and Vaginal Routes
Description
Nurses administer medications into body cavities.
Nursing Considerations
- Maintain patient privacy
- Use appropriate lubrication
- Position the patient correctly
NCLEX Note
Avoid rectal medications in patients with neutropenia or rectal bleeding.
Comparing Routes: Key Nursing Priorities
When comparing medication routes, nurses actively evaluate:
- Speed of onset
- Patient condition
- Safety risks
- Patient preference
Clinical judgment guides safe and effective route selection.
NCLEX Strategy for Medication Routes
On the NCLEX, successful nurses:
- Prioritize patient safety
- Assess level of consciousness
- Identify contraindications
- Select the least invasive effective route
A well-organized nursing bundle helps nursing students apply this information quickly and confidently.
Final Thoughts for Nurses and Nursing Students
Understanding medication routes strengthens safety and confidence in nursing practice. Whether preparing for the NCLEX or working as a registered nurse, nurses must know when and how to use each route appropriately.