What is the first step a nurse should take when administering oral medication?

The first step a nurse should take when administering oral medication is to assess the patient's ability to swallow. This is crucial because ensuring that a patient can safely swallow medication helps prevent choking and aspiration, which can lead to serious complications such as aspiration pneumonia. Assessing the patient's swallowing capability also allows the nurse to identify any necessary modifications to the medication administration process, such as using liquid formulations instead of tablets or considering alternative routes if the patient has difficulty swallowing.

The other options present varying levels of considerations for medication administration, but they cannot be prioritized over the fundamental assessment of the patient's swallowing ability. For example, administering medication with grapefruit juice could potentially interfere with the metabolism of certain drugs and isn't a universal practice. Similarly, not giving oral medication to someone with a nasogastric tube in place may not always be necessary depending on the circumstances. Lastly, crushing enteric-coated tablets is generally inappropriate, as it can alter the delayed-release mechanism of the medication. Therefore, the initial assessment of swallowing is the essential first step in ensuring safe and effective medication administration.