APC Clinical Procedures and Protocols 2 — Questions and Answers
Question 1: When performing a medication reconciliation at hospital admission, which source of information is considered the most reliable?
- The patient's own medication list
- The hospital discharge summary from the previous admission
- A structured interview with the patient combined with dispensing records (Correct answer)
- The prescriber's recall of previously prescribed medications
Correct answer: A structured interview with the patient combined with dispensing records
A structured patient interview combined with dispensing records provides the most complete and accurate medication history at admission.
Question 2: Under Australian guidelines, what is the recommended maximum duration for empiric antibiotic therapy before reviewing the clinical indication?
- 24 hours
- 48–72 hours (Correct answer)
- 5 days
- 7 days
Correct answer: 48–72 hours
Empiric antibiotic therapy should be reviewed at 48–72 hours to reassess the clinical indication and microbiological results.
Question 3: A pharmacist identifies a patient is receiving both warfarin and a new prescription for fluconazole. What is the most appropriate immediate action?
- Dispense both and advise the patient to monitor for unusual bleeding
- Contact the prescriber to discuss the interaction and recommend an INR check within 2–3 days (Correct answer)
- Refuse to dispense the fluconazole until the warfarin is ceased
- Reduce the warfarin dose by 50% before dispensing
Correct answer: Contact the prescriber to discuss the interaction and recommend an INR check within 2–3 days
Fluconazole significantly inhibits CYP2C9 and increases warfarin levels, so the prescriber must be informed and an early INR check arranged.
Question 4: Which aseptic technique principle is critical when preparing a cytotoxic product in a biological safety cabinet (BSC)?
- Working at the front edge of the cabinet to minimise turbulence
- Placing all materials at least 15 cm inside the BSC work zone (Correct answer)
- Keeping the BSC sash at maximum height for ventilation
- Turning off the BSC blower 5 minutes before commencing work
Correct answer: Placing all materials at least 15 cm inside the BSC work zone
Materials must be placed at least 15 cm inside the BSC to remain within the unidirectional airflow zone and prevent contamination.
Question 5: A patient on haemodialysis requires gentamicin dosing. Compared with a patient with normal renal function, what adjustment is generally indicated?
- Same dose, same frequency
- Higher dose, same frequency
- Same or slightly reduced dose, markedly extended dosing interval (Correct answer)
- Lower dose, more frequent administration
Correct answer: Same or slightly reduced dose, markedly extended dosing interval
Gentamicin is renally cleared, so haemodialysis patients typically receive a similar single dose but at an extended interval (often post-dialysis dosing).
Question 6: According to Australian Immunisation Handbook protocols, which interval is required between two doses of live attenuated vaccines given by different injections?
- No minimum interval required
- At least 2 weeks
- At least 4 weeks (28 days) (Correct answer)
- At least 3 months
Correct answer: At least 4 weeks (28 days)
Two different live attenuated injectable vaccines must be separated by at least 28 days to avoid immune interference.
Question 7: When counselling a patient on how to use a metered-dose inhaler (MDI) without a spacer, which step is most commonly performed incorrectly?
- Shaking the inhaler before use
- Breathing out fully before actuation
- Coordinating actuation with the start of a slow, deep inhalation (Correct answer)
- Holding the breath for 10 seconds after inhalation
Correct answer: Coordinating actuation with the start of a slow, deep inhalation
Poor coordination between pressing the canister and beginning inhalation is the most frequent MDI technique error, reducing lung deposition.
APC Clinical Procedures and Protocols 2
When performing a medication reconciliation at hospital admission, which source of information is considered the most reliable?