CCN Medication Administration & Emergency Response 4 — Questions and Answers
Question 1: An inmate on warfarin therapy has an INR result of 4.9 and is not bleeding. What is the most appropriate nursing action?
- Administer a dose of vitamin K per standing protocol and notify the provider
- Withhold the next warfarin dose and notify the provider for further orders (Correct answer)
- Continue warfarin as scheduled and repeat INR in one week
- Administer fresh frozen plasma immediately
Correct answer: Withhold the next warfarin dose and notify the provider for further orders
A supratherapeutic INR without active bleeding typically requires holding the anticoagulant and provider notification to determine whether vitamin K or dose adjustment is needed.
Question 2: Which medication used in correctional settings requires a REMS (Risk Evaluation and Mitigation Strategy) program due to risk of agranulocytosis?
- Haloperidol
- Clozapine (Correct answer)
- Quetiapine
- Risperidone
Correct answer: Clozapine
Clozapine requires enrollment in the REMS program and regular ANC monitoring due to its risk of potentially fatal agranulocytosis.
Question 3: An inmate is found pulseless and not breathing. After activating the emergency response system, what is the correct next step per current BLS guidelines?
- Perform a head-tilt/chin-lift and give 2 rescue breaths first
- Begin high-quality chest compressions immediately (Correct answer)
- Apply the AED and analyze rhythm before compressions
- Check for a pulse for up to 30 seconds before starting CPR
Correct answer: Begin high-quality chest compressions immediately
Current AHA BLS guidelines emphasize immediate high-quality chest compressions (C-A-B sequence) upon confirming unresponsiveness and absent breathing/pulse.
Question 4: A nurse preparing medications notices that two inmates have similar names (John Smith and John Smyth). Which is the BEST practice to prevent a medication error?
- Verify identity using the inmate's date of birth and ID number in addition to name (Correct answer)
- Ask the inmate to verbally confirm their name only
- Administer to the first inmate who responds to the name
- Flag the records with a sticky note as a reminder
Correct answer: Verify identity using the inmate's date of birth and ID number in addition to name
Using at least two patient identifiers — such as name plus date of birth or ID number — is the standard to prevent wrong-patient medication errors.
Question 5: An inmate on buprenorphine/naloxone (Suboxone) for opioid use disorder is transferred to a new unit. What is the nurse's priority action regarding this medication?
- Discontinue the medication until a new provider evaluation is completed
- Verify the active prescription and ensure continuity of the medication without interruption (Correct answer)
- Switch the inmate to methadone for easier administration
- Hold the medication for 24 hours during the transition period
Correct answer: Verify the active prescription and ensure continuity of the medication without interruption
Continuity of MOUD (medications for opioid use disorder) is essential; interruption can precipitate withdrawal and increase risk of relapse or overdose.
Question 6: A correctional nurse responding to a suspected overdose finds an inmate with a GCS of 6 and a respiratory rate of 4. After administering naloxone, what is the expected response if opioids are the cause?
- Gradual improvement in consciousness over 30 minutes
- Rapid reversal of respiratory depression and increased level of consciousness within 2–5 minutes (Correct answer)
- No change because naloxone requires IV administration to be effective
- Immediate seizure activity due to acute withdrawal
Correct answer: Rapid reversal of respiratory depression and increased level of consciousness within 2–5 minutes
Naloxone rapidly reverses opioid-induced respiratory depression, typically producing clinical improvement within 2–5 minutes of intramuscular or intravenous administration.
Question 7: Which of the following is the correct technique for administering a tuberculin skin test (TST) in a correctional intake setting?
- Inject 0.1 mL of PPD subcutaneously into the upper arm
- Inject 0.1 mL of PPD intradermally into the volar forearm, producing a wheal (Correct answer)
- Inject 0.5 mL of PPD intramuscularly into the deltoid
- Apply a PPD patch to the volar forearm for 48 hours
Correct answer: Inject 0.1 mL of PPD intradermally into the volar forearm, producing a wheal
The TST requires intradermal injection of 0.1 mL PPD into the volar forearm, which should produce a 6–10 mm wheal confirming correct placement.
CCN Medication Administration & Emergency Response 4
An inmate on warfarin therapy has an INR result of 4.9 and is not bleeding.
What is the most appropriate nursing action?