CNO - College of Nurses of Ontario Safe Medication Administration Questions and Answers — Questions and Answers
Question 1: A nurse is preparing to administer a high-alert medication that requires an independent double check. Which of the following actions best represents a true independent double check according to the Institute for Safe Medication Practices (ISMP) and CNO's principle of safety?
- The first nurse states the dose they calculated out loud, and the second nurse confirms it is correct.
- Both nurses look at the medication vial and the physician's order together at the same time.
- The first nurse prepares the medication, and the second nurse performs their own separate check of the order, calculation, and preparation before comparing results. (Correct answer)
- The second nurse watches the first nurse draw up the medication and then signs the medication administration record (MAR).
Correct answer: The first nurse prepares the medication, and the second nurse performs their own separate check of the order, calculation, and preparation before comparing results.
A true independent double check requires two clinicians to separately and individually check all components of the medication use process (e.g., order, dose calculation, pump settings). This prevents one nurse's potential error from influencing the other's assessment. The other options describe forms of checking that are not independent and can lead to confirmation bias.
Question 2: A physician gives a nurse a telephone order for a new medication. To comply with the CNO's Medication practice standard, what is the most critical action the nurse must take after transcribing the order?
- Ask a colleague to review the transcribed order.
- Administer the medication immediately to ensure timely care.
- Read the order back to the prescriber for verification. (Correct answer)
- Wait for the prescriber to sign the order before administering the medication.
Correct answer: Read the order back to the prescriber for verification.
The CNO's standards emphasize clear communication to ensure safety. When taking verbal or telephone orders, the nurse is accountable for accurately recording the information and must read it back to the prescriber to verify its correctness and prevent errors. While having a colleague review it is good practice, the direct confirmation with the prescriber is the most critical step.
Question 3: A nurse discovers they administered a medication to the wrong client. After assessing the client and ensuring their immediate safety, what is the nurse's next accountability according to the CNO's standards?
- Complete the incident report to fulfill organizational requirements.
- Notify the prescriber and the nursing manager of the error. (Correct answer)
- Document the error only in the client's chart.
- Ask the client not to mention the mistake to anyone.
Correct answer: Notify the prescriber and the nursing manager of the error.
After ensuring client safety, the nurse's accountability is to report the medication error to the appropriate individuals, which includes the prescriber and the nurse's manager. This facilitates timely intervention and management of the client's health and initiates the necessary follow-up and quality improvement processes. Documentation and incident reports are also required but follow notification.
Question 4: A competent client with a history of hypertension refuses their scheduled dose of metoprolol, stating, "I feel fine today and I don't want to take it." Which action by the nurse demonstrates accountability and respect for the client's right to refuse?
- Insisting the client take the medication by explaining the risks of a hypertensive crisis.
- Hiding the medication in the client's food to ensure they receive the dose.
- Documenting the refusal on the MAR and notifying the prescriber of the missed dose. (Correct answer)
- Telling the client they cannot be responsible for what happens if they don't take the medication.
Correct answer: Documenting the refusal on the MAR and notifying the prescriber of the missed dose.
According to the CNO standards and the 10 Rights of Medication Administration, clients have the right to refuse medication. The nurse's professional accountability is to respect the competent client's decision, withhold the medication, document the refusal accurately, and inform the prescriber. This ensures the care team is aware of the situation and can make any necessary adjustments to the plan of care.
Question 5: When performing the three checks of medication administration, the nurse reads the medication administration record (MAR), retrieves the medication, and compares it to the MAR. What is the essential third check the nurse must perform?
- Comparing the medication label to the MAR one last time at the client's bedside. (Correct answer)
- Asking the client if the medication looks familiar to them.
- Checking the expiry date of the medication just before leaving the medication room.
- Scanning the medication barcode after administering it to the client.
Correct answer: Comparing the medication label to the MAR one last time at the client's bedside.
The three checks are a fundamental safety process. The first check is when retrieving the medication, the second is when preparing it, and the crucial third check occurs at the client's bedside, comparing the medication label against the MAR just before administration. This final check confirms the 'five rights' at the point of care, minimizing the risk of error.
Question 6: A nurse is documenting the administration of a PRN (as needed) dose of morphine for a client's post-operative pain. In addition to the date, time, drug, dose, and route, what other information is essential to include in the client's record to meet CNO documentation standards?
- The name of the pharmacist who dispensed the medication.
- The client's expected discharge date.
- The time the client's family was notified.
- The pre-administration pain assessment and the post-administration evaluation of the medication's effectiveness. (Correct answer)
Correct answer: The pre-administration pain assessment and the post-administration evaluation of the medication's effectiveness.
CNO's Documentation standard requires a clear, complete, and accurate record of the care provided. For PRN medications, this includes not only the details of administration but also the nursing assessment that justified giving the dose (the 'right reason') and the evaluation of its outcome (the 'right evaluation'), which demonstrates the nurse's application of the nursing process.
CNO - College of Nurses of Ontario Safe Medication Administration Questions and Answers
A nurse is preparing to administer a high-alert medication that requires an independent double check.
Which of the following actions best represents a true independent double check according to the Institute for Safe Medication Practices (ISMP) and CNO's principle of safety?