CPNRE - Canadian Practical Nurse Registration Examination Safe Medication Administration Questions and Answers 1 — Questions and Answers
Question 1: A practical nurse is preparing to administer a high-alert medication, such as insulin. According to the Institute for Safe Medication Practices (ISMP) Canada, which of the following actions is a critical safety step?
- Administering the medication within a 60-minute window of the scheduled time.
- Asking the client to state their full name and date of birth.
- Performing an independent double-check with another regulated healthcare professional. (Correct answer)
- Documenting the administration immediately after preparing the medication.
Correct answer: Performing an independent double-check with another regulated healthcare professional.
ISMP Canada identifies high-alert medications as those that bear a heightened risk of causing significant patient harm when used in error. A key recommended safeguard is the use of independent double-checks for these medications to reduce the likelihood of errors reaching the patient.
Question 2: A client is prescribed a new antihypertensive medication. After administering the first dose, the practical nurse should prioritize monitoring for which of the following?
- Therapeutic effect
- Adverse effects (Correct answer)
- Drug-food interactions
- The client's understanding of the medication schedule
Correct answer: Adverse effects
While all options are important aspects of medication management, the immediate priority after administering the first dose of a new medication is to monitor for any adverse effects, such as orthostatic hypotension with an antihypertensive, which could pose an immediate safety risk to the client. The LPN must have the knowledge to manage adverse reactions.
Question 3: A practical nurse receives a telephone order from a physician for a client. Which of the following actions by the nurse best ensures accuracy and client safety?
- Writing the order down and administering it immediately to ensure timely care.
- Repeating the order back to the physician for verification before ending the call. (Correct answer)
- Asking a colleague to listen to the voicemail to confirm the order.
- Waiting for the physician to enter the order into the electronic system later.
Correct answer: Repeating the order back to the physician for verification before ending the call.
To prevent errors with verbal or telephone orders, the best practice is to write the order down verbatim and then read it back to the prescriber for confirmation. This "read-back" process is a crucial safety check to ensure the nurse heard and transcribed the order correctly before administration. If an order is unclear or incomplete, the LPN must contact the authorized prescriber for clarification.
Question 4: When a practical nurse is performing the three checks of medication administration, which of the following is the correct procedure?
- Check the medication label against the MAR when selecting it, before pouring it, and after administering it.
- Check the medication label against the MAR when selecting it, at the bedside before opening, and when documenting.
- Check the medication label against the MAR when removing it from the dispenser, when preparing it, and at the bedside before administering it. (Correct answer)
- Check the medication label against the MAR in the medication room, once in the hallway, and again at the bedside.
Correct answer: Check the medication label against the MAR when removing it from the dispenser, when preparing it, and at the bedside before administering it.
The three checks of medication administration are a fundamental safety protocol. The nurse must check the medication against the Medication Administration Record (MAR) three times: 1) when taking the medication from its storage location, 2) when preparing or pouring the medication, and 3) at the client's bedside just before administering it.
Question 5: A client refuses to take their prescribed morning dose of an oral medication, stating, "I don't want to take that pill today." What is the practical nurse's most appropriate initial action?
- Documenting the refusal and discarding the medication.
- Informing the client that the medication is essential for their health.
- Exploring the client's reason for the refusal. (Correct answer)
- Notifying the charge nurse and the prescriber immediately.
Correct answer: Exploring the client's reason for the refusal.
Clients have the right to refuse medication. The nurse's first responsibility is to assess the situation by exploring the client's reasons for refusal. This demonstrates respect for client autonomy and allows the nurse to identify and address any misunderstandings, concerns, or adverse effects the client may be experiencing before taking further action.
Question 6: A practical nurse notes that a physician's handwritten order in a client's chart is illegible. What is the most appropriate action for the nurse to take?
- Ask another experienced nurse on the unit to interpret the order.
- Contact the pharmacy to see how they have interpreted similar orders.
- Administer the medication based on the nurse's best judgment of the order.
- Contact the prescribing physician directly to clarify the order. (Correct answer)
Correct answer: Contact the prescribing physician directly to clarify the order.
To ensure client safety and prevent medication errors, the practical nurse must never guess or assume what an illegible order says. The only safe and acceptable action is to contact the original prescriber for clarification before preparing or administering the medication.
CPNRE - Canadian Practical Nurse Registration Examination Safe Medication Administration Questions and Answers 1
A practical nurse is preparing to administer a high-alert medication, such as insulin.
According to the Institute for Safe Medication Practices (ISMP) Canada, which of the following actions is a critical safety step?