CPNRE Safe Medication Administration 4 — Questions and Answers
Question 1: A client is prescribed warfarin 5 mg orally daily. Before administering the dose, the practical nurse notes the client's INR is 4.2. What is the most appropriate action?
- Administer the dose as prescribed
- Hold the dose and notify the physician/NP (Correct answer)
- Administer half the prescribed dose
- Administer the dose and recheck INR in 2 hours
Correct answer: Hold the dose and notify the physician/NP
An INR of 4.2 is above the therapeutic range (typically 2.0–3.0 for most indications), indicating an increased bleeding risk, so the dose should be withheld and the prescriber notified.
Question 2: When preparing an intramuscular injection, the practical nurse accidentally contaminates the needle by touching the syringe barrel. What should the nurse do?
- Wipe the needle with an alcohol swab and proceed
- Replace only the needle before administration
- Discard the entire syringe and prepare a new one (Correct answer)
- Administer the medication and document the contamination
Correct answer: Discard the entire syringe and prepare a new one
Once sterility is compromised, the entire syringe and needle must be discarded and a new preparation made to prevent infection.
Question 3: A practical nurse is administering medications to four clients. Which medication requires the nurse to perform an additional safety check by verifying apical pulse before administration?
- Metformin 500 mg orally
- Digoxin 0.125 mg orally (Correct answer)
- Amoxicillin 500 mg orally
- Pantoprazole 40 mg orally
Correct answer: Digoxin 0.125 mg orally
Digoxin is a cardiac glycoside; apical pulse must be counted for one full minute before administration and withheld if the rate is below 60 bpm in adults.
Question 4: A client who requires a subcutaneous injection of heparin 5,000 units reports bruising at all previous injection sites on the abdomen. What is the best nursing action?
- Administer the injection into one of the existing bruised areas to minimize new bruising
- Rotate to the outer aspect of the upper arm for this injection (Correct answer)
- Delay the injection until all bruising resolves
- Administer the injection 2 cm from a bruised area on the abdomen
Correct answer: Rotate to the outer aspect of the upper arm for this injection
Rotating to an alternate approved site such as the upper arm avoids further trauma and impaired absorption at bruised abdominal sites.
Question 5: The practical nurse is administering oral medications and finds that a tablet prescribed for a client is not available on the unit. What is the correct first action?
- Substitute a similar medication from another client's supply
- Contact the pharmacy to obtain the correct medication (Correct answer)
- Crush a different strength tablet to approximate the dose
- Document the omission and administer the next scheduled dose instead
Correct answer: Contact the pharmacy to obtain the correct medication
The pharmacy must be contacted to supply the correct, prescribed medication; substituting from another client's supply is unsafe and unprofessional.
Question 6: A practical nurse administers a medication and the client immediately develops urticaria, dyspnea, and hypotension. After calling for emergency assistance, what is the priority nursing action?
- Administer an antihistamine as prescribed
- Establish IV access and prepare to administer epinephrine (Correct answer)
- Document the reaction and monitor vital signs
- Obtain an order for a corticosteroid
Correct answer: Establish IV access and prepare to administer epinephrine
Anaphylaxis requires immediate epinephrine administration, so IV access must be established while emergency assistance responds.
Question 7: When reviewing a medication administration record (MAR), the practical nurse notes a medication order that is unclear due to illegible handwriting. What is the most appropriate action?
- Interpret the order based on the client's diagnosis and administer the most likely medication
- Contact the prescriber for clarification before administering the medication (Correct answer)
- Ask a colleague to interpret the handwriting and proceed
- Hold all medications until the physician makes rounds
Correct answer: Contact the prescriber for clarification before administering the medication
Only the prescriber can clarify their own order; administering a guessed interpretation risks a medication error.
CPNRE Safe Medication Administration 4
A client is prescribed warfarin 5 mg orally daily.
Before administering the dose, the practical nurse notes the client's INR is 4.2.
What is the most appropriate action?