CPNRE Safe Medication Administration 5 — Questions and Answers
Question 1: A practical nurse is preparing to administer two IV medications that are known to be incompatible. What is the safest approach?
- Mix both medications in the same syringe and administer quickly
- Flush the IV line with normal saline between each medication (Correct answer)
- Administer both medications simultaneously through a Y-site
- Increase the infusion rate so the medications do not mix
Correct answer: Flush the IV line with normal saline between each medication
Flushing with compatible solution (e.g., normal saline) between incompatible IV medications prevents precipitation and adverse chemical reactions.
Question 2: A client has a prescription for morphine 4–8 mg IV PRN for pain. The client rates pain as 7/10. What dose should the practical nurse consider administering first?
- 8 mg, the maximum dose, to achieve faster relief
- 4 mg, the minimum dose, and reassess response (Correct answer)
- 6 mg, the midpoint dose, as a compromise
- No dose until the physician specifies an exact amount
Correct answer: 4 mg, the minimum dose, and reassess response
Starting with the lowest effective dose and reassessing follows safe opioid prescribing principles and reduces the risk of adverse effects.
Question 3: After administering a transdermal nitroglycerin patch, the practical nurse discovers a previous patch still in place on the client's back. What action should be taken first?
- Leave both patches on and document the finding
- Remove the old patch, document the error, and notify the supervising nurse or physician (Correct answer)
- Remove the newly applied patch and leave the old one in place
- Apply a third patch to a new site to compensate for any missed absorption
Correct answer: Remove the old patch, document the error, and notify the supervising nurse or physician
The old patch must be removed immediately to prevent nitroglycerin toxicity, and the error must be documented and reported according to facility policy.
Question 4: The practical nurse is administering an oral liquid medication to a client with dysphagia. Which action best promotes safe administration?
- Mix the medication in a large glass of water to thin it further
- Position the client upright or at a 45-degree angle before administration (Correct answer)
- Administer the medication rapidly to minimize aspiration time
- Instruct the client to tilt their head back while swallowing
Correct answer: Position the client upright or at a 45-degree angle before administration
Upright or semi-upright positioning uses gravity to facilitate swallowing and significantly reduces the risk of aspiration.
Question 5: A practical nurse draws up insulin glargine and discovers the solution appears cloudy with visible particles. What should the nurse do?
- Roll the vial between the palms to resuspend the particles and administer
- Administer the dose since insulin glargine commonly appears cloudy
- Discard the vial and obtain a new one before administering (Correct answer)
- Filter the insulin through a needle filter before drawing up again
Correct answer: Discard the vial and obtain a new one before administering
Insulin glargine is normally clear; cloudiness or particulate matter indicates contamination or degradation, and the vial must be discarded.
Question 6: A practical nurse is preparing to give a client their scheduled dose of metoprolol 50 mg orally. The client's blood pressure is 88/54 mmHg and heart rate is 52 bpm. What is the priority action?
- Administer the medication and recheck vital signs in 30 minutes
- Administer a reduced dose of 25 mg to minimize the hypotensive effect
- Withhold the medication and notify the prescriber immediately (Correct answer)
- Encourage the client to drink fluids before administering the medication
Correct answer: Withhold the medication and notify the prescriber immediately
Metoprolol is a beta-blocker that lowers blood pressure and heart rate; administering it with already low BP and bradycardia risks serious hemodynamic compromise.
Question 7: During a medication reconciliation on admission, a client reports taking several herbal supplements. Why is this information clinically significant?
- Herbal supplements are natural and therefore safe to take with all prescribed medications
- Many herbal supplements interact with prescribed medications and can alter drug efficacy or cause adverse effects (Correct answer)
- Herbal supplements are only relevant if the client takes more than five prescription medications
- This information is only needed if the client is scheduled for surgery
Correct answer: Many herbal supplements interact with prescribed medications and can alter drug efficacy or cause adverse effects
Herbal products can have pharmacokinetic interactions with prescribed drugs (e.g., St. John's Wort reducing antiretroviral levels), making their documentation essential for safe medication management.
CPNRE Safe Medication Administration 5
A practical nurse is preparing to administer two IV medications that are known to be incompatible.
What is the safest approach?