DOH Nursing Medication Management 4 — Questions and Answers
Question 1: A nurse is preparing to administer a high-alert medication (concentrated potassium chloride). What additional safety step is required?
- Independent double-check by a second nurse before administration (Correct answer)
- Simply verify the order and proceed
- Administer via rapid IV push to complete quickly
- Document only after administration is complete
Correct answer: Independent double-check by a second nurse before administration
High-alert medications (concentrated electrolytes, insulin, anticoagulants, opioids, chemotherapy) require an independent double-check by a second nurse who independently verifies the drug, dose, concentration, route, rate, and patient identity before administration.
Question 2: A patient is prescribed digoxin 0.125 mg daily. Which assessment finding warrants withholding the dose?
- Apical pulse of 52 bpm and patient reports nausea and visual disturbances (yellow halos) (Correct answer)
- Apical pulse of 68 bpm with no symptoms
- Blood pressure of 125/80 mmHg
- Respiratory rate of 16 breaths per minute
Correct answer: Apical pulse of 52 bpm and patient reports nausea and visual disturbances (yellow halos)
Bradycardia (<60 bpm), nausea, and visual disturbances (xanthopsia — seeing yellow-green halos) are classic signs of digoxin toxicity. The drug must be withheld, the physician notified, and a digoxin level drawn. Hyperkalemia and hypomagnesemia potentiate toxicity.
Question 3: A patient with a sulfa allergy is prescribed trimethoprim-sulfamethoxazole (TMP-SMX). What should the nurse do?
- Do not administer; notify the physician immediately, as TMP-SMX contains a sulfonamide (Correct answer)
- Administer and monitor for mild rash only
- Administer with diphenhydramine premedication
- Give the first dose and observe in clinic for 30 minutes
Correct answer: Do not administer; notify the physician immediately, as TMP-SMX contains a sulfonamide
TMP-SMX contains sulfamethoxazole, a sulfonamide antibiotic. A documented sulfa allergy is a contraindication. The prescriber must be notified before administration. Reactions can range from rash and Stevens-Johnson syndrome to anaphylaxis.
Question 4: A patient on opioid analgesia has a respiratory rate of 8 breaths/min and is difficult to arouse. What is the priority intervention?
- Administer naloxone (Narcan) IV/IM/IN, stimulate the patient, apply oxygen, and call for help (Correct answer)
- Document the findings and reassess in 30 minutes
- Decrease the opioid dose for next scheduled administration
- Apply non-rebreather mask and wait for physician orders
Correct answer: Administer naloxone (Narcan) IV/IM/IN, stimulate the patient, apply oxygen, and call for help
Respiratory rate <12/min with decreased level of consciousness indicates opioid-induced respiratory depression, a life-threatening emergency. Naloxone (opioid antagonist) must be given immediately. Oxygen supports ventilation while naloxone takes effect (1–2 minutes IV). Respiratory support may be needed.
Question 5: A patient is prescribed levothyroxine (thyroxine). When is the correct time to administer this medication?
- 30–60 minutes before breakfast on an empty stomach (Correct answer)
- With the largest meal of the day to improve absorption
- At bedtime only with a glass of milk
- Anytime during the day; timing is irrelevant
Correct answer: 30–60 minutes before breakfast on an empty stomach
Levothyroxine absorption is significantly reduced by food, calcium, iron, and antacids. It must be taken on an empty stomach, 30–60 minutes before the first meal of the day. Alternatively, some guidelines support taking it at bedtime, 3–4 hours after the last meal.
Question 6: A nurse is preparing to administer a blood transfusion. Which IV solution must be used to prime the tubing?
- Normal saline (0.9% NaCl) only (Correct answer)
- 5% dextrose in water (D5W)
- Lactated Ringer's solution
- Any available IV crystalloid solution
Correct answer: Normal saline (0.9% NaCl) only
Only normal saline (0.9% NaCl) is compatible with blood products. Dextrose solutions cause red blood cell clumping (rouleaux formation). Lactated Ringer's contains calcium, which can cause clot formation in the blood tubing. Use of incompatible solutions can cause hemolysis.
DOH Nursing Medication Management 4
A nurse is preparing to administer a high-alert medication (concentrated potassium chloride).
What additional safety step is required?