DOH Nursing Medication Management 1 — Questions and Answers
Question 1: What are the 'Five Rights' of medication administration?
- Right patient, right drug, right dose, right route, right time (Correct answer)
- Right nurse, right drug, right dose, right chart, right time
- Right patient, right drug, right dose, right chart, right nurse
- Right patient, right dose, right doctor, right route, right record
Correct answer: Right patient, right drug, right dose, right route, right time
The Five Rights are the foundation of safe medication administration: Right Patient (two identifiers), Right Drug (verify against order), Right Dose (calculate and verify), Right Route (check order and appropriateness), Right Time (within acceptable window). Modern practice adds Right Documentation as a sixth right.
Question 2: A patient is prescribed gentamicin 5 mg/kg IV once daily. The patient weighs 70 kg. What is the correct dose?
- 350 mg (Correct answer)
- 500 mg
- 150 mg
- 175 mg
Correct answer: 350 mg
5 mg/kg × 70 kg = 350 mg. Once-daily dosing of aminoglycosides achieves a higher peak concentration (concentration-dependent killing) while allowing the trough to fall low enough to reduce nephrotoxicity and ototoxicity. Trough levels should be monitored.
Question 3: Which medication interaction should the nurse be most concerned about when a patient on warfarin is prescribed aspirin?
- Synergistic anticoagulation/antiplatelet effect dramatically increasing bleeding risk (Correct answer)
- Warfarin metabolism is accelerated, reducing its effectiveness
- No interaction exists between warfarin and aspirin
- Aspirin reverses warfarin's anticoagulant effect
Correct answer: Synergistic anticoagulation/antiplatelet effect dramatically increasing bleeding risk
Warfarin and aspirin used together significantly increase bleeding risk through two different mechanisms: warfarin inhibits clotting factor synthesis while aspirin irreversibly inhibits platelet aggregation. This combination requires careful risk-benefit assessment and close monitoring.
Question 4: A patient is prescribed IV vancomycin. Which monitoring parameter is most important?
- Renal function (serum creatinine, BUN) and vancomycin trough levels (Correct answer)
- Liver function tests
- Cardiac monitoring only
- Blood glucose every 6 hours
Correct answer: Renal function (serum creatinine, BUN) and vancomycin trough levels
Vancomycin is nephrotoxic and ototoxic. Renal function is monitored because the drug is renally cleared and accumulates with renal impairment. AUC-guided monitoring (area under the curve) is preferred over trough-only monitoring per current guidelines to optimize efficacy and minimize toxicity.
Question 5: A patient is prescribed metformin. What is the most important contraindication to assess before administration?
- Renal impairment (eGFR <30 mL/min/1.73m²) due to lactic acidosis risk (Correct answer)
- History of type 1 diabetes
- Allergy to sulfonamides
- Age over 70 years without eGFR assessment
Correct answer: Renal impairment (eGFR <30 mL/min/1.73m²) due to lactic acidosis risk
Metformin is contraindicated in significant renal impairment (eGFR <30) because decreased renal clearance leads to drug accumulation and potentially fatal lactic acidosis. Hold metformin before contrast dye procedures and reassess when renal function stabilizes.
Question 6: Which over-the-counter medication is most dangerous for patients with liver failure?
- Paracetamol (acetaminophen) (Correct answer)
- Ibuprofen
- Aspirin
- Loratadine
Correct answer: Paracetamol (acetaminophen)
Paracetamol is metabolized in the liver and its toxic metabolite (NAPQI) is normally conjugated by glutathione. In liver failure, glutathione is depleted and normal doses can cause hepatotoxicity. Maximum dose in liver disease is significantly reduced. Even therapeutic doses can cause harm.
DOH Nursing Medication Management 1
What are the 'Five Rights' of medication administration?