NCNZ Medication Management (NZ Regulations) 2 β Questions and Answers
Question 1: A patient is prescribed warfarin. Which food-drug interaction is most clinically significant and must be discussed in patient education?
- Vitamin K-rich foods (e.g., green leafy vegetables) can reduce warfarin's anticoagulant effect (Correct answer)
- High-protein foods increase warfarin levels dangerously
- Grapefruit juice enhances warfarin absorption significantly
- Calcium-rich dairy products neutralise warfarin
Correct answer: Vitamin K-rich foods (e.g., green leafy vegetables) can reduce warfarin's anticoagulant effect
Vitamin K is the coagulation factor precursor that warfarin antagonises. Large or variable intake of vitamin K-rich foods (spinach, broccoli, kale) can reduce INR control. Patients should be advised to keep their vitamin K intake consistent rather than eliminate these foods.
Question 2: Under NZ guidelines, which route of insulin administration is used for rapid correction of hyperglycaemia in a hospitalised patient?
- IV (intravenous) short-acting insulin via syringe driver or bolus under medical supervision (Correct answer)
- Subcutaneous insulin is always sufficient for hospitalised patients
- Intramuscular insulin for fastest absorption
- Oral hypoglycaemic agents replace insulin in hospital
Correct answer: IV (intravenous) short-acting insulin via syringe driver or bolus under medical supervision
IV insulin (e.g., actrapid/soluble insulin) infusion or bolus is used in hospital for DKA management, perioperative glycaemic control, and critical illness. Subcutaneous insulin is standard for stable patients; IV allows rapid dose titration.
Question 3: A nurse notices that a patient has been prescribed both an SSRI and tramadol. What is the most important interaction to be aware of?
- Risk of serotonin syndrome β both agents increase serotonergic activity (Correct answer)
- Tramadol reduces SSRI efficacy
- The combination causes dangerous bradycardia
- Tramadol requires increased dosing when given with SSRIs
Correct answer: Risk of serotonin syndrome β both agents increase serotonergic activity
Both SSRIs and tramadol (which inhibits serotonin reuptake and has weak serotonergic activity) can cause serotonin syndrome when combined. Symptoms include agitation, tremor, hyperthermia, and autonomic instability. The combination should be used cautiously and monitored.
Question 4: Which of the following is the correct process for documenting medication administration in NZ hospital practice?
- Document immediately after administration, including time, dose, route, and signature β never pre-sign (Correct answer)
- Pre-sign the medication chart before administration to save time
- Document at the end of the shift for all medications given during the shift
- Document only if the dose differs from the prescribed dose
Correct answer: Document immediately after administration, including time, dose, route, and signature β never pre-sign
Documentation must occur immediately after administration to prevent double-dosing and ensure accurate records. Pre-signing (documenting before administering) is unsafe β it records an act that may not have occurred.
Question 5: A patient prescribed methotrexate weekly asks why they are not taking it daily like other tablets. What is the most important nursing consideration?
- Methotrexate for rheumatoid arthritis is prescribed ONCE WEEKLY β daily dosing causes fatal toxicity (Correct answer)
- Methotrexate is always given daily and the patient is confused
- Weekly dosing is for convenience only; daily would also be safe
- The patient should ask the pharmacist, not the nurse
Correct answer: Methotrexate for rheumatoid arthritis is prescribed ONCE WEEKLY β daily dosing causes fatal toxicity
Methotrexate for rheumatoid arthritis and other non-oncological indications is prescribed once weekly. Daily dosing is a well-documented and potentially fatal prescribing and administration error. Nurses must verify the dosing frequency and educate patients clearly.
Question 6: Which of the following NZ-specific resources provides nurses with authoritative prescribing and pharmacology information?
- New Zealand Formulary (NZF) β nzf.org.nz (Correct answer)
- MIMS Australia
- British National Formulary (BNF)
- UpToDate drug database
Correct answer: New Zealand Formulary (NZF) β nzf.org.nz
The New Zealand Formulary (NZF) is the primary, free, NZ-specific reference for prescribers and nurses, providing information on medicines available and funded in NZ, including doses, interactions, and contraindications relevant to NZ practice.
NCNZ Medication Management (NZ Regulations) 2
A patient is prescribed warfarin.
Which food-drug interaction is most clinically significant and must be discussed in patient education?