NCNZ Medication Management (NZ Regulations) 2

Question 1

A patient is prescribed warfarin. Which food-drug interaction is most clinically significant and must be discussed in patient education?

Accepted Answer

Vitamin K-rich foods (e.g., green leafy vegetables) can reduce warfarin's anticoagulant effect

Answer

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?

Accepted Answer

IV (intravenous) short-acting insulin via syringe driver or bolus under medical supervision

Answer

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?

Accepted Answer

Risk of serotonin syndrome — both agents increase serotonergic activity

Answer

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?

Accepted Answer

Document immediately after administration, including time, dose, route, and signature — never pre-sign

Answer

Documentation must occur immediately after administration to prevent double-dosing and ensure accurate records. Pre-signing (documenting before administering) is unsafe — 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?

Accepted Answer

Methotrexate for rheumatoid arthritis is prescribed ONCE WEEKLY — daily dosing causes fatal toxicity

Answer

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.

NCNZ Practice Test

NCNZ Practice Test

NCNZ Medication Management (NZ Regulations) 2