NMBI Medication Management 2 — Questions and Answers
Question 1: What is a drug interaction and how should a nurse manage the risk?
- When one drug affects the action of another, potentially causing harm; nurses should check for interactions before administration and report concerns to the prescriber (Correct answer)
- Drugs never interact with each other
- Only pharmacists need to worry about drug interactions
- Drug interactions only occur with herbal remedies
Correct answer: When one drug affects the action of another, potentially causing harm; nurses should check for interactions before administration and report concerns to the prescriber
Drug interactions can increase or decrease a drug's effect, or cause unexpected side effects. Nurses should be aware of common interactions, check new prescriptions against current medications, use drug reference resources, and consult pharmacists when in doubt.
Question 2: What is the correct procedure for disposing of unused medications in a clinical setting?
- Return to pharmacy for disposal, or use designated pharmaceutical waste containers; controlled drugs must be witnessed and documented when destroyed (Correct answer)
- Flush them down the toilet
- Put them in the regular waste bin
- Give them to another patient who needs them
Correct answer: Return to pharmacy for disposal, or use designated pharmaceutical waste containers; controlled drugs must be witnessed and documented when destroyed
Unused medications must be returned to the pharmacy or placed in designated pharmaceutical waste containers (not general waste). Controlled drugs must be destroyed in the presence of a witness, with the destruction recorded in the controlled drugs register.
Question 3: What does 'PRN' mean on a medication prescription?
- Pro re nata — the medication is to be given as required or as needed, based on the nurse's assessment of the patient's condition (Correct answer)
- The medication must be given at a predetermined time
- The medication is prescribed permanently
- The prescription requires renewal
Correct answer: Pro re nata — the medication is to be given as required or as needed, based on the nurse's assessment of the patient's condition
PRN (pro re nata) means 'as needed'. The nurse assesses the patient's symptoms and administers the medication within the prescribed parameters (dose, frequency, maximum in 24 hours). The nurse must document the reason for giving the PRN medication and its effect.
Question 4: What is the nurse's role in medication reconciliation?
- To accurately document all medications the patient is taking at every transition of care (admission, transfer, discharge) to prevent discrepancies and errors (Correct answer)
- Medication reconciliation is only done at discharge
- It is the pharmacist's sole responsibility
- It only applies to controlled drugs
Correct answer: To accurately document all medications the patient is taking at every transition of care (admission, transfer, discharge) to prevent discrepancies and errors
Medication reconciliation involves creating an accurate list of all medications (including over-the-counter and herbal) at every transition point. Nurses play a key role in gathering this information, identifying discrepancies, and communicating with the multidisciplinary team.
Question 5: What precautions must be taken when administering high-risk medications (such as insulin, anticoagulants, or potassium chloride)?
- Independent double-checking by two nurses, additional patient monitoring, awareness of critical dose ranges, and knowledge of reversal agents (Correct answer)
- No additional precautions beyond the standard Five Rights
- Only check if the dose seems high
- High-risk medications do not require special handling
Correct answer: Independent double-checking by two nurses, additional patient monitoring, awareness of critical dose ranges, and knowledge of reversal agents
High-risk medications (known as APINCH drugs — Anti-infectives, Potassium, Insulin, Narcotics, Chemotherapy, Heparin) require enhanced safety measures including independent double-checking, concentration verification, pump programming verification, and heightened patient monitoring.
Question 6: What should a nurse do if a patient refuses their prescribed medication?
- Respect the patient's right to refuse, explain the potential consequences, document the refusal and the reason, and notify the prescriber (Correct answer)
- Force the patient to take the medication
- Crush the medication and hide it in food
- Ignore the refusal and try again later without documenting it
Correct answer: Respect the patient's right to refuse, explain the potential consequences, document the refusal and the reason, and notify the prescriber
A competent adult has the right to refuse medication. The nurse should explore the reason for refusal, provide information about potential consequences, document the refusal (including the patient's stated reason), and notify the prescriber so alternative plans can be considered.
NMBI Medication Management 2
What is a drug interaction and how should a nurse manage the risk?