NMC CBT Medicines Management and Pharmacology 2 — Questions and Answers
Question 1: Which correctly lists the '5 Rights' of medication administration?
- Right patient, right drug, right dose, right route, right time (Correct answer)
- Right patient, right drug, right dose, right reason, right documentation
- Right patient, right prescription, right pharmacy, right dose, right time
- Right drug, right dose, right route, right time, right documentation
Correct answer: Right patient, right drug, right dose, right route, right time
The traditional 5 Rights are: right patient, right drug, right dose, right route, and right time.
The 5 Rights: (1) Right patient (two identifiers from identity band); (2) Right drug (check against prescription); (3) Right dose (verify and calculate); (4) Right route (oral, IV, IM, SC, etc.); (5) Right time. Extended frameworks add: right reason, right documentation, right to refuse, right form, right response.
Question 2: A patient takes warfarin. Which blood test monitors its effect, and what is the typical target INR range?
- APTT ratio, target 1.5-2.5
- INR, target 2.0-3.0 (Correct answer)
- Platelet count, target 150-400
- PT, target 12-15 seconds
Correct answer: INR, target 2.0-3.0
Warfarin is monitored using INR. Target 2.0-3.0 for most indications (AF, DVT, PE); 2.5-3.5 for mechanical heart valves.
Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X). INR standardises the prothrombin time. Below target = thrombotic risk; above = bleeding risk. Check INR before administering. Common interactions: antibiotics, NSAIDs, alcohol, vitamin K-rich foods. APTT monitors unfractionated heparin.
Question 3: A patient develops a rash after amoxicillin. Which type of adverse drug reaction is this?
- Type A (augmented) — dose-dependent, predictable
- Type B (bizarre) — dose-independent, likely allergic (Correct answer)
- Type C (chronic) — cumulative dose
- Type D (delayed) — long after administration
Correct answer: Type B (bizarre) — dose-independent, likely allergic
An allergic rash is Type B — unpredictable, dose-independent, involving an immunological mechanism.
Type A (80% of ADRs): predictable, dose-dependent, related to pharmacological action (e.g., hypoglycaemia from insulin). Type B: unpredictable, dose-independent, often immunological (e.g., penicillin allergy). Type C: cumulative dose (e.g., osteoporosis from steroids). Type D: delayed (e.g., cancers from chemo). Type E: withdrawal. Report via Yellow Card Scheme.
Question 4: What procedure is required for administering a Schedule 2 controlled drug?
- A single experienced nurse can administer
- Two registered practitioners must check and administer, and the controlled drug register must be updated (Correct answer)
- Only doctors can administer
- Stored in a locked cupboard but no witness needed
Correct answer: Two registered practitioners must check and administer, and the controlled drug register must be updated
Schedule 2 CDs require two registered practitioners for checking and administration, with the CD register completed.
Schedule 2 drugs (morphine, fentanyl, oxycodone, etc.): double-locked storage; regular stock reconciliation; two practitioners independently check drug, dose, identity, prescription; CD register completed with date, time, patient, drug, dose, balance, both signatures; wastage witnessed and recorded. Based on the Shipman Inquiry recommendations.
Question 5: What is the Yellow Card Scheme?
- Hospital medication stock shortage reporting
- Reporting suspected adverse drug reactions to the MHRA (Correct answer)
- Flagging drug allergies in medical records
- Pharmacy dispensing error reporting
Correct answer: Reporting suspected adverse drug reactions to the MHRA
The Yellow Card Scheme collects reports of suspected ADRs, operated by the MHRA.
The MHRA's Yellow Card Scheme collects reports of suspected ADRs to licensed medicines, vaccines, herbal medicines, and medical devices. Especially important to report: reactions to newly licensed medicines (black triangle in BNF); serious reactions; reactions in children. All nurses have a professional responsibility to report.
Question 6: A nurse discovers they gave the wrong insulin dose. What is the correct sequence of actions?
- Complete the incident form first, then inform the patient
- Assess the patient immediately, take corrective action, inform the medical team, inform the patient, complete an incident report (Correct answer)
- Inform the ward manager and wait for instructions
- Administer glucose and document in notes
Correct answer: Assess the patient immediately, take corrective action, inform the medical team, inform the patient, complete an incident report
Patient safety is the immediate priority: assess, correct, escalate, be transparent, then document and report.
Sequence: (1) Assess for harm (insulin overdose: check for hypoglycaemia); (2) Corrective action (check BG, give glucose if needed); (3) Inform medical team urgently; (4) Stay and monitor; (5) Inform patient honestly (duty of candour); (6) Complete Datix; (7) Inform nurse in charge; (8) Document everything. NMC Code Section 14: be open when things go wrong.
NMC CBT Medicines Management and Pharmacology 2
Which correctly lists the '5 Rights' of medication administration?