NMC CBT - Nursing and Midwifery Council Computer-Based Test Medicines Management and Pharmacology 1 — Questions and Answers
Question 1: A nurse is about to administer oral metformin to a patient scheduled for an IV contrast CT scan later that day. What is the most appropriate action?
- Administer the metformin as prescribed and document it
- Withhold the metformin and inform the prescriber, as it should be held before contrast administration (Correct answer)
- Substitute metformin with insulin for that dose only
- Delay the CT scan until the patient's next metformin dose is due
Correct answer: Withhold the metformin and inform the prescriber, as it should be held before contrast administration
Metformin should be withheld before iodinated contrast procedures due to the risk of contrast-induced nephropathy leading to metformin accumulation and lactic acidosis. The nurse must withhold the dose and notify the prescriber.
Question 2: When documenting the administration of a controlled drug in the Controlled Drug Register, which piece of information is NOT routinely required?
- The patient's name and date of birth
- The dose administered and the amount remaining in stock
- The names of the two nurses who checked the drug
- The patient's GP's name and practice address (Correct answer)
Correct answer: The patient's GP's name and practice address
The Controlled Drug Register requires patient identification, dose given, stock balance, date/time, and signatures of both checking nurses. The patient's GP details are not a standard mandatory entry in the register.
Question 3: A patient prescribed digoxin has a resting heart rate of 52 beats per minute. What is the nurse's priority action before administering the dose?
- Administer the dose as the rate is only slightly below normal
- Withhold the dose and inform the prescriber, documenting the decision (Correct answer)
- Give half the prescribed dose to reduce the risk of bradycardia
- Ask the patient if they feel dizzy before deciding whether to give the drug
Correct answer: Withhold the dose and inform the prescriber, documenting the decision
Digoxin slows the heart rate and is typically withheld if the apical pulse is below 60 bpm. The nurse must withhold the dose, document the reason, and notify the prescriber for further guidance.
Question 4: Which route of administration provides the fastest onset of drug action in an emergency?
- Sublingual
- Intramuscular
- Intravenous (Correct answer)
- Subcutaneous
Correct answer: Intravenous
Intravenous administration delivers the drug directly into the bloodstream, bypassing absorption entirely and providing the fastest onset of action — critical in emergencies such as anaphylaxis or cardiac arrest.
Question 5: A nurse discovers a discrepancy in the controlled drug stock count at the end of a shift. What is the correct immediate action?
- Correct the register entry and recount at the start of the next shift
- Report the discrepancy immediately to the senior nurse on duty and document it according to local policy (Correct answer)
- Assume a recording error occurred and adjust the register to match the physical stock
- Inform the patient's family in case the drug was taken without authorisation
Correct answer: Report the discrepancy immediately to the senior nurse on duty and document it according to local policy
Any controlled drug discrepancy must be reported immediately to the senior nurse and documented per local policy. This triggers a formal investigation and may require reporting to the Accountable Officer. Adjusting records without investigation would be a serious breach of governance.
Question 6: A patient is prescribed paracetamol 1 g QDS orally. They mention they have been self-administering 'Lemsip Max' sachets (each containing 1000 mg paracetamol) throughout the day for a cold. What is the nurse's concern?
- Lemsip Max may interact with the prescribed paracetamol and reduce its effectiveness
- The patient may be receiving a total daily paracetamol dose exceeding the safe maximum of 4 g (Correct answer)
- Lemsip Max contains aspirin which is contraindicated with paracetamol
- There is no concern as over-the-counter products do not count toward prescribed drug totals
Correct answer: The patient may be receiving a total daily paracetamol dose exceeding the safe maximum of 4 g
The prescribed QDS dose already equals 4 g/day — the maximum safe adult dose. Adding Lemsip Max sachets containing further paracetamol risks hepatotoxicity through overdose. The nurse must assess total intake and inform the prescriber.
NMC CBT - Nursing and Midwifery Council Computer-Based Test Medicines Management and Pharmacology 1
A nurse is about to administer oral metformin to a patient scheduled for an IV contrast CT scan later that day.
What is the most appropriate action?