NMC CBT NMC-CBT Medicines Management and Pharmacology 3 — Questions and Answers
Question 1: A patient is receiving a continuous IV infusion of heparin. Which laboratory test is used to monitor its therapeutic effect?
- INR (International Normalised Ratio)
- Platelet count
- APTT (Activated Partial Thromboplastin Time) (Correct answer)
- Prothrombin time
Correct answer: APTT (Activated Partial Thromboplastin Time)
APTT is the standard monitoring test for unfractionated heparin therapy, with a therapeutic target typically 1.5–2.5 times the control value.
Question 2: A patient with type 1 diabetes is nil by mouth before surgery. What is the most appropriate action regarding their insulin?
- Omit all insulin until the patient can eat
- Continue long-acting insulin and start a variable rate IV insulin infusion (Correct answer)
- Administer the usual morning dose of short-acting insulin only
- Double the long-acting insulin dose to compensate for fasting
Correct answer: Continue long-acting insulin and start a variable rate IV insulin infusion
Patients with type 1 diabetes require basal insulin even when fasting; a variable rate IV insulin infusion (VRIII) should be commenced perioperatively.
Question 3: Which of the following is the antidote for paracetamol overdose?
- Flumazenil
- Naloxone
- Acetylcysteine (N-acetylcysteine) (Correct answer)
- Activated charcoal alone
Correct answer: Acetylcysteine (N-acetylcysteine)
N-acetylcysteine (Parvolex) replenishes glutathione stores and prevents hepatotoxicity caused by paracetamol overdose.
Question 4: A nurse is preparing to give an intramuscular injection of metoclopramide. Which site is most commonly used for IM injections in adults?
- Dorsogluteal site
- Ventrogluteal site (Correct answer)
- Deltoid muscle
- Vastus lateralis
Correct answer: Ventrogluteal site
The ventrogluteal site is now the preferred IM injection site in adults due to fewer major blood vessels and nerves, lower infection risk, and larger muscle mass.
Question 5: What does a 'black triangle' symbol (▼) on a medication mean in the UK?
- The drug is a controlled substance requiring special storage
- The medication is subject to additional monitoring by the MHRA (Correct answer)
- The drug is only available on private prescription
- The medication has been recalled by the manufacturer
Correct answer: The medication is subject to additional monitoring by the MHRA
The black triangle indicates that the medicine is subject to additional monitoring, and healthcare professionals and patients are encouraged to report all suspected side effects.
Question 6: A patient prescribed lithium complains of coarse tremor, vomiting, and confusion. What should the nurse suspect?
- A normal therapeutic response to lithium
- Lithium toxicity (Correct answer)
- Lithium withdrawal syndrome
- An allergic reaction to lithium
Correct answer: Lithium toxicity
Coarse tremor, vomiting, and confusion are classic signs of lithium toxicity, which requires immediate cessation and urgent medical review.
Question 7: When administering eye drops, how far should the dropper be held from the eye to prevent contamination and injury?
- 1–2 mm
- 1–2 cm (Correct answer)
- 5–10 cm
- Directly touching the conjunctiva
Correct answer: 1–2 cm
The dropper should be held approximately 1–2 cm above the lower conjunctival sac to avoid touching the eye and contaminating the bottle.
NMC CBT NMC-CBT Medicines Management and Pharmacology 3
A patient is receiving a continuous IV infusion of heparin.
Which laboratory test is used to monitor its therapeutic effect?