NMC OSCE Medicine Administration 2 — Questions and Answers
Question 1: You are preparing to administer IV medication through a peripheral cannula. What checks must you perform on the cannula site before administration?
- Check for signs of phlebitis (redness, swelling, pain, palpable venous cord), infiltration, patency by flushing with 0.9% saline, and check the dressing is intact and dated (Correct answer)
- Check the cannula is the correct colour only
- No checks needed if the cannula was inserted today
- Only check that fluid is running through it
Correct answer: Check for signs of phlebitis (redness, swelling, pain, palpable venous cord), infiltration, patency by flushing with 0.9% saline, and check the dressing is intact and dated
Before IV administration, assess the cannula site using the Visual Infusion Phlebitis (VIP) score: check for pain, redness, swelling, palpable venous cord, and pyrexia. Flush with 0.9% sodium chloride to confirm patency (no resistance, swelling, or pain). Ensure the dressing is clean, dry, intact, and dated. Replace the cannula if any signs of phlebitis.
Question 2: A patient refuses to take their prescribed medication. According to NMC standards, what is the correct nursing action?
- Respect the patient's right to refuse, explain the consequences, document the refusal and reasons, and inform the prescriber (Correct answer)
- Crush the medication and hide it in food
- Tell the patient they must take it as prescribed
- Omit the medication without documentation
Correct answer: Respect the patient's right to refuse, explain the consequences, document the refusal and reasons, and inform the prescriber
Competent adults have the right to refuse any treatment, including medication. The nurse must respect this decision, ensure the patient understands the potential consequences of not taking the medication, document the refusal (including the reason if given), and inform the prescriber. Covert administration without consent is only permissible in specific circumstances under the Mental Capacity Act 2005.
Question 3: When reconstituting a powdered antibiotic for intravenous administration, which document should you consult for specific dilution instructions?
- The Summary of Product Characteristics (SmPC) or local injectable medicines guide (Correct answer)
- The patient's care plan
- The ward noticeboard
- The nurse's personal notes from training
Correct answer: The Summary of Product Characteristics (SmPC) or local injectable medicines guide
The Summary of Product Characteristics (SmPC) provides authoritative information on reconstitution diluent, volume, concentration, rate of administration, and compatibility. Many hospitals also have local injectable medicines guides (e.g., Medusa) accessible via the intranet. Using incorrect diluent or concentration can cause drug precipitation, phlebitis, or adverse reactions.
Question 4: A medication error occurs: a patient receives double the prescribed dose of an antihypertensive. What is the correct sequence of actions?
- Assess the patient for adverse effects, take immediate clinical action if needed, inform the prescriber and nurse in charge, complete a Datix/incident report, and inform the patient using duty of candour (Correct answer)
- Hide the error and monitor the patient quietly
- Complete the incident report first, then check the patient
- Wait until the end of the shift to report it
Correct answer: Assess the patient for adverse effects, take immediate clinical action if needed, inform the prescriber and nurse in charge, complete a Datix/incident report, and inform the patient using duty of candour
Patient safety is the immediate priority: assess for adverse effects (hypotension, bradycardia) and take clinical action. Then inform the prescriber and nurse in charge immediately. Complete an incident report (Datix or equivalent). Under duty of candour (NMC Code), inform the patient honestly about what has happened. Reflect on the error to prevent recurrence.
Question 5: What is the maximum volume that should be administered via intramuscular injection at a single site in an adult?
- 5 mL (for large muscles such as ventrogluteal); 2 mL for the deltoid (Correct answer)
- 20 mL
- 10 mL at any site
- 1 mL at all sites
Correct answer: 5 mL (for large muscles such as ventrogluteal); 2 mL for the deltoid
The maximum volume for a single IM injection site varies by muscle: ventrogluteal and vastus lateralis can accommodate up to 5 mL, while the deltoid muscle should receive no more than 1-2 mL. Exceeding these volumes causes pain, poor absorption, and tissue damage. Larger volumes should be divided between two sites.
Question 6: A patient is prescribed warfarin. Before administration, which blood test result must the nurse check and what is the therapeutic range for most indications?
- INR (International Normalised Ratio); therapeutic range is typically 2.0-3.0 for most indications (Correct answer)
- Full blood count; haemoglobin above 120 g/L
- Serum potassium; range 3.5-5.0 mmol/L
- Blood glucose; range 4-7 mmol/L
Correct answer: INR (International Normalised Ratio); therapeutic range is typically 2.0-3.0 for most indications
The INR monitors warfarin's anticoagulant effect. The target INR for most indications (atrial fibrillation, DVT, PE) is 2.0-3.0. For mechanical heart valves, the target may be 2.5-3.5. The nurse must check the most recent INR before administering warfarin and ensure a valid dose is prescribed based on that result.
NMC OSCE Medicine Administration 2
You are preparing to administer IV medication through a peripheral cannula.
What checks must you perform on the cannula site before administration?