NMC OSCE Medicines Management 2 — Questions and Answers
Question 1: A nurse is administering insulin. Which of the following is the most important safety check specific to insulin?
- Checking the expiry date
- Confirming the type of insulin (e.g., rapid-acting vs long-acting) (Correct answer)
- Checking the manufacturer
- Using an orange needle
Correct answer: Confirming the type of insulin (e.g., rapid-acting vs long-acting)
Insulin errors are a leading cause of serious harm. Confirming the exact type of insulin (e.g., rapid-acting NovoRapid vs long-acting Lantus) is critical because mixing up types can cause severe hypoglycaemia or hyperglycaemia.
Question 2: Under UK law, which professional is responsible for a drug error made when following a verbal order from a doctor?
- The doctor who gave the verbal order
- The nurse who administered the drug (Correct answer)
- Both share equal responsibility
- The ward manager
Correct answer: The nurse who administered the drug
Under NMC standards and UK law, the nurse who administers a drug is professionally accountable for that administration. Verbal orders carry significant risk; nurses should not administer drugs based on verbal orders without proper prescription documentation except in emergency situations.
Question 3: What does the abbreviation PRN mean on a prescription chart?
- Per rectum now
- As required (Correct answer)
- Prolonged release night
- Pre-operative routine notation
Correct answer: As required
PRN comes from the Latin 'pro re nata' meaning 'as required' or 'as needed'. It indicates that the medication should be given when a specific condition or need arises, not on a regular scheduled basis.
Question 4: A patient is on warfarin and is prescribed a new course of ciprofloxacin. What is the key concern?
- Ciprofloxacin reduces warfarin absorption
- Ciprofloxacin inhibits warfarin metabolism, increasing bleeding risk (Correct answer)
- There is no significant interaction
- Ciprofloxacin increases warfarin excretion
Correct answer: Ciprofloxacin inhibits warfarin metabolism, increasing bleeding risk
Ciprofloxacin (and other quinolone antibiotics) inhibit the hepatic enzymes that metabolise warfarin, leading to increased warfarin levels and INR, with significantly increased risk of bleeding. INR should be monitored closely.
Question 5: Which route of administration has the fastest onset of action?
- Oral
- Subcutaneous
- Intravenous (Correct answer)
- Intramuscular
Correct answer: Intravenous
Intravenous (IV) administration delivers the drug directly into the bloodstream, bypassing absorption stages, giving the fastest onset of action. This is why IV routes are used in emergencies and for drugs requiring immediate effect.
Question 6: A nurse is about to administer a medication when the patient states they are allergic to it. What is the correct immediate action?
- Administer it if the dose is small
- Stop, withhold the medication, and inform the prescriber immediately (Correct answer)
- Ask the patient to sign a waiver
- Check if the allergy is listed on the chart before acting
Correct answer: Stop, withhold the medication, and inform the prescriber immediately
Any reported allergy must be taken seriously. The nurse must withhold the medication immediately, document the allergy, and inform the prescriber. Administering a medication to someone who reports an allergy could cause anaphylaxis or death.
NMC OSCE Medicines Management 2
A nurse is administering insulin.
Which of the following is the most important safety check specific to insulin?