NMC Medicines Management and Safety 2 — Questions and Answers
Question 1: A patient is prescribed metformin 500mg twice daily but accidentally receives 1000mg twice daily for three days. What is the most important immediate action?
- Document the error and continue the incorrect dose until reviewed
- Stop all medications and await physician review
- Report the error, assess the patient for adverse effects, and notify the prescriber immediately (Correct answer)
- Administer an antidote to counteract the overdose
Correct answer: Report the error, assess the patient for adverse effects, and notify the prescriber immediately
When a medication error occurs, the nurse must immediately assess the patient for harm, notify the prescriber, and report through the organisation's incident reporting system.
Question 2: Which of the following is a 'high-alert' medication requiring extra verification steps before administration?
- Paracetamol 500mg oral
- Intravenous potassium chloride concentrate (Correct answer)
- Oral vitamin B12 supplement
- Topical hydrocortisone 1%
Correct answer: Intravenous potassium chloride concentrate
Concentrated potassium chloride IV is a high-alert medication because errors can cause fatal cardiac arrhythmias; it requires double-checking and is typically restricted to diluted premixed bags.
Question 3: A nurse is about to administer a medication when the patient states, 'That pill looks different from usual.' What is the correct response?
- Reassure the patient that medications often change appearance and proceed
- Hold the medication, verify the prescription and product, and investigate before administering (Correct answer)
- Ask another nurse to administer it instead
- Document the patient's concern and give the medication as prescribed
Correct answer: Hold the medication, verify the prescription and product, and investigate before administering
Patient concerns about medication appearance must be taken seriously; the nurse should withhold the dose and verify the drug, dose, and formulation before proceeding.
Question 4: Under the Misuse of Drugs Regulations 2001, which schedule of controlled drug requires a witness signature when administering and wasting the remainder?
- Schedule 5
- Schedule 4
- Schedule 3
- Schedule 2 (Correct answer)
Correct answer: Schedule 2
Schedule 2 controlled drugs (e.g., morphine, diamorphine) require two registered nurses to check, sign the controlled drug register, and witness disposal of any unused portion.
Question 5: A patient with a known penicillin allergy is prescribed amoxicillin. What should the nurse do?
- Administer it because the allergy is likely mild
- Withhold the medication and contact the prescriber immediately (Correct answer)
- Give half the dose to test for a reaction
- Ask the patient if they want to try it
Correct answer: Withhold the medication and contact the prescriber immediately
Amoxicillin is a penicillin antibiotic; administering it to a penicillin-allergic patient poses a serious anaphylaxis risk, so the nurse must withhold it and alert the prescriber.
Question 6: What does the abbreviation 'PRN' on a medication chart indicate?
- Administer at the prescribed regular time
- Administer only when the patient requests it
- Administer as required based on clinical need (Correct answer)
- Administer with food only
Correct answer: Administer as required based on clinical need
PRN (pro re nata) means 'as needed' — the medication should be given when a specific condition or symptom warrants it, within defined parameters.
Question 7: When transcribing a verbal medication order over the phone, what is the safest practice?
- Write the order immediately and administer the drug
- Read back the entire order to the prescriber for confirmation before acting (Correct answer)
- Ask a colleague to listen and confirm
- Wait until the prescriber can write the order in person
Correct answer: Read back the entire order to the prescriber for confirmation before acting
Read-back of verbal and telephone orders is a WHO safety recommendation to verify accuracy and prevent transcription errors before medication is given.
NMC Medicines Management and Safety 2
A patient is prescribed metformin 500mg twice daily but accidentally receives 1000mg twice daily for three days.
What is the most important immediate action?