NMC Medicines Management and Safety 3 — Questions and Answers
Question 1: A patient is receiving warfarin therapy. Which dietary change could significantly reduce the drug's effectiveness?
- Increasing calcium-rich foods
- Eating large amounts of vitamin K–rich foods such as spinach and kale (Correct answer)
- Reducing sodium intake
- Increasing fluid intake
Correct answer: Eating large amounts of vitamin K–rich foods such as spinach and kale
Vitamin K antagonises warfarin's anticoagulant effect; a sudden large increase in vitamin K intake can raise the INR target and cause sub-therapeutic anticoagulation.
Question 2: Which route of administration bypasses first-pass metabolism in the liver?
- Oral
- Rectal (all doses)
- Intravenous (Correct answer)
- Sublingual
Correct answer: Intravenous
Intravenous administration delivers the drug directly into the bloodstream, completely bypassing hepatic first-pass metabolism and achieving 100% bioavailability.
Question 3: A patient is prescribed gentamicin. Which parameter is essential to monitor to prevent toxicity?
- Blood glucose levels
- Serum gentamicin levels and renal function (Correct answer)
- Liver enzymes only
- Complete blood count daily
Correct answer: Serum gentamicin levels and renal function
Gentamicin is nephrotoxic and ototoxic; serum drug levels (trough and peak) and renal function must be monitored to maintain therapeutic range and avoid toxicity.
Question 4: What is the correct technique for administering a subcutaneous insulin injection?
- Aspirate before injecting to check for blood
- Inject at 90° into a pinched skin fold without aspiration (Correct answer)
- Massage the injection site vigorously after administration
- Always use the same injection site to ensure consistent absorption
Correct answer: Inject at 90° into a pinched skin fold without aspiration
Current evidence-based practice recommends injecting insulin at 90° (or 45° in thin patients) into a pinched skin fold without aspiration, as aspiration is unnecessary for subcutaneous injections.
Question 5: Under the NMC Code, if a nurse is asked to administer a medication they believe is unsafe, what is their professional responsibility?
- Follow the instruction of the senior nurse without question
- Administer the drug but document their concern afterwards
- Refuse and raise the concern immediately through appropriate channels (Correct answer)
- Administer a reduced dose as a compromise
Correct answer: Refuse and raise the concern immediately through appropriate channels
The NMC Code requires nurses to refuse to participate in unsafe practice and to raise concerns promptly to protect patient safety.
Question 6: A patient's medication is labelled 'enteric-coated.' What does this mean for administration?
- The tablet should be crushed and mixed with water before giving
- The tablet must not be crushed or chewed as it is designed to dissolve in the intestine (Correct answer)
- The tablet should be taken on an empty stomach only
- The coating is purely cosmetic
Correct answer: The tablet must not be crushed or chewed as it is designed to dissolve in the intestine
Enteric coating protects the drug from stomach acid and the gastric mucosa; crushing or chewing destroys this protection and may cause drug inactivation or gastric irritation.
Question 7: Which organisation is responsible for regulating medicines and medical devices in the United Kingdom?
- The Care Quality Commission (CQC)
- The Medicines and Healthcare products Regulatory Agency (MHRA) (Correct answer)
- The National Institute for Health and Care Excellence (NICE)
- The Nursing and Midwifery Council (NMC)
Correct answer: The Medicines and Healthcare products Regulatory Agency (MHRA)
The MHRA is the UK government agency responsible for ensuring medicines, medical devices, and blood components meet appropriate standards of safety, quality, and efficacy.
NMC Medicines Management and Safety 3
A patient is receiving warfarin therapy.
Which dietary change could significantly reduce the drug's effectiveness?