OSCE OSCE Pharmacology and Medication Administration 2 — Questions and Answers
Question 1: A patient is prescribed warfarin. Which INR range is typically targeted for atrial fibrillation?
- 1.0–1.5
- 2.0–3.0 (Correct answer)
- 3.5–4.5
- 4.5–5.5
Correct answer: 2.0–3.0
For atrial fibrillation, the therapeutic INR range for warfarin is 2.0–3.0 to balance stroke prevention with bleeding risk.
Question 2: Which medication requires a tuberculin skin test (PPD) before initiation due to risk of reactivating latent TB?
- Methotrexate
- Adalimumab (Humira) (Correct answer)
- Prednisone
- Hydroxychloroquine
Correct answer: Adalimumab (Humira)
TNF-alpha inhibitors like adalimumab can reactivate latent tuberculosis, so a PPD or IGRA test is required before starting therapy.
Question 3: A nurse is about to give IV potassium chloride. What is the maximum safe rate of peripheral IV KCl infusion?
- 5 mEq/hr
- 10 mEq/hr (Correct answer)
- 20 mEq/hr
- 40 mEq/hr
Correct answer: 10 mEq/hr
Peripheral IV potassium chloride should not exceed 10 mEq/hr to prevent phlebitis and cardiac arrhythmias.
Question 4: Which opioid analgesic is considered safest for patients with renal failure?
- Morphine
- Codeine
- Fentanyl (Correct answer)
- Meperidine
Correct answer: Fentanyl
Fentanyl has no active renally-cleared metabolites, making it the preferred opioid in renal failure patients.
Question 5: A patient taking lithium develops tremor, polyuria, and confusion. Serum lithium is 2.1 mEq/L. What is the next step?
- Reduce the lithium dose by half
- Hold lithium and provide IV fluids (Correct answer)
- Add a beta-blocker for tremor
- Switch to valproate immediately
Correct answer: Hold lithium and provide IV fluids
A lithium level above 1.5 mEq/L with toxicity symptoms requires stopping lithium and providing supportive care with IV hydration.
Question 6: Which statement about subcutaneous insulin administration is correct?
- Always inject into the same spot for consistent absorption
- Rotate injection sites within the same region each day (Correct answer)
- Massage the site vigorously after injection
- Use the deltoid muscle for fastest absorption
Correct answer: Rotate injection sites within the same region each day
Rotating injection sites within the same region prevents lipohypertrophy while maintaining relatively consistent insulin absorption.
Question 7: A patient has a penicillin allergy documented as anaphylaxis. Which antibiotic class should be used with extreme caution due to cross-reactivity?
- Macrolides
- Fluoroquinolones
- Carbapenems (Correct answer)
- Aminoglycosides
Correct answer: Carbapenems
Carbapenems share the beta-lactam ring structure with penicillins and carry a small but real risk of cross-reactivity in penicillin-allergic patients.
OSCE OSCE Pharmacology and Medication Administration 2
A patient is prescribed warfarin.
Which INR range is typically targeted for atrial fibrillation?