OSCE OSCE Pharmacology and Medication Administration 4 — Questions and Answers
Question 1: A patient is prescribed a statin for hyperlipidemia and develops muscle pain with a CK level 10 times the upper limit of normal. What is the priority action?
- Reduce the statin dose by half
- Switch to a different statin
- Discontinue the statin immediately (Correct answer)
- Add CoQ10 supplementation and continue
Correct answer: Discontinue the statin immediately
Markedly elevated CK with muscle symptoms indicates statin-induced myopathy or rhabdomyolysis, requiring immediate discontinuation to prevent renal failure.
Question 2: Which 'five rights' of medication administration is being verified when the nurse checks the patient's armband?
- Right drug
- Right route
- Right patient (Correct answer)
- Right time
Correct answer: Right patient
Checking the patient's armband and using two identifiers verifies the right patient, a core component of safe medication administration.
Question 3: A patient receives 1,000 mg of acetaminophen (paracetamol) every 6 hours. What is the total daily dose, and is it within safe limits for a healthy adult?
- 3,000 mg/day — safe
- 4,000 mg/day — at the maximum safe limit (Correct answer)
- 5,000 mg/day — exceeds the limit
- 2,500 mg/day — below therapeutic range
Correct answer: 4,000 mg/day — at the maximum safe limit
Four doses of 1,000 mg equals 4,000 mg/day, which is the maximum recommended daily dose for healthy adults per current guidelines.
Question 4: Which class of medications requires dose reduction in hepatic impairment due to extensive first-pass metabolism?
- Oral beta-blockers like propranolol (Correct answer)
- Renally-excreted aminoglycosides
- IV vancomycin
- Inhaled corticosteroids
Correct answer: Oral beta-blockers like propranolol
Propranolol undergoes extensive hepatic first-pass metabolism; liver impairment reduces clearance, leading to significantly elevated plasma levels.
Question 5: A patient on warfarin is started on ciprofloxacin. What monitoring change is required?
- Increase warfarin dose prophylactically
- Monitor INR more frequently as it may rise (Correct answer)
- Switch warfarin to enoxaparin during antibiotic course
- No change needed — interaction is not clinically significant
Correct answer: Monitor INR more frequently as it may rise
Ciprofloxacin inhibits CYP1A2 and CYP3A4, reducing warfarin metabolism and increasing anticoagulant effect, requiring more frequent INR monitoring.
Question 6: When reconstituting a powdered antibiotic for IV administration, what is the most important step after adding the diluent?
- Shake the vial vigorously for 30 seconds
- Gently swirl until completely dissolved before checking clarity (Correct answer)
- Warm the vial to body temperature first
- Filter the solution through a 10-micron filter
Correct answer: Gently swirl until completely dissolved before checking clarity
After adding diluent, the vial should be gently swirled and inspected for complete dissolution and clarity/absence of particulates before administration.
Question 7: A patient with severe penicillin allergy requires treatment for syphilis. What is the recommended alternative?
- Cephalexin
- Doxycycline (Correct answer)
- Azithromycin
- Clindamycin
Correct answer: Doxycycline
Doxycycline is the recommended alternative for non-pregnant patients with penicillin allergy who have early syphilis, though penicillin remains preferred.
OSCE OSCE Pharmacology and Medication Administration 4
A patient is prescribed a statin for hyperlipidemia and develops muscle pain with a CK level 10 times the upper limit of normal.
What is the priority action?