OSCE Pharmacology and Medication Administration 3 — Questions and Answers
Question 1: A patient is receiving morphine via PCA pump and is difficult to arouse with a respiratory rate of 8/min. What is the priority intervention?
- Administer naloxone and prepare for resuscitation (Correct answer)
- Stop the PCA and reposition the patient
- Increase oxygen flow rate and reassess in 5 minutes
- Notify the physician and document the findings
Correct answer: Administer naloxone and prepare for resuscitation
Naloxone reverses opioid-induced respiratory depression and is the priority intervention for this life-threatening emergency.
Question 2: Which medication requires protection from light during IV administration?
- Normal saline
- Nitroglycerin (Correct answer)
- Sodium bicarbonate
- Metronidazole
Correct answer: Nitroglycerin
Nitroglycerin degrades when exposed to light, requiring amber or foil-wrapped tubing and bottles during administration.
Question 3: A nurse is teaching a patient about transdermal nitroglycerin patches. Which instruction is most important?
- Apply the patch to the same site each day for best absorption
- Remove the old patch before applying a new one (Correct answer)
- Cover the patch with a heating pad to enhance drug absorption
- Apply the patch immediately after bathing for better skin adhesion
Correct answer: Remove the old patch before applying a new one
Failing to remove the old patch before applying a new one can cause nitroglycerin toxicity due to double dosing.
Question 4: When reconstituting a powdered medication, the nurse should inject the diluent at which angle into the vial?
- Straight down into the powder
- Along the side of the vial wall (Correct answer)
- At a 45-degree angle toward the center
- Directly into the center of the vial stopper
Correct answer: Along the side of the vial wall
Injecting diluent along the vial wall prevents excessive foaming and ensures complete dissolution of the powder.
Question 5: A patient is prescribed lithium carbonate. Which lab value requires the nurse to hold the medication and notify the physician?
- Serum lithium level of 0.8 mEq/L
- Serum lithium level of 1.5 mEq/L (Correct answer)
- Serum sodium of 140 mEq/L
- Serum creatinine of 0.9 mg/dL
Correct answer: Serum lithium level of 1.5 mEq/L
A lithium level of 1.5 mEq/L is at the upper therapeutic limit and approaching toxic range (>1.5 mEq/L), requiring immediate notification.
Question 6: A nurse is preparing to give a subcutaneous heparin injection. Which site is preferred?
- Outer upper arm deltoid area
- Anterolateral or posterolateral abdominal fat (Correct answer)
- Upper outer quadrant of the buttocks
- Anterior thigh
Correct answer: Anterolateral or posterolateral abdominal fat
The abdomen provides the most consistent subcutaneous fat layer for heparin absorption and is the preferred injection site.
Question 7: Which medication interaction should alert the nurse when a patient on selective serotonin reuptake inhibitors (SSRIs) is prescribed tramadol?
- Risk of nephrotoxicity
- Risk of serotonin syndrome (Correct answer)
- Risk of hypoglycemia
- Risk of QT prolongation only
Correct answer: Risk of serotonin syndrome
Combining SSRIs with tramadol (which also increases serotonin) can trigger life-threatening serotonin syndrome.
OSCE Pharmacology and Medication Administration 3
A patient is receiving morphine via PCA pump and is difficult to arouse with a respiratory rate of 8/min.
What is the priority intervention?