RPN Safe Medication Administration 5 — Questions and Answers
Question 1: A patient is receiving a continuous heparin infusion. The nurse notes the aPTT result is 3.5 times the control value. What is the appropriate action?
- Increase the infusion rate to enhance anticoagulation
- Continue the current rate since this is within therapeutic range
- Decrease or hold the infusion and notify the prescriber (Correct answer)
- Administer protamine sulfate immediately without a prescriber order
Correct answer: Decrease or hold the infusion and notify the prescriber
An aPTT greater than 3 times the control indicates supratherapeutic anticoagulation and bleeding risk; the infusion should be decreased or held and the prescriber notified.
Question 2: Before administering a new medication, the RPN is uncertain about the correct dose. What is the safest action?
- Administer the dose written on the MAR without questioning
- Estimate based on similar medications given previously
- Consult a current drug reference or contact the pharmacist before administration (Correct answer)
- Ask a colleague who has given the medication before
Correct answer: Consult a current drug reference or contact the pharmacist before administration
Using a current drug reference or consulting the pharmacist ensures the nurse has accurate, evidence-based information before administration.
Question 3: Which patient statement indicates a need for further teaching about sublingual nitroglycerin?
- I will sit down before placing the tablet under my tongue
- I can take up to three tablets five minutes apart if chest pain persists
- I should swallow the tablet with a full glass of water (Correct answer)
- I will store my tablets in a dark, cool place away from moisture
Correct answer: I should swallow the tablet with a full glass of water
Sublingual nitroglycerin must dissolve under the tongue, not be swallowed, as swallowing bypasses the rapid sublingual absorption route.
Question 4: When administering oral medications through a nasogastric (NG) tube, the nurse should:
- Mix all medications together in one syringe for efficiency
- Flush the tube with 15–30 mL of water before and after each medication (Correct answer)
- Crush enteric-coated tablets and dissolve them in normal saline
- Clamp the NG tube for 30 minutes after each medication
Correct answer: Flush the tube with 15–30 mL of water before and after each medication
Flushing the NG tube before and after each medication prevents clogging and ensures the full dose reaches the stomach and medications are not mixed.
Question 5: A nurse is teaching a newly hired RPN about medication reconciliation. Which statement best describes its purpose?
- It is a process to verify that pharmacy has filled all ordered prescriptions
- It compares a patient's current medication orders to all medications the patient has been taking to prevent discrepancies (Correct answer)
- It is used to determine which medications a patient can afford
- It identifies medications that can be substituted with generic versions
Correct answer: It compares a patient's current medication orders to all medications the patient has been taking to prevent discrepancies
Medication reconciliation compares the patient's complete medication list against new orders at transitions of care to identify and resolve discrepancies.
Question 6: Which of the following is the most critical step when preparing two IV medications to be administered at the same time via the same IV line?
- Administer the medications sequentially without flushing
- Check a compatibility reference to ensure the drugs can be co-administered (Correct answer)
- Mix both medications in one IV bag to simplify administration
- Increase the IV flow rate to dilute potential interactions
Correct answer: Check a compatibility reference to ensure the drugs can be co-administered
Checking a compatibility resource is essential because incompatible IV medications can precipitate or inactivate each other, causing harm or ineffective treatment.
Question 7: A patient taking phenytoin asks if they can take an antacid at the same time as their morning dose. How should the nurse respond?
- Yes, taking them together is safe and may protect the stomach
- Yes, antacids enhance phenytoin absorption
- No, antacids can decrease phenytoin absorption and should be separated by at least 2 hours (Correct answer)
- No, antacids are contraindicated in all seizure disorders
Correct answer: No, antacids can decrease phenytoin absorption and should be separated by at least 2 hours
Antacids can bind to phenytoin in the GI tract and reduce its absorption, so they should be separated by at least 2 hours to ensure therapeutic drug levels.
RPN Safe Medication Administration 5
A patient is receiving a continuous heparin infusion.
The nurse notes the aPTT result is 3.5 times the control value.
What is the appropriate action?