STANDARDS OF MEDICINES MANAGEMENT

What are the professional responsibilities of the qualified nurse in medicines management?

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·       Making sure that the group of patients that they are caring for receive their medications on time If they are not competent to administer intravenous medications, they should ask a competent nursing colleague to do so on their behalf

 

·       The safe handling and administration of all medicines to patients in their care This includes making sure that patients understand the medicines they are taking, the reason they are taking them and the likely side effects

 

·       Making sure they know the names, actions, doses and side effects of all the medications used in their area of clinical practice

 

·       To liaise closely with pharmacy so that their knowledge is kept up to date

 

Correct answer

The safe handling and administration of all medicines to patients in their care This includes making sure that patients understand the medicines they are taking, the reason they are taking them and the likely side effects

 

What are the key reasons for administering medications to patients?

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·       To provide relief from specific symptoms, for example pain, and managing side effects as well as therapeutic purposes

 

·       As part of the process of diagnosing their illness, to prevent an illness, disease or side effect, to offer relief from symptoms or to treat a disease

 

·       As part of the treatment of long term diseases, for example heart failure, and the prevention of diseases such as asthma

 

·       To treat acute illness, for example antibiotic therapy for a chest infection, and side effects such as nausea

 

Correct answer

As part of the process of diagnosing their illness, to prevent an illness, disease or side effect, to offer relief from symptoms or to treat a disease

 

Why would the intravenous route be used for the administration of medications?

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·       It is a useful form of medication for patients who refuse to take tablets because they don't want to comply with treatment

 

 

·       It is cost effective because there is less waste as patients forget to take oral medication

 

·       The intravenous route reduces the risk of infection because the drugs are made in a sterile environment and kept in aseptic conditions

 

·       The intravenous route provides an immediate therapeutic effect and gives better control of the rate of administration as a more precise dose can be calculated so treatment can be more reliable

 

Correct answer

The intravenous route provides an immediate therapeutic effect and gives better control of the rate of administration as a more precise dose can be calculated so treatment can be more reliable

 

IV injection need to be reconsidered when,?

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·       Medicine is available in tab form

·       Poor alimentary absorption

·       Drug interaction due to GI secretions

 

Correct answer

Medicine is available in tab form

 

According to MHRA, the clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimizing potential harm best describes:

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·       Medicine control

·       Medicine management

·       Medicine administration

·       Medicine economics

 

Correct answer

Medicine management

 

What are the potential benefits of self-administration of medicines by patients?

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·       Nurses have more time for other aspects of patient care and it therefore reduces length of stay

 

·       It gives patients more control and allows them to take the medications on time, as well as giving them the opportunity to address any concerns with their medication before they are discharged home

 

·       Reduces the risk of medication errors, because patients are in charge of their own medication

 

·       Creates more space in the treatment room, so there are fewer medication errors

 

 

 

Correct answer

It gives patients more control and allows them to take the medications on time, as well as giving them the opportunity to address any concerns with their medication before they are discharged home

 

A patient recently admitted to hospital, requesting to self-administer the medication, has been assessed for suitability at Level 2 This means that:

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·       The registrant is responsible for the safe storage of the medicinal products and the supervision of the administration process ensuring the patient understands the medicinal product being administered

 

·       The patient accepts full responsibility for the storage and administration of the medicinal products

 

·       None of the above

 

Correct answer

None of the above

 

Patient bring own medication to hospital and wants to self-administer what is your role?

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·       Allow him

·       Give medications back to relatives to take back

·       Keep it in locker, use from medication trolley

·       Explain to patient about medication before he administer it

 

 

As a newly qualified nurse, what would you do if a patient vomits when taking or immediately after taking tablets?

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·       Comfort the patient, check to see if they have vomited the tablets, and ask the doctor to prescribe something different as these obviously don't agree with the patient

 

·       Check to see if the patient has vomited the tablets and, if so, document this on the prescription chart If possible, the drugs may be given again after the administration of antiemetics or when the patient no longer feels nauseous It may be necessary to discuss an alternative route of administration with the doctor

 

·       In the future administer antiemetics prior to administration of all tablets

 

·       Discuss with pharmacy the availability of medication in a liquid form or hide the tablets in food to take the taste away

 

Correct answer

Check to see if the patient has vomited the tablets and, if so, document this on the prescription chart If possible, the drugs may be given again after the administration of antiemetics or when the patient no longer feels nauseous It may be necessary to discuss an alternative route of administration with the doctor

 

As a nurse you carry out a medicines reconciliation needs with the patient and they will be assessed for their ability to self-administer. What is seen inthe second level of self-administration?

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·       Nurse adminisers medicines from cabinet, obtains consent prior to administration and signs drug administration chart

 

·       Patient administers medicine with nurse supervision and asks the nurse to open the cupboard containing the medication

 

·       Patient keeps and administers own medicines The nurse must check that the appropriate medication was taken

 

·       Nurse administers medicines from the designated area, checks for allergies and obtains consent prior to administration

 

Correct answer

Patient administers medicine with nurse supervision and asks the nurse to open the cupboard containing the medication

 

What could be the reason why you instruct your patient to retain on its original container and discard nitroglycerine medications after 8 weeks?

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·       Removing from its darkened container exposes the medicine to the light and its potency will decrease after 8 weeks

 

·       It will have a greater concentration after 8weeks

 

Correct answer

Removing from its darkened container exposes the medicine to the light and its potency will decrease after 8 weeks

 

A patient approached you to give his medications now but you are unable to give the medicine. What is your initial action?

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·       Inform the doctor

·       Inform your team leader

·       Inform the pharmacist

·       Routinely document medications not given

 

Correct answer

Routinely document medications not given

 

Which of the following is not considered a medication?

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·       Whole blood

·       Albumin

·       Blood clotting factors

·       Antibodies

 

Correct answer

Whole blood

 

You were on your medication rounds and the emergency alarm goes off. What will you do first?

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·       Lock your trolley

·       Rush to your patient’s bedroom

·       Check first if everyone had their medications

·       a and c

 

Correct answer

Lock your trolley

 

Registrants must only supply and administer medicinal products in accordance with one or more of the following processes, except:

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·       Carer specific direction (CSD)

·       Patient medicines administration chart (may be called medicines administration record MAR)

·       Patient group direction (PGD)

·       Medicines Act exemption

 

Correct answer

Carer specific direction (CSD)

 

Client had fractured hand and being cared at home requiring analgesia. The medication was prescribed under PGD. Which of the following statements are correct relating to this:

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·       A PGD can be delegated to student nurse who can administer medication with supervision

 

·       PGD’s cannot be delegated to anyone

 

·       This type of prescription is not made under PGD

 

·       This can be delegated to another RN who can administer in view of a competent person

 

When you tell a 3rd year student under your care to dispense medication to your patient what will you assess?

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·       Whether s/he is able to give medicine

·       Whether s/he is under your same employment

·       His/her competence and skills

·       Supervise directly

 

Correct answer

His/her competence and skills

 

Independent and supplementary nurse and midwife are those who are?

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·       Nurse and midwife student who cleared medication administration exam

 

·       Nurses and midwives educated in appropriate medication prescription for certain pharmaceuticals

 

·       Registrants completed a programme to prescribe under community nurse practitioner’s drug formulary

 

·       Nurses and midwives whose name is entered in the register

 

Correct answer

Nurses and midwives educated in appropriate medication prescription for certain pharmaceuticals

 

You are transcribing medications from prescription chart to a discharge letter. Before sending this letter what action must be taken?

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·       A registrant should sign this letter

·       Transcribing is not allowed in any circumstances

·       The letter has to be checked by a nurse in charge

·       Letter can be sent directly to the patient after transcribing

 

Correct answer

A registrant should sign this letter

 

You are caring for a Hindu client and it’s time for drug administration; the client refuses to take the capsule referring to the animal product that might have been used in its making, what is the appropriate action for the nurse to perform?

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·       She will not administer and document the ommissions in the patients chart

 

·       The nurse will ignore the clients request and administer forcebily

 

·       The nurse will open the capsule and administer the powdered drug

 

·       The nurse will establish with the pharmacist if the capsule is suitable for vegetarians

 

Correct answer

The nurse will establish with the pharmacist if the capsule is suitable for vegetarians

 

Which color card is used to report adverse drug reaction?

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·       Green Card

·       Yellow Card

·       White Card

·       Blue Card

 

Correct answer

Yellow Card

 

A patient doesn't take a tablet which is prescribed by a doctor. Nurse should:

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·       Inform the incident to senior nurse and ward in charge

·       Inform pharmacist

·       Do not inform anybody and document in routinely chart

 

Correct answer

Inform the incident to senior nurse and ward in charge

 

A nurse in acute care setting was not able to give the routine medication for the patient. What is the appropriate action of the nurse?

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·       Inform the pharmacist

 

·       Inform the Senior nurse that the medicine was not given

 

·       Call the GP and inform that the medicine was not given

 

·       Record the omission on the chart and state the reason

 

Correct answer

Record the omission on the chart and state the reason

 

Which of the following is not a part of the 6 rights of medication administration?

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·       Right time

·       Right route

·       Right medication

·       Right reason

 

Correct answer

Right reason

 

You are teaching a second year student on medication safety. The increased pressures encountered in the clinical area has a potential to contribute to mistakes in medication administration, with this, the most common cause of errors happens when there is:

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·       Failure to check identity and dosage

·       Failure to take note of contraindications

·       Failure to record allergic reactions

·       All of the above

 

Correct answer

Failure to check identity and dosage

 

You are training the staffs on medication errors. Which is the most common error that occurs due to stressful clinical environment?

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·       Wrong dose and identity

·       Failure to capture allergies

·       Wrong contraindications

·       Wrong constitution of drug

 

Correct answer

Wrong dose and identity

 

You have discovered that the last dose of intravenous antibiotic administered to service user was the wrong dose. Which of the following should you do?

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·       Document the event in the service user’s medical record only

·       File an incident report, and document the event in the service user’s medical record

 

·       Document in the service user’s medical record that an incident report was filed

 

·       File an incident report, but don’t document the even on the service user’s record, because information about the incident is protected

 

What are the most common types of medication error?

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·       Nurses being interrupted when completing their drug rounds, different drugs being packaged similarly and stored in the same place and calculation errors

 

·       Unsafe handling and poor aseptic technique

 

·       Doctors not prescribing correctly and poor communication with the multidisciplinary team

 

·       Administration of the wrong drug, in the wrong amount to the wrong patient, via the wrong route

 

Correct answer

Administration of the wrong drug, in the wrong amount to the wrong patient, via the wrong route

 

You have been asked to give Mrs Patel her mid day oral metronidazole. You have never met her before. What do you need to check on the drug chart before you administer?

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·       Her name and address, the date of the prescription and dose

·       Her name, date of birth, the ward, consultant, the dose and route, and that it is due at 1200

 

·       Her name, date of birth, hospital number, if she has any known allergies, the prescription for metronidazole: dose, route, time, date and that it is signed by the doctor, and when it was last given

 

·       Her name and address, date of birth, name of ward and consultant, if she has any known allergies specifically to penicillin, that prescription is for metronidazole: dose, route, time, date and that it is signed by the doctor, and when it was last given and who gave it so you can check with them how she reacted

 

Correct answer

Her name, date of birth, hospital number, if she has any known allergies, the prescription for metronidazole: dose, route, time, date and that it is signed by the doctor, and when it was last given

 

You noticed that a colleague committed a medication administration error. Which should be done in this situation?

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·       You should provide a written statement and also complete a Trust incident form

·       You should inform the doctor

·       You should report this immediately to the nurse in charge

·       You should inform the patient

 

Correct answer

You should report this immediately to the nurse in charge

 

As a nurse when you are administering medication, you made an error. Taking health and safety of the patient into consideration, what is your action?

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·       Call the prescriber Report through yellow card scheme and document it in patient notes

 

·       Let the next of kin know about this and document it

 

·       Document this in patient notes and inform the line manager

 

·       Assess for potential harm to client, inform the line manager and prescriber and document in patient notes

 

Correct answer

Assess for potential harm to client, inform the line manager and prescriber and document in patient notes

 

Medication errors account for around a quarter of the incidents that threaten patient safety .in a study publishes in 2000 it was found that 10% of all patients admitted to hospital suffer an adverse event. How much of these incidents were prevented

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·       20%

·       30%

·       50%

·       60%

 

Correct answer

50%

 

How should we transport controlled drugs? Select which does not apply:

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·       Controlled drugs should be transferred in a secure, locked or sealed, tamper-evident container

 

·       Have valid ID badge

 

·       A person collecting controlled drugs should be aware of safe storage and security and the importance of handling over to an authorized person to obtain a signature

 

·       None of these answers are correct

 

Correct answer

None of these answers are correct

 

On which step of the WHO analgesic ladder would you place tramadol and codeine?

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Step 1: Non Opioid Drugs

 

Step 2: Opioids for Mild to Moderate Pain

 

Step 3: Opioids for Moderate to Severe Pain

 

Herbal medicine

 

On checking the stock balance in the controlled drug record book as a newly qualified nurse, you and a colleague notice a discrepancy. What would you do?

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·       Check the cupboard, record book and order book If the missing drugs aren't found, contact pharmacy to resolve the issue You will also complete an incident form

 

·       Document the discrepancy on an incident form and contact the senior pharmacist on duty

 

·       Check the cupboard, record book and order book  If the missing drugs aren't found the police need to be informed

 

·       Check the cupboard, record book and order book and inform the registered nurse or person in charge of the clinical area If the missing drugs are not found then inform the most senior nurse on duty You will also complete an incident form

 

 

A patient in your care is on regular oral morphine sulphate. As a qualified nurse, what legal checks do you need to carry out every time you administer it, which are in addition to those you would check for every other drug you administer?

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·       Check to see if the patient has become tolerant to the medication so it is no longer effective as analgesia

 

·       Check to see whether the patient has become addicted

 

·       Check the stock of oral morphine sulphate in the CD cupboard with another registered nurse and record this in the control drug book; together, check the correct prescription and the identity of the patient

 

·       Check the stock of oral morphine sulphate in the CD cupboard with another registered nurse and record this in the control drug book; then ask the patient to prove their identity to you

 

Correct answer

Check the stock of oral morphine sulphate in the CD cupboard with another registered nurse and record this in the control drug book; together, check the correct prescription and the identity of the patient

 

You are dispending Morphine Sulphate in the treatment room, which has been witnessed by another qualified nurse. Your patient refuses the medication when offered. What will you do next?

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·       Go back to the treatment room and write a line across your documentation on the CD book; sign it as refused

 

·       Dispose the medication using the denaturing kit, document as refused and disposed on the MARS, and write it on the nurse’s notes

 

·       Dispose the medication and document it on the patient’s care plan

 

·       Store the medication in the CD pod for an hour, and then ask your patient again if he/she wants to take his medication

 

Correct answer

Dispose the medication using the denaturing kit, document as refused and disposed on the MARS, and write it on the nurse’s notes

 

You are about to administer Morphine Sulfate to a pediatric patient. The information written on the controlled drug book was not clearly written – 15 mg or 0.15 mg. What will you do first?

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·       Not administer the drug, and wait for the General Practitioner to do his rounds

 

·       Administer 015 mg, because 15 mg is quite a big dose for a paediatric patient

 

·       Double check the medication label and the information on the controlled drug book; ring the chemist to verify the dosage

 

·       Ask a senior staff to read the medication label with you

 

You were running a shift and a pack of controlled drugs were delivered by the chemist/pharmacist whilst you were giving the morning medications. What would you do first?

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·       Keep the controlled drugs in the trolley first, then store it after you have done morning drugs

 

·       Count the controlled drugs, store them in controlled drug cabinet and record them on the controlled drug book

 

·       Count the controlled drugs, store them in the medication trolley and record them on the controlled drug book

 

·       Record them in the controlled drug book and delegate one of the carers to store them in the controlled drug cabinet

 

Correct answer

Count the controlled drugs, store them in controlled drug cabinet and record them on the controlled drug book

 

General guidance for the storage of controlled drugs should include the following except:

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·       Cupboards must be kept locked when not in use

·       Keys must only be available to authorized member of staff

 

·       Regular drugs can also be stored in the controlled drug storage

 

·       The cupboard must be dedicated to the storage of controlled drugs

 

Correct answer

Regular drugs can also be stored in the controlled drug storage

 

You were on a night shift in a ward and has been allocated to dispose controlled medications. Which of the following is correct?

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·       Controlled drugs destruction and pharmacy stock check should be done at different times

 

·       Controlled drugs should be destroyed with the use of the Denaturing Kit

 

·       Excessive quantities of controlled drugs can be stored in the cupboard whilst awaiting for destruction

 

·       None of the Above

 

Correct answer

Controlled drugs should be destroyed with the use of the Denaturing Kit

 

Manu is in persistent pain and has Oromorph PRN. All your carers are on their rounds, and you are about to administer this drug. What would you do?

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·       Dispense 10 mL Oromorph and administer immediately to relieve pain

 

·       Dispense 10 mL Oromorph and call one of the carers to witness

 

·       Call one of the carers to witness dispensing and administering the drug

 

·       Administer the drug and ask one of the carers to sign the book after their pad rounds

 

Correct answer

Call one of the carers to witness dispensing and administering the drug

 

Who has the overall responsibility for the safe and appropriate management of controlled drugs within the clinical area?

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·       All registered nurses

·       The nurse in charge

·       The consultant

·       All staff

 

Correct answer

The nurse in charge

 

The nurses on the day shift report that the controlled drug count is incorrect. What is the most appropriate nursing action?

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·       Report the discrepancy to the nurse manager and pharmacy immediately

 

·       Report the incident to the local board of nursing

 

·       Inform a doctor

 

·       Report the incident to the NMC

 

Correct answer

Report the discrepancy to the nurse manager and pharmacy immediately

 

A newly admitted client refusing to hand over his own medications and this includes controlled drugs. What is your action?

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·       You have to take it any way and document it

 

·       Call the doctor and inform about the situation

 

·       Document this refusal as these medications are his property and should not do anything without his consent

 

·       Refuse the admission as this is against the policy

 

Correct answer

Document this refusal as these medications are his property and should not do anything without his consent

 

Your patient has been prescribed Tramadol 50 mgs tablet for pain relief. Upon receipt of the tablets from the pharmacist you will:

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·       Record this in the controlled drug register book with the pharmacist witnessing

 

·       Put it in the patient’s medicine pod

 

·       Store it in ward medicine cupboard

 

·       Ask the pharmacist to give it to the patient

 

Correct answer

Record this in the controlled drug register book with the pharmacist witnessing

 

As nurses have undertaken increasingly specialized roles, the need for them to have powers to independently prescribe medications has become more apparent. What is the best definition of supplementary prescribing?

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·       A voluntary partnership between an independent prescriber and a supplementary prescriber to implement an agreed patient specific clinical management plan with the patient's agreement

 

 

·       Supplementary prescribers prescribe in partnership with a pharmacist and are able to prescribe any medicine including controlled drugs and unlicenced medicines that are listed in an agreed clinical management plan

 

·       This allows nurses who are registered as independent prescribers to prescribe any licenced medicines to include controlled drugs and unlicenced medicines but only within their own level of experience and competence

 

·       Supplementary prescribers who are appropriately qualified nurses are allowed to prescribe medications listed in the whole British National Formulary (BNF)

 

When acting in their capacity under a Patient Group Directions (PGD), nurses are authorized to:

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·       Supply or offer to supply diamorphine and morphine where administration of such drugs is required for the immediate, necessary treatment of sick or injured persons including addiction in any setting

 

·       Supply or administer any Schedule 3 or 4 controlled drug in accordance with a PGD except anabolic steroids in Part 2 of Schedule 4 and inject able preparations of treating a person who is addicted to the drug

 

·       Prescribe a controlled drug provided that the drug is included in the clinical management plan as the authority to prescribe is given on the basis that nurses must only prescribe within their competence

 

·       Prescribe any controlled drug listed in Schedule 1-5 for any medical condition, except diamorphine, cocaine and dipipanone  for the treatment of addiction as the authority to prescribe is given on the basis that nurses must only prescribe within their competence.