Which of these is a high-alert medication that needs an independent double check before giving?

Concentrated potassium chloride

On a ward, morphine and pethidine are stored in a:

Open shelf in the treatment room

Sublingual nitroglycerin tablets are kept in their tightly closed dark glass bottle because:

Light, air and moisture break the drug down

The tablets react with plastic containers

Children cannot open glass bottles

They must be kept cold in the refrigerator

Clinical pharmacology and drug administration

25 Kerala PSC Staff Nurse Gr II practice questions on Clinical pharmacology and drug administration, part of Fundamentals of Nursing and First Aid. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Which of these is a high-alert medication that needs an independent double check before giving?
1. AOral rehydration salts
2. BConcentrated potassium chloride
3. CParacetamol tablets
4. DVitamin C tablets
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Answer: B · Concentrated potassium chloride
High-alert drugs are those that cause serious harm when given in error, such as concentrated potassium chloride, insulin, heparin and opioids. A bolus of concentrated KCl can stop the heart. These drugs are stored separately, labelled and checked by two nurses. KCl is always diluted and infused at a controlled rate.
- A: ORS is a low-risk preparation.
- C: Paracetamol at normal doses is not on high-alert lists.
- D: Vitamin C has a wide safety margin.
Question 2 · Easy
On a ward, morphine and pethidine are stored in a:
1. AOpen shelf in the treatment room
2. BPatient's bedside locker
3. CDouble-locked cupboard
4. DDrug trolley left unlocked
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Answer: C · Double-locked cupboard
Narcotic and other controlled drugs are kept in a double-locked cupboard, with the key held by the nurse in charge. Each dose is entered in a controlled drug register with the patient's name, dose, balance and signatures. Stock is counted at each change of shift. These rules prevent misuse and diversion.
- A: An open shelf allows anyone to take controlled drugs.
- B: Controlled drugs are never left with the patient.
- D: An unlocked trolley breaks the safe-custody rule.
Question 3 · Easy
A drug injected into the subarachnoid space is given by the:
1. AIntraosseous route
2. BEpidural route
3. CIntra-articular route
4. DIntrathecal route
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Answer: D · Intrathecal route
Intrathecal means into the cerebrospinal fluid in the subarachnoid space, as in spinal anaesthesia and some cancer drugs. Epidural drugs stay outside the dura. Intra-articular injections go into a joint and intraosseous into bone marrow. Only preservative-free drugs meant for intrathecal use may be given this way.
- A: Intraosseous means into the marrow of a bone.
- B: The epidural space lies outside the dura, not in the subarachnoid space.
- C: Intra-articular means into a joint cavity.
Question 4 · Easy
Unopened insulin vials should be stored:
1. AIn the freezer compartment
2. BIn a refrigerator at 2-8 °C
3. COn a sunny window sill
4. DIn a warm drawer above 30 °C
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Answer: B · In a refrigerator at 2-8 °C
Unopened insulin is kept in the refrigerator at 2-8 °C, away from the freezer. Freezing and heat both destroy the protein and make the insulin lose strength. A vial in use may be kept at room temperature, below about 25-30 °C, for about 4 weeks. Frozen insulin must be thrown away.
- A: Freezing denatures insulin, so frozen vials must be discarded.
- C: Sunlight and heat break down insulin.
- D: Temperatures above 30 °C reduce insulin potency.
Question 5 · Medium
Sublingual nitroglycerin tablets are kept in their tightly closed dark glass bottle because:
1. AThe tablets react with plastic containers
2. BLight, air and moisture break the drug down
3. CChildren cannot open glass bottles
4. DThey must be kept cold in the refrigerator
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Answer: B · Light, air and moisture break the drug down
Nitroglycerin is volatile and is decomposed by light, heat, air and moisture, so it is kept in the original amber glass bottle with the cap tight. Tablets carried loose or in a pill box lose strength. A fresh tablet usually gives a slight tingling or burning under the tongue. The patient replaces the stock by the expiry date.
- A: Glass is used to stop loss of the volatile drug; reaction with plastic is not the main reason.
- C: Child safety is achieved by caps, not by the glass.
- D: Nitroglycerin tablets are stored at room temperature, not in a fridge.
Question 6 · Easy
The five rights of drug administration are right patient, drug, dose, route and:
1. ATime
2. BDoctor
3. CPharmacy
4. DPrice
Answer and explanation in LearnFree account
Question 7 · Easy
The abbreviation 'h.s.' on a prescription means:
1. AHalf strength
2. BAt bedtime
3. CEvery hour
4. DBefore meals
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Question 8 · Easy
One teaspoon of a liquid medicine is taken as:
1. A5 mL
2. B15 mL
3. C2.5 mL
4. D10 mL
Answer and explanation in LearnFree account
Question 9 · Hard
A nurse draws U-40 insulin to the 20-unit mark of a U-100 insulin syringe. How much insulin does the patient actually receive?
1. A12 units, an underdose
2. B50 units, an overdose
3. C20 units, the correct dose
4. D8 units, an underdose
Answer and explanation in LearnFree account
Question 10 · Hard
A patient receives 500 mL of 5% dextrose. How many grams of glucose has he received?
1. A25 g
2. B2.5 g
3. C5 g
4. D50 g
Answer and explanation in LearnFree account
Question 11 · Hard
At the bedside a patient says, 'This white tablet is not the yellow one I take every morning.' What should the nurse do?
1. ATell him the colour does not matter
2. BRecord that the patient refused it
3. CHold the dose and recheck the order
4. DGive it and recheck the chart later
Answer and explanation in LearnFree account
Question 12 · Medium
A diabetic patient has soft, rubbery swellings on the abdomen where he always injects insulin. This is due to:
1. ALipoatrophy from impure insulin
2. BAbscesses from poor skin preparation
3. CInsulin allergy at the injection sites
4. DLipohypertrophy from not rotating sites
Answer and explanation in LearnFree account
Question 13 · Easy
A drug ordered 'q.i.d.' is given:
1. AFour times a day
2. BOnce a day
3. CThree times a day
4. DEvery other day
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Question 14 · Easy
Atropine eye drops, used to dilate the pupil before an eye examination, are a:
1. AKeratolytic
2. BAnticholinesterase
3. CMydriatic
4. DMiotic
Answer and explanation in LearnFree account
Question 15 · Easy
A drug order written as 'stat' should be given:
1. AAt bedtime
2. BOnly when needed
3. CTwice a day
4. DImmediately, once
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Question 16 · Medium
A drug is said to have a narrow therapeutic index when:
1. AIt needs a loading dose to start working
2. BIts toxic dose is close to its effective dose
3. CIt is excreted mainly through the kidney
4. DIt acts on only one type of receptor
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Question 17 · Medium
Toxicity that builds up when a slowly excreted drug such as digoxin is given repeatedly is called:
1. ATachyphylaxis
2. BCumulation
3. CIdiosyncrasy
4. DTolerance
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Question 18 · Easy
In the apothecary system, 1 grain is approximately equal to:
1. A30 mg
2. B60 mg
3. C100 mg
4. D15 mg
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Question 19 · Medium
Tab. metformin 0.5 g is ordered. Tablets in stock contain 250 mg each. How many tablets are given?
1. A5 tablets
2. B1 tablet
3. C2 tablets
4. D½ tablet
Answer and explanation in LearnFree account
Question 20 · Medium
Digoxin 0.125 mg is the same as:
1. A1.25 micrograms
2. B1250 micrograms
3. C125 micrograms
4. D12.5 micrograms
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Question 21 · Hard
A 1,000 mL bag of normal saline is started at 08:00 to run at 125 mL/h. When is it expected to finish?
1. A18:00
2. B16:00
3. C20:00
4. D12:00
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Question 22 · Medium
A patient on oral tetracycline is told not to take it with milk because milk:
1. ABinds the drug and reduces its absorption
2. BIncreases the risk of photosensitivity
3. CCauses the drug to irritate the stomach
4. DSpeeds the drug's excretion by the kidney
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Question 23 · Medium
A child is advised to take liquid iron through a straw mainly to:
1. AImprove absorption of the iron
2. BMask the bitter taste of iron
3. CReduce the risk of constipation
4. DPrevent staining of the teeth
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Question 24 · Medium
The main purpose of filling an incident report after a medication error is to:
1. ADecide on disciplinary action for the nurse
2. BFind the cause and prevent a recurrence
3. CRecord the error in the patient's case sheet
4. DInform the patient's family about the error
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Question 25 · Hard
500 mL of 5% dextrose is to run over 4 hours with a set delivering 15 drops/mL. What is the drip rate?
1. A125 drops/min
2. B21 drops/min
3. C31 drops/min
4. D42 drops/min
Answer and explanation in LearnFree account

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Clinical pharmacology and drug administration

Which of these is a high-alert medication that needs an independent double check before giving?

On a ward, morphine and pethidine are stored in a:

A drug injected into the subarachnoid space is given by the:

Unopened insulin vials should be stored:

Sublingual nitroglycerin tablets are kept in their tightly closed dark glass bottle because:

The five rights of drug administration are right patient, drug, dose, route and:

The abbreviation 'h.s.' on a prescription means:

One teaspoon of a liquid medicine is taken as:

A nurse draws U-40 insulin to the 20-unit mark of a U-100 insulin syringe. How much insulin does the patient actually receive?

A patient receives 500 mL of 5% dextrose. How many grams of glucose has he received?

At the bedside a patient says, 'This white tablet is not the yellow one I take every morning.' What should the nurse do?

A diabetic patient has soft, rubbery swellings on the abdomen where he always injects insulin. This is due to:

A drug ordered 'q.i.d.' is given:

Atropine eye drops, used to dilate the pupil before an eye examination, are a:

A drug order written as 'stat' should be given:

A drug is said to have a narrow therapeutic index when:

Toxicity that builds up when a slowly excreted drug such as digoxin is given repeatedly is called:

In the apothecary system, 1 grain is approximately equal to:

Tab. metformin 0.5 g is ordered. Tablets in stock contain 250 mg each. How many tablets are given?

Digoxin 0.125 mg is the same as:

A 1,000 mL bag of normal saline is started at 08:00 to run at 125 mL/h. When is it expected to finish?

A patient on oral tetracycline is told not to take it with milk because milk:

A child is advised to take liquid iron through a straw mainly to:

The main purpose of filling an incident report after a medication error is to:

500 mL of 5% dextrose is to run over 4 hours with a set delivering 15 drops/mL. What is the drip rate?