Free ISMP Safe Medication Principles Questions and Answers — Questions and Answers
Question 1: The ________ is the earliest and most sensitive indication of an acute malignant hyperthermia crisis.
- Nausea and vomiting
- An increase in end-tidal carbon dioxide (Correct answer)
- Sudden increase in body temperature
- Crying patient
Correct answer: An increase in end-tidal carbon dioxide
An increase in end-tidal carbon dioxide (ETCO2) is recognized as the earliest and most sensitive indicator of an acute malignant hyperthermia (MH) crisis. MH is a rare but life-threatening reaction to certain anesthetic agents. The sudden, unexplained rise in ETCO2 reflects the hypermetabolic state and increased CO2 production characteristic of MH, often occurring before a significant rise in body temperature.
Question 2: Which medication do you take in a mental health crisis?
- Ryanodex
- Dantrium
- Revonto
- Dantrolene (Correct answer)
- All of the above
Correct answer: Dantrolene
Dantrolene is the specific medication used to treat malignant hyperthermia (MH), a severe and potentially fatal reaction that can occur during or after certain types of anesthesia. It works by interfering with calcium release from the sarcoplasmic reticulum in muscle cells, thereby reducing the muscle rigidity and hypermetabolism associated with MH. Ryanodex, Dantrium, and Revonto are different formulations or brand names of dantrolene.
Question 3: What are the two acceptable methods for destroying controlled narcotics, according to the DEA?
- placing whole pills or liquids into the trash can
- incineration or chemical digestion (Correct answer)
- flushing and running down the drain
- coffee grounds and kitty litter
Correct answer: incineration or chemical digestion
The DEA has strict regulations for the destruction of controlled narcotics to prevent diversion and abuse. The two acceptable methods for rendering controlled substances non-retrievable and unusable are incineration (burning at a high temperature) or chemical digestion. Other methods like flushing or placing in trash with coffee grounds/kitty litter are generally not compliant for controlled substances in healthcare settings.
Question 4: All of these are effective strategies to prevent the abuse of substances that sound alike and look alike (SALAD), with the exception of
- storing SALAD in separate areas
- putting stickers on all SALAD
- posting the SALAD list provided by the Institute for Safe Medication Practice (ISMP)
- identifying SALAD on your facility's printed formulary (Correct answer)
Correct answer: identifying SALAD on your facility's printed formulary
Identifying SALAD (Sound-Alike, Look-Alike Drug) medications solely on a facility's *printed* formulary is generally not an effective standalone strategy to prevent errors. This method doesn't actively prevent selection errors at the point of prescribing or dispensing. Effective strategies involve active barriers like physical separation, using visual alerts (stickers), and referencing comprehensive lists from organizations like ISMP to directly mitigate confusion during medication processes.
Question 5: Reconstituted vancomycin 1 gram vials require 20 ml of sterile water for injection. How many ml are required after reconstituting with the SWFI for a dose of 750 mg?
- 7.5 ml
- 20 ml
- 15 ml (Correct answer)
- 10 ml
- none of the above
Correct answer: 15 ml
To solve this, first calculate the concentration of the reconstituted vancomycin. 1 gram (1000 mg) dissolved in 20 ml yields a concentration of 1000 mg / 20 ml = 50 mg/ml. To determine the volume needed for a 750 mg dose, divide the desired dose by the concentration: 750 mg / (50 mg/ml) = 15 ml. Therefore, 15 ml is required for a 750 mg dose.
Question 6: Where can you find and utilize sterile, multiple-dose injectable medications?
- in the medication room (Correct answer)
- in the operating room
- at the patient bedside
- on the medication cart in the OR hallway
Correct answer: in the medication room
Sterile, multiple-dose injectable medications should be stored and prepared in a designated, clean medication room or preparation area. This environment helps maintain sterility, reduces the risk of contamination, and allows for proper labeling and handling according to established protocols. Using them at the patient bedside or in hallways increases the risk of contamination and medication errors.
Question 7: When are single-dose vials appropriate for usage in numerous patients?
- the syringe has all the proper labeling requirements
- the syringe is prepared in a medication prep area in advance of medication administration
- there's a national shortage and it's difficult to obtain the drug
- Never (Correct answer)
Correct answer: Never
Single-dose vials are designed for use on a single patient for a single administration and should never be used for multiple patients. Once accessed, the sterility of the vial cannot be guaranteed for subsequent uses, even with proper labeling or preparation. Using single-dose vials for multiple patients poses a significant risk of contamination and transmission of infections, making it an unsafe practice.
Free ISMP Safe Medication Principles Questions and Answers
The ________ is the earliest and most sensitive indication of an acute malignant hyperthermia crisis.