Adult Critical Care Medication Safety
Examination DEFINED ANSWERS LATEST
ALREADY GRADED A+ (2025/2026
1. A nurse is preparing to administer IV epinephrine for anaphylactic shock. The
order reads “epinephrine 0.3 mg IM.” The nurse accidentally draws up 1:1000
epinephrine and administers it intravenously. What is the primary safety concern?
A) Inadequate absorption
B) Severe hypertension and arrhythmias due to rapid IV administration of IM
concentration
C) Hypotension due to beta-2 stimulation
D) Anaphylaxis from preservatives
Answer: B
Rationale: 1:1000 epinephrine (1 mg/mL) is formulated for intramuscular
injection. IV administration of this concentration can cause an acute hypertensive
crisis and ventricular arrhythmias. The IV formulation for emergencies is typically
1:10,000 (0.1 mg/mL).
---
2. Which medication order requires an independent double-check before
administration in the ICU?
A) Acetaminophen 650 mg PO
B) IV insulin infusion
C) Normal saline 0.9% at 75 mL/h
,D) Ondansetron 4 mg IV push
Answer: B
Rationale: Insulin is a high-alert medication. IV insulin infusions require
independent verification by a second nurse of the drug, dose, pump settings, and
patient identity to prevent severe hypo- or hyperglycemia.
---
3. During a code blue, a nurse retrieves an ampule labeled “ephedrine” when
“epinephrine” was requested. This error is an example of:
A) Wrong dose error
B) Look-alike, sound-alike (LASA) drug confusion
C) Equipment failure
D) Illegible handwriting
Answer: B
Rationale: Ephedrine and epinephrine have similar names and appearance and
are often stored near each other on crash carts. Confusion can lead to
administration of the wrong vasopressor with markedly different potency and
indications.
---
4. A critically ill patient receiving a continuous infusion of norepinephrine
develops extravasation. What is the recommended immediate management?
A) Apply cold compress only
B) Administer phentolamine infiltration into the area
,C) Administer hyaluronidase
D) Elevate the limb and wait
Answer: B
Rationale: Norepinephrine is a potent vasoconstrictor; extravasation can cause
tissue ischemia and necrosis. The antidote phentolamine (an alpha-adrenergic
blocker) is infiltrated subcutaneously to vasodilate and improve blood flow.
---
5. A patient on a heparin drip for pulmonary embolism has an aPTT of 120
seconds (therapeutic range 60–80). The protocol instructs to hold heparin for 1
hour and decrease the rate. What is the primary safety rationale?
A) To prevent heparin-induced thrombocytopenia
B) To avoid excessive bleeding risk from supratherapeutic anticoagulation
C) To prevent allergic reaction
D) To reduce cost of heparin
Answer: B
Rationale: A supratherapeutic aPTT indicates excessive anticoagulation and
heightened bleeding risk. Holding the infusion and reducing the rate per protocol
mitigates this danger. HIT is immune-mediated, not directly related to aPTT levels.
---
6. Which medication should be administered via a dedicated central line when
possible due to its vesicant properties and high risk of extravasation injury?
A) Vancomycin
, B) Norepinephrine
C) Furosemide
D) Magnesium sulfate
Answer: B
Rationale: Norepinephrine is a potent vesicant. Extravasation causes severe tissue
necrosis; central line administration is preferred. If a peripheral line must be used,
frequent site monitoring and availability of phentolamine are required.
---
7. The ICU nurse is about to administer IV push potassium chloride 20 mEq over
10 minutes. What is the immediate safety concern?
A) The rate is too fast; potassium chloride must never be given as IV push
B) Concentration is too high for peripheral line
C) Order is missing indication
D) Patient needs cardiac monitoring, but it’s optional
Answer: A
Rationale: Potassium chloride must never be given IV push because it can cause
fatal cardiac arrhythmias and cardiac arrest. It must be diluted and administered
as a slow infusion, typically at rates not exceeding 10–20 mEq/h.
---
8. A smart infusion pump with dose error reduction software is used for a
propofol infusion. The nurse bypasses the drug library and programs rate in mL/h.
What is the primary risk?
Examination DEFINED ANSWERS LATEST
ALREADY GRADED A+ (2025/2026
1. A nurse is preparing to administer IV epinephrine for anaphylactic shock. The
order reads “epinephrine 0.3 mg IM.” The nurse accidentally draws up 1:1000
epinephrine and administers it intravenously. What is the primary safety concern?
A) Inadequate absorption
B) Severe hypertension and arrhythmias due to rapid IV administration of IM
concentration
C) Hypotension due to beta-2 stimulation
D) Anaphylaxis from preservatives
Answer: B
Rationale: 1:1000 epinephrine (1 mg/mL) is formulated for intramuscular
injection. IV administration of this concentration can cause an acute hypertensive
crisis and ventricular arrhythmias. The IV formulation for emergencies is typically
1:10,000 (0.1 mg/mL).
---
2. Which medication order requires an independent double-check before
administration in the ICU?
A) Acetaminophen 650 mg PO
B) IV insulin infusion
C) Normal saline 0.9% at 75 mL/h
,D) Ondansetron 4 mg IV push
Answer: B
Rationale: Insulin is a high-alert medication. IV insulin infusions require
independent verification by a second nurse of the drug, dose, pump settings, and
patient identity to prevent severe hypo- or hyperglycemia.
---
3. During a code blue, a nurse retrieves an ampule labeled “ephedrine” when
“epinephrine” was requested. This error is an example of:
A) Wrong dose error
B) Look-alike, sound-alike (LASA) drug confusion
C) Equipment failure
D) Illegible handwriting
Answer: B
Rationale: Ephedrine and epinephrine have similar names and appearance and
are often stored near each other on crash carts. Confusion can lead to
administration of the wrong vasopressor with markedly different potency and
indications.
---
4. A critically ill patient receiving a continuous infusion of norepinephrine
develops extravasation. What is the recommended immediate management?
A) Apply cold compress only
B) Administer phentolamine infiltration into the area
,C) Administer hyaluronidase
D) Elevate the limb and wait
Answer: B
Rationale: Norepinephrine is a potent vasoconstrictor; extravasation can cause
tissue ischemia and necrosis. The antidote phentolamine (an alpha-adrenergic
blocker) is infiltrated subcutaneously to vasodilate and improve blood flow.
---
5. A patient on a heparin drip for pulmonary embolism has an aPTT of 120
seconds (therapeutic range 60–80). The protocol instructs to hold heparin for 1
hour and decrease the rate. What is the primary safety rationale?
A) To prevent heparin-induced thrombocytopenia
B) To avoid excessive bleeding risk from supratherapeutic anticoagulation
C) To prevent allergic reaction
D) To reduce cost of heparin
Answer: B
Rationale: A supratherapeutic aPTT indicates excessive anticoagulation and
heightened bleeding risk. Holding the infusion and reducing the rate per protocol
mitigates this danger. HIT is immune-mediated, not directly related to aPTT levels.
---
6. Which medication should be administered via a dedicated central line when
possible due to its vesicant properties and high risk of extravasation injury?
A) Vancomycin
, B) Norepinephrine
C) Furosemide
D) Magnesium sulfate
Answer: B
Rationale: Norepinephrine is a potent vesicant. Extravasation causes severe tissue
necrosis; central line administration is preferred. If a peripheral line must be used,
frequent site monitoring and availability of phentolamine are required.
---
7. The ICU nurse is about to administer IV push potassium chloride 20 mEq over
10 minutes. What is the immediate safety concern?
A) The rate is too fast; potassium chloride must never be given as IV push
B) Concentration is too high for peripheral line
C) Order is missing indication
D) Patient needs cardiac monitoring, but it’s optional
Answer: A
Rationale: Potassium chloride must never be given IV push because it can cause
fatal cardiac arrhythmias and cardiac arrest. It must be diluted and administered
as a slow infusion, typically at rates not exceeding 10–20 mEq/h.
---
8. A smart infusion pump with dose error reduction software is used for a
propofol infusion. The nurse bypasses the drug library and programs rate in mL/h.
What is the primary risk?
