Medication Safety Competency Exam —
Code: NUR-MEDSAFE | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse prepares to administer digoxin to an older adult. The patient's
apical pulse is 54/min, and the patient reports nausea and seeing yellow-
green halos. What is the nurse's priority action?
A. Administer the medication with food
B. Recheck the pulse after 30 minutes
C. Hold the digoxin and notify the healthcare provider
D. Administer half of the prescribed dose
Answer: Hold the digoxin and notify the healthcare provider
,Rationale: Bradycardia, nausea, and visual disturbances are classic findings
associated with digoxin toxicity. The nurse should withhold the medication and
promptly notify the healthcare provider for further evaluation.
2. A patient is prescribed an IV medication that is considered a high-alert
medication. Which nursing action best reduces the risk of a serious
medication error?
A. Prepare the medication quickly to avoid delays
B. Ask another patient to verify the medication
C. Perform an independent double-check according to institutional policy
D. Document administration before giving the medication
Answer: Perform an independent double-check according to institutional policy
Rationale: High-alert medications can cause significant harm when
administered incorrectly. An independent double-check helps identify errors
involving the medication, dose, route, patient, and pump settings before
administration.
3. A nurse receives an order for potassium chloride 40 mEq IV push. What
should the nurse do?
A. Administer it slowly over 10 minutes
B. Dilute it with sterile water and administer IV push
C. Question the order because concentrated potassium chloride must not be
administered IV push
D. Administer it through a central line using a syringe pump
Answer: Question the order because concentrated potassium chloride must not
be administered IV push
Rationale: Concentrated potassium chloride given by IV push can cause fatal
dysrhythmias and cardiac arrest. Potassium replacement should be
appropriately diluted and administered at a controlled rate according to
institutional protocols.
, 4. A patient receiving warfarin has an INR of 5.8 and reports new gum
bleeding. What is the priority nursing action?
A. Administer the scheduled warfarin
B. Encourage increased intake of vitamin K immediately
C. Hold the medication and notify the healthcare provider
D. Recheck the INR in one month
Answer: Hold the medication and notify the healthcare provider
Rationale: A markedly elevated INR combined with active bleeding indicates
increased hemorrhage risk. Warfarin should be withheld and the patient
promptly evaluated for appropriate management.
5. A nurse is administering insulin. Which practice is safest?
A. Use a standard 5-mL syringe
B. Draw insulin using any available syringe
C. Use an insulin syringe calibrated in insulin units and verify the dose carefully
D. Estimate the dose based on the patient's meal size
Answer: Use an insulin syringe calibrated in insulin units and verify the dose
carefully
Rationale: Insulin is a high-alert medication. Using the appropriate insulin
syringe and carefully verifying the dose reduces the risk of potentially serious
dosing errors.
6. A nurse discovers that a patient received another patient's medication.
What is the nurse's first priority?
A. Complete an incident report
B. Notify the pharmacy
C. Assess the patient for adverse effects and immediate clinical instability
D. Document the error at the end of the shift
Answer: Assess the patient for adverse effects and immediate clinical instability
, Rationale: After a medication error, patient safety takes priority. The nurse
should immediately assess the patient, stabilize the patient if necessary, and
then follow organizational procedures for notification and reporting.
7. A patient taking an ACE inhibitor develops facial swelling and difficulty
breathing. What is the priority intervention?
A. Administer the next dose with food
B. Place the patient flat and reassess in one hour
C. Treat the reaction as an emergency and initiate appropriate airway
management measures
D. Encourage oral fluids
Answer: Treat the reaction as an emergency and initiate appropriate airway
management measures
Rationale: Facial and airway swelling may indicate angioedema, a potentially
life-threatening adverse reaction to ACE inhibitors. Airway compromise must be
addressed immediately.
8. A medication label reads "0.5 mg," while the electronic order reads "5 mg."
What should the nurse do?
A. Administer 5 mg because the electronic order is newer
B. Administer 0.5 mg because it is printed on the label
C. Stop the medication process and clarify the discrepancy before
administration
D. Ask another nurse to choose the dose
Answer: Stop the medication process and clarify the discrepancy before
administration
Rationale: A discrepancy between the prescription and medication label must be
resolved before administration. Guessing or selecting one dose independently
could cause a tenfold medication error.
Code: NUR-MEDSAFE | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse prepares to administer digoxin to an older adult. The patient's
apical pulse is 54/min, and the patient reports nausea and seeing yellow-
green halos. What is the nurse's priority action?
A. Administer the medication with food
B. Recheck the pulse after 30 minutes
C. Hold the digoxin and notify the healthcare provider
D. Administer half of the prescribed dose
Answer: Hold the digoxin and notify the healthcare provider
,Rationale: Bradycardia, nausea, and visual disturbances are classic findings
associated with digoxin toxicity. The nurse should withhold the medication and
promptly notify the healthcare provider for further evaluation.
2. A patient is prescribed an IV medication that is considered a high-alert
medication. Which nursing action best reduces the risk of a serious
medication error?
A. Prepare the medication quickly to avoid delays
B. Ask another patient to verify the medication
C. Perform an independent double-check according to institutional policy
D. Document administration before giving the medication
Answer: Perform an independent double-check according to institutional policy
Rationale: High-alert medications can cause significant harm when
administered incorrectly. An independent double-check helps identify errors
involving the medication, dose, route, patient, and pump settings before
administration.
3. A nurse receives an order for potassium chloride 40 mEq IV push. What
should the nurse do?
A. Administer it slowly over 10 minutes
B. Dilute it with sterile water and administer IV push
C. Question the order because concentrated potassium chloride must not be
administered IV push
D. Administer it through a central line using a syringe pump
Answer: Question the order because concentrated potassium chloride must not
be administered IV push
Rationale: Concentrated potassium chloride given by IV push can cause fatal
dysrhythmias and cardiac arrest. Potassium replacement should be
appropriately diluted and administered at a controlled rate according to
institutional protocols.
, 4. A patient receiving warfarin has an INR of 5.8 and reports new gum
bleeding. What is the priority nursing action?
A. Administer the scheduled warfarin
B. Encourage increased intake of vitamin K immediately
C. Hold the medication and notify the healthcare provider
D. Recheck the INR in one month
Answer: Hold the medication and notify the healthcare provider
Rationale: A markedly elevated INR combined with active bleeding indicates
increased hemorrhage risk. Warfarin should be withheld and the patient
promptly evaluated for appropriate management.
5. A nurse is administering insulin. Which practice is safest?
A. Use a standard 5-mL syringe
B. Draw insulin using any available syringe
C. Use an insulin syringe calibrated in insulin units and verify the dose carefully
D. Estimate the dose based on the patient's meal size
Answer: Use an insulin syringe calibrated in insulin units and verify the dose
carefully
Rationale: Insulin is a high-alert medication. Using the appropriate insulin
syringe and carefully verifying the dose reduces the risk of potentially serious
dosing errors.
6. A nurse discovers that a patient received another patient's medication.
What is the nurse's first priority?
A. Complete an incident report
B. Notify the pharmacy
C. Assess the patient for adverse effects and immediate clinical instability
D. Document the error at the end of the shift
Answer: Assess the patient for adverse effects and immediate clinical instability
, Rationale: After a medication error, patient safety takes priority. The nurse
should immediately assess the patient, stabilize the patient if necessary, and
then follow organizational procedures for notification and reporting.
7. A patient taking an ACE inhibitor develops facial swelling and difficulty
breathing. What is the priority intervention?
A. Administer the next dose with food
B. Place the patient flat and reassess in one hour
C. Treat the reaction as an emergency and initiate appropriate airway
management measures
D. Encourage oral fluids
Answer: Treat the reaction as an emergency and initiate appropriate airway
management measures
Rationale: Facial and airway swelling may indicate angioedema, a potentially
life-threatening adverse reaction to ACE inhibitors. Airway compromise must be
addressed immediately.
8. A medication label reads "0.5 mg," while the electronic order reads "5 mg."
What should the nurse do?
A. Administer 5 mg because the electronic order is newer
B. Administer 0.5 mg because it is printed on the label
C. Stop the medication process and clarify the discrepancy before
administration
D. Ask another nurse to choose the dose
Answer: Stop the medication process and clarify the discrepancy before
administration
Rationale: A discrepancy between the prescription and medication label must be
resolved before administration. Guessing or selecting one dose independently
could cause a tenfold medication error.
