Medicines management and administration: DipIMC practice questions
PHEM curriculum unit 3.5 · Theme 3: Using Pre-hospital Equipment
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 3.5, Manage and administer medicines.
Below are 3 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 55 questions on this unit.
Question 1 · Law, Ethics & Human Factors · Easy
A doctor on an immediate care scheme is completing the drug section of a patient report form after treating a child. Following the documentation conventions set out in the JRCALC medicines overview, which entry is written correctly?
AAdrenaline 0.15 mg (0.15 ml) intramuscular
BParacetamol 0.5 g (10 ml) oral suspension
CMorphine sulfate 3.0 mg (3 ml) intravenous
DNaloxone 400 mcg (1 ml) intramuscular thigh
EMidazolam 2.5 mg (0.5 ml) buccal solution
Show answer
Answer: E
Midazolam 2.5 mg (0.5 ml) buccal solution
The JRCALC medicines overview (Table 7.1) sets out the documentation conventions. Unnecessary decimal points are avoided, so 3 mg, not 3.0 mg. Quantities of 1 gram or more are written in grams, but quantities under a gram are written in milligrams, so 500 mg, not 0.5 g. Quantities under a milligram are written in micrograms, so 150 micrograms, not 0.15 mg. 'Micrograms', 'nanograms' and 'units' are not abbreviated, so 'mcg' is wrong. Where a decimal cannot be avoided, a zero is written before the point when there is no other figure, so 0.5 ml, not .5 ml. The midazolam entry obeys every rule: the 2.5 mg dose genuinely needs its decimal, the volume carries a leading zero, and the units are standard. Each of the others breaks exactly one convention. Misread doses are a common source of medication error, and the same conventions apply on the patient record and at handover.
Question 2 · Law, Ethics & Human Factors · Moderate
After giving 6 mg from a 10 mg morphine ampoule to a patient with a femoral fracture, a paramedic on a rapid response car has 4 mg left in the syringe. Which statement about the handling of the remainder is correct?
ADiscard it before a witness and record it in the controlled drug register
BDiscard it alone, recording only the 6 mg given on the patient report form
CKeep the labelled syringe in the drug bag for the next patient who needs morphine
DReturn it to the receiving hospital's pharmacy for destruction by a pharmacist
EHand it to the emergency department nurse to be discarded with the ward's stock
Show answer
Answer: A
Discard it before a witness and record it in the controlled drug register
JRCALC records that morphine injection is a Class A controlled drug in Schedule 2 of the Misuse of Drugs Regulations 2001, subject to the Misuse of Drugs (Safe Custody) Regulations 1973: it must be stored securely, its movements recorded in a controlled drug register, and it may be possessed and administered only by healthcare professionals authorised in the legislation. Unused morphine in an opened vial or syringe must be discarded in the presence of a witness. Discarding it alone skips the witness; keeping a part-used syringe for another patient is unsafe; and handing it to the hospital pharmacy or ward staff moves the ambulance clinician's own controlled drug outside the organisation's accountable system. Under the Controlled Drugs (Supervision of Management and Use) Regulations 2013, each designated body must appoint a fit, proper and suitably experienced person as its controlled drugs accountable officer, so the disposal belongs within the organisation's own governed system.
Where this comes from
JRCALC Clinical Guidelines — Morphine sulfateJRCALC / AACE·Additional information: Schedule 2 controlled drug and CD register“Morphine sulfate — additional information: Schedule 2 controlled drug”
JRCALC Clinical Guidelines — Morphine sulfateJRCALC / AACE·Additional information: witnessed discard of unused morphine“Morphine sulfate — additional information: unused morphine discarded in the presence of a witness”
law-117 · Law, Ethics & Human Factors · Law & Ethics · Moderate · v3
Question 3 · Law, Ethics & Human Factors · Hard
A crew is preparing an intravenous drug for a 7-year-old, calculating the volume to draw up from a weight-based dose. One clinician draws it up while the other is with the parents. Under the six rights and double-check guidance in the JRCALC medicines overview, which statement is correct?
AAn independent second check is required only for controlled drugs, not for other injectable medicines
BThe clinician who prepared the drug, not the one who gives it, is responsible for the administration
CNo independent check is needed when the dose and volume are read directly from the Page for Age table
DAn independent check of medicine, dose, route and expiry matters particularly for a child under 12
EIf no second clinician is available, the drug must be withheld until one arrives, whatever the urgency
Show answer
Answer: D
An independent check of medicine, dose, route and expiry matters particularly for a child under 12
The JRCALC medicines overview sets out the six rights of administration (right patient, reason, medicine, route, dose and documentation) and says that, whenever possible, a second check by another member of staff must be obtained before administration. The check is an independent double check of the medicine, dose, route and expiry, and JRCALC singles out four situations where it is important: children under 12 years, injectable medicines, calculations and controlled drugs, so it is not confined to controlled drugs; this case meets three of the four. JRCALC also states that nothing should be administered unless the administering clinician has seen the container from which the medicine came, and that the person who administers is responsible for the administration regardless of who prepared the drug. Reading from a Page for Age table does not remove the need to check, because the 'right dose' step itself warns the clinician to make sure the table has been read correctly. Because JRCALC asks for the second check whenever it is possible, a time-critical drug is not withheld simply because a second clinician is absent; if unsure, JRCALC advises seeking advice from the clinical team.
Where this comes from
JRCALC Clinical Guidelines — Medicines overview (D0010)JRCALC / AACE·2. Safety aspects: six rights and double checks“Medicines overview — 2. Safety aspects: six rights and double checks”
JRCALC Clinical Guidelines — Medicines overview (D0010)JRCALC / AACE·Key points: second check, original container, responsibility for administration“Medicines overview — key points: second check, original container, administering clinician responsible”
law-118 · Law, Ethics & Human Factors · Clinical Governance · Hard · v2