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NMC CBT·ModuleMEDICINES-MANAGEMENT

Module 5: Medicines Management and Pharmacology

Module 5 assesses the medicines management and pharmacology knowledge required for safe UK nursing practice. Topics include the six rights of medication administration, legal frameworks for medicines, controlled drug storage, checking and administration, patient group directions, non-medical prescribing, pharmacokinetics (ADME), pharmacodynamics, drug receptor theory, therapeutic index, analgesics, antibiotics, cardiovascular and respiratory drugs, types of adverse drug reactions, drug interactions and contraindications, anaphylaxis recognition and emergency management, and medication error reporting.

Questions
690
Units
4
Topics
16

What’s in it.

4 units

Sample questions

3 of many

A few questions from this module, with the answer and a full explanation. The complete bank is available when you start practising.

  1. A nurse is caring for a patient newly prescribed Trelegy Ellipta once daily. The patient has previously used a salbutamol inhaler twice daily as their only treatment. What educational point is MOST important?

    • Trelegy's LAMA component provides immediate relief during acute breathlessness, making salbutamol redundant
    • Trelegy replaces salbutamol completely; no additional reliever inhaler is needed once established on triple therapy
    • Trelegy is a once-daily maintenance inhaler; salbutamol must still be available for acute breathlessness as Trelegy does not provide immediate symptom relief
      Correct answer
    • Trelegy and salbutamol must not be used together as they cause additive bronchoconstriction
    Explanation

    Trelegy Ellipta is a once-daily maintenance inhaler providing sustained bronchodilation and anti-inflammatory therapy. Its components (ICS, LABA, LAMA) do not provide rapid acute bronchodilation for breathlessness. Patients must retain a SABA reliever (salbutamol or terbutaline) for acute symptom management.

    Education on this point is essential — a common error is for patients to assume the triple inhaler eliminates the need for a reliever. Consistent once-daily administration (same time each day) and correct Ellipta device technique are also important.

  2. A patient taking ramipril develops a persistent dry cough. What is the mechanism responsible for this side effect?

    • Ramipril reduces angiotensin II, which causes airway dryness and irritation
    • ACE inhibitors directly irritate bronchial smooth muscle causing bronchoconstriction
    • ACE inhibitors block the breakdown of bradykinin, causing its accumulation in the airways and stimulating sensory nerve endings to produce a cough
      Correct answer
    • The cough is caused by ACE inhibitor-induced pulmonary oedema
    Explanation

    ACE inhibitors block angiotensin-converting enzyme, which normally degrades bradykinin in addition to converting angiotensin I to angiotensin II. Inhibition of this enzyme leads to bradykinin accumulation. In the airways, bradykinin stimulates sensory C-fibres and mast cells, resulting in a persistent dry, irritating, non-productive cough.

    This is a class effect of all ACE inhibitors. ARBs do not inhibit ACE and therefore do not cause bradykinin accumulation or cough.

  3. A nurse is reviewing a newly received PGD for a travel health clinic. She notes that it includes: the organisation's name, start and expiry date, description of the vaccine, clinical indication, inclusion and exclusion criteria, dose, frequency, route, warnings, follow-up requirements, and two signatures. What additional element required by Schedule 16 should the nurse check for?

    • The patient's name and NHS number, which must be pre-entered into the PGD before it is used
    • A cost-effectiveness analysis demonstrating the PGD is the most efficient supply mechanism
    • The prescribing consultant's signature confirming clinical appropriateness for each patient
    • A statement of the records to be kept when operating under the PGD, and the circumstances in which further advice should be sought from a doctor before supply
      Correct answer
    Explanation

    Schedule 16 of the Human Medicines Regulations 2012 requires a PGD to include: a statement of the records to be kept (documenting each supply), and a description of the circumstances in which further advice should be sought from a doctor before supply or administration. These are mandatory elements that the nurse should confirm are present before operating under the PGD.

    Patient names are not pre-entered into the PGD; individual records are kept separately when the PGD is used for each patient.

Frequently asked questions

4 questions
What are the six rights of medication administration in the NMC CBT?

The six rights of medication administration are: right patient, right drug, right dose, right route, right time, and right documentation. These form the foundation of safe medicines administration and are core to the NMC CBT Medicines Management module.

Is pharmacology tested in the NMC CBT?

Yes. The NMC CBT tests pharmacokinetics (absorption, distribution, metabolism, excretion), pharmacodynamics, drug receptor theory, therapeutic index, half-life, and knowledge of common drug classes including analgesics, antibiotics, cardiovascular, respiratory, psychiatric, and diabetic medications.

How are controlled drugs managed under UK law?

Controlled drugs in the UK are governed by the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001. Nurses must follow strict protocols for storage (locked CD cabinet), double-checking, recording in the controlled drugs register, and witnessing administration.

What should a nurse do if they witness anaphylaxis?

Anaphylaxis is a medical emergency. The nurse should call for help, administer intramuscular adrenaline (0.5mg of 1:1000 in adults) into the outer thigh, position the patient appropriately (lying flat with legs elevated unless breathing is compromised), monitor airway, breathing, and circulation, and prepare for advanced airway management if needed.