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Med Competency

Seen something like this before?

Here are the long awaited answers to the Medication Competency test.    For those who asked, I am delighted that you think enough of the test to want to use it in your agency and I grant to you my full permission.

The test was hard but honestly, I chose most of the questions from medication monographs that should be used in teaching meds.  Mona Landry made an excellent that they were available in their CareAnywhere program.  They are also available on every point of care software I have used with clients.  So, let that be a lesson.  Just because nurses have the tools does not mean that they will use them.  For agencies without point of care, you certainly have the internet.  In fact, over 85 percent of homes in the country are wired to the information superhighway so information is available everywhere.  Even on smart phones, drug information is available.

So why aren’t we looking up medications?

In order for me to make an effort to learn something new, I must first be aware that I don’t know something.  But that isn’t enough.  Surprisingly, there is much I do not know about nuclear physics  and stamp collecting.  I am only motivated to learn when something interests me or the information will help me in my daily activities.  I am one of the most fortunate people on earth that what interests me is also part of my work.

Periodically testing competency accomplishes only the first part of the learning process.  I believe that nurses do not regularly research medications because they are unaware that they lack knowledge.  I know I am frequently surprised when I research common medications.

Unlike nurses in the field, I am pretty confident that anything I write down for this blog or anything that goes into a report for a client will be read and analyzed.  In order to ensure that I offer only good information, I look things up regularly.  I read the program integrity manual (ZPIC work), Medicare Beneficiary Manual (chapter 7, I believe is home health these days but it may be 6), the State Operations Manual, the OASIS manual and various state regs all the time.  I keep copies on my iPad for when I visit client offices.

Because my work is reviewed (at times scrutinized), I am made aware almost immediately when I make a mistake.  Field nurses who chart inaccurately about medications may assume that they are correct in their teaching because they have taught this way for years and nobody has said anything about it.

A field nurse may assume that he or she knows what is required to Proton Pump inhibitors.  After all, most patients take at least one.   Do they really need to be on them or are they left over from a prior illness?  Manufacturer’s information states that these meds should be taken for 14 days.  Our patients take them for years.  But because no one has ever died of proton pump inhibitor overdose (to the best of my knowledge), we assume they are safe.

In addition to the safety of the medication, there are costs involved which are burdensome to the patient and to the payor sources.

In doing ZPIC work, I see tons of opportunities for agencies to have provided reasonable and necessary care that were overlooked.  From a ZPIC perspective this costs money.  From a nursing perspective it costs our patients more than they can afford in quality of life and potential side effects.  Although it doesn’t seem like it at times, we are being a ton of money from Medicare to provide reasonable and necessary services to patients.  Reasonable and Necessary means that only a skilled nurse can perform the skill safely.  When it comes to teaching and training, my general rule of thumb is that if the information is available to anyone who watches Oprah, it really doesn’t required the skills of a nurse to teach.


Good:  Taught patient that Coumadin is given to prevent blood clots but it can also cause excessive bleeding.  In order to take the medication safely, blood tests must be performed periodically so the medication can be adjusted.  Because large amounts of vitamin K affect the medication, you should not increase or decrease the amounts of green leafy vegetables normally eaten as this will affect your lab results.  If you miss a dose of Coumadin, be sure to call the agency.  After missing a dose, the lab results may be low for a few days following the missed dose.

Bad:  Taught patient to take Coumadin exactly as ordered and to keep all follow-up MD appointments.

Email me any questions or comments.  If you have any competency tests you would like to share that are in the public domain (not subject to copyright laws), please send them to me.

9 Comments Post a comment
  1. Susan #

    Thank you for posting the answers. We were talking about them at work and I look forward to challenging my staff with this.

    October 24, 2011
  2. Gail #

    Are you sure about #14?

    October 24, 2011

    • I guess anything is possible when messing with the endocrine system but, this is the information that I found from It states that the most common side effects are:

      Rapid or irregular heartbeat
      Chest pain or shortness of breath
      Muscle weakness
      Change in appetite
      Weight loss
      Frequent bowel movements
      Excessive sweating
      Heat intolerance
      Impaired fertility
      Decreased bone density
      Changes in menstrual periods
      Other unusual medical events

      Technically feeling cold all the time could fall under ‘other unusual medical events’ but looking at the list, they all seem to do with speeding up metabolism. Furthermore, the reason I included being cold all the time as an option is because that is a frequent symptom of hypothyroidism, the condition for which Synthroid is prescribed.

      Am I sure. Of course not. I am certain of very few things these days. There is always an exception, a caveat, an outlier, etc. Either way, if your patient on thyroid meds begins to experience heat intolerance or feeling cold all the time, it might be a good time to ask for lab orders.

      October 24, 2011
  3. Gail #

    Well, I put “heat intolerance” and since that is on the list above, I guess I got that one right even tho the answer key said “feeling cold all the time”. ?????? I don’t really have any of those side effects, (wish I had the weight loss one, but oh, well). I run a fan all the time in my office when all my neighbors have heaters under their desks. I can’t stand to be in those hot offices for more than a few minutes. The recent 109 degree weather nearly killed me. I stayed inside under the AC as much as possible. So, maybe I do have some heat intolerance. Whatever. I have to take it, so I get my regular lab tests done to keep me in line. My recent TSH was elevated so I had to up my dose.

    October 25, 2011

    • I’m not sure a near death experience in 109 degree weather counts as heat intolerance although it amazes me to see those guys out there working construction.

      The important thing isn’t whether or not you got the question right. What impresses me is that you thought about it and at least cared enough to try. Furthermore, when you still had questions, you went looking for answers. I mean, I know it’s highly unlikely but what if I was wrong:) It has been known to happen. If I am doing my job correctly, I am the first one to find out. If I don’t look for references to support my answers, a nurse who has listened to my advice may be the first one to find out I was wrong as she watches her patient writhe in agony from some side effect. Whether I am right or proven wrong, I always appreciate someone who takes the time out of their day to question something I wrote. The worst that could happen is that I am more confident in my answer and the best that could happen is that you prevent me giving bad information.

      Do you know how many people listen to what a consultant or a surveyor or any expert has to say and never questions it even when they are dead wrong? I cannot speak for all consultants, but I am not that good folks. I get by only with the help of my colleagues.

      October 25, 2011
  4. Gail #

    You are soooooo funny! I passed men and women working out in all that heat this summer on my way to work and I thought the same thing. I think they must become acclimated to that kind of heat. They must have some sort of tolerance. My husband has it. He loves summer; the hotter the better.
    Anyway, here’s my thinking. One symptom of hypothyroidism is feeling cold; so if a patient is taking their thyroid medicine, they shouldn’t feel cold anymore. Right? Yes? No? Maybe? 🙂
    And anybody who thinks that they are right all the time….usually finds out the hard way that they’re not. I like being right. But, when I’m not, I’m OK with that.
    P.S. Reading this blog is one of the highlights of my day. I consider it part of my work for the day. I always gleen some new information or learn something new, or something you say sparks my curiousity to look stuff up. I try to learn something new everyday. And, yes, I am sure there are those who revere the word “consultant” tagged behind someone’s name. But who ever said you can’t question the consultant??? And, the consultant should be able to back up what he/she said with some sort of evidence based information. Yes? No? Maybe? 🙂 🙂

    October 26, 2011

    • The consultant should always be able to support his or her information. There is no licensing or certification for consultants. I’m just a nurse like you. The advantage I bring is that I have time to look these things up. All kidding aside, I make mistakes like everyone else. Find me a consultant who never makes a mistake and I will find you one with a very short career.

      October 28, 2011
  5. Rebecca Fearing #

    Can u please e mail me the med competency test? Thanks

    December 2, 2011

    • Only if you send to me your email address:) You can email me at

      December 6, 2011

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