Question 1

The standard treatment of pneumonia in a four year old child would include daily dose of cotrimoxazole?

Accepted Answer

Answer reason: Per IMNCI/standard pediatric guidelines, children 12 months to 5 years with pneumonia receive cotrimoxazole pediatric tablet 120 mg: 1 tablet twice daily for 5 days.

Question 2

Dose of I.V. adrenaline in term infant during neonatal resuscitation?

Accepted Answer

Answer reason: NRP recommends IV epinephrine 0.01–0.03 mg/kg using 1:10,000 (0.1 mg/mL); this equals 0.1–0.3 mL/kg.

Question 3

Suitable sites for anti-rabies injection (ARV)-?

Accepted Answer

Answer reason: For rabies vaccine, the recommended IM site in adults is the deltoid; gluteal injections are avoided due to reduced immunogenicity, and inner thigh or anterior abdominal wall are not recommended sites.

Question 4

Intradermal injection is given at an angle of ...?

Accepted Answer

Answer reason: Intradermal injections are inserted almost parallel to the skin at a shallow angle of about 5–15° with the bevel up; among the options, 15° is correct.

Question 5

The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care?

Accepted Answer

Answer reason: Glaucoma is a chronic condition requiring ongoing control of intraocular pressure; topical antiglaucoma medications are typically used lifelong. Overuse of the eyes is not causative, salt/fluid restriction is not standard teaching.

Question 6

Which of the following drug should be with hold in haemodialysis?

Accepted Answer

Answer reason: Antihypertensive medications are typically held before hemodialysis to prevent intradialytic hypotension since fluid removal lowers blood pressure. The other listed drugs are not routinely withheld for this reason.

Question 7

The route of administration of hepatitis B vaccine is?

Accepted Answer

Answer reason: Hepatitis B vaccine is given intramuscularly (deltoid in adults, anterolateral thigh in infants) for optimal immunogenicity; subcutaneous or intradermal routes are not recommended.

Question 8

Which of the following is the correct interpretation of the ERROR OF PARALLAX?

Accepted Answer

Answer reason: Parallax occurs when the eye is not level with the meniscus. Looking from above makes the liquid level appear lower than it is (false low); looking from below gives a false high.

Question 9

When administering a tuberculin skin test, the nurse should insert the needle at a?

Accepted Answer

Answer reason: Tuberculin skin tests are given intradermally with the bevel up at a shallow angle (5–15 degrees); 15 degrees is the best answer.

Question 10

The nurse is caring for a client with osteoporosis who is being discharged on (alendronate) Fosamax. Which statement would indicate a need for further teaching?

Accepted Answer

Answer reason: Alendronate must be taken in the morning on an empty stomach with a full glass of plain water and the client must remain upright for at least 30 minutes. Taking it immediately before bedtime is unsafe and increases risk of esophageal irritation.

Question 11

The nurse is caring for a client with epilepsy who is to receive Dilantin 100mg IV push. The client has an IV of D5 1/2NS infusing at 100mL/hr. When administering the Dilantin, the nurse should first?

Accepted Answer

Answer reason: IV phenytoin (Dilantin) is compatible only with normal saline; dextrose solutions cause precipitation. With D5 1/2NS infusing, the nurse should first flush the line with normal saline before giving the IV push dose.

Question 12

The nurse is discharging a client with asthma who has a prescription for zafirlukast (Accolate). Which comment by the client would indicate a need for further teaching?

Accepted Answer

Answer reason: Zafirlukast should be taken on an empty stomach (1 hour before or 2 hours after meals). Reporting flu-like symptoms, monitoring liver function, and knowing it is not for acute attacks are correct teachings.

Question 13

Which statements regarding the use of topical corticosteroids for dermatitis should the nurse discuss with the patient?

Accepted Answer

Answer reason: Proper patient teaching for topical corticosteroids includes applying a thin film only to the affected skin. Option B is unsafe; application should not be liberal or to unaffected areas.

Question 14

Which statement suggests that the client understands discharge instructions for using an epinephrine auto-injector for severe peanut allergy?

Accepted Answer

Answer reason: Correct use of an epinephrine auto-injector is immediate intramuscular injection into the outer thigh at a 90-degree angle at the first sign of anaphylaxis. This statement reflects both timing and technique. Other options are incomplete or incorrect for client instruction (e.g., arm injection is not recommended).

Question 15

Before administering a new medication to a patient, a nurse notices a discrepancy between the medication's label and the physician's orders; what is the most appropriate action for the nurse to take?

Accepted Answer

Answer reason: A discrepancy indicates a potential medication error; the nurse must hold the drug and clarify with the prescriber. Consulting a colleague or proceeding after documentation does not ensure safety, and administering per the label may contradict the order.

Question 16

Which of the following statements about the administration of subcutaneous injections is true?

Accepted Answer

Answer reason: Subcutaneous tissue is less vascular than muscle, leading to slower absorption; insulin is given SC to allow gradual absorption. IM depth is greater than SC, and SC sites should be rotated, not kept the same.

Question 17

A client is prescribed alendronate for osteoporosis. What is the primary nursing consideration when administering alendronate?

Accepted Answer

Answer reason: Bisphosphonates like alendronate must be taken first thing in the morning with a full glass of water on an empty stomach and the client should remain upright for at least 30 minutes to prevent esophageal irritation. Milk or food decreases absorption; lying down increases esophagitis risk.

Question 18

A client is prescribed nitroglycerin for angina. What education should the nurse provide regarding nitroglycerin administration?

Accepted Answer

Answer reason: Sublingual nitroglycerin can be taken preventively before exertion or stress to avert angina. Taking with antacids or on an empty stomach is not required for SL dosing. Storage guidance (option D) concerns handling, not administration.

Question 19

A client is prescribed isosorbide dinitrate for angina. What education should the nurse provide regarding isosorbide dinitrate?

Accepted Answer

Answer reason: Abrupt withdrawal of long-acting nitrates like isosorbide dinitrate can precipitate rebound angina; doses should be tapered. Antacids are not indicated, taking on an empty stomach is not required, and prophylactic pre-activity dosing is typically emphasized with short-acting nitroglycerin rather than scheduled isosorbide dinitrate.

Question 20

Which client actions indicate correct use of a metered dose inhaler (MDI) to administer corticosteroid medication?

Accepted Answer

Answer reason: Rinsing the mouth after an inhaled corticosteroid prevents oral candidiasis and is a key teaching point specific to corticosteroid MDIs. Tilting the head down and lying supine are incorrect; waiting 5 minutes is unnecessary between puffs of the same medication; holding the inhaler upright is correct but not corticosteroid-specific.

Question 21

Which statement by a patient newly diagnosed with hypertension indicates a need for further teaching?

Accepted Answer

Answer reason: Stopping antihypertensive medication when BP normalizes is unsafe; therapy is typically ongoing and abrupt discontinuation can cause rebound hypertension. The other statements reflect appropriate self-management.

Question 22

Which action by the newly hired nurse administering medications via a double-lumen nasogastric tube with an air vent requires follow-up?

Accepted Answer

Answer reason: For a double-lumen (Salem sump) NG tube, the blue air-vent lumen should remain open to air and is not irrigated with water; irrigation can be done with air only if needed. The other actions are appropriate for NG medication administration.

Question 23

What dietary recommendation should the nurse provide to a patient on warfarin therapy?

Accepted Answer

Answer reason: Warfarin’s effect is reduced by vitamin K found in green leafy vegetables; intake should be consistent to maintain stable INR. Avoiding dairy, increasing citrus, or eliminating carbohydrates do not affect warfarin control.

Question 24

What is the primary element of the DOTS strategy to cure tuberculosis?

Accepted Answer

Answer reason: DOTS centers on directly observed therapy—having a health worker watch the client take each dose and monitor adherence and progress until cure.

Question 25

Which client comment about using topical gentamicin sulfate indicates the need for additional teaching?

Accepted Answer

Answer reason: Topical gentamicin should be applied thinly to limited affected skin; using it on large open areas increases systemic absorption and risk of aminoglycoside toxicity. The other statements reflect appropriate use and follow-up.

Question 26

What instructions should the nurse provide to a client prescribed sublingual nitroglycerin for angina regarding its administration?

Accepted Answer

Answer reason: Sublingual nitroglycerin must be placed under the tongue to dissolve for rapid absorption and relief of angina. It should not be swallowed, applied to skin, or taken with meals for effect.

Question 27

A client is prescribed alendronate for osteoporosis. What education should the nurse provide regarding alendronate?

Accepted Answer

Answer reason: Bisphosphonates like alendronate should be taken first thing in the morning on an empty stomach with a full glass of water and the client must remain upright for at least 30 minutes to prevent esophageal irritation. Milk interferes with absorption, lying down increases risk of esophagitis, and the client should not discontinue without provider guidance.

Question 28

A client is prescribed metoprolol for hypertension. What assessment finding should the nurse report to the healthcare provider before administering metoprolol?

Accepted Answer

Answer reason: Potassium 3.2 mEq/L is hypokalemia and an abnormal lab that should be reported prior to medication administration due to risk for dysrhythmias. The other findings are within acceptable ranges for giving metoprolol.

Question 29

A client is receiving chemotherapy and reports nausea and vomiting. What is the priority nursing intervention?

Accepted Answer

Answer reason: Chemotherapy commonly causes nausea and vomiting; the priority is to administer the prescribed antiemetic to control symptoms and prevent dehydration. A large meal may worsen nausea, a laxative is unrelated, and withholding fluids risks dehydration.

Question 30

A client is receiving chemotherapy and reports severe nausea. What nursing intervention is most appropriate?

Accepted Answer

Answer reason: Chemotherapy-induced nausea is best treated with prescribed antiemetics. Large meals and high-fat foods can worsen nausea, and pain medication does not address nausea.

Question 31

A client is admitted with a hypertensive crisis. What is the priority nursing intervention?

Accepted Answer

Answer reason: In hypertensive crisis the priority is rapid blood pressure reduction with fast-acting antihypertensive medication (typically IV). Sodium increase is contraindicated, glucose monitoring is not priority, and a diuretic alone is not the first-line urgent intervention.

Question 32

A client is admitted with suspected bacterial meningitis. What is the priority nursing intervention?

Accepted Answer

Answer reason: Bacterial meningitis is a life-threatening infection; immediate broad-spectrum antibiotics reduce morbidity and mortality. Antipyretics and analgesics are supportive, and fluid restriction is not a priority unless indicated (e.g., SIADH).

Question 33

A client is admitted with diabetic ketoacidosis (DKA). What is the priority nursing intervention?

Accepted Answer

Answer reason: In DKA, insulin therapy is a priority to stop ketogenesis and lower hyperglycemia. Monitoring every 8 hours is too infrequent, oral fluids are inappropriate in acute DKA (needs IV fluids), and bicarbonate is not routine unless severe acidosis (pH < 6.9).

Question 34

A client is admitted with a suspected overdose of opioids. What is the priority nursing intervention?

Accepted Answer

Answer reason: Naloxone is the opioid antagonist that rapidly reverses opioid-induced respiratory/CNS depression, making it the priority intervention. Giving more opioids would worsen the overdose; charcoal is not first-line once toxicity is evident; an antiemetic is nonessential.

Question 35

What is the first step a nurse should take before drawing up medication from an ampule?

Accepted Answer

Answer reason: Use aseptic technique by disinfecting the ampule’s neck with alcohol before opening; then snap the neck and withdraw the medication with a filter needle.

Question 36

What is the primary reason for administering a deep intramuscular (IM) injection of an iron preparation?

Accepted Answer

Answer reason: Iron preparations (e.g., iron dextran) are irritating to subcutaneous tissue. A deep IM, often with Z-track, deposits the drug deep in muscle to prevent leakage and minimize local tissue irritation and staining.

Question 37

Which of the following patients would be least likely to be suitable for intradermal injections?

Accepted Answer

Answer reason: Intradermal injections require adequate dermal thickness to form a wheal; elderly patients often have thin, fragile skin, increasing risk of tearing and unreliable results. The other options are not contraindications to intradermal injections.

Question 38

What is the reason for using an intradermal route instead of subcutaneous for certain medications?

Accepted Answer

Answer reason: Intradermal injections are used for tests like TB and allergy testing to provoke a localized immune reaction in the dermis. Absorption is slower and only very small volumes are used, so the other options are incorrect.

Question 39

A client is prescribed levothyroxine for hypothyroidism. What should the nurse instruct the client regarding levothyroxine administration?

Accepted Answer

Answer reason: Food decreases levothyroxine absorption; instruct to take it on an empty stomach, typically 30–60 minutes before breakfast. Do not take with food, bedtime is not standard, and mixing/crushing with juice is not recommended.

Question 40

Which patient assessment is a priority before administering an osmotic diuretic?

Accepted Answer

Answer reason: Osmotic diuretics (e.g., mannitol) require adequate renal function for filtration and excretion and are contraindicated in renal failure/anuria. Therefore, verifying renal function is the priority pre-administration assessment.

Question 41

When is the safest time for a nurse to administer sertraline (Zoloft) to a client with depression?

Accepted Answer

Answer reason: Sertraline, an SSRI, can be activating and may cause insomnia; dosing in the morning reduces this risk. It is not given PRN, does not require an empty stomach, and bedtime dosing may worsen sleep disturbance.

Question 42

What is the primary purpose of subcutaneous injections?

Accepted Answer

Answer reason: Subcutaneous tissue is less vascular than muscle, leading to slower, sustained absorption of medications; it is not used for immediate effect, IV access, or resuscitation.

Question 43

What is the proper way to pull the ear when administering otic medication to a 2-year-old client?

Accepted Answer

Answer reason: For children under 3 years old, the pinna is pulled down and back to straighten the ear canal for proper drop administration.

Question 44

What is the correct dose of intravenous adrenaline for term neonatal resuscitation in an infant?

Accepted Answer

Answer reason: Neonatal resuscitation guidelines recommend IV epinephrine 0.01–0.03 mg/kg of 1:10,000 (0.1 mg/mL) solution, which equals 0.1–0.3 mL/kg. Hence option C.

Question 45

What is the recommended route of administering streptomycin for tuberculosis treatment?

Accepted Answer

Answer reason: Streptomycin for TB is administered by deep intramuscular injection to ensure proper absorption and minimize local irritation; it is not given subcutaneously or intravenously.

Question 46

A client is prescribed sertraline for depression. What education should the nurse provide regarding sertraline?

Accepted Answer

Answer reason: Sertraline (an SSRI) may cause drowsiness or insomnia; dosing at bedtime can minimize daytime sedation. It does not require an empty stomach or milk, and tyramine restrictions apply to MAOIs, not SSRIs.

Question 47

A client with pneumonia is prescribed antibiotics. What is the most important nursing intervention related to antibiotic therapy?

Accepted Answer

Answer reason: Ensuring timely, accurate administration of antibiotics achieves therapeutic levels and eradicates infection, preventing resistance. Fluids and vital sign checks are supportive; cough suppressants can impair secretion clearance.

Question 48

What is the recommended route of administration for diclofenac sodium injection?

Accepted Answer

Answer reason: Diclofenac sodium injection is typically administered as a deep intramuscular injection; it is not recommended subcutaneously or intradermally, and IV use is not the standard route for the common formulation.

Question 49

When providing teaching for a patient with iron-deficiency anemia who has been prescribed iron supplements, with which beverage should the iron be taken?

Accepted Answer

Answer reason: Vitamin C enhances absorption of oral iron; orange juice is vitamin C–rich. Milk can decrease absorption, and water or ginger ale provide no benefit.

Question 50

The nurse is assessing a seven year-old after several days of treatment for a documented strep throat. Which of the following statements suggests that FURTHER teaching is needed?

Accepted Answer

Answer reason: Inconsistent dosing indicates misunderstanding; antibiotics should be taken exactly as prescribed on a regular schedule, not sporadically morning or night.

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