Question 1

The nurse reviews an order to administer Rh (D) immune globulin to an Rh negative woman following the birth of an Rh positive baby. Which assessment is a PRIORITY before the nurse gives the injection?

Accepted Answer

Answer reason: Rho(D) immune globulin is given only if the mother has not developed anti-D antibodies; a negative Coombs test confirms no sensitization, making it the priority assessment before administration.

Question 2

A 4-year-old with cystic fibrosis has a prescription for Viokase pancreatic enzymes to prevent malabsorption. The correct time to give pancreatic enzyme is?

Accepted Answer

Answer reason: Pancreatic enzymes for cystic fibrosis are taken with all meals and snacks so they mix with food in the duodenum and prevent malabsorption; giving long before/after meals or on an empty stomach is ineffective.

Question 3

The nurse is preparing to administer regular insulin by continuous IV infusion to a client with diabetic ketoacidosis. The nurse should?

Accepted Answer

Answer reason: Insulin adsorbs to IV tubing; priming/flush and discarding the first ~50 mL saturates the tubing to ensure accurate delivery. Insulin for DKA should not be mixed with dextrose or Ringer’s lactate, and an infusion pump is required for precise dosing.

Question 4

The client admitted with angina is given a prescription for nitroglycerine. The client should be instructed to?

Accepted Answer

Answer reason: Nitroglycerin tablets should be kept in their original dark glass (brown) bottle to protect from light and moisture. A is incorrect (usually replace about every 6 months, not 3). B is incorrect (dose is every 5 minutes up to 3 doses). D is incorrect because tablets are taken sublingually, not crushed with water.

Question 5

While preparing medications, the nurse notes an unusually large dose of medication for a client. Which action would be most appropriate?

Accepted Answer

Answer reason: An unusually large dose suggests a potential medication error; the nurse should hold the drug and clarify the order with the prescriber rather than administer it, ask another nurse, or escalate to a supervisor first.

Question 6

While prescribing β-lactamases resistant penicillin what should be advice to the patient for its use?

Accepted Answer

Answer reason: Food reduces the absorption of beta-lactamase–resistant penicillins (e.g., cloxacillin, dicloxacillin). Advise to take on an empty stomach—typically 1 hour before or 2 hours after meals.

Question 7

A client is readmitted with a recurrent urinary tract infection. The client is to be discharged home on methenamine mandelate (Mandelamine). The nurse should instruct the client to limit intake of which of the following fluids?

Accepted Answer

Answer reason: Methenamine requires acidic urine to convert to formaldehyde and be effective. Milk alkalinizes urine, so intake should be limited; water and tea are relatively neutral and some juices (e.g., cranberry) acidify.

Question 8

A client is to begin IV antibiotic therapy for a pulmonary infection. What should be completed before the first dose of antibiotic is administered?

Accepted Answer

Answer reason: Obtain cultures before starting antibiotics to identify the causative organism and avoid altered results. UA, chest X-ray, and RBC count are not required prior to initial antibiotic administration for a pulmonary infection.

Question 9

When administering an intramuscular injection to an infant, which site should the nurse use?

Accepted Answer

Answer reason: For infants, the preferred IM site is the vastus lateralis (anterolateral thigh) due to adequate muscle mass and low risk of nerve or vessel injury. Deltoid lacks mass, dorsogluteal risks the sciatic nerve, and ventrogluteal is not the first choice for young infants.

Question 10

Which parameter should be checked before administering digoxin?

Accepted Answer

Answer reason: Digoxin can cause bradycardia and AV block; the nurse must check the apical pulse for one full minute and hold the dose if it is below the prescribed threshold (e.g.,

Question 11

A client is diagnosed with type 1 diabetes mellitus. What is the most important aspect of the client's self-care management?

Accepted Answer

Answer reason: Type 1 diabetes involves absolute insulin deficiency; survival and glycemic control depend on consistent exogenous insulin. Diet, exercise, and glucose monitoring are important supports, but insulin administration is the priority.

Question 12

A client is prescribed warfarin (Coumadin) therapy. What vitamin should the nurse instruct the client to consume consistently?

Accepted Answer

Answer reason: Warfarin antagonizes vitamin K–dependent clotting factors. To keep INR stable, clients should maintain a consistent intake of vitamin K (commonly from leafy green vegetables).

Question 13

By which routes are killed vaccines typically administered?

Accepted Answer

Answer reason: Inactivated (killed) vaccines are given parenterally via subcutaneous or intramuscular routes; they are not administered intravenously.

Question 14

Why might a small air bubble be left in a prefilled heparin syringe?

Accepted Answer

Answer reason: Prefilled heparin syringes often include a small air bubble to create an air-lock in subcutaneous injections, helping ensure the full dose is delivered and preventing medication from tracking/leaking back through the needle path.

Question 15

What type of needle is typically used for subcutaneous injections?

Accepted Answer

Answer reason: Subcutaneous injections use small needles to minimize tissue trauma—typically 25–30 gauge. 18- and 22-gauge are larger and used for IM/IV; 25-gauge is a common standard for SC meds.

Question 16

Which type of injection leaves a wheal?

Accepted Answer

Answer reason: Intradermal injections are placed into the dermis and create a small bleb or wheal (e.g., TB test). IV, IM, and SC injections do not typically form a wheal.

Question 17

What is the term for the administration of a drug in liquid form into a body cavity or body orifice?

Accepted Answer

Answer reason: Instillation refers to administering liquid medications drop by drop into a body cavity or orifice (e.g., eye or ear). Inhalation is via the respiratory tract, infiltration is diffusion into tissues, and insertion typically involves solid forms like suppositories.

Question 18

Which is the most preferred administration route in an unconscious patient?

Accepted Answer

Answer reason: Unconscious patients cannot safely swallow; oral/enteral routes risk aspiration and unreliable absorption. Parenteral administration allows safe, rapid delivery of medications.

Question 19

Which of the following injections is NOT given subcutaneously?

Accepted Answer

Answer reason: Insulin and heparin are routinely administered subcutaneously, and morphine can be given SC. Diclofenac (Voren) is given deep IM and is not administered subcutaneously due to tissue irritation/necrosis risk.

Question 20

The nurse has an order for medication to be administered intrathecally; by which method will the medication be administered?

Accepted Answer

Answer reason: Intrathecal administration delivers medication into the cerebrospinal fluid within the subarachnoid space (e.g., spinal injection).

Question 21

A client with clotting disorder has an order to continue Lovenox (enoxaparin) injections after discharge. The nurse should teach the client that Lovenox injections should?

Accepted Answer

Answer reason: Enoxaparin is administered subcutaneously in the abdomen; do not aspirate and do not expel the air bubble. Therefore, abdominal injection is the correct teaching.

Question 22

The nurse has a preop order to administer Valium (diazepam) 10mg and Phenergan (promethazine) 25mg. The correct method of administering these medications is to?

Accepted Answer

Answer reason: Diazepam and promethazine are not compatible in the same syringe; they can be given during the same preop period but must be administered in separate syringes/lines.

Question 23

A client admitted for treatment of bacterial pneumonia has an order for intravenous ampicillin. Which specimen should be obtained prior to administering the medication?

Accepted Answer

Answer reason: Cultures should be obtained before starting antibiotics to identify the causative organism and guide therapy; for pneumonia this is a sputum culture and sensitivity.

Question 24

A client who uses a respiratory inhaler asks the nurse to explain how he can know when half his medication is empty so that he can refill his prescription. The nurse should tell the client to?

Accepted Answer

Answer reason: The water float test provides an estimate of remaining doses in a metered-dose inhaler; other methods (listening, mist, or hissing) are unreliable because propellant may remain even when medication is depleted.

Question 25

A client with angina is being discharged with a prescription for Transderm Nitro (nitroglycerin) patches. The nurse should tell the client to?

Accepted Answer

Answer reason: Transdermal nitroglycerin patches are rate-controlled; cutting them alters delivery and dose. The other options are incorrect: do not shave (clip hair to avoid skin irritation), do not clean with alcohol (use soap and water), and do not occlude with plastic wrap, which increases absorption.

Question 26

The physician has prescribed nitroglycerin sublingual tablets as needed for a client with angina. The nurse should tell the client to take the medication?

Accepted Answer

Answer reason: PRN sublingual nitroglycerin should be taken at the first sign of angina to rapidly relieve ischemic chest pain. It is not given on a fixed schedule, after exertion, or routinely at bedtime.

Question 27

A client is to receive Dilantin (phenytoin) via a nasogastric (NG) tube. When giving the medication, the nurse should?

Accepted Answer

Answer reason: For enteral medication administration, the NG tube should be flushed with adequate water before and after dosing to maintain patency and prevent drug-feed interactions, especially with phenytoin. Water (not saline) is used, and small volumes (2–5 mL) are inadequate. Thus flushing with 2–4 oz of water before and after is correct.

Question 28

The physician has prescribed Gantrisin (sulfisoxazole) 1g in divided doses for a client with a urinary tract infection. The nurse should administer the medication?

Accepted Answer

Answer reason: Sulfisoxazole (a sulfonamide) is best absorbed on an empty stomach; it should be given before meals rather than with or after food.

Question 29

How is insulin injection typically administered?

Accepted Answer

Answer reason: Insulin is routinely given by subcutaneous injection for steady absorption; IV insulin is reserved for emergencies, IM is not standard, and intramural is not an injection route.

Question 30

In the cold chain process, how many months can vaccines be stored in cold rooms or cold stores?

Accepted Answer

Answer reason: At state/regional stores with walk-in cold rooms, EPI guidelines allow vaccine storage for up to 6 months.

Question 31

When should omeprazole be taken in relation to food?

Accepted Answer

Answer reason: Omeprazole, a proton pump inhibitor, is most effective when taken 30–60 minutes before a meal to inhibit active proton pumps during the meal.

Question 32

An infant with a ventricular septal defect is discharged with a prescription for lanoxin elixir 0.01mg PO q 12hrs. The bottle is labeled 0.10mg per 1/2 tsp. The nurse should instruct the mother to?

Accepted Answer

Answer reason: For infant oral liquids—especially narrow-therapeutic-index drugs like digoxin—accurate dosing is essential. The calibrated dropper that comes with the medication ensures precise measurement. A nipple or spoon provides inaccurate dosing, and putting it in a bottle risks the infant not taking the full dose.

Question 33

The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should?

Accepted Answer

Answer reason: Lisinopril (ACE inhibitor) and furosemide (loop diuretic) are commonly co-administered for hypertension and heart failure; no contraindication to giving them together. Therefore the nurse should administer as ordered.

Question 34

The client has recently been diagnosed with diabetes. Which of the following indicates understanding of the management of diabetes?

Accepted Answer

Answer reason: Demonstrating correct insulin injection technique shows application of self-care skills for medication management, which best evidences understanding. The other options reflect general knowledge or interest rather than demonstrated competency.

Question 35

Before administering eardrops to a toddler, the nurse should recognize that it is essential to consider which of the following?

Accepted Answer

Answer reason: Otic medication technique depends on age: for children under 3 years, pull the pinna down and back; older children, up and back. Weight, IQ, or general developmental level are not essential determinants of administration technique.

Question 36

The client has an order for sliding scale insulin at 1900 hours and Lantus insulin at the same hour. The nurse should?

Accepted Answer

Answer reason: Lantus (insulin glargine) cannot be mixed with other insulins; it must be given as a separate injection. Sliding-scale insulin may be given at the same time but in a different syringe/site.

Question 37

Which of the following instructions should be included in the teaching for the client with rheumatoid arthritis?

Accepted Answer

Answer reason: NSAIDs used for rheumatoid arthritis can irritate the gastric mucosa; taking them with meals reduces GI upset. Exercise should be encouraged to maintain joint mobility, alternating hot/cold is not routine teaching for all cases, and complete avoidance of weight-bearing activity is not indicated.

Question 38

The client has an order for a trough to be drawn on the client receiving Vancomycin. The nurse is aware that the nurse should contact the lab for them to collect the blood?

Accepted Answer

Answer reason: A trough level is the minimum serum concentration and should be drawn immediately before the next scheduled dose; for vancomycin this is typically 30 minutes before the fourth dose at steady state.

Question 39

A client with cystic fibrosis is taking pancreatic enzymes. The nurse should administer this medication?

Accepted Answer

Answer reason: Pancreatic enzyme replacements should be taken with meals (and snacks) to aid digestion in cystic fibrosis. Once-daily or bedtime dosing is ineffective; timing with meals is key.

Question 40

A client with a severe corneal ulcer has an order for Gentamycin gtt. q 4 hours and Neomycin 1 gtt q 4 hours. Which of the following schedules should be used when administering the drops?

Accepted Answer

Answer reason: When administering multiple ophthalmic drops, wait at least 5 minutes between medications to prevent one from washing out the other and to allow absorption.

Question 41

The physician has prescribed ranitidine (Zantac) for a client with erosive gastritis. The nurse should administer the medication?

Accepted Answer

Answer reason: Ranitidine, an H2-receptor blocker, is commonly dosed as 300 mg at bedtime to best suppress nocturnal acid secretion and promote mucosal healing; it is not timed with meals.

Question 42

A client is discharged home with a prescription for Coumadin (sodium warfarin). The client should be instructed to?

Accepted Answer

Answer reason: Warfarin therapy requires regular monitoring of PT/INR to ensure therapeutic anticoagulation and safety. Increasing fruits/vegetables (vitamin K) can antagonize warfarin, extra fluids are not specific, and avoiding crowds is unrelated.

Question 43

Which size of needle gauge is used for intramuscular injection?

Accepted Answer

Answer reason: IM injections typically use a 22–23 gauge needle for most aqueous solutions; 25–27 gauge is for subcutaneous/intradermal, and 18–20 is larger than usually required.

Question 44

What type of needle is recommended when withdrawing medication from an ampule to ensure no glass comes into the syringe?

Accepted Answer

Answer reason: A filter needle is used when withdrawing from an ampule to trap any glass particles and prevent them from entering the syringe.

Question 45

What angle should the needle be inserted for an intradermal injection?

Accepted Answer

Answer reason: Intradermal injections are given at a shallow angle (about 5–15 degrees) with the bevel up to form a small wheal; thus 15 degrees is correct.

Question 46

What is the recommended gauge size of an intramuscular injection needle for an adult?

Accepted Answer

Answer reason: Adult IM injections typically use a 22–25 gauge needle; among the choices, 22 gauge is the standard recommendation.

Question 47

What is the appropriate angle for needle insertion when administering a subcutaneous injection of insulin?

Accepted Answer

Answer reason: Subcutaneous injections are typically inserted at a 45-degree angle to ensure the medication is deposited into the subcutaneous tissue (90 degrees may be used with short needles or ample adipose tissue).

Question 48

Which site is most appropriate for administering a subcutaneous injection?

Accepted Answer

Answer reason: The abdomen is a primary site with adequate subcutaneous tissue and is commonly used for SQ medications (e.g., insulin, heparin). The gluteus maximus, vastus lateralis, and deltoid are intramuscular injection sites.

Question 49

What is the correct route of administration for the hepatitis B vaccine?

Accepted Answer

Answer reason: Hepatitis B vaccine should be administered intramuscularly (deltoid in adults, anterolateral thigh in infants) for optimal immunogenicity; intradermal or subcutaneous routes reduce response and epidermal is not a valid route.

Question 50

Which area should be avoided for a subcutaneous injection of heparin?

Accepted Answer

Answer reason: Heparin is given subcutaneously in areas with adequate subcutaneous tissue such as the abdomen, lateral thigh, or upper outer arm; the lower back is not a recommended SC site for heparin.

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