Question 1

The nurse receives an order to give a client iron by deep injection. The nurse know that the reason for this route is to?

Accepted Answer

Answer reason: Iron preparations can cause significant local pain, staining, and tissue injury; delivering the medication into a large muscle mass (often with a Z-track technique) reduces leakage into subcutaneous tissue. This rationale is about minimizing local complications at the injection site rather than improving systemic absorption or “even distribution.” Ensuring the full dose is given is true of many parenteral routes, but it is not the key reason specifically cited for deep injection with iron.

Question 2

Which of the following drugs should the nurse anticipate administering to a client before they are to receive electroconvulsive therapy?

Accepted Answer

Answer reason: A depolarizing paralytic provides rapid onset and short duration, minimizing post-procedure respiratory compromise while preventing fractures and severe muscle contractions. Benzodiazepines can raise the seizure threshold and may blunt ECT efficacy, so they are typically avoided or held. Antipsychotics like chlorpromazine are not routine pre-ECT meds and may increase adverse effects (e.g., hypotension, prolonged seizure risk), and an induction agent like thiopental may be used but does not replace the need for a paralytic for motor suppression and safety.

Question 3

The nurse is performing a pre-kindergarten physical on a 5 year-old. The last series of vaccines will be administered. What is the preferred site for injection by the nurse?

Accepted Answer

Answer reason: In young children, the anterolateral thigh provides a reliable muscle mass and consistent landmarking for safe intramuscular injections. The dorsogluteal region is avoided because of proximity to the sciatic nerve and variable subcutaneous fat thickness that can lead to inadvertent subcutaneous administration. The other thigh muscle listed is not used as a standard IM landmark, and the gluteal option is not a recognized preferred pediatric injection site.

Question 4

The nurse is giving instructions to the parents of a child with cystic fibrosis. The nurse would emphasize that pancreatic enzymes should be taken?

Accepted Answer

Answer reason: Taking them with every meal and snack best prevents steatorrhea, abdominal bloating, and poor weight gain by improving fat and protein absorption. A fixed schedule such as once daily or only after meals can miss snacks or delay delivery beyond optimal mixing with the bolus of food, reducing effectiveness. Limiting use to carbohydrate intake is incorrect because exocrine pancreatic insufficiency most clinically impacts fat and protein digestion rather than only carbohydrates.

Question 5

The nurse prepares to give a one year-old child an intramuscular injection. Where is the best site for this injection?

Accepted Answer

Answer reason: This location also avoids major nerves and blood vessels compared with gluteal sites. The deltoid may be used for some vaccines in older children when adequate muscle mass is present, but it is often too small in a 1-year-old for routine IM volumes. The dorsogluteal site is avoided due to proximity to the sciatic nerve and variable subcutaneous fat thickness.

Question 6

A client with angina has been instructed about the use of sublingual nitroglycerin. Which of the following statements made to the nurse indicates a need for further teaching?

Accepted Answer

Answer reason: " Sublingual nitroglycerin for acute angina should be taken as one tablet at a time, allowing time to assess response and limiting hypotension and headache risk. The correct self-administration teaching is 1 tablet SL, repeat every 5 minutes as needed up to a total of 3 doses. Taking multiple tablets simultaneously can cause abrupt vasodilation leading to dizziness/syncope without improving safe titration of symptom relief. A key safety element is to stop activity and sit/lie down when taking the dose to reduce fall risk.

Question 7

The nurse is providing instructions for a client with pneumonia. What is the most important information to convey to the client?

Accepted Answer

Answer reason: " The key principle is that antibiotics must be taken for the full prescribed course to fully eradicate infection and prevent relapse or antibiotic resistance. Pneumonia symptoms can improve before the causative organism is eliminated, so stopping early increases the risk of recurrence and complications. This instruction is a high-priority, safety-focused medication teaching point that directly affects outcomes. In contrast, monitoring temperature or scheduling follow-up imaging can be helpful, but they do not prevent treatment failure as directly as adherence to the full antibiotic regimen.

Question 8

The nurse prepares to administer eye drops to a 6 year-old child. Which of these demonstrates the correct method for instillation of eye drops?

Accepted Answer

Answer reason: Pulling the lower lid down exposes this pocket so the medication pools and spreads over the eye with blinking. Instilling drops directly on the cornea increases stinging and the risk of contamination/injury and can trigger blinking that expels the medication. Placing drops in the inner canthus primarily increases drainage into the nasolacrimal duct, reducing ocular contact time and systemic safety.

Question 9

The nurse assesses a client who has been re-admitted to the psychiatric in-patient unit for schizophrenia. His symptoms have been managed for several months with fluphenazine (Prolixin). Which should be a focus of the first assessment?

Accepted Answer

Answer reason: A first assessment should quickly determine whether the client has been receiving the medication as prescribed (missed doses, stopped due to side effects, inability to obtain refills, or lack of insight), because this directly drives immediate stabilization and next-step treatment planning. Fluphenazine is an antipsychotic where nonadherence is a frequent barrier and is highly actionable for nursing interventions (education, side-effect management, long-acting formulations, coordination of follow-up). Home stressors and alcohol use are important contributors, but they are secondary once the most common and reversible precipitant—nonadherence—has been assessed. Heat exposure is relevant to antipsychotic-associated impaired thermoregulation, but it is less likely than nonadherence to explain readmission and is not the most priority first check in this context.

Question 10

The nurse has been teaching a client with Insulin Dependent Diabetes Mellitus. Which statement by the client indicates a need for further teaching?

Accepted Answer

Answer reason: Insulin suspensions such as NPH must be mixed gently by rolling to resuspend particles without creating bubbles. Vigorous shaking can cause frothing and inaccurate dosing when drawing up insulin, increasing risk of hypo- or hyperglycemia. Using a sliding scale for short-acting insulin is a standard approach to match correction doses to blood glucose. Refrigeration of unopened insulin is appropriate, and prefilled syringes may be used when prepared correctly and stored safely, but the unsafe technique here is the mixing method.

Question 11

A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethizine hydrochloride (Phenergan) 50 mg IM to a pre-operative client. Which action should the nurse take first?

Accepted Answer

Answer reason: Ensuring the client voids beforehand promotes comfort and prevents postoperative urinary retention and bladder distention during transport and early anesthesia recovery. This is the most immediate preparatory step that reduces physiologic complications before giving the medications. Safety steps like side rails and call bell are appropriate, but they do not address a time-sensitive physiologic need that should be completed prior to administering sedating premedication.

Question 12

What is the initial response of the nurse?

Accepted Answer

Answer reason: An initial hold allows time to assess the client, review parameters (e.g., vitals, labs, recent intake, symptoms), and verify the order or indication with the prescriber/pharmacy if needed. Adjusting timing or dose without adequate assessment or authorization can worsen adverse effects or lead to therapeutic failure. Increasing the next dose is particularly unsafe because it compounds risk if the original issue was overdose, contraindication, or an adverse reaction.

Question 13

The nurse will administer liquid medicine to a 9 month-old child. Which of the following methods is appropriate?

Accepted Answer

Answer reason: Using an oral syringe allows precise measurement and controlled delivery, and placing it along the side of the mouth (buccal area near the tongue/cheek) helps the infant swallow gradually rather than gag. A medicine cup is unsafe and inaccurate for a 9-month-old because the infant cannot reliably sip and the dose can be spilled. Mixing medication in a bottle is discouraged because the infant may not finish the feeding, resulting in an incomplete dose and potential medication instability or taste aversion to formula.

Question 14

The nurse is teaching an elderly client how to use MDI's (multi-dose inhalers). The nurse is concerned that the client is unable to coordinate the release of the medication with the inhalation phase. What is the nurse's best recommendation to improve delivery of the medication?

Accepted Answer

Answer reason: This increases lung deposition and decreases oropharyngeal deposition, improving therapeutic delivery and reducing local side effects. It is a simple, low-cost, evidence-based technique modification that directly addresses the coordination problem without changing the medication delivery system. Nebulizers can help but are not the first-line fix when the main barrier is MDI timing, and relying on others (family or visiting nurse) does not reliably solve the technique issue during unsupervised dosing.

Question 15

You are teaching a client about the patient controlled analgesia (PCA) planned for post-operative care. Which indicates further teaching may be needed by the client?

Accepted Answer

Answer reason: PCA is designed to let the patient self-administer preset bolus doses when pain occurs, without waiting for staff, while safety lockout intervals limit dose frequency. Saying they must call the nurse before taking extra doses shows misunderstanding of the core purpose of PCA and could lead to delayed analgesia and poorer postoperative outcomes. The pump’s programming (lockout, dose limits, and sometimes basal infusion) provides overdose protection when used as intended and by the patient only. If pain is not relieved despite appropriate use, the correct action is to notify the nurse for reassessment and possible adjustment rather than avoiding self-dosing.

Question 16

In preparing medications for a client with a gastrostomy tube, the nurse should contact the health care provider before administering which of the following drugs through the tube?

Accepted Answer

Answer reason: g., hypotension/bradycardia with diltiazem). G-tube administration typically requires liquid medications or immediate-release tablets that can be safely crushed and dissolved, with appropriate flushing to prevent clogging. This order should prompt the nurse to hold the dose and contact the prescriber/pharmacist for an alternative formulation (e.g., immediate-release or liquid) and specific administration guidance. In contrast, liquid preparations like acetaminophen and digoxin elixir are usually compatible with tube delivery when given correctly, whereas the key red-flag here is the sustained-release tablet.

Question 17

A client has had heart failure. Which intervention is most important for the nurse to implement prior to the initial administration of Digoxin to this client?

Accepted Answer

Answer reason: The apical pulse best reflects the true ventricular rate in heart failure and in patients who may have irregular rhythms (e.g., atrial fibrillation), and counting for a full minute improves accuracy. Radial pulses and automated device readings can underestimate the rate when pulses are weak or irregular, risking unsafe administration. Assessing for a pulse deficit is useful but is secondary to obtaining the actual apical rate needed to decide whether to hold the dose and notify the provider.

Question 18

A 2 year-old child is being treated with Amoxicillin suspension, 200 milligrams per dose, for acute otitis media. The child weighs 30 lb. (15 kg) and the daily dose range is 20-40 mg/kg of body weight, in three divided doses every 8 hours. Using principles of safe drug administration, what should the nurse do next?

Accepted Answer

Answer reason: The acceptable total daily dose is 20–40 mg/kg/day × 15 kg = 300–600 mg/day, given in 3 divided doses, which equals 100–200 mg per dose. The ordered 200 mg per dose (600 mg/day) is at the upper end of the recommended range, so it is appropriate to administer. Holding the drug or calling to clarify is indicated when the dose is outside the safe range, which is not the case here.

Question 19

The nurse is reinforcing teaching to a 24 year-old woman receiving acyclovir (Zovirax) for a Herpes Simplex Virus type 2 infection. Which of these instructions should the nurse give the client?

Accepted Answer

Answer reason: Prompt initiation shortens symptom duration, decreases lesion severity, and reduces viral shedding compared with delayed treatment. An important teaching point is that acyclovir does not eradicate latent herpes, so a “complete course for an effective cure” is misleading. Routine long-term prophylaxis is reserved for selected patients with frequent recurrences rather than an arbitrary multi-year requirement, and pregnancy concerns require provider guidance rather than abrupt self-discontinuation.

Question 20

A client with moderate persistent asthma is admitted for a minor surgical procedure. On admission the peak flow meter is measured at 480 liters/minute. Post-operatively the client is complaining of chest tightness. The peak flow has dropped to 200 liters/minute. What should the nurse do first?

Accepted Answer

Answer reason: A short-acting beta-agonist is the fastest first-line intervention and is commonly available as a PRN order for asthma exacerbation in the hospital setting. Oxygen can be added if hypoxemia is present, but it does not relieve bronchoconstriction and should not delay giving the rescue inhaler/nebulizer. Notifying the provider is appropriate if the client fails to improve or has severe distress, but the priority is to initiate the standing rescue therapy rather than wait or recheck later.

Question 21

A client with amyotrophic lateral sclerosis has a percutaneous endoscopic gastrostomy (PEG) tube for the administration of feedings and medications. Which nursing action is appropriate?

Accepted Answer

Answer reason: Water flushes before and after administration clear the lumen, reduce medication–formula interactions, and minimize clogging that can interrupt nutrition and require tube replacement. Crushing “all” medications is unsafe because some are enteric-coated or extended-release and can cause toxicity or loss of effect when altered. Routine peroxide use can irritate tissue and impair healing, and manipulating/squeezing the tube to “break up” contents risks tube damage without addressing the underlying need for proper flushing technique.

Question 22

The nurse is teaching a client about precautions with Coumadin. The nurse should instruct the client to avoid foods with excessive amounts of which nutrient?

Accepted Answer

Answer reason: Warfarin (Coumadin) exerts its anticoagulant effect by inhibiting vitamin K–dependent clotting factor synthesis, so dietary vitamin K directly affects the medication’s effectiveness. Excessive intake can reduce anticoagulation, leading to a lower INR and increased risk of clot formation. Teaching focuses on avoiding large amounts and, most importantly, maintaining a consistent intake to prevent wide INR fluctuations. Calcium and iron do not meaningfully antagonize warfarin’s mechanism in the way vitamin K does. Vitamin E can increase bleeding risk at high doses, but it is not the key dietary nutrient that counteracts warfarin.

Question 23

A client on a medical-surgical floor is experiencing acute delirium tremens with seizure activity. The nurse immediately administers what prescribed medication?

Accepted Answer

Answer reason: An IV benzodiazepine provides the fastest onset when active seizure activity is present, making it the priority “immediate” medication. Phenytoin does not effectively treat withdrawal seizures because the mechanism is not a primary epileptic focus. Chlordiazepoxide is useful for withdrawal but is oral and slower in onset, so it is not the best choice during an acute seizure.

Question 24

The nurse is planning care for a client with a total body surface area (TBSA) burned 50%, including the torso and bilateral lower extremities. Which of the following actions should the nurse include in the client’s plan of care during the acute phase of burn treatment?

Accepted Answer

Answer reason: Severe burns cause massive fluid shifts, edema, and altered peripheral perfusion, making absorption from intramuscular sites unreliable and delayed. IM injections also risk tissue injury and infection in compromised, edematous tissue and can lead to unpredictable analgesic effects. During burn management, pain control is better achieved with IV (and sometimes enteral) routes where onset and titration are dependable. In contrast, restricting movement with splints is not the overall goal in the acute phase because early range-of-motion is typically encouraged to prevent contractures unless contraindicated by grafting or specific provider orders.

Question 25

The nurse is conducting a home visit with a client who has a history of angina. Which of the following BEST demonstrates that further teaching about nitroglycerin therapy is required?

Accepted Answer

Answer reason: " Nitroglycerin tablets are unstable and lose potency when exposed to heat, light, moisture, or air, so storage must protect the drug from environmental degradation. Keeping them on a windowsill in a dish exposes them to light and temperature fluctuations and typically leaves them unprotected from humidity/air, increasing the risk of ineffective dosing during angina. Appropriate teaching is to keep tablets in the original, tightly closed, dark glass container at room temperature and replace them per expiration guidance. By contrast, limiting use to up to 3 doses within 15 minutes aligns with standard instructions to treat suspected angina while prompting escalation if pain persists.

Question 26

The homecare nurse performs teaching for a client receiving digoxin (Lanoxin) 0.25 mg, furosemide (Lasix) 40 mg, and potassium chloride (K-Dur) 20 mEq. Which of the following statements, if made by the patient to the nurse, BEST indicates that teaching is successful?

Accepted Answer

Answer reason: Patients taking potassium chloride must avoid potassium-containing salt substitutes because these products can significantly increase potassium intake and raise the risk of hyperkalemia, which can cause dangerous dysrhythmias. This is especially important in a client also taking digoxin, since potassium abnormalities (low or high) can predispose to cardiac rhythm disturbances and toxicity concerns. Other statements show unsafe technique or incomplete understanding: potassium is typically taken with food/full glass of water to reduce GI irritation rather than on an empty stomach, and many KCl tablets are extended-release and should not be crushed due to mucosal injury and altered release. Increasing dietary potassium may be appropriate in some cases with loop diuretics, but it is not the best universal teaching point compared with the clear safety hazard of salt substitutes.

Question 27

The nurse is administering ear drops to a 7 years old boy. How does the nurse pull the patient's ear?

Accepted Answer

Answer reason: In children older than 3 years and in adults, the ear canal is best straightened by pulling the pinna up and back. A 7-year-old fits this age group, so this positioning optimizes delivery and reduces discomfort. Pulling down and back is the technique used for children younger than 3 years because their ear canal angle is different.

Question 28

Which instruction should be given to the client taking alendronate sodium (Fosamax)?

Accepted Answer

Answer reason: Keeping the client upright after dosing reduces esophageal exposure and helps the tablet pass into the stomach, improving safety. The key administration teaching is to take it with a full glass of plain water and avoid lying down for at least 30 minutes (and until after the first food of the day), which also supports absorption. Forcing fluids is not the primary safety instruction for this drug, and combining with estrogen is not required and may add unnecessary risk depending on the client.

Question 29

Insulin is injected into?

Accepted Answer

Answer reason: Intradermal injections are intended for diagnostic testing (e.g., TB) and would not provide appropriate insulin kinetics. Intramuscular delivery can accelerate and vary absorption, increasing hypoglycemia risk, and is generally avoided for routine insulin dosing. Intrathecal administration is reserved for select CNS therapies and is unsafe and inappropriate for insulin.

Question 30

The nurse observes the newly hired registered nurse prepare to administer neutral protamine hagedorn (NPH) insulin to a client. Which action by the newly hired nurse requires follow-up?

Accepted Answer

Answer reason: Insulin is a protein suspension that must be mixed gently to avoid creating foam and air bubbles that can lead to inaccurate dosing. NPH insulin should be rolled between the hands or inverted gently until uniformly cloudy, not vigorously agitated. Checking blood glucose, verifying/rotating injection sites, and teaching hypoglycemia symptoms are appropriate safety actions before or around administration. The observed vigorous mixing step is the key medication-preparation error that warrants immediate follow-up to prevent dosing inaccuracies and glycemic complications.

Question 31

A nurse is caring for a client who has suspected appendicitis. Which of the following actions should the nurse take?

Accepted Answer

Answer reason: Providing prescribed analgesia reduces physiologic stress responses (tachycardia, hypertension) and supports comfort while diagnostic workup continues. Increasing fluids by mouth is often avoided because the client is typically kept NPO in anticipation of imaging, anesthesia, or surgery. Laxatives/suppositories and unnecessary ambulation can increase intra-abdominal pressure and potentially worsen pain or complications if perforation occurs.

Question 32

In an adult client, the nurse plans to administer 2 mL of medication I.M. Which technique is most accurate?

Accepted Answer

Answer reason: Withdrawing medication from a vial requires injecting an equal volume of air to the amount to be withdrawn to prevent a vacuum from forming and to allow accurate measurement. For a 2 mL dose, injecting 2 mL of air maintains appropriate pressure and supports smooth aspiration of the medication. Using a tuberculin syringe is intended for small volumes (typically up to 1 mL) and is not the most accurate choice for a 2 mL IM dose. A 45-degree insertion angle and a 5/8" needle are consistent with subcutaneous administration, whereas IM injections are given at 90 degrees with needle length selected to reach muscle safely.

Question 33

The nurse is caring for a Type 2 diabetic who now requires insulin in addition to oral hypoglycemic therapy. Which of the following orders should the nurse question?

Accepted Answer

Answer reason: Rapid-acting insulins such as lispro are intended to cover carbohydrate intake at meals and have a quick onset with a short duration. Giving a fixed dose at bedtime, without linking it to a meal or a clearly defined correction protocol, raises concern for nocturnal hypoglycemia because the peak effect can occur while the patient is asleep. Basal glycemic control at night is typically provided by intermediate- or long-acting insulin (e.g., NPH, glargine, detemir) rather than a rapid-acting agent. In contrast, metformin XR and glyburide are appropriate oral agents in type 2 diabetes when used with attention to contraindications and hypoglycemia risk, and sliding-scale short-acting insulin based on an elevated preprandial glucose is a common ordered approach.

Question 34

A nurse is conducting the 4:00 p.m. med pass. The patient in room 42B is to receive a narcotic for pain. Before the nurse administers the narcotic to the patient, what should she do first?

Accepted Answer

Answer reason: Comparing the patient’s wristband identifiers (name and DOB) to the medication order verifies the right patient and prevents wrong-patient administration. Room number is not an acceptable identifier and can change with transfers, so relying on it increases error risk. Asking the patient to verify the medication is less reliable and cannot replace identifier-based verification, and documentation is performed after administration.

Question 35

Insulin lipodystrophy should be treated in part by?

Accepted Answer

Answer reason: Rotating/alternating injection sites allows affected tissue to recover and improves consistency of insulin absorption and glycemic control. Dose reduction does not address the local tissue problem and can worsen hyperglycemia. Oral agents are not a treatment for injection-site lipodystrophy and would not correct absorption variability from damaged tissue.

Question 36

A nurse is preparing to administer liquid medication to a 2-year-old child. Which approach should the nurse use?

Accepted Answer

Answer reason: Placing the liquid along the side of the mouth/inside the cheek allows slower swallowing and avoids triggering gagging that can occur with squirting toward the back of the throat. Mixing medication in a bottle is unsafe because the child may not finish the feed, leading to an incomplete dose. Offering “now or later” is not developmentally appropriate for a 2-year-old and may delay needed therapy, and asking a toddler to swallow a pill is generally inappropriate.

Question 37

A client with osteomylitis has an order for a trough level to be done because he is taking Gentamycin. When should the nurse call the lab to obtain the trough level?

Accepted Answer

Answer reason: Aminoglycosides like gentamicin require therapeutic drug monitoring because of nephrotoxicity and ototoxicity, and timing errors make levels uninterpretable. By the fourth dose, steady state is typically approached in standard multiple-dose regimens, so drawing it shortly before that dose provides a meaningful trough. Drawing after a dose would reflect a peak/early distribution phase rather than a trough, and drawing before the first dose does not measure drug accumulation.

Question 38

The nurse is preparing to administer medications to a client with pneumonia who had five liquid bowel movements so far today. Which action by the nurse is most appropriate?

Accepted Answer

Answer reason: With multiple liquid stools, the immediate medication-safety action is to avoid giving agents that can worsen diarrhea or cause further fluid/electrolyte loss. Docusate is a stool softener and is not appropriate to continue when the client is already having frequent loose stools. Antidiarrheals such as loperamide should not be started without evaluating for infectious causes (including possible C. difficile) and provider guidance. Holding antibiotics is unsafe because it can compromise treatment of pneumonia and does not address the likely medication-related or infectious etiology of the diarrhea.

Question 39

Which of the following is the appropriate route of administration for insulin?

Accepted Answer

Answer reason: The standard and most appropriate routine route for outpatient insulin therapy is subcutaneous injection, which provides predictable absorption from subcutaneous tissue for basal and bolus dosing. Intravenous insulin is reserved for specific acute situations (e.g., DKA, perioperative or ICU protocols) where rapid titration is needed, not routine administration. Intramuscular and intradermal routes do not provide the intended absorption profile and are not standard for insulin delivery.

Question 40

The nurse prepares to administer medication via IV push into an established IV line. Which action does the nurse take?

Accepted Answer

Answer reason: IV push medications must be administered at the prescribed rate to reduce risk of adverse effects such as hypotension, dysrhythmias, or CNS toxicity from rapid bolus dosing. Using a watch supports accurate control of the seconds/minutes required for safe delivery, rather than estimating the rate. Selecting the port farthest from the insertion site increases dead space and delays medication delivery, and the priority is correct technique for safe dosing. Teaching should occur before administration when possible, not deferred until after the procedure.

Question 41

A client is ordered diuretics. Which of the following would be the best time of day for the nurse to schedule this medication?

Accepted Answer

Answer reason: Giving the dose in the morning aligns the peak diuretic effect with waking hours when the client can safely access the bathroom. Scheduling at night commonly leads to nocturia, poor sleep, and higher risk of dizziness-related injury when getting up. Noon can be acceptable for a second daily dose, but the best standard scheduling for routine once-daily diuretics is early in the day.

Question 42

The nurse can administer which mediation through a nasogastric (NG) tube?

Accepted Answer

Answer reason: This option can be administered as a liquid formulation or as an immediate-release tablet that can be crushed and diluted for NG delivery. Enteric-coated products should not be crushed because that destroys the protective coating and can increase gastric irritation and alter absorption. Regular insulin is not given via NG tube (it is administered subcutaneously or IV), and sublingual nitroglycerine is intended for rapid absorption through oral mucosa, not gastric administration.

Question 43

The cheat who had a kidney transplant has newly prescribed medications. Which prescribed medication should the nurse administer for BP control?

Accepted Answer

Answer reason: This option represents a dihydropyridine calcium channel blocker that lowers systemic vascular resistance, making it appropriate for managing elevated blood pressure. Tacrolimus is an immunosuppressant used to prevent graft rejection and can actually contribute to hypertension and nephrotoxicity rather than treat BP. Digoxin is used for certain dysrhythmias/heart failure and epoetin alfa treats anemia of chronic kidney disease, so neither is a primary BP medication.

Question 44

The clinic nurse is preparing to administer monovalent HepB (hepatitis B vaccine) IM to a newborn. Which site is best for the nurse to select?

Accepted Answer

Answer reason: This site also has fewer major nerves and blood vessels at risk compared with gluteal locations, reducing the chance of injury. The deltoid is typically too small in infants and is reserved for older children and adults. The dorsogluteal site is avoided due to proximity to the sciatic nerve and variable fat thickness that can lead to improper IM delivery.

Question 45

A 2-month-old child receives a dose of ceftriaxone (Rocephin) intramuscularly. Which is the preferred site of injection for this client?

Accepted Answer

Answer reason: Infants have limited, reliably developed muscle mass in the upper arm and gluteal regions, so the safest and most predictable IM absorption site is the anterolateral thigh. The vastus lateralis is well developed by birth and is away from major nerves and blood vessels, reducing risk of sciatic nerve injury. The dorsogluteal site is avoided in infants because of proximity to the sciatic nerve and variable subcutaneous fat thickness. The deltoid is generally reserved for older children with adequate muscle mass and smaller injection volumes.

Question 46

A key nursing task is to administer injections to clients. This requires the nurse’s knowledge of needle sizes and lengths. Which needle size is the largest?

Accepted Answer

Answer reason: Needle gauge is inversely related to needle diameter: the smaller the gauge number, the larger the needle bore. A larger bore is used when higher flow rates or thicker fluids are needed (e.g., rapid IV fluids, blood administration). Among the listed choices, 18 is the lowest gauge number, so it corresponds to the greatest diameter. A common error is assuming a higher gauge number means a larger needle, but it is the opposite.

Question 47

The nurse prepares to give an intramuscular injection to a client. Which is considered the safest and preferred site for intramuscular injections?

Accepted Answer

Answer reason: IM injection site selection prioritizes minimizing risk of nerve/vascular injury while allowing reliable muscle mass for medication deposition. The ventrogluteal site is preferred because it is away from major nerves and large blood vessels and has consistent muscle thickness, reducing the chance of sciatic nerve damage. The dorsogluteal site is avoided due to proximity to the sciatic nerve and variable subcutaneous fat that can lead to inadvertent subcutaneous injection. Deltoid has limited volume capacity and higher risk of injury if landmarks are incorrect, so it is mainly used for small-volume injections such as vaccines.

Question 48

A client with pernicious anemia undergoes gastrectomy. Which route should the nurse use to administer cyanocobalamin (vitamin B12) after the surgery?

Accepted Answer

Answer reason: Without intrinsic factor, gastrointestinal administration (oral/buccal) cannot be relied upon to correct deficiency in a predictable way. Parenteral administration bypasses the GI tract and provides dependable replacement to restore erythropoiesis and prevent neurologic complications. A transdermal option is not a standard, evidence-based route for cyanocobalamin replacement in this setting.

Question 49

The nurse is caring for the infant diagnosed with PDA. By which route should the nurse expect to administer indomethacin?

Accepted Answer

Answer reason: The IV route is preferred in many newborn/PDA treatment protocols because it avoids variable gastrointestinal absorption and allows close monitoring during administration. This medication can significantly affect renal perfusion and platelet function, so a route that supports careful titration and monitoring is clinically safest. Oral or rectal routes are not the expected standard in acute PDA management in infants, and IM administration is not used due to poor suitability and potential tissue injury in neonates.

Question 50

Prednisone is prescribed tid for a child receiving chemotherapy. Which is the best schedule for the nurse to suggest to a parent?

Accepted Answer

Answer reason: Corticosteroids should be timed to mimic normal diurnal cortisol secretion and to minimize insomnia and gastric irritation. Giving the first dose in the morning and avoiding late-evening or nighttime dosing reduces sleep disturbance, mood changes, and HPA-axis disruption. A roughly daytime TID schedule with the last dose in the late afternoon/early evening best balances therapeutic coverage with tolerability. Options with a late-night (10 p.m.) or overnight (2 a.m.) dose are more likely to cause insomnia and poor adherence.

Train with a large NCLEX question bank and jump into a full exam-style simulator

Medication Administration NCLEX Practice Test

Continue Learning