Question 1

Which assessment finding would alert a nurse to change the intranasal route for vasopressin administration that has been prescribed for a client?

Accepted Answer

Answer reason: Active epistaxis indicates mucosal trauma/fragility, and spraying can exacerbate bleeding while reducing medication delivery to the mucosa. In a client receiving vasopressin (often for diabetes insipidus), unreliable absorption risks inadequate antidiuretic effect and poor symptom control. Mild irritation can be monitored and managed, but bleeding is a clearer safety and efficacy trigger to change routes. Pneumonia or coughing does not inherently prevent nasal absorption in the same direct way as active nasal bleeding.

Question 2

A 15-month-old child is diagnosed with pediculosis of the eyebrows. Which intervention is included in the treatment?

Accepted Answer

Answer reason: Safe management of lice in the eyebrow/eyelash area prioritizes avoiding neurotoxic or irritating pediculicides near the eyes in very young children. Occlusive therapy with a thick petrolatum application helps smother lice and loosens nits, allowing careful removal with a fine comb or manual picking. Lindane is avoided in infants/toddlers due to CNS toxicity risk and is not appropriate around the eyes. Shaving is unnecessary and can cause skin trauma, and leaving it untreated risks ongoing infestation and spread.

Question 3

Which statement concerning pancreatic enzymes for a cystic fibrosis client is correct?

Accepted Answer

Answer reason: Pancreatic enzyme replacement in cystic fibrosis must be timed with any intake containing fat/protein so digestion and absorption occur in the intestinal lumen. Giving doses with every meal and snack matches this pharmacokinetic/physiologic requirement and reduces steatorrhea, abdominal distention, and poor weight gain. A key safety point is that the enteric-coated granules should not be crushed because that destroys the protective coating and can inactivate enzymes and irritate oral mucosa. Capsules may be opened and the beads mixed with an acidic soft food if needed for children who cannot swallow capsules, making the “may not be opened” statement incorrect.

Question 4

A client receiving an injection of morphine requests “my buttocks be used for the injection.” The nurse explains that this site is not preferred because it is in close proximity to?

Accepted Answer

Answer reason: IM injections in the dorsogluteal (buttocks) area are avoided because the nearby sciatic nerve can be injured if the injection is misplaced. Sciatic nerve damage can cause severe pain, numbness/paresthesia, and motor weakness, making it a significant preventable complication of medication administration. For this reason, the ventrogluteal site is generally preferred for gluteal IM injections due to fewer major nerves and vessels in the injection zone. The other listed nerves are not the major structure classically at risk with a buttocks IM injection site.

Question 5

The nurse is caring for clients with second- and third-degree burns. Which medication should the nurse plan to apply topically to treat bacterial and yeast infections?

Accepted Answer

Answer reason: This agent is a standard topical burn medication with broad antimicrobial activity that covers many bacteria and also has activity against yeast, helping prevent and treat burn-wound infection. The other options are not topical burn antimicrobials used for this purpose (e.g., bismuth subsalicylate is for GI symptoms; gold sodium thiomalate is an older antirheumatic; arsenic trioxide is a chemotherapy agent). Selecting a burn-specific topical antimicrobial best aligns with safe wound management and infection prevention in second- and third-degree burns.

Question 6

The client calls a clinic to renew the prescription for insulin being administered subcutaneously via an insulin pump. Which insulin type, if prescribed by the HCP, should the nurse question?

Accepted Answer

Answer reason: Long-acting insulin analogs are not appropriate for continuous subcutaneous infusion due to their pharmacokinetic profile and formulation characteristics, which can lead to unreliable delivery and glycemic control. The rapid-acting analogs are commonly used in pumps and match the intended pump mechanism. Questioning this order helps prevent hypo/hyperglycemia related to inappropriate insulin selection for pump administration.

Question 7

The hospitalized client is prescribed to receive ferrous fumarate 200 mg oral daily. When transcribing the medication onto the client’s MAR, at which time in military time should the nurse schedule the daily dose for best absorption?

Accepted Answer

Answer reason: Scheduling the dose mid-morning maximizes the chance it is given between meals rather than with breakfast or dinner. 0830 is typically close to breakfast service, 1230 coincides with lunch, and 1730 is near dinner, all of which increase the likelihood of reduced absorption. While iron may be given with food if GI upset occurs, the question asks specifically for best absorption.

Question 8

A nurse is preparing to administer “Regular insulin 4 units subcutaneously” to a client with type 1 diabetes mellitus. Which equipment does the nurse need to perform the injection?

Accepted Answer

Answer reason: A 27-gauge needle is appropriate for insulin due to its small diameter, which reduces tissue trauma. A ½-inch length is commonly used for subcutaneous injections, especially for small doses like 4 units. The 22-gauge options are too large for routine insulin injections, and a 1-inch needle increases the risk of reaching muscle, particularly in thin clients.

Question 9

The nurse is discharging the child with sickle cell disease who has undergone a splenectomy. The child has an allergy to penicillin. The nurse should anticipate teaching about which prophylactic medication?

Accepted Answer

Answer reason: Standard prophylaxis is a penicillin-class agent, but a true penicillin allergy requires an alternative antibiotic. A macrolide such as erythromycin is an accepted substitute to provide ongoing bacterial coverage when penicillins cannot be used. Epoetin treats anemia, morphine treats pain, and amoxicillin is a penicillin derivative that would be avoided in penicillin allergy.

Question 10

The HCP’s progress notes state a plan to initiate an oral NSAID for the child’s pain. Based on this information, the nurse should consult with the HCP when noting that which medication was the only analgesic prescribed?

Accepted Answer

Answer reason: The listed medication is an opioid analgesic rather than an NSAID, so it does not match the documented plan and warrants clarification to prevent a mismatch between intended therapy and prescribed medication. In contrast, the other choices are NSAIDs that align with initiating oral NSAID therapy. Consulting the prescriber helps ensure the analgesic regimen matches the intended anti-inflammatory approach and avoids inappropriate medication selection for the plan of care.

Question 11

The nurse is preparing to administer an analgesic for short-term mild pain to the child who has a history of acute renal insufficiency. Which medication should the nurse select from the list of options from the HCP's symptom control protocol?

Accepted Answer

Answer reason: NSAIDs like ibuprofen decrease renal prostaglandin synthesis, which can reduce renal blood flow and precipitate or worsen kidney injury. Opioids (morphine, meperidine) are generally reserved for moderate to severe pain, and their metabolites may accumulate in renal dysfunction, increasing risk of sedation or neurotoxicity. Therefore, acetaminophen is preferred for short-term mild pain when renal function is a concern.

Question 12

The nurse is preparing to administer digoxin and diuretics to an infant diagnosed with truncus arteriosus. What is best method of administration?

Accepted Answer

Answer reason: An oral syringe provides the most precise measurement and allows controlled administration into the side of the infant’s mouth to reduce loss and ensure the full dose is taken. Measuring spoons and droppers are less reliable for exact mL dosing and increase risk of dosing error. Mixing medication in a full bottle risks incomplete dosing if the infant does not finish the feeding and can also affect drug stability or absorption.

Question 13

An infant has a positive test result for diabetes insipidus. The nurse should anticipate the physician ordering a test dose of which medication?

Accepted Answer

Answer reason: A test dose of vasopressin is used to assess responsiveness (and clinically can help distinguish central from nephrogenic DI by observing reduction in urine output and increased urine specific gravity/osmolality). This medication directly replaces the missing ADH effect at the kidney collecting ducts, promoting water reabsorption. Growth hormone and ACTH target entirely different endocrine axes and would not correct the hallmark water-balance problem of DI. Nursing monitoring after a test dose focuses on strict I&O, urine specific gravity, vital signs, and signs of water intoxication/hyponatremia as urine output falls.

Question 14

A 2-year-old client has an order for instillation of antipyrine and benzocaine otic (Auralgan) into the external ear canal. Which action by the nurse is correct?

Accepted Answer

Answer reason: In children younger than 3 years, the external auditory canal is more horizontal, so straightening it for ear-drop administration requires pulling the pinna down and back. This positioning helps the medication flow into the canal rather than pooling near the opening. Pulling up and back is the technique used for older children and adults and would be less effective in a 2-year-old. Using the correct technique also reduces discomfort and improves therapeutic delivery of the otic medication.

Question 15

A client is to receive an injection of methylprednisolone sodium succinate (Solu-Medrol) 125 mg. The vial on hand has 125 mg per 2 mL. Which is the least likely site to use for this medication?

Accepted Answer

Answer reason: IM site selection is guided by volume tolerance and risk of neurovascular injury. A 2 mL injection is at the upper end of what the deltoid can safely and comfortably accept, and larger volumes increase pain and the chance of improper placement. Ventrogluteal and vastus lateralis are preferred for larger-volume IM injections because they have more muscle mass and can accommodate 2 mL more reliably. Dorsogluteal is generally avoided in many settings due to sciatic nerve/variable fat pad concerns, but it is still a large muscle area; the question asks least likely, making the small-volume deltoid the best choice.

Question 16

The nurse is instructing the client who will be discharged on anticoagulant therapy. Which of the following is an appropriate instruction?

Accepted Answer

Answer reason: Maintaining consistent dosing and timing helps keep anticoagulation levels stable and reduces the risk of either clotting (underdosing) or bleeding (overdosing). Regular administration at the same time each day supports adherence and safer therapeutic control, especially for medications with narrow therapeutic windows. An electric razor is typically recommended to minimize cuts, so advising against it is unsafe teaching. NSAIDs like ibuprofen and aspirin increase bleeding risk, and high vitamin K foods (green leafy vegetables) should be kept consistent rather than emphasized as “important to eat daily.”.

Question 17

The nurse is caring for a preoperative client with insulin-dependent diabetes. On the morning of surgery, the nurse should carry out which of the following nursing actions?

Accepted Answer

Answer reason: Preoperative patients are typically NPO and insulin requirements change, so administering the usual regimen can precipitate hypoglycemia while holding all insulin can lead to hyperglycemia and ketosis. The safest nursing action is to verify the provider’s perioperative insulin plan (often a reduced basal dose with close glucose monitoring and specific correction orders). Oral antidiabetic agents are generally held before surgery due to fasting status and perioperative risks. An IV insulin infusion is not routine for all insulin-dependent clients and is usually reserved for major surgery, critical illness, or significant hyperglycemia under a specific protocol.

Question 18

A nurse has given discharge instructions to a client with chronic cholecystitis. Which response by the client indicates the teaching has been effective?

Accepted Answer

Answer reason: Chronic cholecystitis education commonly includes measures to decrease biliary tract spasm and manage pain/nausea while avoiding dietary triggers. Anticholinergics can reduce smooth-muscle spasm and biliary colic symptoms, so adherence reflects correct understanding of the treatment plan. Increasing dietary fat would stimulate gallbladder contraction and can worsen symptoms, making it a classic incorrect teaching statement. Rest is nonspecific and does not demonstrate understanding of disease-specific self-management, and antacids are not generally contraindicated for this condition.

Question 19

The nurse is providing teaching for parents who are planning to administer prescribed growth hormone to their child at home. The parents ask the nurse what the best time is to give the medication. What is the best response by the nurse?

Accepted Answer

Answer reason: Administering it at night helps mimic the natural circadian pattern and supports optimal therapeutic effect while maintaining a consistent daily routine. Dosing earlier in the day or specifically around meals is not required and does not match the normal nocturnal surge. Consistent bedtime administration also simplifies adherence for families giving injections at home.

Question 20

Which instruction would the nurse include for the parents of a child who is to receive nystatin oral solution?

Accepted Answer

Answer reason: Nystatin oral suspension treats oral candidiasis by direct contact with the oral mucosa, so administration should maximize mucosal contact time. Giving it after a feeding helps keep the medication in the mouth longer rather than being immediately washed away by food or liquid. Mixing it with a feeding or splitting the dose around a feeding can reduce effective contact with lesions and may lead to less consistent delivery to affected areas. A practical teaching point is to apply/“swish” around the mouth when possible and avoid immediate intake afterward to preserve local action.

Question 21

The nurse administers a prochlorperazine suppository to the adult client. Which action best ensures the nurse that the medication is correctly administered?

Accepted Answer

Answer reason: If the suppository is inserted beyond the sphincter, the nurse may feel the sphincter close and “pull” the suppository inward, indicating correct placement and reducing expulsion risk. Left-side positioning and lubrication support comfort and ease of insertion but do not confirm that the suppository is past the sphincter. Stool characteristics 30 minutes later are not a reliable indicator of correct administration and may reflect bowel activity rather than medication placement.

Question 22

An infant client who takes oral medication can be encouraged to swallow the medication by which method?

Accepted Answer

Answer reason: Infants have a strong sucking reflex, so using an empty nipple helps trigger coordinated suck–swallow mechanics and improves acceptance of the medication. Mixing medication in a full bottle is unsafe because the infant may not finish the feeding, leading to an underdose and potential medication waste. Positioning with the head lower than the feet increases aspiration risk and is contraindicated for oral administration. Syringe dosing can be used, but the safer technique is to deliver small amounts into the side of the mouth; specifying 1 mL with each swallow is not the key strategy for encouraging swallowing and may still increase choking/aspiration risk if delivered too quickly.

Question 23

A client who has difficulty taking medications requests that the tablet be crushed and mixed with applesauce. Which medication is appropriate for the nurse to crush?

Accepted Answer

Answer reason: Medications should not be crushed when they are enteric-coated or sustained/extended-release, because altering the formulation can cause loss of protective effects, dose dumping, or drug inactivation. Enteric-coated aspirin is designed to resist stomach acid and reduce gastric irritation, and crushing defeats that protection. Cardizem SR is sustained-release, and crushing can release the full dose at once, risking hypotension/bradycardia. Omeprazole is typically formulated as delayed-release/enteric-coated granules to prevent acid destruction, while standard levothyroxine tablets (not extended-release) may be crushed when needed to facilitate administration.

Question 24

A client has eye ointment instilled in both eyes. Which action should the nurse take immediately after medication administration?

Accepted Answer

Answer reason: After ophthalmic medications, occluding the nasolacrimal duct reduces drainage into the nasopharynx and limits systemic absorption. This helps keep more medication in contact with the conjunctival sac and decreases risk of systemic side effects. Squeezing the eyes shut tightly can force medication out of the conjunctival sac and increase irritation. Lying flat is not required for proper absorption and does not address systemic absorption risk.

Question 25

The nurse uses an intradermal injection to administer a tuberculin test. Which statement indicates the injection is administered correctly?

Accepted Answer

Answer reason: Intradermal injections are intended to deposit a small volume into the dermis, creating a visible, raised wheal that confirms correct depth and technique. A wheal indicates the fluid spread within the dermal layer rather than leaking or being delivered subcutaneously. Redness or mild itching can occur later as a local reaction and does not verify proper placement at the time of administration. Correct technique also uses the bevel up; a downward bevel orientation is inconsistent with standard intradermal administration.

Question 26

The nurse observes a colleague about to administer an IM injection to the 12-month-old. Which intervention requires the nurse to intervene?

Accepted Answer

Answer reason: In a 12-month-old, the dorsogluteal site is avoided because of proximity to the sciatic nerve and inconsistent muscle development, making injury and poor absorption more likely. Preferred sites at this age are the vastus lateralis or (if adequately developed) the ventrogluteal. The other observed actions can be appropriate depending on medication and child size (e.g., limiting volume, appropriate needle length, and use of topical anesthetic with correct timing), but choosing the dorsogluteal site represents an unsafe technique requiring intervention.

Question 27

Medical management of coronary artery disease (CAD) has been discussed with a client. The nurse anticipates that management will include which of the following?

Accepted Answer

Answer reason: This typically involves oral agents such as antiplatelets, statins, beta blockers, ACE inhibitors/ARBs, and antianginals as appropriate to symptoms and risk profile. Invasive procedures like catheterization, PTCA, or CABG are reserved for diagnostic clarification or significant ischemia/obstructive disease not adequately controlled with medications and risk-factor modification. The question asks what is anticipated as part of medical management, making pharmacologic therapy the most universally applicable option.

Question 28

The nurse is providing instruction to a single parent about administering levothyroxine (Synthroid) to her neonate. What is the most important information for the nurse to provide?

Accepted Answer

Answer reason: Levothyroxine absorption is decreased by substances in formula (notably iron and calcium) and can also be inconsistent when mixed into larger volumes, risking underdosing in a neonate where precise thyroid replacement is critical for growth and neurodevelopment. Giving it separately helps ensure the full dose is taken and maintains predictable absorption. Crushing is commonly required for infants, so prohibiting crushing would interfere with safe administration rather than promote it. Doubling doses after a missed dose increases the risk of adverse effects and is unsafe; missed-dose instructions should emphasize contacting the provider/pharmacist for guidance.

Question 29

An iron dextran (INFeD) injection has been ordered for an 8-month-old child with iron deficiency anemia whose parents haven’t been compliant with oral supplements. How should the nurse administer the injection?

Accepted Answer

Answer reason: The Z-track technique displaces skin and subcutaneous tissue to seal the medication in the muscle, reducing leakage and minimizing skin discoloration and local irritation. This method is a key safety step with IM iron in infants/children because small tissue volumes increase the risk of cosmetic staining and discomfort. Intradermal and subcutaneous routes are inappropriate for iron dextran, and plain IM without Z-track increases the chance of medication seepage into subcutaneous tissue.

Question 30

The client is prescribed ferrous sulfate 300 mg PO bid. Which action should be taken by the nurse?

Accepted Answer

Answer reason: The nursing principle is to verify that a medication order is complete, clear, and within the expected therapeutic dosing range before administration. Ferrous sulfate 300 mg orally twice daily is a common adult regimen for iron-deficiency anemia, and both the route (PO) and frequency (bid) are clearly specified. Because the order is not ambiguous and does not exceed typical dosing, there is no safety-based indication to hold the dose or call the prescriber. A common distractor is assuming the nurse must question the frequency; however, twice-daily dosing is routinely used to provide adequate elemental iron and improve repletion.

Question 31

The client with glaucoma is prescribed a miotic cholinergic medication. Which data support the teaching for this medication has been effective?

Accepted Answer

Answer reason: Effective teaching is demonstrated by correct adherence behaviors that maintain continuous therapeutic control of intraocular pressure. Glaucoma medications must be taken consistently, including during travel, because missed doses can lead to elevated intraocular pressure and progressive optic nerve damage. Placing drops in the inner canthus is not correct administration (drops should go in the conjunctival sac), making that choice evidence of ineffective teaching. Routine glove use is not required for self-instillation and does not indicate understanding of key medication principles.

Question 32

A nurse gives a subcutaneous injection of heparin sodium (Heparin). Which is a true statement regarding this injection?

Accepted Answer

Answer reason: Heparin is an anticoagulant, so minimizing tissue trauma during administration is a key safety principle to reduce bleeding and bruising. Pulling back on the plunger can create additional tissue disruption and may increase the chance of puncturing a small vessel, promoting local bleeding and hematoma. Standard technique for subcutaneous heparin includes avoiding aspiration and avoiding post-injection massage because both increase bruising risk. Rotating injection sites is also important to prevent repeated tissue injury, making “same general area” an unsafe practice.

Question 33

The client has returned from the operating room with the nursing diagnosis of acute pain. The nurse knows the best means of providing comfort would be to administer?

Accepted Answer

Answer reason: Morphine sulfate 0.2 mg/ml via patient-controlled analgesia. Postoperative acute pain is best managed with a rapid-onset, titratable method that maintains steady analgesia while minimizing delays in dosing. PCA allows the patient to self-administer small, frequent doses within programmed safety limits, improving pain control and reducing peaks and troughs seen with intermittent PRN dosing. Intramuscular injections have slower, less predictable absorption after surgery and can be unnecessarily painful. Oral opioids may be inappropriate immediately post-op if nausea, ileus, or NPO status is present, making this option less reliable for prompt comfort.

Question 34

A nurse is teaching nursing students about maintaining a healthy liver. Which measure should the nurse include in her teaching?

Accepted Answer

Answer reason: Medication-related hepatotoxicity is a common, preventable cause of liver injury, so safe medication use is a key health-maintenance teaching point. Following prescription directions reduces overdose risk, avoids unsafe combinations, and supports appropriate monitoring when drugs have hepatic metabolism or known liver warnings. In contrast, taking OTC medications “as needed” can encourage unsupervised use of agents like acetaminophen, which can cause severe liver damage even with modest dosing errors. Routine nutritional supplements are not universally protective and some herbal products can be hepatotoxic, and a low-protein diet is not a general recommendation for a healthy liver (it is reserved for specific conditions such as hepatic encephalopathy).

Question 35

Which assessment should a nurse do prior to administering disulfiram (Antabuse) to a client with a history of alcohol abuse?

Accepted Answer

Answer reason: Disulfiram works by inhibiting aldehyde dehydrogenase, so ingesting alcohol while on therapy can precipitate an acute reaction with flushing, severe nausea/vomiting, hypotension, and potential cardiovascular collapse. A key safety assessment before administration is confirming recent abstinence and that no alcohol has been consumed within the required window (commonly at least 12 hours, and longer for some products/exposures). This directly prevents an avoidable, potentially life-threatening adverse event at the point of medication administration. Motivation measures (AA commitment or admitting a problem) may influence long-term adherence but do not address the immediate physiologic risk of giving the drug too soon after alcohol exposure.

Question 36

The nurse is planning teaching for the client who is using miconazole cream topically for tinea pedis. Which instruction should the nurse include?

Accepted Answer

Answer reason: Topical antifungals are most effective when applied to clean, dry skin and worked into the involved area to ensure adequate contact with the stratum corneum where dermatophytes reside. Rubbing it in helps distribute medication across the affected skin (and immediate surrounding area) and improves penetration compared with simply placing it on the surface. Occlusive dressings are generally avoided for tinea pedis because they trap moisture and can worsen fungal growth or maceration. Stopping therapy as soon as symptoms improve increases the risk of incomplete eradication and recurrence, so clients are typically instructed to continue for the full recommended course.

Question 37

Two hours after administering iron dextran, the nurse is drawing the client’s blood sample for a laboratory test. Which intervention should the nurse implement when noting that the client’s blood has a brownish hue?

Accepted Answer

Answer reason: Iron dextran can cause benign discoloration of serum/plasma, producing a brownish hue that can be relevant for laboratory interpretation without indicating acute harm. The nurse’s priority is to accurately communicate specimen characteristics to the lab and in the medical record so results can be interpreted in context and any assay interference can be considered. Re-drawing from another site does not eliminate medication-related discoloration and may unnecessarily subject the client to another venipuncture. Discarding the sample or urgently notifying the HCP is not indicated in isolation when the client is otherwise stable and the finding is an expected medication-related change.

Question 38

The nurse is caring for the infant whose mother has tested positive for hepatitis B surface antigen. The nurse is preparing to administer the hepatitis B vaccine to the infant. To prevent infection, which medication should the nurse administer along with the hepatitis B vaccine?

Accepted Answer

Answer reason: Giving hepatitis B immune globulin provides ready-made anti-HBs antibodies while the vaccine prompts the infant to develop long-term immunity. This combined approach is time-sensitive and is intended to prevent establishment of infection after exposure at birth. Antivirals and antibiotics do not prevent hepatitis B acquisition in this setting, and antipyretics only treat symptoms rather than providing prophylaxis.

Question 39

Methylphenidate hydrochloride is prescribed for the child with ADHD. The nurse should teach the parents to administer the medication in which way?

Accepted Answer

Answer reason: Methylphenidate should be given on a scheduled basis as prescribed, not PRN in response to behaviors, because consistent dosing is needed for symptom control and safe titration. Administering near bedtime is inappropriate because stimulants can cause insomnia and worsen sleep onset. Giving the dose with or after meals is a practical nursing teaching point to support nutrition while the child is on therapy.

Question 40

The nurse has provided discharge teaching for a client who was hospitalized and treated for acute diverticulitis. Which statement by the client indicates understanding of the discharge instructions?

Accepted Answer

Answer reason:  Completing the full prescribed antimicrobial course is essential to fully treat the infection and reduce the risk of relapse or complications such as abscess or perforation. Stopping therapy early can allow bacteria to persist and symptoms to recur even if the client feels better. In contrast, reducing fluids can worsen constipation and increase colonic pressure, and intentionally increasing intra-abdominal pressure can aggravate diverticular disease and raise complication risk. While fiber intake is typically advanced after the acute episode resolves, the most universally correct discharge action here is adherence to the antibiotic regimen.

Question 41

A 3-year-old child has a positive culture for a Streptococcus organism. The most important discharge instruction for the nurse to give the parents would be?

Accepted Answer

Answer reason: The key discharge principle is to complete the full antibiotic course to fully eradicate Streptococcus and prevent complications and recurrence. Stopping therapy when fever resolves can leave residual bacteria, increasing the risk of ongoing infection and post-streptococcal sequelae. Aspirin is inappropriate in young children with febrile illness due to the risk of Reye syndrome. Hydration is supportive but does not address the most safety-critical treatment adherence issue for this diagnosis.

Question 42

A client is learning to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, would indicate the need for further teaching?

Accepted Answer

Answer reason: The correct sequence is to inject air into NPH, then air into regular, withdraw regular (clear) first, and withdraw NPH last. Drawing up NPH before regular risks carrying NPH into the regular vial via the needle, changing the regular insulin’s action profile and creating unpredictable glycemic control. Injecting air equal to the dose and clearing bubbles are routine syringe techniques that support accurate dosing and are not the primary error in mixing order.

Question 43

Which statement by the parent of a child with otitis media indicates an understanding of a nurse’s discharge instruction on the use of antibiotics?

Accepted Answer

Answer reason: Antibiotics must be taken for the prescribed duration to fully eradicate the pathogen and reduce recurrence and resistance. Symptom improvement (such as less ear pain) can occur before the infection is cleared, so stopping early risks treatment failure and relapse. Using antibiotics only “whenever” pain occurs reflects PRN misuse and increases inappropriate exposure. Otitis media antibiotics are typically given orally (not placed into the ear canal) unless a specific otic preparation is prescribed for a different indication.

Question 44

A client with long-standing rheumatoid arthritis has frequent complaints of joint pain. The nurse’s plan of treatment is based on the understanding that chronic pain is most effectively relieved when analgesics are administered in which way?

Accepted Answer

Answer reason: Around-the-clock dosing is more effective than waiting for pain to become severe, which can require higher doses and makes pain harder to control. PRN-only dosing tends to allow breakthrough pain and contributes to delayed relief and increased functional limitation. Alternating I.M. and I.V. routes is unnecessary and increases invasiveness and risk when oral or consistent scheduled regimens are typically preferred for chronic conditions like rheumatoid arthritis.

Question 45

The nurse is providing education for a client newly diagnosed with Addison’s disease who is receiving a maintenance dose of steroids. What is the most important information for the nurse to include?

Accepted Answer

Answer reason: The priority teaching is adherence: missed doses or abrupt discontinuation can precipitate severe hypotension, shock, and hypoglycemia. Dose changes should be made according to provider guidance (often “stress dosing” during illness/surgery), not independently based on routine diet and exercise. Fluid restriction is inappropriate because patients are more prone to dehydration and hyponatremia from aldosterone deficiency; hypoglycemia awareness is helpful but does not outweigh strict medication adherence for crisis prevention.

Question 46

The nurse is caring for the client with CA receiving piroxicam. Which instruction is most important for the nurse to include in the medication teaching plan?

Accepted Answer

Answer reason: Piroxicam is an NSAID that inhibits prostaglandin synthesis, reducing the protective gastric mucosal barrier and increasing the risk of GI irritation, ulceration, and bleeding. Taking it with food (or milk) is a key safety teaching point that helps minimize stomach upset and improves tolerability, supporting adherence. In contrast, self-escalating the dose increases toxicity risk without nurse/provider guidance, and adding ginkgo raises bleeding risk due to antiplatelet effects when combined with an NSAID. Advising the client to lie down is not a primary safety measure for this medication and does not address the most clinically significant preventable adverse effect.

Question 47

The HCP is preparing to administer sterile water injections to decrease the laboring client's back pain. The nurse would prepare the client to receive the injections by which administration route?

Accepted Answer

Answer reason: This technique targets the dermis in the lower back where pain is referred, rather than producing a systemic medication effect. IV administration into fluids is inappropriate because sterile water is not an analgesic infusion and would not provide the intended local effect. Subcutaneous or intramuscular routes would place the fluid too deep and are not the standard method for this specific nonpharmacologic analgesia technique.

Question 48

The 8-year-old weighing 25 kg is prescribed azithromycin 250-mg oral tablet daily to treat bacterial pneumonia. Which intervention should the nurse implement?

Accepted Answer

Answer reason: Oral antibiotic administration in children should prioritize safe ingestion and adherence while monitoring for expected, usually mild GI effects. A preferred beverage after swallowing helps clear the taste, supports comfort, and decreases the chance the child will refuse future doses. GI upset (including diarrhea) can occur with macrolides and is typically monitored and managed rather than being an automatic reason to hold therapy unless severe or suggestive of C. difficile. Food timing is not a strict requirement for azithromycin tablets, and 250 mg once daily is within common pediatric dosing limits for a 25-kg child, so it does not inherently indicate an excessive dose.

Question 49

The nurse is providing discharge instructions for a client with iron deficiency anemia. What is the most important information for the nurse to include about the prescribed ferrous gluconate therapy?

Accepted Answer

Answer reason:  Oral iron is absorbed best in an acidic environment and its absorption is reduced by substances that bind iron or raise gastric pH. Taking it without food maximizes bioavailability, improving hemoglobin repletion and iron store restoration. Antacids and milk (calcium) decrease absorption, making them poor administration choices. High-fiber/whole-grain foods can also impair absorption, so they are not preferred when the goal is optimal therapeutic effect.

Question 50

The nurse is providing teaching for a client being discharged with a prescription reading 1 gtt to both ears three times a day. Which of the following statements by the nurse would be most accurate?

Accepted Answer

Answer reason: A medication order written as “1 gtt to both ears three times a day” means instilling a single drop into each affected ear at each scheduled administration, repeated three times per day. Accurate patient teaching must translate abbreviations into clear instructions to reduce dosing errors and promote adherence. Options that change the frequency to twice or four times daily do not match the prescription. Giving three drops once daily incorrectly converts the total daily number of doses and would alter the intended dosing schedule and therapeutic effect.

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