Question 1

A child with diabetes insipidus has a viral illness that includes congestion, nausea, and vomiting. What is the most important information for the nurse to tell the parents?

Accepted Answer

Answer reason: Children with diabetes insipidus require consistent antidiuretic therapy to prevent excessive free-water loss, dehydration, and hypernatremia. Congestion can make intranasal absorption unreliable, and nausea/vomiting can prevent retention/absorption of oral doses, creating a high risk of undertreatment. Switching to an alternate route (e.g., parenteral or an oral form if tolerated) maintains therapeutic effect during the acute illness. Telling parents to make no changes or to delay dosing does not address impaired absorption and can allow rapid fluid imbalance to develop.

Question 2

Liquid oral iron supplements have been prescribed for a child. The parents tell the nurse they are apprehensive to administer the medication. What is the most important information for the nurse to provide?

Accepted Answer

Answer reason: Liquid iron can stain tooth enamel, so administration should minimize contact with the teeth to prevent permanent discoloration. Using a dropper placed toward the back of the mouth or having the child drink through a straw reduces staining risk and improves adherence. Giving iron with food may reduce GI upset but also decreases absorption, so it is not the most important teaching point. Vomiting or constipation are potential side effects that should be managed with provider guidance rather than stopping the medication or altering the dose independently.

Question 3

The client tells the nurse that she frequently experiences nausea and vomiting after receiving radiation and chemotherapy. The nurse adapts the plan of care to include antiemetics. What is the most appropriate time for the administration of the medication?

Accepted Answer

Answer reason: Administering it about 30 minutes prior allows adequate onset and helps prevent nausea rather than trying to reverse it once established. Waiting until symptoms start can lead to harder-to-control vomiting and dehydration risk. Giving it only with or after therapy is less protective for patients with a known pattern of post-treatment nausea.

Question 4

Each member of the family of a child diagnosed with pinworms is prescribed a single dose of pyrantel pamoate (Antiminth). What is the most important information for the nurse to tell the family?

Accepted Answer

Answer reason: Pyrantel pamoate treats pinworm by eliminating the intestinal worms but does not reliably eradicate newly hatched worms from surviving eggs. A repeat dose is commonly needed about 2 weeks later to break the reinfection cycle as eggs mature into adult worms. This instruction is higher priority than noncritical side-effect counseling because it directly determines treatment success for the entire household. Statements implying the medication rapidly kills eggs are misleading and can lead to premature reassurance and recurrence.

Question 5

The nurse is reviewing information with a client about tetracycline (Achromycin) that has been prescribed for severe inflammatory acne. It is most important for the nurse to instruct the client to take the medication?

Accepted Answer

Answer reason: Tetracyclines chelate with divalent/trivalent cations (notably calcium), which significantly decreases absorption if taken with dairy or certain foods/supplements. Giving it on an empty stomach maximizes bioavailability and improves therapeutic effect for acne. Taking it with a full glass of water helps reduce esophageal irritation/ulceration and supports safe administration. The dairy option is a classic contraindicated administration instruction and is therefore the key priority to avoid.

Question 6

The HCP prescribed intermittent flushing of an infant’s peripheral IV access device to maintain patency. Which action should be taken by the nurse?

Accepted Answer

Answer reason: The order states intermittent flushing but does not specify the solution (saline vs heparinized saline) or volume, so the nurse should verify both with the prescriber and/or agency protocol. Automatically using 5 mL normal saline may be excessive for some infant peripheral lines and is not justified without an ordered or protocol-defined volume. Using heparin carries unnecessary bleeding risk and is not routinely indicated for peripheral IV patency unless specifically ordered per institutional policy.

Question 7

The nurse is administering metoclopramide 10 mg IV to the client with decreased peristalsis. Which action would result in a medication error?

Accepted Answer

Answer reason: Giving it after meals can reduce effectiveness and represents incorrect timing, which is a classic “right time” medication administration error. IV push over about 1–2 minutes is an accepted administration rate for many settings and aligns with typical practice standards. Recognizing Y-site incompatibility and using appropriate IV-port technique are safety actions that help prevent incompatibility or contamination errors rather than cause them.

Question 8

The client has a low serum potassium level. What should the nurse consider when preparing to administer potassium replacement intravenously?

Accepted Answer

Answer reason: IV potassium is a high-alert medication that commonly causes burning and phlebitis because it is irritating to the vascular endothelium, so nurses should anticipate and manage infusion-site discomfort. Local measures such as warm compresses (and sometimes cold) can help relieve pain and reduce inflammation while the infusion is running. IV push potassium is unsafe due to the risk of fatal dysrhythmias, which makes that distractor clearly incorrect. Concentration limits vary by institutional policy and whether the line is peripheral vs central, so the most universally applicable nursing consideration among these choices is managing local vein irritation.

Question 9

The client who inhales a corticosteroid medication through a metered-dose inhaler states, “I have a foul taste in my mouth after I use the inhaler.” Which is the nurse’s best response?

Accepted Answer

Answer reason:  A core principle of metered-dose inhaler technique is to maximize delivery to the lungs while minimizing oropharyngeal deposition, which can cause unpleasant taste and local corticosteroid effects. A spacer reduces medication impact in the mouth and throat by improving aerosol dispersion and coordination, lowering residue that leads to bad taste and oral candidiasis risk. Simply reassuring the client dismisses a modifiable administration problem and does not improve adherence. Shaking the canister helps with dose uniformity but does not address mouth deposition as effectively as a spacer.

Question 10

The student nurse is administering a clonidine transdennal patch to the client with hypertension. Which action requires the observing nurse to intervene?

Accepted Answer

Answer reason: Transdermal systems can deliver an unintended bolus dose if the medication reservoir is disrupted or if vigorous friction/heat increases absorption. Clonidine can cause clinically significant hypotension and bradycardia, so actions that may accelerate absorption create a preventable safety risk. Proper technique is to apply to clean, dry, hairless intact skin and press firmly to ensure adhesion without rubbing. In contrast, verifying two identifiers, wearing gloves for handling/removal, and folding the old patch medication-side inward for disposal are appropriate safety steps.

Question 11

The nurse is preparing to administer cefotaxime. Which action is most appropriate when the nurse notes that the client has an allergy to ceftriaxone?

Accepted Answer

Answer reason: Cephalosporins share structural similarities, and an allergy to one agent (e.g., ceftriaxone) raises concern for cross-reactivity with other cephalosporins such as cefotaxime. The safest nursing action is to hold the medication and ensure the prescriber is aware so the order can be reassessed and an alternative selected if needed. Administering the drug despite the documented allergy creates an avoidable risk for hypersensitivity reactions, including anaphylaxis. Checking with pharmacy or asking about past exposure may provide information, but neither addresses the immediate safety priority of preventing administration of a potentially contraindicated medication.

Question 12

The male client diagnosed with a brain tumor is having a closed magnetic resonance imaging (MRI) scan in 1 hour. The client tells the radiology nurse, “I don’t like small enclosed spaces.” Which action should the nurse implement?

Accepted Answer

Answer reason: Claustrophobia during a closed MRI can trigger acute anxiety and inability to remain still, which can compromise image quality and lead to an aborted study. With the scan scheduled in 1 hour, the most effective, timely nursing intervention is to collaborate with the provider for a prescribed anxiolytic (often a short-acting benzodiazepine) and ensure appropriate monitoring and safety planning. Therapeutic communication and education may help but are frequently insufficient alone when the client anticipates panic in an enclosed scanner. Rescheduling delays needed diagnostics and does not address the underlying anxiety, whereas premedication can enable safe completion of the MRI.

Question 13

A client who is being discharged home will be giving his own enoxaparin sodium (Lovenox) subcutaneously. Which statement by the client indicates the need for further education?

Accepted Answer

Answer reason: Subcutaneous anticoagulant injections require site rotation to reduce bruising, tissue irritation, and development of induration or hematoma. Enoxaparin is commonly given in the anterolateral or posterolateral abdominal area at least 2 inches away from the umbilicus, alternating sides and varying exact locations. Not aspirating and pinching a skin fold are appropriate technique elements that reduce bleeding and ensure subcutaneous placement. Using the same side repeatedly reflects unsafe administration teaching and warrants further education.

Question 14

The charge nurse is observing a licensed practical nurse (LPN) applying a nitroglycerin patch to the client diagnosed with angina. Which action warrants immediate intervention from the charge nurse?

Accepted Answer

Answer reason: Safe transdermal medication administration requires removing the previous patch before applying a new one to prevent unintentional dose stacking and toxicity. Leaving an old nitroglycerin patch in place can cause excessive vasodilation leading to severe hypotension, headache, dizziness/syncope, and reflex tachycardia, which is an immediate safety risk. Applying the patch to a non-hairy area improves adhesion and absorption consistency. Dating/timing and wearing gloves are appropriate practices that help ensure correct dosing intervals and prevent caregiver absorption.

Question 15

The client with pericarditis is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which teaching instruction should the nurse discuss with the client?

Accepted Answer

Answer reason: NSAIDs commonly irritate the gastric mucosa and increase the risk of dyspepsia, gastritis, and GI bleeding. Taking the medication with food or milk helps reduce local stomach irritation and improves tolerability, which supports adherence during treatment of inflammatory pain. Avoiding driving is not a routine NSAID precaution because significant sedation is not an expected effect. Alternating with acetaminophen is not a standard instruction and could increase the risk of unsupervised overuse or masking worsening symptoms without addressing NSAID safety.

Question 16

The client with COPD is prescribed salmeterol diskus inhaler and fluticasone Rotadisk inhaler. Which instruction should the nurse include to prevent the client from developing oropharyngeal candidiasis?

Accepted Answer

Answer reason: Inhaled corticosteroids can deposit in the oropharynx and locally suppress immune defenses, increasing risk of Candida overgrowth (thrush). Rinsing and spitting after inhaler use removes residual steroid from the mouth and pharynx, which is the key preventive measure. Drinking water beforehand and waiting between medications do not meaningfully reduce steroid residue left on mucosa. Proper mouthpiece seal improves drug delivery but does not address the local fungal risk from steroid deposition.

Question 17

The client calls a clinic 2 weeks after taking oral carbidopa—levodopa, stating that the medication has been ineffective in controlling the symptoms of PD. What nursing action is most important?

Accepted Answer

Answer reason: Initial nursing priority with an “ineffective medication” complaint is to assess adherence and administration factors that commonly reduce therapeutic response. Carbidopa-levodopa effectiveness can be blunted by improper timing, missed doses, or taking it with high-protein meals that compete with absorption/transport, so reinforcing correct use can quickly resolve the problem without unnecessary dose escalation. At two weeks, many patients should have at least some symptomatic improvement, making “wait 1–2 months” an unsafe delay if the issue is administration-related. A high-protein diet and vitamin B6 can worsen response (B6 increases peripheral levodopa metabolism when not adequately blocked), so reinforcing that would be counterproductive.

Question 18

A nurse is preparing to administer pilocarpine 1%, eyedrops to a client. The order reads: Instill 2 gtt both eyes four times a day. What is the correct administration?

Accepted Answer

Answer reason: The prescription specifies 2 drops in both eyes four times per day, which directly matches this option. The distractors change either the site (sclera or lacrimal duct rather than conjunctival sac) and/or the frequency (two or three times daily), making them inconsistent with the order. Proper technique is to instill into the conjunctival sac and can include nasolacrimal occlusion afterward to reduce systemic absorption, but that does not change the ordered administration parameters.

Question 19

A 3-year-old sister of a neonate is diagnosed with pertussis. The mother has a history of having been immunized as a child. Which information should be included in teaching the mother about possible infection of her neonate?

Accepted Answer

Answer reason: Postexposure chemoprophylaxis is recommended for close contacts of pertussis cases, and neonates are at highest risk for severe disease and complications. Giving an appropriate macrolide to the exposed infant reduces the likelihood of developing symptomatic infection and helps limit transmission within the household. Prior childhood vaccination of the mother does not reliably prevent exposure of the neonate because immunity wanes over time and passive protection is incomplete. Immune globulin is not an effective preventive strategy for pertussis, and infection is not inevitable when timely prophylaxis and infection-control measures are implemented.

Question 20

Before a child’s hospital discharge, the nurse is teaching the parents how to administer an oral medication to the child. Which nurse instruction would be most appropriate?

Accepted Answer

Answer reason: Taste-masking and decreasing oral sensitivity can improve a child’s acceptance of oral medications and reduce gagging or refusal. A cold flavored ice pop can numb taste buds briefly, making unpleasant-tasting medicine easier to take while keeping the medication formulation intact. Giving milk after may be contraindicated for some drugs and is not a universal teaching point. Crushing pills or opening capsules is unsafe unless specifically verified as allowable (e.g., not enteric-coated or extended-release), and telling a child it will taste good risks loss of trust.

Question 21

Prior to instilling nasal medications, it is important for the client to have clear nasal passages. The client can blow the nose to clear the nasal passages. Which client should not perform this preliminary intervention?

Accepted Answer

Answer reason: Blowing the nose can markedly increase intrathoracic pressure and transiently raise intracranial pressure through a Valsalva-like effect. After a head injury, avoiding actions that can elevate intracranial pressure is a key safety principle to reduce risk of worsening cerebral edema or complications. Therefore, instructing this client to blow the nose before nasal medication is not appropriate. In contrast, a prior MI or COPD history may warrant caution with strenuous Valsalva, but gentle nose blowing is not a standard contraindication in the same way as protecting the injured brain.

Question 22

The nurse prepares to give an injection to an elderly client. When the nurse aspirates prior to injecting, a small amount of blood is noted in the syringe. Which action is most appropriate for the nurse to take?

Accepted Answer

Answer reason: Blood return on aspiration indicates the needle tip is likely in a blood vessel, and intravascular administration of a medication intended for IM/subcutaneous use can cause rapid systemic effects and serious adverse reactions. The safest action is to stop the injection, remove the needle, and discard the syringe/medication because sterility and dose integrity can no longer be assured once blood contaminates the syringe contents. Repositioning and re-aspirating does not eliminate the risk of unintended IV delivery if the tip remains near a vessel, especially in older adults with fragile tissues and variable anatomy. Slowing the injection or advancing the needle does not address the core safety issue of incorrect placement and potential contamination.

Question 23

The client with increased intracranial pressure is receiving mannitol (Osmitrol), an osmotic diuretic. Which intervention should the nurse implement?

Accepted Answer

Answer reason: Mannitol can crystallize in solution, and administering crystals can cause vascular irritation or embolic complications. Using a filter needle (and verifying the solution is clear) prevents infusion of particulate matter and is a key safe-administration step. Routine CBC monitoring is not a primary safety measure for this drug, and holding the dose based on bradycardia is not a standard parameter for mannitol. While fluid shifts can stress the cardiovascular system, telemetry is not the essential universal intervention compared with preventing crystal infusion.

Question 24

The client who had a synthetic valve replacement a year ago is hospitalized with unstable angina. IV heparin and nitroglycerin infusions were started, but then nitroglycerin was discontinued after the client's pain resolved. The HCP prescribes to start oral warfarin 5 mg at 1900 hours. Which is the nurse's best action?

Accepted Answer

Answer reason: In high-risk situations (e.g., mechanical valve history and acute coronary syndrome treatment with IV heparin), it is appropriate to overlap heparin with warfarin until therapeutic anticoagulation is achieved and stable. Stopping heparin solely because warfarin is initiated can leave the client under-anticoagulated and increase thrombotic risk. There is no inherent contraindication to starting warfarin while a heparin infusion is running; the nurse should administer it and continue monitoring for bleeding and appropriate labs per protocol.

Question 25

The client who is to receive a scheduled dose of digoxin has an irregular apical pulse at 92 bpm and a serum potassium of 3.9 mEq/L. Which nursing documentation reflects the most appropriate action?

Accepted Answer

Answer reason: Serum potassium level WNL. Digoxin given for rapid apical pulse. Digoxin is typically administered if the apical pulse is not bradycardic and there are no findings suggesting toxicity, because the medication’s goal is to control ventricular rate and improve cardiac output. An apical rate of 92 bpm is not below the common hold threshold (often

Question 26

The client with Addison’s disease is taking fludrocortisone 100 meg orally once daily. Which statement made by the client regarding the fludro-cortisone therapy requires further teaching by the nurse?

Accepted Answer

Answer reason:  Abruptly stopping adrenal replacement therapy can precipitate adrenal crisis because the body cannot mount an adequate cortisol/aldosterone response to stress. If hyperglycemia occurs, the safe teaching is to contact the prescriber for evaluation and possible dose adjustment rather than self-discontinuation. Fludrocortisone has some glucocorticoid activity and can contribute to increased glucose, but this is managed clinically, not by stopping the drug. In contrast, monitoring daily weight and vital signs and maintaining adequate potassium intake are appropriate because mineralocorticoid effects can cause fluid retention, hypertension, and hypokalemia.

Question 27

The clinic nurse is teaching the parent how to give eye drops to the 3-year-old who has bacterial conjunctivitis and purulent drainage out of both eyes, swollen eyelids, and inflamed conjunctiva. What information should the nurse provide?

Accepted Answer

Answer reason: Safe pediatric eye-drop administration prioritizes positioning that stabilizes the head and reduces aspiration/choking risk if the child cries or coughs. An upright sitting position allows the caregiver to control the child’s head and eyelids and promotes accurate instillation into the conjunctival sac while minimizing contamination from drainage. A head-down position is unnecessary and can increase discomfort and movement, making administration harder. Restraint is not a routine teaching point unless absolutely needed for safety, and detailed explanations are developmentally excessive for a 3-year-old; simple, brief directions and distraction are preferred.

Question 28

The most important intervention for nurse to implement when giving phenytoin (Dilantin) to a client with a nasogastric (NG) tube for feeding is?

Accepted Answer

Answer reason: Enteral tube feedings significantly reduce phenytoin absorption by binding the medication and altering GI availability, which can lead to subtherapeutic levels and breakthrough seizures. Separating administration from feeds (and typically flushing the tube before/after) is the key nursing action to ensure predictable absorption and therapeutic effect. Monitoring levels is important but does not prevent the absorption problem at the time of administration. Head-of-bed elevation supports aspiration prevention but is not the primary medication-specific intervention being tested, and the water-bubble method for tube placement is unsafe and not recommended.

Question 29

The experienced nurse is observing the student nurse provide care to the client. Which action by the student nurse most definitely requires the observing nurse to intervene?

Accepted Answer

Answer reason: Sustained-release/extended-release dosage forms must not be crushed, chewed, or opened because altering the formulation can cause dose dumping and loss of controlled delivery. This can lead to toxicity, intensified adverse effects, or subtherapeutic levels later, creating a significant safety risk that warrants immediate intervention. The appropriate nursing action would be to verify if an alternative formulation is available or contact the prescriber/pharmacy for a suitable substitution. By contrast, separating medications into individual cups, using proper conjunctival sac instillation technique, and flushing an IV port prior to IV push are generally appropriate medication-administration practices when performed correctly.

Question 30

The experienced nurse instructs the new nurse to give an IM injection into the dorsogluteal muscle of the older adult client. Which is the new nurse’s best action?

Accepted Answer

Answer reason: IM site selection prioritizes minimizing risk to major nerves and blood vessels while ensuring reliable absorption. The ventrogluteal site has a thicker muscle mass with fewer large nerves and vessels nearby, making it the safest, preferred site for IM injections, especially in adults. The dorsogluteal site carries higher risk of sciatic nerve injury and inconsistent subcutaneous fat thickness, which can lead to improper placement. Technique choices (e.g., Z-track) and needle length are secondary to choosing the safest appropriate site in the first place.

Question 31

An LPN is administering medications to adult clients. Which action requires the RN to intervene?

Accepted Answer

Answer reason: The correct volume is 0.1 mL, so drawing up 1 mL represents a tenfold dosing error and indicates unsafe technique that the RN should immediately correct. This type of error can lead to an invalid test and unnecessary adverse local reactions. By contrast, not aspirating for subcutaneous heparin is appropriate, and holding an insulin pen in place for several seconds is recommended to ensure full dose delivery.

Question 32

The nurse, working the evening shift, is planning to administer insulin subcutaneously to a child. Which statement made by the nurse to the mother would be inappropriate?

Accepted Answer

Answer reason:  Medication administration in children prioritizes safety, preparation, and therapeutic communication rather than surprise procedures. Administering an injection while a child is sleeping can startle the child, increase fear and mistrust, and removes the opportunity for appropriate coping and comfort positioning. It also reduces the nurse’s ability to assess the child’s immediate response and ensure the child remains still during needle insertion, increasing risk of injury. In contrast, using comfort measures and topical anesthetic, and acknowledging normal emotional responses, supports atraumatic care while still completing the treatment safely.

Question 33

The nurse is working with the LPN who is helping care for the HIV-positive client with severe esophagitis caused by Candida albicans. Which action by the LPN requires the nurse to intervene immediately?

Accepted Answer

Answer reason: Immediately giving water washes the medication off the mucosa, reducing local antifungal exposure and treatment effectiveness in a client who already has severe pain and mucosal inflammation. This is a medication-administration error with direct impact on therapeutic outcome, so it warrants prompt correction and teaching. In contrast, recommending non-irritating foods and using standard precautions/appropriate PPE can be reasonable supportive or safety measures depending on unit policy.

Question 34

An ampule of promethazine hydrochloride (Phenergan) is opened by the nurse. Why should the nurse choose to use a filter needle to draw this medication into the syringe?

Accepted Answer

Answer reason: Core principle: when withdrawing medication from an ampule, a filter needle is used to prevent inadvertent administration of glass microfragments created when snapping the neck. These particles can be aspirated into the syringe through a standard needle and, if injected, may cause local tissue irritation, phlebitis, or embolic complications. A filter needle is specifically designed to trap particulate matter during withdrawal, after which it is replaced with an appropriate administration needle. The other choices describe issues unrelated to the unique particulate contamination risk associated with opening ampules.

Question 35

The nurse is preparing to administer digoxin (Lanoxin) to an infant. What is the most important intervention by the nurse?

Accepted Answer

Answer reason: Digoxin can cause clinically significant bradycardia and conduction disturbances, and infants are particularly vulnerable because of narrow therapeutic range. Nursing safety priority is to assess the apical pulse before administration and hold the medication when the heart rate is below the ordered/age-specific threshold to prevent toxicity-related dysrhythmias. Doubling a missed dose increases the risk of toxicity. Mixing it with food and giving with antacids can reduce reliable absorption and make it difficult to ensure the full dose is taken.

Question 36

The hospitalized child who has a blood lead level of 50 mcg/dL is to receive succimer 10 mg/kg oral capsule q8hr for 5 days. The child weighs 20 kg. Which intervention by the student nurse should be corrected by the observing nurse?

Accepted Answer

Answer reason: The ordered dose is 10 mg/kg for a 20-kg child, which equals 200 mg per dose q8h, so giving contents equivalent to two 100-mg capsules is the correct amount. However, succimer is supplied as capsules containing powder and should be opened and mixed with a small amount of soft food only as directed; describing them as “beads” suggests incorrect handling and raises concern for improper product manipulation and incomplete ingestion. Encouraging fluids and providing parent teaching about chelation are appropriate supportive interventions and do not conflict with safe administration.

Question 37

The nurse is evaluating whether the client on multiple oral medications is taking the medications correctly. Which finding should be most concerning to the nurse because the absorption rate of medications can be increased?

Accepted Answer

Answer reason: A low-fiber meal reduces binding/adsorption of some medications and speeds transit compared with high-fiber meals, while high-fat intake can enhance dissolution of lipophilic drugs and increase bile-mediated solubilization, leading to higher absorption for many agents. This combination is therefore concerning when the question asks specifically about factors that can increase absorption and raise risk for stronger-than-intended effects. By contrast, milk with tetracycline classically decreases absorption due to chelation with calcium, which is the opposite of the stated concern.

Question 38

The nurse is caring for the child who has a virulent infection. The HCP prescribes cefazolin sodium IV 50 mg every 6 hours. The Pediatric Dosage Handbook states the safe range of cefazolin is 6.25 to 25 mg per kg per day. The child weighs 18 lb. What is the most appropriate action by the nurse?

Accepted Answer

Answer reason: The child weighs 18 lb (about 8.2 kg), so the safe total daily dose range is approximately 51 to 205 mg/day. The order is 50 mg every 6 hours (4 doses/day) for a total of 200 mg/day, which is within the upper end of the safe range. Because the dose is appropriate and not excessive, the nurse should proceed rather than delay therapy or alter the schedule independently.

Question 39

A 63-year-old male receives enalapril maleatehydrochlorothiazide (Vaseretic) for 6 months for hypertension. Three days ago, the client began experiencing difficulty swallowing, mild difficulty breathing, and discomfort in the back of his throat. The client is seen in the emergency department, where the physician diagnoses a drug reaction to the enalapril. The client’s wife brings a bag of the client’s medications to the hospital, and states the medication is administered to the client every day. The nurse should?

Accepted Answer

Answer reason: With suspected ACE-inhibitor–related angioedema (throat discomfort, dysphagia, mild dyspnea), the priority is to prevent further exposure and ensure accurate medication reconciliation for safe prescribing. Recording the exact home medications and doses supports the provider’s immediate decision-making about discontinuation and alternative therapy and helps prevent inadvertent re-administration. Giving the medications now is unsafe because the suspected offending drug may be in the bag and could worsen airway compromise. Having the wife administer inpatient medications is inappropriate and violates medication-administration safety and accountability standards.

Question 40

A nurse is teaching the parents of an infant with diabetes insipidus about an injectable drug used to treat the disorder. Which statement made by a parent would indicate the need for further teaching?

Accepted Answer

Answer reason:  Injectable desmopressin used for diabetes insipidus is a delicate suspension that should be handled gently to avoid foaming, dosing inaccuracy, and potential medication degradation. The parent statement indicates incorrect technique because vigorous shaking can alter the uniformity of the dose and make accurate measurement difficult. Proper preparation typically involves warming the vial in the hands or under warm water and gently mixing as directed to ensure an even suspension. Refrigerated storage is commonly recommended for this medication to maintain stability. The key safety issue is correct preparation to ensure the infant receives a reliable dose.

Question 41

The 25-year-old client, hospitalized with an exacerbation of distal ulcerative colitis, is prescribed mesalamine rectally via enema. The client states that an enema is disgusting and wants to know why the medication cannot be given orally. Which is the best response by the nurse?

Accepted Answer

Answer reason:  The key principle is that topical 5-ASA therapy is preferred for distal ulcerative colitis because it maximizes local anti-inflammatory effect at the rectum/sigmoid while minimizing systemic exposure. Delivering the medication directly to inflamed distal mucosa improves efficacy compared with relying solely on oral delivery. Saying oral therapy is “not possible” is inaccurate because oral mesalamine can be used, but it may be less effective alone for distal disease. Options that imply the nurse can independently change the route are unsafe and outside scope without a provider order.

Question 42

The adolescent client is taught how to use a continuous subcutaneous insulin infusion pump for tight glucose control of type 1 DM. Which statement by the client indicates the need for additional teaching?

Accepted Answer

Answer reason:  Insulin pumps can improve glycemic control by providing adjustable basal insulin and meal boluses, but they do not reliably produce weight loss. Improved insulin delivery and tighter control may actually be associated with weight gain due to reduced glycosuria and better caloric utilization. Therefore, expecting weight to drop reflects a misunderstanding of the therapy’s typical outcomes and indicates a need for additional teaching. The other statements align with correct pump self-management: carbohydrate-based bolusing, frequent glucose monitoring, and scheduled infusion-set/site changes to prevent occlusion and infection.

Question 43

The parents of the 7-year—old child with type 1 DM are planning to drive 1200 miles for a vacation at the beach. They question the nurse about insulin storage for the trip. Which response by the nurse is most accurate?

Accepted Answer

Answer reason: “Put the insulin in a cooler with an ice pack and store it out of the sun. Place unopened insulin in the refrigerator at your destination.” Insulin potency is reduced by temperature extremes and direct heat/light exposure, so travel teaching focuses on keeping it cool but not frozen. Using a cooler with an ice pack and keeping it out of the sun helps maintain a safe temperature range during a long car trip. Freezing can denature insulin and make dosing unreliable, so it should not be frozen. Insulin does not have to be obtained at the destination as long as it is stored properly and the family carries an adequate supply.

Question 44

The nurse is preparing to administer morphine sulfate IV to the child in severe pain. The child has an IV infusion of D5W at 50 mL/hr through a PICC. Which intervention is best when administering the medication?

Accepted Answer

Answer reason: IV opioids should be administered slowly and in a controlled manner to reduce adverse effects such as respiratory depression, hypotension, and excessive sedation. Dilution and giving over several minutes helps ensure accurate delivery of a small volume medication and decreases venous irritation while allowing ongoing assessment of the child’s response. Using the medication port closest to the client minimizes the amount of drug that remains in the tubing and ensures the intended dose reaches the circulation promptly. A PICC can be used for IV analgesics, so questioning the order on that basis is unnecessary, and disconnecting the primary infusion increases contamination and line-manipulation risk.

Question 45

The nurse completes teaching the parents of the 2-year-old hospitalized with epiglottitis about ciprofloxacin administration when at home. The nurse should document that teaching was effective when the parent makes which statement?

Accepted Answer

Answer reason:  Fluoroquinolones can chelate with divalent/trivalent cations (e.g., calcium), which reduces gastrointestinal absorption and can make the antibiotic less effective. Avoiding administration with dairy or calcium-fortified products shows correct understanding of a key medication–food interaction that directly impacts therapeutic outcome. Tapering or reducing dosing based on symptom improvement is unsafe because antibiotics should be taken exactly as prescribed for the full course to prevent treatment failure and resistance. Diarrhea can occur with antibiotics; parents should report severe/persistent diarrhea or signs of C. difficile, but stopping the medication automatically is not appropriate teaching.

Question 46

The inexperienced nurse used a child’s ear illustration to teach the child’s mother how to administer eardrops. While pointing to the illustration, the nurse stated, “Warm the solution and clean your 2-year-old’s ear. Then pull the child’s ear up and back, instill the medication, and depress on the tragus of the ear. Keep the child side-lying for about 5 minutes and then insert a small cotton fluff loosely in the auditory canal for about 20 minutes.” Which action is best for the observing nurse to take during or following the teaching?

Accepted Answer

Answer reason: Proper otic medication administration depends on age-related ear canal anatomy to ensure the drops reach the canal and reduce discomfort or ineffective dosing. For children younger than 3 years, the pinna is pulled down and back; pulling up and back is for older children and adults. Because the teaching includes an incorrect, safety-relevant step, the observing nurse should correct it in real time to prevent the parent from performing the technique incorrectly at home. Having the parent return-demonstrate is valuable, but it does not address the fact that the instruction being practiced is wrong.

Question 47

The nurse observes a nursing student prepare and administer medications to adult clients. Which action by the nursing student warrants intervention by the nurse?

Accepted Answer

Answer reason: Giving a buccal drug sublingually may increase or alter onset and peak levels, creating risk for under- or overdosing depending on the medication. By contrast, injecting air into a vial before withdrawal is standard technique to equalize pressure, and measuring 2 tsp as 10 mL is correct. The incorrect route instruction represents a preventable medication-administration error requiring immediate correction.

Question 48

An 82-year-old female client who recently relocated to the United States from a small Caribbean island is treated for a laceration to the right forearm. The physician orders both tetanus immune globulin human (Baytet) (TIG), and diphtheriatetanus (DT). Which is a true statement regarding this client’s medication care?

Accepted Answer

Answer reason: Passive immunization (immune globulin) and active immunization (toxoid-containing vaccine) may be administered at the same visit for tetanus-prone wounds, but they must be given at separate sites to avoid any interaction and to ensure reliable immune response. Using different extremities also helps distinguish local reactions and improves documentation accuracy if adverse effects occur. TIG provides immediate passive antibodies, while the DT vaccine stimulates longer-term active immunity, so they complement each other rather than replace one another. Options that swap “active” and “passive” immunity are incorrect because immune globulin is passive and toxoid vaccine is active.

Question 49

A client has several medications administered via nasogastric tube. Which statement made by the nurse indicates proper knowledge about this form of medication administration?

Accepted Answer

Answer reason: Safe enteral medication administration prioritizes aspiration prevention by maintaining an upright position during and after administration to reduce reflux and inadvertent airway entry. This statement reflects correct technique because head-of-bed elevation supports gastric emptying and helps protect the airway while medications pass through the tube. Crushing and mixing multiple medications together can create incompatibilities and increase the risk of tube clogging, and continuous feedings are typically paused to verify placement and reduce interaction with formula. Needing to push hard is unsafe because resistance suggests obstruction or improper preparation and can damage the tube or force material back toward the airway.

Question 50

A client has the following medications ordered: albuterol sulfate (Proventil) inhaler 2 puffs every 4 hours and fluticasone propionate (Flovent) one puff in each nostril twice a day. Which is a true statement regarding the use of these two medications?

Accepted Answer

Answer reason: Short-acting beta2-agonists are used first to rapidly open the airways, improving airflow and enhancing the delivery and effectiveness of anti-inflammatory therapy given afterward. Using a bronchodilator before a steroid helps medication penetrate more effectively to target tissues and reduces persistent symptoms. These medications are commonly prescribed together for obstructive airway/allergic conditions and are not contraindicated as a pair. Combining them into a single product is not appropriate because they are different drug classes with different dosing schedules and delivery routes.

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