Question 1

For a client complaining of periocular aching after a surgical repair of a detached retina, which medication would be the most appropriate analgesic?

Accepted Answer

Answer reason: Acetaminophen is the safest choice because it provides pain relief without increasing intraocular pressure or causing coughing or straining, which could compromise healing after retinal surgery.

Question 2

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. The nurse should

Accepted Answer

Answer reason: The ordered dose totals 600 mg per day (200 mg every 8 hours), which is appropriate for a 15-kg child based on the recommended range of 20–40 mg/kg/day (300–600 mg/day). Since the dose falls within the safe therapeutic range, the medication should be given as prescribed.

Question 3

A woman diagnosed with bipolar disorder is to take lithium (Lithane) as part of the treatment. The nurse should discuss with the client?

Accepted Answer

Answer reason: Alcohol increases the sedative and dehydrating effects of lithium, which can raise serum lithium levels and greatly increase the risk of toxicity. Clients taking lithium must avoid alcohol to maintain stable hydration and safe drug levels.

Question 4

The nurse is observing a student nurse administering ear drops to a 2-year-old. Which observation by the nurse would indicate correct technique?

Accepted Answer

Answer reason: For children under 3 years old, the correct technique for administering ear drops is to pull the pinna down and back to straighten the ear canal and ensure proper medication delivery.

Question 5

A client is admitted with a suspected deep vein thrombosis (DVT). What is the priority nursing intervention?

Accepted Answer

Answer reason: Administering anticoagulant therapy is the priority because it prevents clot extension and reduces the risk of a life-threatening pulmonary embolism, which is the most serious complication of DVT.

Question 6

A client newly diagnosed with diabetes is started on Precose (acarbose). The nurse should tell the client that the medication should be taken:

Accepted Answer

Answer reason: Acarbose must be taken with the first bite of a meal because it works in the intestine to delay carbohydrate absorption; taking it before or after eating makes it ineffective.

Question 7

Intravenous injections are more suitable for oily solutions:

Accepted Answer

Answer reason: Intravenous injections are not suitable for oily solutions because oily preparations can cause emboli, vessel irritation, and impaired blood flow. Oily solutions are typically administered intramuscularly, not IV.

Question 8

What is the appropriate distance of the dropper from the eye when instilling eye drops?

Accepted Answer

Answer reason: For ophthalmic drops, the dropper should be held about 1–2 cm above the conjunctival sac to avoid contaminating the tip while allowing the drop to fall accurately. 1.5–2 cm best matches this standard.

Question 9

How often should nitroglycerin (NTG) be given?

Accepted Answer

Answer reason: For acute angina, sublingual nitroglycerin is administered every 5 minutes, up to three doses, with reassessment if pain persists.

Question 10

What is the primary reason for rotating injection sites in patients who require frequent subcutaneous injections?

Accepted Answer

Answer reason: Rotating subcutaneous injection sites prevents lipodystrophy and tissue changes that alter drug uptake, helping to maintain predictable and consistent medication absorption (e.g., insulin).

Question 11

A client with diabetes is prescribed regular insulin and NPH insulin. What is the appropriate nursing action when administering these insulins?

Accepted Answer

Answer reason: When preparing regular (clear) and NPH (cloudy) insulin together, the correct sequence is to draw up and give the regular insulin first to avoid contaminating it with NPH, ensuring accurate dosing and predictable action.

Question 12

The nurse is discharging a client with a prescription for eye drops. Which observation by the nurse would indicate a need for further client teaching?

Accepted Answer

Answer reason: Different ophthalmic drops should be spaced several minutes apart (typically about 5 minutes) to avoid washout and to ensure absorption. Giving a second drop immediately after the first is incorrect and indicates a need for further teaching.

Question 13

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

Accepted Answer

Answer reason: For infants around 1 year old, the preferred IM site is the vastus lateralis on the lateral thigh because it is well developed and away from major nerves and blood vessels. The deltoid is underdeveloped, and the dorsogluteal site risks sciatic nerve injury; the ventrogluteal site is acceptable, but the vastus lateralis is the best choice for this age.

Question 14

Which is true regarding the administration of antacids?

Accepted Answer

Answer reason: Antacids change gastric pH and can bind many drugs, reducing their absorption. They should be given separately from other medications, typically by at least 1 to 2 hours.

Question 15

The nurse is caring for a client with active tuberculosis who has a history of noncompliance. Which of the following actions by the nurse would represent appropriate care for this client?

Accepted Answer

Answer reason: For clients with TB who are nonadherent, directly observed therapy improves adherence. Engaging a family member to supervise daily medication intake is appropriate. The other options do not ensure adherence or constitute inappropriate changes to therapy.

Question 16

The nurse is performing an intramuscular injection using the Z-track method. Which technique would the nurse use to prevent tracking of the medication?

Accepted Answer

Answer reason: The Z-track technique uses a small air lock after medication to prevent tracking of the drug through subcutaneous tissue.

Question 17

To enhance the percutaneous absorption of nitroglycerin ointment, it would be most important for the nurse to select a site that is?

Accepted Answer

Answer reason: Transdermal absorption is improved on clean, dry, hairless skin where the medication has full contact with the intact epidermis. Hair impedes contact and dosing; proximity to the heart, muscular tissue, or bony prominences does not enhance absorption and may reduce comfort or perfusion.

Question 18

All of the following interventions are appropriate for administering potassium chloride except?

Accepted Answer

Answer reason: Potassium chloride must never be given IV push/bolus due to the risk of fatal hyperkalemia. It should be diluted, infused via a pump, and urine output should be monitored.

Question 19

The client has an order for FeSO4 liquid. Which method of administration would be best?

Accepted Answer

Answer reason: Vitamin C (orange juice) increases the absorption of oral iron. Milk and food decrease the absorption, and giving liquid iron undiluted can stain teeth.

Question 20

The physician has ordered Dilantin (phenytoin) 100 mg intravenously for a client with generalized tonic-clonic seizures. The nurse should administer the medication?

Accepted Answer

Answer reason: IV phenytoin must be administered slowly, not exceeding 50 mg/min, to avoid hypotension and dysrhythmias. It should not be mixed with dextrose and is best administered via a larger vein. For 100 mg, 2–3 minutes is the safe rate.

Question 21

The nurse is preparing a client for discharge following inpatient treatment for pulmonary tuberculosis. The nurse should instruct the client to?

Accepted Answer

Answer reason: Clients with TB must complete the full prescribed drug regimen, even when symptoms improve, to prevent treatment failure and drug-resistant TB. Antacids like Amphogel reduce isoniazid absorption, and routine isolation from children or pregnant people is not the primary discharge instruction once therapy is initiated.

Question 22

A client has been prescribed amitriptyline for depression. Which instruction should the nurse include in the teaching plan?

Accepted Answer

Answer reason: Amitriptyline is a tricyclic antidepressant with significant sedative effects and is typically administered at bedtime to minimize daytime drowsiness and improve sleep. Morning administration may increase the risk of sedation and impaired functioning during the day. Tyramine restrictions apply to MAOIs, not tricyclic antidepressants, and the medication does not require administration with dairy products or on an empty stomach.

Question 23

A client is receiving an IV antibiotic infusion and is scheduled to have blood drawn at 1:00 p.m. for a "peak" antibiotic level measurement. The nurse notes that the IV infusion is running behind schedule and will not be completed by 1:00 p.m. The nurse should?

Accepted Answer

Answer reason: Peak antibiotic levels are drawn at a precise time after the infusion is completed. Because the infusion is delayed, drawing at 1:00 would yield an invalid level. The appropriate action is to reschedule the lab time; do not stop or speed up the infusion, and physician notification is not required for this routine adjustment.

Question 24

The client with preeclampsia is admitted to the unit with an order for IV magnesium sulfate. Which action by the nurse indicates a lack of understanding of magnesium sulfate?

Accepted Answer

Answer reason: For magnesium sulfate in preeclampsia, use an infusion pump, maintain a quiet, dark environment, and monitor urine output with a Foley to prevent toxicity. There is no reason to avoid BP checks in one arm; frequent BP monitoring is required. Thus, placing a sign not to check BP in the left arm shows a misunderstanding.

Question 25

What gauge needle is used for intradermal injections?

Accepted Answer

Answer reason: Intradermal injections (e.g., TB testing) use very fine needles, typically 25–27-gauge, to form a small bleb in the dermis. 20–25-gauge needles are used for IM injections, and 27–30-gauge needles are more typical for subcutaneous insulin injections.

Question 26

What is the maximum amount of an intramuscular (IM) injection that can be administered?

Accepted Answer

Answer reason: For adults, the typical maximum volume per IM injection site is 3 mL to ensure proper absorption and minimize tissue injury. Larger volumes (5 mL or more) are not standard and increase the risk of complications.

Question 27

When giving ear drops to a 4-year-old child, the ear pinna should be pulled?

Accepted Answer

Answer reason: For children 3 years of age and older, the auricle is pulled up and back to straighten the ear canal for otic medication.

Question 28

As a knowledgeable nurse, you know that the following are part of the five rights, except?

Accepted Answer

Answer reason: The five rights of medication administration are right patient, right drug, right dose, right route, and right time; "right room" is not one of them.

Question 29

The volume of SC medication must be no more than?

Accepted Answer

Answer reason: For subcutaneous injections, the recommended maximum volume is 1 mL to prevent tissue distension and ensure proper absorption.

Question 30

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

Accepted Answer

Answer reason: Esomeprazole, a proton pump inhibitor, is most effective when taken before meals so the pumps are active with food; taking it about 30 minutes before a meal optimizes acid suppression in erosive gastritis.

Question 31

What distance should the dropper be from the nose during instillation of nasal drops?

Accepted Answer

Answer reason: For nasal drops, the dropper is held about 1 cm above the nares to avoid contamination and deliver accurate drops; the closest option is 0.5–1 cm.

Question 32

Abbreviation 'A.C.' means?

Accepted Answer

Answer reason: It stands for ante cibum, meaning before meals; it is used for medication timing. After meals is P.C., and at night is h.s.

Question 33

The nurse is administering a Mantoux test. Which is part of the correct technique for administering this test?

Accepted Answer

Answer reason: Mantoux (tuberculin) testing is administered intradermally on the forearm using a small needle with the bevel up to raise a wheal. Among the choices, the only element that reflects the correct technique is keeping the needle bevel up; the other options specify incorrect routes or needle lengths.

Question 34

A client experienced a major burn over 55% of his body 36 hours ago. The client is restless and anxious and states, "I am in pain." There is a physician's prescription for intravenous morphine. The nurse's first action would be to?

Accepted Answer

Answer reason: Before administering IV morphine, the nurse must assess respiratory status due to the risk of opioid-induced respiratory depression. Ensuring adequate respirations is the immediate safety priority.

Question 35

The nurse is caring for a COPD client who is discharged on PO theophylline. Which of the following statements by the client would indicate a correct understanding of discharge instructions?

Accepted Answer

Answer reason: Oral theophylline can cause GI irritation and is commonly taken with food or milk to lessen upset. It does not cause a slow pulse (it can cause tachycardia), should not be withheld when symptoms improve, and IV therapy is not part of routine home instructions.

Question 36

What is characteristic of the intramuscular route of drug administration?

Accepted Answer

Answer reason: IM injections can deliver aqueous and oily/depot preparations; onset is typically faster than oral administration, and IM is not limited to water-based or hypertonic solutions.

Question 37

At what angle should an intradermal injection be given?

Accepted Answer

Answer reason: Intradermal injections are inserted with the bevel up at a shallow angle of about 5–15 degrees; 15° is the best option provided.

Question 38

Before administering a client's morning dose of Lanoxin (digoxin), the nurse checks the apical pulse and finds a rate of 54. The appropriate nursing intervention is to?

Accepted Answer

Answer reason: Hold digoxin when the adult apical pulse is below 60 bpm due to risk of bradycardia/toxicity and notify the provider for further orders.

Question 39

Which intramuscular injection method?

Accepted Answer

Answer reason: Intramuscular injections are inserted perpendicular to the skin into muscle at a 90° angle; 45° is typical for subcutaneous injections.

Question 40

The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site demonstrates which of the following?

Accepted Answer

Answer reason: Correct intradermal injections deposit medication within the dermis and produce a small bleb or wheal at the site; absence of swelling, pallor, or focus on leakage does not confirm proper technique.

Question 41

Oral hormonal contraceptives should be commenced from?

Accepted Answer

Answer reason: Traditional regimen for combined oral contraceptive pills is to start on the 5th day of menstruation to ensure the client is not pregnant and to establish contraceptive protection.

Question 42

What diluent is used for BCG?

Accepted Answer

Answer reason: BCG vaccine (freeze-dried) is reconstituted with sterile 0.9% sodium chloride (normal saline); other diluents like dextrose, Ringer lactate, or distilled water are not appropriate.

Question 43

Maximum dose for the IM route?

Accepted Answer

Answer reason: For adults, the maximum recommended volume for a single intramuscular injection in a large muscle is up to 5 mL.

Question 44

An external insulin pump is prescribed for a client with diabetes mellitus. When the client asks the nurse about the pump's functioning, the nurse bases the response on which information about the pump?

Accepted Answer

Answer reason: External insulin pumps deliver a continuous basal infusion of rapid/short-acting insulin subcutaneously, with patient-initiated bolus doses before meals. They are not NPH-based, do not attach to the pancreas, and do not inherently monitor glucose.

Question 45

A vaccine can be stored at a subcentre for?

Accepted Answer

Answer reason: At subcentres, vaccines should not be stored overnight; they are kept in a vaccine carrier only for the immunization session and must be returned the same day, i.e., within 24 hours.

Question 46

The dose of vitamin K in a premature baby is?

Accepted Answer

Answer reason: Standard neonatal prophylaxis: preterm/low-birth-weight infants receive 0.5 mg vitamin K IM at birth; term infants receive 1 mg.

Question 47

The physician orders the patient to start taking omalizumab. As the nurse, how will you administer this medication?

Accepted Answer

Answer reason: Omalizumab (Xolair) is an anti-IgE monoclonal antibody administered only by subcutaneous injection at intervals; it is not given IV, IM, or orally.

Question 48

A 2-year-old patient with cystic fibrosis is scheduled to take pancrelipase. How will you administer this medication?

Accepted Answer

Answer reason: Pancrelipase capsules may be opened and the contents sprinkled on a small amount of acidic soft food (pH ≤4.5) such as applesauce; avoid mixing with milk or dairy products like yogurt, pudding, or ice cream because higher pH can inactivate the enteric-coated enzymes.

Question 49

The nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

Accepted Answer

Answer reason: While trigger avoidance is important, ensuring adherence to prescribed asthma medications most directly prevents bronchoconstriction and inflammation, making it the highest priority teaching point.

Question 50

A patient with asthma is prescribed inhaled salmeterol and fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in which to take these medications?

Accepted Answer

Answer reason: Salmeterol is a long-acting bronchodilator and should be inhaled first to dilate the airways. Waiting a few minutes allows better airway opening so the inhaled corticosteroid (fluticasone) that follows can deposit more effectively in the bronchial tree, maximizing its anti-inflammatory effect.

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