Question 1

A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure?

Accepted Answer

Answer reason: Holding short-acting insulin (or adjusting the dose per protocol and current glucose) helps prevent an avoidable low blood sugar during the procedure when monitoring and intake may be limited. Phosphate binders are timed with meals, so the main issue is meal timing rather than dialysis itself. While some antibiotics may be dialyzable and need post-dialysis scheduling, they are not routinely withheld solely to prevent an acute pre-procedure complication like hypoglycemia.

Question 2

A 72-year-old client is scheduled for cardioversion. Which medication, if received within the previous 24 hours, should the nurse report to the health care provider?

Accepted Answer

Answer reason: Digoxin increases myocardial sensitivity and can predispose the client to dangerous dysrhythmias during cardioversion. If the client has received digoxin within the previous 24 hours, the provider should be notified to reduce the risk of complications. The other medications do not carry the same risk in this context.

Question 3

Nurse Thompson is advising a client on the proper storage of unopened vials of Humulin NPH insulin. How should the client store the insulin?

Accepted Answer

Answer reason: Unopened insulin should be stored under refrigerated conditions (about 2–8°C/36–46°F) to maintain potency until the expiration date. Freezing can denature insulin and make it ineffective, so it must not be kept in the freezer. Heat and direct sunlight accelerate degradation, making a sunny location unsafe. While opened vials may often be kept at room temperature for comfort and stability over a limited in-use period, the question asks specifically about unopened vials, which should be refrigerated.

Question 4

A nurse is preparing to apply a transdermal nicotine patch for a client. Which of the following actions should the nurse take?

Accepted Answer

Answer reason: Transdermal nicotine can be absorbed through the nurse’s skin, so gloves must be worn during application to prevent unintended exposure. The patch should be applied immediately after opening (not within 1 hour), hairy areas should not be shaved due to skin irritation (hairless sites should be selected instead), and used patches should be folded with adhesive sides together rather than simply placed in tissue.

Question 5

A client is prescribed furosemide for edema. What should the nurse teach?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that promotes fluid loss, so clients are typically not placed on strict fluid restriction unless specifically ordered. Sodium should not be increased, potassium should not be restricted (risk of hypokalemia), and the medication should be taken in the morning to prevent nocturia.

Question 6

A nurse is educating a client about self-administering enoxaparin injections at home. Which statements by the client indicate a correct understanding of the procedure?

Accepted Answer

Answer reason: Subcutaneous anticoagulant injections require technique that minimizes local tissue trauma and bleeding. Rotating sites reduces bruising, lipodystrophy, and irritation and helps maintain consistent absorption over time. With enoxaparin, clients should avoid massaging the site because it increases capillary bleeding and hematoma formation. Aspiration is not recommended for subcutaneous injections and can also increase tissue trauma without improving safety.

Question 7

Prior to administering a sliding scale dose of insulin, what should be the first thing the nurse verifies?

Accepted Answer

Answer reason: Administering insulin without an accurate current glucose risks causing iatrogenic hypoglycemia or failing to correct hyperglycemia appropriately. Verifying the last dose time or injection site is important for overall insulin safety and site rotation, but it does not determine the ordered sliding-scale dose. After confirming the glucose, the nurse should then ensure the order matches the scale and that the insulin formulation aligns with the intended onset/peak for correction coverage.

Question 8

You are working in the Surgical Intensive Care Unit (SICU), caring for a 67-year-old male with Stage 3 colon cancer who has recently undergone emergency surgery to relieve a bowel obstruction due to adhesions from earlier surgeries. He has experienced numerous complications since his surgery, resulting in a prolonged SICU stay, and was diagnosed earlier today with a resistant Staphylococcal infection in his surgical wound. His surgeon has ordered vancomycin (Vancocin) 15mg/kg/dose intravenously every 12 hours. Regarding vancomycin (Vancocin) administration, you know?

Accepted Answer

Answer reason: g., flushing, pruritus, hypotension) and increases patient risk, so the key administration principle is to infuse slowly to improve tolerance. A minimum of 60 minutes is the standard for typical doses, with larger doses often requiring longer infusion times to reduce reaction risk. Routine “peak” monitoring is generally not the priority teaching point in common nursing administration questions compared with safe infusion rate and renal/ototoxicity monitoring. Co-infusing in the same line with other medications is unsafe due to incompatibilities/precipitation risk unless compatibility is specifically verified, so it should not be assumed.

Question 9

Which of the following instructions should the nurse NOT include when educating a patient on how to use a DPI inhaler?

Accepted Answer

Answer reason: Dry powder inhalers are breath-actuated devices and the medication is delivered when the patient generates adequate inspiratory flow through the device, not by propellant mixing. Shaking is a teaching point for many metered-dose inhalers, but it can be inappropriate/irrelevant for DPIs and may interfere with correct preparation depending on the device. Appropriate DPI technique includes exhaling away from the mouthpiece (often through pursed lips), then inhaling quickly and deeply to disperse the powder and activate the inhaler. Breath-holding for about 5–10 seconds after inhalation promotes distal deposition and improves medication effect.

Question 10

A nurse is providing care for a diabetic patient. The nurse explains to the patient that they are rotating the location of insulin injections to prevent ___?

Accepted Answer

Answer reason: Rotating injection sites reduces this tissue trauma and helps maintain predictable insulin uptake and glycemic control. While hypo- or hyperglycemia can occur from dosing, timing, food intake, or activity, site rotation specifically targets prevention of injection-site lipodystrophy. Anaphylaxis is an acute allergic reaction and is not prevented by changing injection location.

Question 11

The client with severe liver disease and an elevated ammonia level begins striking out at staff. After successfully calming the client, which action does the nurse take next?

Accepted Answer

Answer reason: Elevated ammonia from severe liver disease can precipitate hepatic encephalopathy with agitation and altered behavior, so the priority after immediate de-escalation is to treat the underlying hyperammonemia. Lactulose reduces ammonia by trapping it in the gut and promoting excretion via increased stooling, making it a direct and time-sensitive intervention. A low-protein diet may be part of longer-term management but will not quickly address acute neurologic symptoms. Restraints are a last resort only if the client remains an imminent danger after less restrictive measures and treatment are attempted.

Question 12

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times?

Accepted Answer

Answer reason: Administering it about 1 hour before meals maximizes contact with the gastric lining before food and acid interfere with binding. The bedtime dose helps protect the mucosa during the longest fasting period overnight. Dosing with meals or after meals reduces efficacy because the drug binds to food and is less available to coat the ulcer.

Question 13

The nurse is preparing to administer an intramuscular dose of Phenergan. On a double check, the nurse realizes the route is written as intravenous. The patient does not have an intravenous line in place. What should the nurse do next?

Accepted Answer

Answer reason: The order contains a route discrepancy. The nurse must clarify unclear or conflicting medication orders before administration to prevent errors and ensure legal and safe practice.

Question 14

The nurse notes that the primary health care provider has prescribed sulfamethoxazole and trimethoprim for a client. Which priority action would the nurse take before administering this medication?

Accepted Answer

Answer reason: Sulfamethoxazole/trimethoprim is a sulfonamide-containing antibiotic and can cause severe hypersensitivity reactions (e.g., anaphylaxis, Stevens-Johnson syndrome), so verifying sulfa allergy history is the highest priority. Actions related to obtaining the drug or checking stock are logistical and do not address patient safety risk. Teaching to increase fluids is appropriate for this medication but is done after ensuring it is safe to administer.

Question 15

A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that she or he will perform which action?

Accepted Answer

Answer reason: Taking it with a full glass of water supports the medication’s mechanism and reduces the risk of thickened mucus. The other choices reflect unsafe or ineffective self-administration teaching, such as reducing fluids, which counteracts secretion thinning. Fever would suggest a possible infection requiring assessment rather than self-directed dose escalation.

Question 16

Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions on administration of the medication. Which instruction should the nurse provide?

Accepted Answer

Answer reason: Alendronate can cause significant esophageal irritation and must be taken to minimize reflux and mucosal exposure. Giving it first thing in the morning with a full glass of plain water helps the tablet reach the stomach quickly and improves absorption by avoiding food and other beverages. The client should remain upright for at least 30 minutes after the dose, so instructions that include lying down or taking it at bedtime increase the risk of esophagitis. Taking it with breakfast reduces absorption and therefore decreases therapeutic benefit for osteoporosis.

Question 17

Physical therapy is coming to visit a patient after a total knee replacement. Prior to the therapy session, which action by the nurse would demonstrate proactive thinking?

Accepted Answer

Answer reason: Pre-medicating before physical therapy helps the patient participate more fully in mobility and strengthening while preventing pain escalation that can cause guarding and reduced range of motion. It also supports early ambulation goals after total knee replacement, which reduces complications such as stiffness and venous thromboembolism. By contrast, education materials and emotional support are helpful but do not directly remove the immediate, time-sensitive obstacle to completing the upcoming therapy session.

Question 18

A 14-year-old child was recently diagnosed with type 1 diabetes. The patient is prescribed 10 units of regular insulin and 15 units of neutral protamine Hagedorn (NPH) insulin each morning. How should the nurse instruct this patient to give herself the prescribed doses of insulin?

Accepted Answer

Answer reason:  When mixing short-acting insulin with intermediate-acting insulin, the clear (regular) insulin is drawn up before the cloudy (NPH) to prevent contaminating the regular insulin vial with protamine, which can alter onset and peak. After injecting air into the NPH vial, the nurse teaches to inject air into the regular vial and withdraw the regular dose first, then withdraw the NPH dose into the same syringe. Options that draw up NPH first increase the risk of dosing/absorption variability due to vial contamination. Options that give two separate injections or suggest waiting between injections do not address the standard safe mixing technique and add unnecessary steps.

Question 19

Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication?

Accepted Answer

Answer reason: Insulin lispro begins working in about 10–15 minutes and peaks relatively soon, making administration at mealtime the safest standard practice. Giving it 30 minutes before meals fits short-acting regular insulin and would increase hypoglycemia risk with lispro. Waiting until trays arrive on the floor is unreliable because delivery does not guarantee the client will eat promptly or at all.

Question 20

Nurse Alex is preparing to administer an intramuscular injection of Demerol for postoperative pain management. To ensure accuracy, Nurse Alex carefully selects the correct vial from the narcotics cabinet. What should the label on the vial read?

Accepted Answer

Answer reason: Medication safety requires verifying a drug’s generic name because brand names can vary and look/sound alike. Demerol is the brand name for the opioid analgesic meperidine, which is appropriately stored in a narcotics cabinet for controlled substances. Selecting the vial labeled with the correct generic name helps prevent administering an incorrect medication with different indications or adverse-effect profiles. The other options are non-opioids used for different conditions (NSAID pain/fever, anti-gas, bronchodilation) and would not match the ordered narcotic analgesic.

Question 21

A client with angina has an order for nitroglycerin ointment. Before applying the medication, the nurse should?

Accepted Answer

Answer reason: Removing any prior dose prevents unintentional “stacking” of medication and allows the nurse to apply the ordered amount accurately and at a rotated site. This also supports proper timing of nitrate-free intervals to reduce tolerance. Checking pulses alone does not address the key safety issue of avoiding cumulative dosing, and applying to the same site increases local irritation and does not ensure correct dosing.

Question 22

While reviewing the medication administration record, you notice that valproic acid is listed as "PO." What additional information would be important to document when administering this medication?

Accepted Answer

Answer reason: Safe oral medication administration requires the client to be able to swallow effectively to prevent choking and aspiration. Assessing and documenting an intact swallowing reflex confirms the PO route is appropriate, especially in clients with neurologic impairment, altered mental status, or sedation. Valproic acid can cause CNS effects (e.g., drowsiness), making swallow safety a key pre-administration check tied to immediate harm prevention. Blood pressure monitoring is not a routine requirement for this drug, and skin integrity at an administration site pertains to injections/IV therapy rather than PO dosing.

Question 23

A nurse is reviewing a physician’s prescription sheet for a preoperative client that states that the client must be NPO after midnight. The nurse would telephone the physician to clarify that which of the following medications should be given to the client and not withheld?

Accepted Answer

Answer reason: Chronic corticosteroid therapy must generally be continued because abrupt interruption can precipitate adrenal insufficiency and inadequate stress response during surgery. In NPO status, such critical meds are typically given with a small sip of water and/or stress-dose steroids may be needed depending on dose/duration history. In contrast, iron and estrogen are commonly held perioperatively due to limited short-term necessity and potential perioperative risks, and a muscle relaxant is not usually essential immediately before anesthesia unless specifically ordered.

Question 24

SITUATION: A client was diagnosed with myasthenia gravis, and the health care provider (HCP) prescribed neostigmine (Prostigmin). When is the best time to give the medication?

Accepted Answer

Answer reason: Cholinesterase inhibitors for myasthenia gravis are timed to maximize skeletal muscle strength during activities that require endurance, especially chewing and swallowing. Administering the dose about 30 minutes before meals improves oropharyngeal muscle function and reduces risk for fatigue-related dysphagia and aspiration while eating. Giving it after a full meal delays the benefit until after the highest-risk time for swallowing difficulty has passed. Bedtime or a nonspecific “early morning” schedule does not reliably align peak effect with meals and functional needs.

Question 25

The nurse is conducting a discharge teaching to a client who is admitted to the hospital because of intermittent chest pain typically on exertion. The doctor prescribed nitroglycerin to be given sublingually for angina episodes. Which of the following instructions would be given by the nurse to the client concerning nitroglycerine administration?

Accepted Answer

Answer reason: Sublingual nitroglycerin is unstable when exposed to light, heat, moisture, and air, so patient teaching emphasizes proper storage and timely replacement to maintain effectiveness. Regularly replacing tablets helps prevent therapeutic failure during an acute angina episode. By contrast, the suggested dosing schedule of 4 doses every 30 minutes is unsafe and inconsistent with standard emergency guidance to seek urgent care if pain persists after initial doses. Teaching about shelf life and storage is a high-yield administration instruction that directly improves medication reliability and patient safety.

Question 26

The nurse provides instructions to a client who is taking levothyroxine. The nurse would tell the client to take the medication in which way?

Accepted Answer

Answer reason: Standard teaching is to take it at the same time daily, typically in the morning, 30–60 minutes before breakfast with water. Options that include food or a snack increase variability and can lead to under-replacement and persistent hypothyroid symptoms despite adherence. A non-specific time like lunchtime does not address the key issue of fasting administration and consistency needed for accurate dose titration.

Question 27

The nurse is developing a plan of care for a client who will receive chemotherapy with a neurotoxic agent. At what appropriate time should the nurse plan to implement client and family education regarding these side effects?

Accepted Answer

Answer reason: Neurotoxic chemotherapy can cause peripheral neuropathy and other neurologic changes where early reporting may allow dose adjustment, symptom management, and injury prevention. Waiting until symptoms occur delays detection and increases risk for falls, burns, and impaired function. Education is a nursing responsibility within the plan of care and should not be contingent on the provider’s request or the client initiating it.

Question 28

A 5-year-old client has an order for baclofen one-half of a 10-mg tablet by mouth three times per day. The safe dose range for a 2- to 7-year-old child is 10–15 mg/day in divided doses. Which nursing action is most appropriate?

Accepted Answer

Answer reason: Pediatric medication safety requires verifying both the total daily dose and the per-dose amount against the recommended range and dosing schedule. The order is 5 mg per dose (half of 10 mg) given three times daily, which totals 15 mg/day and is within the 10–15 mg/day safe range, so the daily total does not need questioning. However, the recommended range is stated as “in divided doses,” and without a stated per-dose range, the nurse should clarify that 5 mg TID is the intended division for this age group and indication before giving it. The safest nursing action is to question the per-dose order to ensure the division and timing are appropriate and to prevent adverse effects such as excessive sedation or hypotonia from overly large individual doses.

Question 29

Which of the following would be inappropriate when administering chemotherapy to a child?

Accepted Answer

Answer reason: Limiting assessment to only 10 minutes implies monitoring can stop afterward, which is unsafe and therefore inappropriate. In contrast, using a free-flowing IV line and frequent site checks are key to preventing and detecting vesicant extravasation and tissue injury. Ongoing assessment for both general and drug-specific adverse effects is an expected nursing responsibility with antineoplastic therapy.

Question 30

Nurse Jenny is instilling an otic solution into an adult male client’s left ear. Nurse Jenny avoids doing which of the following as part of the procedure?

Accepted Answer

Answer reason: The key principle in otic medication administration is preventing contamination and avoiding trauma to the ear canal. Touching the dropper tip to the ear canal/edge can introduce microorganisms into the medication and can irritate or injure sensitive canal tissue. In adults, pulling the auricle up and back helps straighten the canal for proper drop delivery, and placing the client side-lying with the affected ear up supports retention of the drops. Warming the solution to room temperature reduces vestibular stimulation that can cause dizziness or nausea.

Question 31

Nurse Matt makes a home visit to the client with diabetes mellitus. During the visit, Nurse Matt notes the client’s additional insulin vials are not refrigerated. What is the best action by the nurse at this time?

Accepted Answer

Answer reason: Insulin that is not currently in use should be stored per manufacturer guidance, typically refrigerated, to maintain potency and predictable glucose-lowering effect. Additional (unopened) vials left at room temperature for prolonged periods may degrade, creating risk for hyperglycemia due to underdosing even when the client administers the usual units. The safest immediate nursing action is to correct the storage problem and provide teaching on appropriate storage conditions for current and spare supplies. Labeling is useful for opened vials but does not address the key safety issue of improper long-term storage, and discarding is not indicated unless the insulin is known to be expired, improperly exposed to extreme temperatures, or shows changes such as clumping or discoloration.

Question 32

Which of the following statements about intravenous administration of steroids is true?

Accepted Answer

Answer reason: IV corticosteroid preparation and administration depend on the specific drug formulation, concentration, and facility policy rather than a universal dilution requirement. Some steroids are supplied for direct IV push (often slow) while others are commonly diluted and infused to reduce vein irritation and allow controlled delivery. Therefore, stating they “must be diluted” is too absolute and incorrect. Likewise, limiting administration to IV push only is unsafe because many IV steroid regimens are appropriately administered by intermittent infusion.

Question 33

Teaching has been adequate when a client being treated with acetylsalicylic acid states?

Accepted Answer

Answer reason: " Aspirin can hydrolyze with moisture/age into salicylic acid and acetic acid, producing a characteristic vinegar odor that signals degradation and reduced medication integrity. Discarding tablets with this odor reflects correct storage/quality teaching and helps prevent use of an unstable product. Taking aspirin on an empty stomach increases gastric irritation risk rather than being a desired practice for most clients. Crushing tablets may be inappropriate with buffered or enteric-coated formulations intended to reduce GI upset.

Question 34

A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate for this injection?

Accepted Answer

Answer reason: Intradermal injections require a very small volume to be delivered into the dermis using a short, fine-gauge needle to create a wheal and avoid subcutaneous placement. Tuberculin (PPD) testing uses 0.1 mL intradermally, typically with a 26–27 gauge needle and a 3/8–1/2 inch length. This option matches the appropriate gauge and short length needed for precise dermal deposition. Longer needles and larger bores (e.g., 20G, 1–3 inches) are intended for IM/IV use and increase the risk of injecting too deeply.

Question 35

Elmer is scheduled for a proctoscopy and has an I.V. The doctor wrote an order for 5mg of I.V. diazepam(Valium). Which order is correct regarding diazepam?

Accepted Answer

Answer reason: Give diazepam in the I.V. port closest to the vein. Diazepam injection is irritating to veins and can cause pain and thrombophlebitis, so it should be administered into a large vein and as close to the venipuncture site as feasible to reduce contact time with the vein wall. The drug is also poorly water-soluble and may precipitate with incompatible IV solutions, so routine dilution in D5W as described is not appropriate. Rapid IV push increases risk of respiratory depression and hypotension, so it should be given slowly with close monitoring rather than rapidly. IV diazepam is not contraindicated in general (it is commonly used for procedural sedation), so questioning the order solely for the IV route is unnecessary.

Question 36

Chemotherapy dosing is usually based on the total body surface. What should the nurse do before administering chemotherapy?

Accepted Answer

Answer reason: Chemotherapy doses are commonly calculated from body surface area, which requires accurate, current height and weight to prevent underdosing or potentially dangerous overdosing. Because weight can change rapidly in oncology patients due to fluid shifts, edema, dehydration, or cachexia, obtaining same-day measurements is a key medication-safety step. Relying on a patient’s stated values can introduce significant error and is not adequate for high-alert medications like antineoplastics. BMI and intake/output may be clinically relevant, but they do not directly provide the precise parameters required to calculate body surface area dosing.

Question 37

A nurse is planning care for a 1-year-old client with acute otitis media.Which is the proper technique when instilling ear drops?

Accepted Answer

Answer reason: Infants and young children have a shorter, more horizontal external ear canal, so the auricle should be pulled down and back to straighten the canal and allow medication to reach the intended area. Pulling up and back is the technique for older children/adults with a more vertical canal. Positioning should place the affected ear upward to retain drops, so having the unaffected ear up is incorrect. Drops should be warmed in the hands (or warm water bath) rather than microwaved to avoid overheating and potential ear canal injury.

Question 38

SITUATION: The healthcare provider orders propranolol hydrochloride (Inderal) 40 mg orally thrice daily for a client. Which of the following client statements would indicate a correct understanding of the medication?

Accepted Answer

Answer reason:  Beta-blockers decrease heart rate and AV-node conduction, so assessing pulse (and typically holding the dose and notifying the provider if the rate is below the ordered parameter, often

Question 39

Shortly after admission to an acute care facility, a male client with a seizure disorder develops status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can the nurse administer the second dose of diazepam, if needed and prescribed?

Accepted Answer

Answer reason: Diazepam has a very rapid onset, so the nurse should reassess airway/breathing, seizure activity, and vital signs shortly after administration, then repeat only per protocol/order at an appropriate interval. A 10–15 minute interval aligns with typical emergent anticonvulsant redosing practices for benzodiazepines in ongoing seizures, balancing urgency with safety monitoring. Seconds is too soon to judge effect and increases risk of oversedation, while 30–45 minutes or 1–2 hours delays treatment of ongoing status epilepticus.

Question 40

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?

Accepted Answer

Answer reason: Effective metered-dose inhaler technique requires slow, deep inhalation coordinated with actuation, followed by a breath-hold (about 10 seconds) to promote lower-airway deposition. Quickly exhaling immediately after inhalation reduces medication delivery to the bronchi and lowers therapeutic effect. Shaking the inhaler, actuating during inhalation, and spacing puffs by about 1–2 minutes are appropriate steps that improve dosing consistency and bronchodilator response. This incorrect exhalation pattern is therefore the clearest indicator that the client needs further teaching.

Question 41

When administering sucralfate (Carafate) to a patient with a nasogastric tube, it is important to?

Accepted Answer

Answer reason: Enteral-tube medication administration prioritizes preventing tube occlusion while ensuring the drug reaches the GI tract in a deliverable form. Sucralfate is a viscous, adherent agent that can readily clog narrow-bore NG tubes if not well dispersed, so crushing to a fine powder and mixing thoroughly with water helps create a uniform slurry that passes through the tube. It should not be given with tube feedings because feeds can decrease local mucosal contact and complicate administration/flush routines. Giving it with antacids is not advised for “maximum benefit” because it can alter gastric pH and timing is typically separated to optimize effect and avoid interactions.

Question 42

A nurse is providing teaching to a client who has a new prescription for diazepam for anxiety disorders. Which of the following client statements indicates an understanding of the teaching?

Accepted Answer

Answer reason: Notifying the prescriber promptly allows reassessment of risk-benefit, consideration of alternative therapies, and planning for tapering if appropriate to avoid maternal withdrawal. Alcohol should be avoided rather than limited, since concurrent use increases sedation and risk of respiratory depression. Skipping doses for days can precipitate rebound anxiety and withdrawal symptoms, especially with ongoing use, so adherence and provider guidance are important.

Question 43

The nurse is caring for a client receiving Morphine sulfate for severe pain. The nurse should implement only the following actions except?

Accepted Answer

Answer reason: Relying only on patient complaints can lead to undertreatment, delayed relief, higher required doses, and poorer functional outcomes. The other actions are standard opioid safety measures: having an opioid antagonist available, assessing respiratory status to reduce risk of respiratory depression, and preventing constipation with fiber due to reduced GI motility. A common nursing priority with morphine is balancing analgesia with monitoring for sedation and hypoventilation, which these measures directly address.

Question 44

A client with diabetes mellitus is self-administering NPH insulin from a vial kept at room temperature. The client asks a nurse about the length of time an unrefrigerated vial of insulin will remain its potency. The most appropriate response to the client is which of the following?

Accepted Answer

Answer reason: Most opened or in-use insulin vials kept at room temperature maintain potency for about 28–31 days, after which effectiveness can decline and glycemic control becomes unreliable. This timeframe is the standard teaching point for patients using insulin at home and helps prevent unexplained hyperglycemia from degraded insulin. Shorter durations (e.g., two weeks) are unnecessarily restrictive, while longer durations (e.g., two or six months) increase the risk of using subpotent insulin.

Question 45

Which of the following is the appropriate initial action by the nurse when preparing insulin administration?

Accepted Answer

Answer reason: Air is injected into the NPH vial first to equalize pressure without drawing any NPH into the syringe, then air is injected into the regular vial and the regular insulin is withdrawn first (“clear before cloudy”). This sequencing maintains accurate dosing and reduces the risk of unpredictable glycemic control. Drawing cloudy insulin first is a common error because it increases the chance that NPH will contaminate the regular insulin vial. Using separate syringes is unnecessary when the prescription is to mix compatible insulins in one syringe.

Question 46

Upon checking, Maria was having hyperglycemia, you tell Maria to?

Accepted Answer

Answer reason: Using the prescribed insulin addresses the underlying pathophysiology (insufficient effective insulin leading to elevated serum glucose) and is the most direct, evidence-based immediate action when no severe symptoms are described. Hydration can be supportive but does not correct hyperglycemia as reliably or quickly as insulin, especially if glucose is significantly elevated. Immediate provider notification is appropriate if there are red flags (e.g., vomiting, altered mental status, ketones, dehydration, very high readings), but in routine hyperglycemia the first safe step is to follow the ordered correction/insulin plan and continue monitoring.

Question 47

The following are nursing interventions when administering insulin except?

Accepted Answer

Answer reason: g., NPH) should be mixed by gently rolling or inverting to resuspend particles without creating bubbles or degrading the protein. Shaking can cause frothing and inaccurate dosing due to bubbles in the syringe, and may alter insulin integrity, making administration less reliable. Using insulin at room temperature can reduce injection discomfort, and sites should be rotated to prevent lipodystrophy. When mixing insulins, the usual rule is “clear before cloudy” to avoid contaminating regular insulin with NPH; the option describing drawing cloudy before clear reflects a known sequencing concept, whereas shaking is clearly contraindicated technique.

Question 48

To prevent lipodystrophy due to insulin injection, the nurse should do the following except?

Accepted Answer

Answer reason: Rapid injection speed does not address the underlying mechanism of tissue changes from repeated local insulin exposure and mechanical injury. Standard teaching emphasizes injecting into subcutaneous tissue (not intramuscularly) and rotating within and between anatomic sites to reduce local complications. Using insulin at room temperature can reduce discomfort and may improve patient technique adherence, but it is injection-site rotation that most directly prevents lipodystrophy.

Question 49

A nurse is teaching a client about methotrexate therapy for rheumatoid arthritis. Which of the following statements by the client indicates understanding of the teaching?

Accepted Answer

Answer reason: Using reliable contraception demonstrates understanding of this high-priority risk reduction. The statement about decreased infection risk is incorrect because methotrexate is immunosuppressive and can increase infection susceptibility. Taking it daily is also incorrect for rheumatoid arthritis, as dosing is typically weekly to reduce toxicity. The hydration statement is not the central, medication-specific teaching compared with strict pregnancy prevention.

Question 50

A nurse is teaching a client about ipratropium. Which the following instruction should the nurse include?

Accepted Answer

Answer reason: Ipratropium is an inhaled anticholinergic bronchodilator; allowing a short interval before the next inhaled drug helps improve airway opening and subsequent deposition of the second medication. The instruction about thinning secretions is inaccurate because mucolytic effects are not its primary action. Pulse monitoring is more emphasized with beta-agonists due to tachycardia risk, whereas ipratropium has minimal systemic cardiac effects when inhaled.

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