Question 1

A nurse is preparing to teach a client about a newly prescribed drug. Prior to providing teaching, the nurse should review the precautions section of a drug handbook for which of the following reasons?

Accepted Answer

Answer reason: g., renal/hepatic impairment, older adults, or comorbidities that increase adverse-effect risk). This section helps the nurse anticipate patient-specific dosing considerations and safety monitoring needs before teaching. Food interactions are typically found under interactions, absorption under pharmacokinetics, and availability under formulation/supply information rather than precautions. Reviewing precautions first supports safer administration and more accurate client education.

Question 2

A nurse is teaching a client about naproxen enteric coated tablets. Which of the following statements should the nurse include in the teaching?

Accepted Answer

Answer reason: Enteric-coated medications are designed to pass through the stomach intact and dissolve in the intestine to reduce gastric irritation and protect the drug from stomach acid. Crushing or chewing destroys the coating, which can cause premature release in the stomach, increased GI adverse effects, and altered absorption. Immediate absorption is not expected because the coating delays dissolution until the tablet reaches a higher pH environment. Allowing the tablet to dissolve in the mouth is inappropriate and risks mucosal irritation and loss of intended delayed-release properties.

Question 3

When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding to give a drug?

Accepted Answer

Answer reason: Many medications have administration times that depend on food because meals can change drug absorption, onset, and gastrointestinal tolerance. Assessing when the patient last ate helps the nurse decide whether a medication should be given with food, on an empty stomach, or separated from meals to optimize therapeutic effect and minimize adverse effects. This is a core “right time” medication-administration consideration, especially for drugs with food-dependent bioavailability or significant GI irritation potential. By contrast, allergies affect whether a medication can be given at all, not primarily the timing of the dose.

Question 4

A client forgot to take their Levothyroxine when directed. The client should ...?

Accepted Answer

Answer reason: Levothyroxine has clinically meaningful effects when taken in excess (e.g., palpitations, tremor, insomnia), so avoiding “make-up” double dosing is important. Taking it as soon as possible supports consistent thyroid hormone replacement and symptom control. Automatically skipping the dose can unnecessarily disrupt therapy, while stopping the medication altogether is unsafe and not indicated for a single missed dose. Notifying the provider is generally unnecessary for one missed dose unless repeated nonadherence or symptoms occur.

Question 5

At what blood pressure would you hold Digoxin in an adult?

Accepted Answer

Answer reason: A systolic blood pressure below 60 mmHg indicates profound hypotension and possible shock, where giving a negative chronotropic/inotropic-risk medication can further compromise circulation. In this setting the nurse should hold the dose and assess for associated findings (dizziness, syncope, altered mentation) and notify the provider. Higher systolic pressures do not, by themselves, constitute a standard hold parameter for digoxin compared with severe hypotension.

Question 6

The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by?

Accepted Answer

Answer reason: Timely administration supports consistent neuromuscular transmission and reduces fluctuations that can precipitate severe weakness and respiratory compromise. This teaching targets the highest-risk, most controllable trigger for crisis: improper medication timing and dosing. While energy conservation strategies like scheduling chores can reduce fatigue, they do not directly prevent pharmacologically driven over- or under-treatment that leads to crisis.

Question 7

The physician has ordered sodium warfarin for the client with thrombophlebitis. The order should be entered to administer the medication at what time?

Accepted Answer

Answer reason: This timing supports safer anticoagulation management and reduces delays in responding to out-of-range coagulation values. Morning dosing can lead to missed opportunities to adjust based on labs drawn and resulted during the day. Therefore, administering in the late afternoon is the most appropriate standard practice.

Question 8

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

Accepted Answer

Answer reason: Mannitol can form crystals in solution, especially with temperature changes, and IV administration must prevent particulate infusion. Filtering the medication (and inspecting the vial/bag for crystals, warming if needed per policy) reduces the risk of embolic complications from infused crystals. Routine CBC monitoring is not a key safety requirement for this osmotic diuretic, and holding the dose for bradycardia is not an appropriate parameter. Telemetry may be used based on the patient’s condition, but the distinctive administration-specific nursing intervention for mannitol is filtration to ensure solution safety.

Question 9

IM injections are given at ?

Accepted Answer

Answer reason: A 90-degree angle provides the most direct path through the dermis and subcutaneous layers into the muscle belly. In contrast, 45 degrees is typically used for subcutaneous injections, and 15 degrees is used for intradermal injections, both of which are too shallow for IM delivery. Using the correct angle also helps minimize medication tracking and local irritation when paired with appropriate site selection and needle length.

Question 10

The LPN/LVN assists in the discharge teaching for a client receiving sodium warfarin (Coumadin). The LPN/LVN determines that further teaching is required if the client makes which of the following statements?

Accepted Answer

Answer reason: " Warfarin teaching prioritizes recognition and prevention of bleeding and avoidance of interacting drugs. A yellow-tinged complexion suggests jaundice/hepatic dysfunction and is not a primary expected warning sign taught for anticoagulation safety compared with bleeding indicators. Black, tarry stools are a key sign of GI bleeding and require prompt provider notification. Wearing medical identification and consulting the provider before starting any new medication are essential because many OTC and prescription drugs increase bleeding risk by interacting with warfarin.

Question 11

The nurse is developing teaching materials for a client diagnosed with ulcerative colitis. The client will receive sulfasalazine. Which of the following instruction is included in the discharge teaching plan?

Accepted Answer

Answer reason: Supplementing folic acid is a standard teaching point to prevent megaloblastic anemia and other deficiency effects while treating ulcerative colitis. Diet advice in active UC typically avoids high-residue foods that can worsen diarrhea and cramping, making the raw/whole-grain option inappropriate as a general discharge instruction. A rash is a potential hypersensitivity reaction that should be reported promptly rather than considered expected, and stopping medication based only on symptom resolution risks relapse and is not safe without prescriber direction.

Question 12

You are the nurse in the medical unit. You are caring for an eighty-year-old woman with a long-standing history of asthma. You are preparing to give a dose of theophylline to the patient. You know that the most critical observation before giving this dose is?

Accepted Answer

Answer reason: The core principle is that theophylline is a methylxanthine with sympathomimetic cardiac stimulation and a narrow therapeutic index, making cardiotoxicity a key safety concern. Baseline assessment of heart rate helps detect preexisting tachycardia or dysrhythmia risk before administration, especially in older adults who are more susceptible to adverse effects. If the pulse is elevated or irregular, giving the dose can worsen tachyarrhythmias and signal possible toxicity or intolerance. Blood pressure and temperature may change secondarily, but they are less direct and sensitive than heart rate for early recognition of cardiac stimulation. Urinary output is not the primary immediate safety parameter for administering this medication.

Question 13

A client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications?

Accepted Answer

Answer reason: Eye drops should be given before ointments because ointment forms an occlusive layer that can block medication absorption. Allowing time between different ophthalmic medications prevents the second medication from washing out or diluting the first and improves therapeutic effect. A waiting interval (commonly about 10–15 minutes) is appropriate when giving drops then ointment so the solution can be absorbed before the thicker preparation is applied. Giving ointment first would decrease penetration of the drop and reduce effectiveness.

Question 14

The nurse is administering a Kayexalate enema to a patient with an elevated potassium level. The patient asks how long he will have to retain the enema. Which of the following responses is correct?

Accepted Answer

Answer reason: " Kayexalate (sodium polystyrene sulfonate) given as a retention enema must remain in the colon long enough to allow cation exchange, binding potassium in the gut for subsequent elimination. Standard nursing teaching is to retain the enema for about 30–60 minutes; among the options, 30 minutes is the best accurate target. Five minutes is too short to be therapeutically effective. Predicting inevitable diarrhea is not an appropriate or reliably accurate statement for patient teaching and may increase anxiety; the key instruction is the retention time and that bowel evacuation will occur after the dwell period.

Question 15

A laboring client, gravida 3 para 2, is admitted to the labor unit reporting severe perineal pressure and urgently requesting pain relief. The client's cervix is 10 cm dilated and 100% effaced, with the fetal head at 0 station. Which pain management technique is most appropriate for this client's report of perineal pressure?

Accepted Answer

Answer reason: A pudendal block provides targeted anesthesia to the lower vagina and perineum and is especially useful late in labor for perineal pain and for procedures such as episiotomy or operative vaginal birth. Epidural analgesia is effective but may be less practical to initiate urgently at full dilation and does not specifically address an immediate need for rapid perineal anesthesia. IV opioids can blunt pain but are less effective for intense perineal pressure and carry risks of maternal sedation and neonatal respiratory depression when birth is imminent.

Question 16

The client diagnosed with chronic kidney disease is scheduled for hemodialysis. When should the nurse plan to administer the client’s daily dose of enalapril to ensure its effectiveness?

Accepted Answer

Answer reason: Giving an ACE inhibitor immediately before or during dialysis can worsen hypotension and may lead to the drug being partially cleared, reducing the intended therapeutic effect. Administering the dose after the session avoids dialysis-associated drug loss and supports safer blood pressure control. Options timed before/during dialysis prioritize convenience but increase risk of hypotension and reduced efficacy.

Question 17

The nurse working in an extended care facility transcribes a prescription from the health care provider for a single daily dose of 150 mg of ranitidine; this is to be taken orally at bedtime for treatment of gastroesophageal reflux disease. Of the following prescriptions, which one is transcribed correctly?

Accepted Answer

Answer reason: The order is for 150 mg orally at bedtime once daily; this option correctly reflects mg (not mcg), oral route, and bedtime timing. Options using mcg are a 1000-fold dosing error and therefore unsafe. The option with “qhs” also matches timing but relies on an abbreviation that can be misread; writing out “at bedtime” is clearer and reduces transcription error risk.

Question 18

The nurse has reinforced teaching with a client who is receiving prescribed NPH insulin and regular insulin. Which of the following statements by the client would indicate a correct understanding of the teaching?

Accepted Answer

Answer reason: " When mixing short-acting (clear) and intermediate-acting (cloudy) insulin, the clear insulin is drawn up first to avoid contaminating the regular insulin vial with NPH, which can alter onset/peak and dosing accuracy. This sequence maintains insulin potency and helps prevent medication errors. Increasing NPH for a single dessert is unsafe because NPH has a delayed peak and is not used to cover immediate carbohydrate intake. Injecting into an exercising limb can speed absorption and increase hypoglycemia risk, and vomiting/sick-day rules generally emphasize not omitting basal insulin while requiring glucose/ketone monitoring and provider guidance rather than self-directed selective withholding.

Question 19

When an analgesic is titrated to manage pain, what is the priority goal?

Accepted Answer

Answer reason: Analgesic titration follows the principle of using the minimum effective dose to achieve analgesia while minimizing harm, especially sedation and respiratory depression with opioids. This goal balances comfort with safety by limiting dose-related adverse effects and allows incremental adjustments based on reassessment. An approach focused solely on being “pain free” can drive unnecessary dose escalation and increase risk without additional clinically meaningful benefit. Patient-reported pain guides dosing, but the nurse must still prioritize safe, effective dosing rather than dosing to subjective needs alone regardless of side-effect profile.

Question 20

Four clients in labor are requesting pain relief. The nurse understands that which client can safely receive a dose of IV butorphanol tartrate, an opioid agonist-antagonist, at this time?

Accepted Answer

Answer reason: At 7 cm dilation, the client is typically in active labor and is an appropriate candidate for IV opioid analgesia if maternal-fetal status is stable. A client at 9 cm with an urge to push is near delivery, so IV opioids are avoided because they can cross the placenta and depress the newborn’s respirations. Recent heroin use is a contraindication because mixed agonist-antagonists can precipitate acute withdrawal in opioid-dependent clients and cause maternal/fetal distress. Very early labor at 3 cm with a desire to ambulate suggests pain is manageable and nonpharmacologic measures/continued mobility are preferred, with IV opioids potentially causing sedation and impairing safe ambulation.

Question 21

Which type of insulin can never be mixed with another?

Accepted Answer

Answer reason: Preparations like glargine and detemir are intended to be given as separate injections because their pH/precipitation or binding properties are disrupted when combined with other insulins. This increases the risk of both hypoglycemia (if absorption speeds up) and hyperglycemia (if basal coverage is reduced). In contrast, short/rapid-acting insulins are commonly mixed with NPH in the same syringe when compatible and ordered, following correct technique (clear before cloudy).

Question 22

The nurse should check the prescription _______ times before administering the medicine to a patient?

Accepted Answer

Answer reason: The prescription/medication label is verified when retrieving the medication, again during preparation/dosing, and a final time at the bedside immediately before administration. This structured repetition reduces cognitive slips and catches discrepancies caused by look-alike/sound-alike drugs or transcription issues. Checking fewer times increases the chance an error reaches the patient, while additional checks beyond this core standard are not the commonly tested requirement in basic nursing procedure questions.

Question 23

The nurse is caring for a patient with asthma and is instructing the patient on the proper use of a spacer device. Which of the following statements by the patient indicates the need for further instruction?

Accepted Answer

Answer reason: " A spacer is an administration aid that improves delivery of metered-dose inhaler medication to the lungs by decreasing oropharyngeal deposition and reducing the need for precise actuation–inhalation coordination. It does not change the prescribed dosing frequency or allow the patient to safely reduce how often the medication is taken. Believing they can use the inhaler less often suggests a misunderstanding that could lead to under-treatment and poor asthma control. In contrast, improved coordination and reduced local steroid deposition (thereby lowering thrush risk when using inhaled corticosteroids) are appropriate benefits of spacer use.

Question 24

A client's diabetes is controlled with a morning dose of glargine and a scheduled, fixed dose of lispro with meals. Before breakfast, the client's fingerstick glucose is 105 mg/dL (5.8 mmol/L). The tray is in the room, and the client is eager to eat. What action should the nurse take?

Accepted Answer

Answer reason: Rapid-acting insulin given with meals should be administered when the meal is present and the client is ready to eat to match carbohydrate absorption and prevent postprandial hyperglycemia. Basal glargine provides background insulin coverage and is generally not held based on a single normal fingerstick value. Holding prandial or basal insulin without an order increases the risk of hyperglycemia and later ketosis, especially when the client is about to eat.

Question 25

Common site for subcutaneous injection in infants is?

Accepted Answer

Answer reason: The anterolateral/outer thigh has a reliable layer of subcutaneous fat in infants and is commonly used for injections when consistent absorption and safety are needed. The deltoid is generally avoided in very young infants due to small muscle mass and proximity to neurovascular structures. Buttocks are avoided because of risk to the sciatic nerve and variable fat distribution that can alter absorption.

Question 26

A client with type 1 diabetes has a prescription for 30 units of insulin glargine at bedtime. Fingerstick blood glucose measurements are prescribed before meals and at bedtime with regular insulin based on a sliding scale. At 9 PM, the client's blood glucose measurement is 180 mg/dL (10.0 mmol/L). What action should the nurse take? Click on the exhibit button for additional information.?

Accepted Answer

Answer reason: A bedtime glucose of 180 mg/dL requires a short-acting correction dose per sliding scale while still giving the scheduled basal dose. Giving both insulins as separate injections preserves the intended pharmacokinetics and avoids unpredictable glycemic effects. The mixing options are unsafe because they violate administration compatibility, and delaying correction until after a snack is unnecessary and can worsen hyperglycemia.

Question 27

Vitamin K is prescribed for a neonate. A nurse prepares to administer the medication in which muscle site?

Accepted Answer

Answer reason: This reduces the risk of sciatic nerve injury that can occur with gluteal sites and avoids small muscle groups that cannot reliably absorb medication. Vitamin K prophylaxis at birth is administered IM, and the recommended site is the vastus lateralis. Deltoid and arm muscles (triceps/biceps) are generally too small in neonates and increase the risk of improper depth and injury.

Question 28

A female patient is prescribed azithromycin for the treatment of a sexually transmitted disease (STD). What is the most important nursing assessment?

Accepted Answer

Answer reason: The core safety principle before giving any medication is to assess for allergy history to prevent an immediate hypersensitivity reaction that can rapidly become life-threatening. Azithromycin can trigger allergic reactions (including anaphylaxis) and a positive allergy history may require changing the drug choice before administration. Questions about sexual contacts and contraception are relevant for counseling and STI management, but they do not typically alter the immediate safety of giving the first dose. A CBC is not a routine prerequisite for administering azithromycin in uncomplicated STI treatment and does not address the highest-risk preventable harm.

Question 29

Four clients in labor are requesting pain medication from the nurse. Which client can safely receive an opioid agonist-antagonist analgesic intravenous (IV) push at this time?

Accepted Answer

Answer reason: g., butorphanol, nalbuphine) are used for labor analgesia but should be given during active labor when birth is not imminent to reduce risk of neonatal respiratory depression. At 5 cm with contractions every 3–4 minutes, this client is in active labor and is an appropriate timing window for IV opioid analgesia. A client at 10 cm who wants to push is too close to delivery, making systemic opioids unsafe. A history of heroin use raises concern for opioid dependence; agonist-antagonists can precipitate acute withdrawal in the mother and fetus, so they are avoided.

Question 30

The nurse is giving discharge instructions to a patient being discharged with a diagnosis of a duodenal ulcer. The physician has prescribed metronidazole (Flagyl) as part of the patient's home care. The nurse knows that the patient understands his instructions when he says?

Accepted Answer

Answer reason: Metronidazole can cause a disulfiram-like reaction when combined with alcohol, leading to flushing, nausea/vomiting, abdominal cramping, tachycardia, and hypotension, so strict avoidance is a key safety teaching point. This statement demonstrates understanding of a high-risk interaction that can be prevented by patient adherence. Stopping the antibiotic early when symptoms improve is unsafe because it can lead to treatment failure and recurrence of infection (e.g., H. pylori eradication regimens require full completion). Routine instructions are to take metronidazole with food if GI upset occurs rather than insisting on an empty stomach, so that option does not reflect correct teaching.

Question 31

What are the appropriate steps for preparing and administering a dose of Humalog insulin using an insulin syringe? Number the actions in the options in order of priority with regard to how the nurse should perform them. (Number 1 would be the first action, and number 5 would be the last.)?

Accepted Answer

Answer reason: Injecting air equal to the ordered dose into the vial first prevents a vacuum from forming, which helps ensure accurate withdrawal and reduces risk of dosing error. The subsequent correct steps involve piercing the cleansed stopper, withdrawing the ordered units, preparing the injection site, and then administering. Because the question requires a complete 1–5 sequence rather than one best option, selecting only one option would be incomplete and potentially misleading.

Question 32

A nurse is reinforcing teaching to a client about home use of transdermal medication. Which of the following statements by the client indicates understanding of the teaching?

Accepted Answer

Answer reason: " Proper transdermal absorption requires intact skin that is free of oils, moisture, and residue that can alter medication delivery or patch adhesion. Cleaning and thoroughly drying the site helps the patch adhere evenly and promotes predictable absorption. Reapplying to the same location increases risk of local irritation and can change absorption, so sites should be rotated. Applying over hair or using lotions/creams can prevent good contact with skin and may increase irritation or interfere with dose delivery.

Question 33

The nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers. Which statement by the client would prompt further instruction?

Accepted Answer

Answer reason: " Misoprostol is a prostaglandin analog used for NSAID-induced ulcer prevention, and teaching includes how to take it to avoid reduced effectiveness. Antacids—especially those containing magnesium—can worsen diarrhea, a common adverse effect of misoprostol, and are not recommended as a strategy to manage GI upset with this drug. Taking it with food can lessen cramping/diarrhea and is acceptable, and continuing the NSAID is expected because the medication is being used for prophylaxis. Reliable contraception is essential because misoprostol can stimulate uterine contractions and cause miscarriage/teratogenic effects.

Question 34

The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action?

Accepted Answer

Answer reason: Unopened insulin should be stored under manufacturer-recommended conditions to preserve potency, which generally means refrigeration at 2–8°C (36–46°F). Refrigeration slows degradation and helps maintain predictable insulin action profiles, which is especially important for intermediate-acting preparations like NPH. Freezing can denature insulin proteins and make the product ineffective or unpredictable, creating a serious risk of hyperglycemia. While opened vials may often be kept at room temperature for a limited time depending on the product, this question asks specifically about unopened vials, for which refrigeration is standard guidance.

Question 35

A client is receiving digoxin, and the pulse range is normally 70 to 76 bpm. After assessing the apical pulse for 1 minute and finding it to be 60 bpm, the nurse should do what first?

Accepted Answer

Answer reason: Digoxin can cause or worsen bradycardia due to its effects on AV node conduction, so a low apical pulse is a safety stop before administration. Standard nursing practice is to hold the dose when the adult apical pulse is below the facility parameter (commonly

Question 36

The nurse is conducting a home care visit with a 78-year-old client with diabetes. Which statement by the client most concerns the nurse?

Accepted Answer

Answer reason: " In safe medication administration, the highest priority is preventing dosing errors that can cause immediate harm. Difficulty seeing syringe markings puts the client at high risk of drawing up the wrong insulin dose, leading to severe hypoglycemia or hyperglycemia and possible emergency events. This indicates a need for adaptive strategies (e.g., prefilled pens, magnifiers, caregiver support) before the client continues self-injection. By comparison, injecting in the abdomen is an appropriate site and the other statements do not imply an imminent, high-risk administration error.

Question 37

When administering an IM injection to an adult, the nurse ensures proper insertion depth by choosing a needle length of?

Accepted Answer

Answer reason: Appropriate IM needle length must reliably reach muscle tissue while minimizing the risk of injecting into subcutaneous fat, which can reduce absorption and increase local irritation. For most adults, a 1 to 1.5 inch needle is the standard range used for common IM sites (e.g., deltoid, ventrogluteal), with final selection based on body habitus and site. Shorter lengths (e.g., 0.5–1 inch) more often fail to penetrate adequately in average-to-larger adults, leading to unintended subcutaneous administration. Longer lengths (e.g., 1.5–2 inches) may be used in select larger patients for deeper sites, but are not the typical default range for adult IM injections.

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