Question 1

The physician has prescribed Synthroid (levothyroxine) for a client with myxedema. Which statement indicates that the client understands the nurse’s teaching regarding the medication?

Accepted Answer

Answer reason: Levothyroxine can cause tachycardia; clients are taught to monitor their pulse before dosing and report elevated rates. It should be taken before breakfast (not after), visual disturbances are not typical, and the drug should not be stopped for mild GI upset.

Question 2

An adolescent with cystic fibrosis has an order for pancreatic enzyme replacement. The nurse knows that the medication should be given?

Accepted Answer

Answer reason: Pancreatic enzymes in cystic fibrosis must be taken with all meals and snacks to aid digestion and nutrient absorption; not given just at bedtime, twice daily, or only in the morning.

Question 3

A client with diabetes mellitus has a prescription for Glucotrol XL (glipizide). The client should be instructed to take the medication?

Accepted Answer

Answer reason: Glipizide XL is an extended-release sulfonylurea taken once daily with the first main meal—typically breakfast—to optimize glycemic control and reduce hypoglycemia risk.

Question 4

The physician has ordered Vancocin (vancomycin) 500mg IV every 6 hours for a client with MRSA. The medication should be administered?

Accepted Answer

Answer reason: Vancomycin must be infused slowly—at least 60 minutes—to prevent hypotension and red man syndrome; never given IV push.

Question 5

A client with Addison's disease asks the nurse what he needs to know to manage his condition. The nurse should give priority to?

Accepted Answer

Answer reason: Addison's disease requires lifelong glucocorticoid/mineralocorticoid replacement; strict adherence prevents adrenal crisis. Therefore education on maintaining the medication regimen is the priority.

Question 6

The nurse calculates the amount of an antibiotic for injection to be given to an infant. The amount of medication to be administered is 1.25mL. The nurse should?

Accepted Answer

Answer reason: For infants, the preferred IM site is the vastus lateralis; dorsogluteal is contraindicated. A 1.25 mL dose exceeds typical single-site infant volumes, so the dose should be split and administered in both vastus lateralis muscles.

Question 7

A client with schizophrenia is receiving depot injections of Haldol Decanoate (haloperidol decanoate). The client should be told to return for his next injection in?

Accepted Answer

Answer reason: Haloperidol decanoate is a long-acting depot antipsychotic typically administered intramuscularly every 4 weeks (monthly) for maintenance therapy.

Question 8

The nurse is preparing to give an oral potassium supplement. The nurse should give the medication?

Accepted Answer

Answer reason: Liquid oral potassium is irritating to the GI tract and should be diluted in at least 4 oz of water or fruit juice and given with/after food. Therefore giving it with 4 oz of juice is the safest option among those listed.

Question 9

The physician has ordered cortisporin ear drops for a 2-year-old. To administer the ear drops, the nurse should?

Accepted Answer

Answer reason: For children under 3 years, straighten the ear canal by pulling the pinna down and back before instilling otic drops. Up and back is for adults/older children; other options are incorrect.

Question 10

A 6-month-old is being treated for thrush with Nystatin (mycostatin) oral suspension. The nurse should administer the medication by?

Accepted Answer

Answer reason: For infant oral thrush, nystatin should be applied directly to the oral mucosa to coat lesions. Using a cotton-tipped swab ensures contact time; mixing with food or liquids dilutes the drug and reduces effectiveness.

Question 11

A client with iron-deficiency anemia is taking an oral iron supplement. The nurse should tell the client to take the medication with?

Accepted Answer

Answer reason: Vitamin C and an acidic environment enhance absorption of oral iron; orange juice is preferred. Milk decreases absorption, and water or apple juice are less effective.

Question 12

Which medicine is administered sublingually?

Accepted Answer

Answer reason: Nitroglycerin tablets are given sublingually for rapid absorption and onset in acute angina; aspirin and clopidogrel are typically administered orally and not sublingually.

Question 13

What is the correct angle used for giving an intramuscular (IM) injection?

Accepted Answer

Answer reason: IM injections are inserted at a 90° angle to reach the muscle; 45° is typically for subcutaneous and 30° for intradermal injections.

Question 14

In the intra-articular route of drug administration, the injection is given into which site?

Accepted Answer

Answer reason: Intra-articular literally means within a joint; drugs are injected into the synovial joint space.

Question 15

What are the common sites for intradermal injections?

Accepted Answer

Answer reason: Intradermal injections are commonly given on lightly pigmented, hairless areas such as the inner forearm, upper chest, and upper back; therefore all listed sites are correct.

Question 16

The nurse is preparing to administer digoxin 0.25 mg IVP to a client in severe congestive heart failure who is receiving D5W/0.9 NaCl at 25 mL/hr. Rank in order of importance?

Accepted Answer

Answer reason: Verifying the patient’s identity is the first priority before any medication preparation or administration to ensure the right patient receives the drug.

Question 17

What is the recommended storage temperature for the polio vaccine?

Accepted Answer

Answer reason: Oral polio vaccine is stored frozen to maintain potency; the cold-chain recommendation is -20°C.

Question 18

Which muscle is commonly used for injection in the shoulder?

Accepted Answer

Answer reason: The deltoid muscle is the standard site for intramuscular injections in the shoulder, especially vaccines; biceps and triceps are not routine IM injection sites.

Question 19

Which coded instruction is used when a drug is to be given at bedtime?

Accepted Answer

Answer reason: Hs means hora somni (at bedtime). ac = before meals; od = once daily/right eye; sos = if necessary.

Question 20

Through which route are immunoglobulins administered?

Accepted Answer

Answer reason: Standard immune globulin preparations used for passive immunization (e.g., tetanus, rabies, hepatitis B) are administered intramuscularly; IV use is specific to IVIG formulations.

Question 21

By which routes are killed vaccines administered?

Accepted Answer

Answer reason: Inactivated (killed) vaccines are administered via parenteral routes such as subcutaneous or intramuscular injection; they are not given intravenously.

Question 22

How many times should a nurse check the prescription before administering medicine to a patient?

Accepted Answer

Answer reason: Nurses perform three checks of the medication/prescription against the MAR: when retrieving, when preparing, and at the bedside before administration.

Question 23

The client has an order for heparin to prevent post-surgical thrombi. Immediately following a heparin injection, the nurse should?

Accepted Answer

Answer reason: Heparin is an anticoagulant; after a subcutaneous injection the priority is to assess for bleeding/hematoma at the site. Do not aspirate or massage.

Question 24

Before administering Methyltrexate orally to the client with cancer, the nurse should check the?

Accepted Answer

Answer reason: For oral methotrexate, the nurse should complete basic pre-administration assessment; checking vital signs is appropriate. The IV site is irrelevant for an oral drug, and routine checks of electrolytes or blood gases are not specifically required before administering the dose.

Question 25

The nurse is teaching a group of new graduates about the safety needs of the client receiving chemotherapy. Before administering chemotherapy, the nurse should?

Accepted Answer

Answer reason: Premedication with an antiemetic is standard before chemotherapy to prevent nausea and vomiting. Routine IV bolus or pain medication is not indicated for all chemotherapy regimens, and eating beforehand may worsen nausea.

Question 26

A client with osteomyelitis has an order for a trough level to be done because he is taking Gentamycin. When should the nurse call the lab to obtain the trough level?

Accepted Answer

Answer reason: Trough levels for aminoglycosides like gentamicin are drawn just before the next dose once steady state is reached—typically 30 minutes before the fourth dose.

Question 27

A new diabetic is learning to administer his insulin. He receives 10U of NPH and 12U of regular insulin each morning. Which of the following statements reflects understanding of the nurse's teaching?

Accepted Answer

Answer reason: When mixing insulins, draw up the clear (regular) insulin first, then the cloudy (NPH) to avoid contaminating regular insulin with protamine.

Question 28

The client is taking prednisone 7.5mg po each morning to treat his systemic lupus erythematosis. Which statement best explains the reason for taking the prednisone in the morning?

Accepted Answer

Answer reason: Glucocorticoids follow a circadian rhythm; dosing in the morning best matches endogenous cortisol secretion, reducing adrenal suppression and side effects. Other choices do not explain the timing rationale.

Question 29

The 10-year-old is being treated for asthma. Before administering Theodur, the nurse should check the?

Accepted Answer

Answer reason: Theo-Dur (theophylline) can cause tachycardia and dysrhythmias; assess the pulse before administration.

Question 30

The doctor orders 2% nitroglycerin ointment in a 1-inch dose every 12 hours. Proper application of nitroglycerin ointment includes?

Accepted Answer

Answer reason: Nitroglycerin ointment should be applied to hairless skin using applicator paper and sites should be rotated to prevent skin irritation and ensure consistent absorption. It is not limited to the chest, should not be rubbed in, and gauze may absorb the drug.

Question 31

The client is admitted with a BP of 210/100. Her doctor orders furosemide (Lasix) 40mg IV stat. How should the nurse administer the prescribed furosemide to this client?

Accepted Answer

Answer reason: Furosemide IV push should be administered slowly to prevent ototoxicity—about 20 mg per minute; therefore a 40 mg dose is given over 1–2 minutes. It does not require a filter or IVPB.

Question 32

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

Accepted Answer

Answer reason: Warfarin is typically given in the late afternoon/evening so that morning PT/INR results can be used to adjust the dose the same day. Of the options, 1700 is most appropriate.

Question 33

To ensure safety while administering a nitroglycerine patch, the nurse should?

Accepted Answer

Answer reason: Gloves prevent transdermal absorption of nitroglycerin by the nurse, avoiding headaches and hypotension. Shaving can abrade skin, hot water increases vasodilation and absorption, and the buttocks is not a preferred site for nitroglycerin patches.

Question 34

The nurse has an order for medication to be administered intrathecally. The nurse is aware that medications will be administered by which method?

Accepted Answer

Answer reason: Intrathecal administration delivers medication directly into the subarachnoid space/CSF, not IV, IM, or rectal routes.

Question 35

The nurse is visiting a home health client with osteoporosis. The client has a new prescription for alendronate (Fosamax). Which instruction should be given to the client?

Accepted Answer

Answer reason: Alendronate should be taken first thing in the morning with a full glass of plain water only; other liquids or foods reduce absorption and increase esophageal irritation risk. The client should remain upright for at least 30 minutes; therefore A and B are incorrect, and D is less accurate than the standard 30-minute separation.

Question 36

The nurse is caring for a 6-year-old client admitted with the diagnosis of conjunctivitis. Before administering eyedrops, the nurse should recognize that it is essential to consider which of the following?

Accepted Answer

Answer reason: Before administering ophthalmic medication for conjunctivitis, any crusting/exudate should be removed with warm water so the drops contact the conjunctiva effectively. A 6-year-old should not self-administer; holding ordered drops due to lack of visible redness is inappropriate.

Question 37

The physician has ordered Amoxil (amoxicillin) 500mg capsules for a client with esophageal varices. The nurse can best care for the client's needs by?

Accepted Answer

Answer reason: Esophageal varices are fragile and can bleed with irritation or trauma. Solid capsules can irritate the esophagus; a liquid or alternative route is safer. Therefore, request an alternate form of amoxicillin.

Question 38

The nurse is caring for a client who is receiving procainamide (Pronestyl) intravenously. It is important for the nurse to monitor?

Accepted Answer

Answer reason: IV procainamide is a Class Ia antiarrhythmic that can cause conduction changes (QRS widening, heart block) and new arrhythmias; continuous ECG monitoring is required. Urine output, potassium, and neuro checks are not the immediate priority for safe administration.

Question 39

Before administering digoxin (Lanoxin) to a client, which of the following nursing assessments is a PRIORITY?

Accepted Answer

Answer reason: Digoxin slows AV conduction and can cause bradycardia; the apical heart rate must be checked and the dose held if below 60 bpm.

Question 40

An 82 year-old client is prescribed eye drops for treatment of glaucoma. What assessment is needed before the nurse begins teaching proper administration of the medication?

Accepted Answer

Answer reason: Elderly clients may have decreased finger dexterity, which can prevent accurate self-administration of eye drops; assessing manual dexterity guides teaching and potential assistance needs. Other options are less directly related to safe administration.

Question 41

The nurse admits a hypertensive client who complains of dizziness after taking diltiazem (Cardizem). Which of the following is the MOST important information for the nurse to assess?

Accepted Answer

Answer reason: Diltiazem can cause dizziness from hypotension/bradycardia; the priority assessment is whether the client is taking the medication as prescribed (timing/dose) to rule out dosing errors or inappropriate timing contributing to symptoms.

Question 42

The physician has ordered transdermal nitroglycerin patches for a client. The nurse should instruct the client to?

Accepted Answer

Answer reason: Transdermal nitroglycerin should be placed on clean, hairless skin to ensure consistent absorption. It is not removed for bathing, a second patch is not applied for chest pain, and ankle edema is not an indication to remove the patch.

Question 43

The nurse prepares to administer eye drops to a six year-old child. The CORRECT way to give the eye drops is to instill them?

Accepted Answer

Answer reason: Ophthalmic drops are instilled into the conjunctival sac by pulling the lower lid down, avoiding contact with the cornea; placing them on the eyeball, in the canthus, or under the upper lid is incorrect.

Question 44

The physician has ordered an iodine solution for a client scheduled to undergo a thyroidectomy. When administering this medication the nurse should?

Accepted Answer

Answer reason: Strong iodine solutions (e.g., Lugol's) should be diluted in fruit juice or other liquids and given with meals to mask taste and reduce GI irritation. Milk and antacids are not indicated; using only a straw does not address irritation or taste.

Question 45

Heparin has been ordered for a client with pulmonary embolis. Which statement, if made by the graduate nurse, indicates a lack of understanding of the medication?

Accepted Answer

Answer reason: Heparin injections should not be aspirated because this increases the risk of tissue damage and hematoma. The other statements reflect appropriate administration and monitoring practices.

Question 46

What does the abbreviation h.s. mean in medication administration?

Accepted Answer

Answer reason: H.S. is the Latin abbreviation for hora somni, meaning at bedtime.

Question 47

How long before mealtime should the nurse administer regular insulin, 10 units SQ?

Accepted Answer

Answer reason: Regular insulin has an onset of 30–60 minutes; administer about 30 minutes before meals to match postprandial glucose rise.

Question 48

What is the appropriate needle size for insulin injection?

Accepted Answer

Answer reason: Insulin is given subcutaneously using a small-gauge, short needle; typical sizes are 25–31 G and 3/8–5/8 inch. Among the options, 25 G with a 5/8-inch length is appropriate.

Question 49

The nurse will administer liquid medicine to a nine month-old child. Which of the following methods is appropriate?

Accepted Answer

Answer reason: For infants, an oral syringe allows accurate dosing and directing the liquid toward the side of the mouth next to the tongue/cheek reduces gagging and aspiration risk. Cup or spoon use is less accurate and may cause choking; mixing with formula risks incomplete dose if the bottle is not finished.

Question 50

An elderly client is on an anticholinergic metered dose inhaler (MDI) for chronic obstructive pulmonary disease. The nurse suggests a spacer to?

Accepted Answer

Answer reason: Spacers hold the aerosol and synchronize inhalation with actuation, improving lung deposition for clients who cannot coordinate MDI use. They do not reduce administration time, directly increase compliance, or prevent COPD exacerbations.

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