Question 1

The nurse is caring for a client with a new order for Bupropion (Wellbutrin) for treatment of depression. The physician's order reads "175 mg. BID x 4 days". What is the appropriate action?

Accepted Answer

Answer reason: 175 mg BID is not a standard or safe initial dosing schedule for bupropion and 175 mg is not a usual tablet strength; the nurse should clarify the order before administration.

Question 2

The nurse is caring for clients over the age of 70. The nurse is aware that when giving medications to older clients, it is BEST to?

Accepted Answer

Answer reason: Older adults have reduced drug clearance and increased sensitivity; starting with lower doses and titrating slowly minimizes toxicity and adverse reactions.

Question 3

In preparing medications for a client with a gastrostomy tube, the nurse should contact the physician before administering which of the following drugs through the tube?

Accepted Answer

Answer reason: Sustained-release tablets must not be crushed for gastrostomy-tube administration; crushing alters drug release and levels, so the provider should be contacted for an alternative form.

Question 4

A client tells the RN she has decided to stop taking Sertraline (Zoloft) because she doesn't like the nightmares, sex dreams and obsessions she's experiencing since starting on the medication. An appropriate response is to caution the client that?

Accepted Answer

Answer reason: SSRIs like sertraline should not be stopped suddenly due to risk of discontinuation syndrome; clients should be cautioned to consult the provider for a taper. Other options are either generic or inappropriate.

Question 5

A client is prescribed an inhaler. When teaching how to use the inhaler, the nurse would instruct the client to breath in the medication?

Accepted Answer

Answer reason: Correct MDI technique is a slow, deep inhalation over about 3–5 seconds while actuating the canister; this ensures optimal deposition. Rapid inhalation or a spacer whistle indicates too fast a breath.

Question 6

A client has an order for antibiotic therapy after hospital treatment of a staph infection. Which of the following should the nurse emphasize?

Accepted Answer

Answer reason: Finishing the entire antibiotic course is essential to eradicate infection and prevent recurrence or resistance; the other options are secondary and not the key emphasis.

Question 7

A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication?

Accepted Answer

Answer reason: Levothyroxine is a thyroid hormone replacement with stimulating effects; taking it in the morning (on an empty stomach) helps prevent insomnia. It typically increases energy and may increase heart rate; it does not require light-protective storage.

Question 8

A client with anemia has a new prescription for ferrous sulfate. In teaching the client about diet and iron supplements, the nurse should emphasize that absorption of iron is enhanced if taken with?

Accepted Answer

Answer reason: Vitamin C (ascorbic acid) increases gastrointestinal absorption of ferrous iron; orange juice provides ascorbic acid. Milk and antacids decrease absorption; acetaminophen is unrelated.

Question 9

The nurse is administering diltiazem (Cardizem) to a client. Prior to administration, it is important for the nurse to monitor the client's?

Accepted Answer

Answer reason: Diltiazem is a calcium channel blocker that causes systemic vasodilation and can lower blood pressure; therefore BP should be monitored before administration.

Question 10

What is the appropriate distance to hold the dropper from the nose during instillation of nasal drops?

Accepted Answer

Answer reason: During nasal drop instillation, the dropper should be held about 1–2 cm above the nares to deliver drops without touching the mucosa and to prevent contamination.

Question 11

What is the route of administration for the MMR vaccine?

Accepted Answer

Answer reason: MMR is a live attenuated vaccine administered subcutaneously (0.5 mL) in fatty tissue.

Question 12

When inquiring about medications during a health history, the nurse should ask about all of the following except?

Accepted Answer

Answer reason: A comprehensive medication history includes prescriptions, OTC drugs, herbal/home remedies, supplements, and how medications are stored and disposed. It is not limited to only oral medications.

Question 13

What is the priority item the nurse should check before administering atenolol?

Accepted Answer

Answer reason: Atenolol is a beta-blocker that can cause hypotension and bradycardia. The nurse should assess blood pressure (and heart rate) prior to administration and hold if hypotensive.

Question 14

What is the correct angle for intramuscular needle insertion?

Accepted Answer

Answer reason: IM injections are administered at a 90° angle to reach muscle; 5–15° is for intradermal and 45° for some subcutaneous injections.

Question 15

Which of the following drugs must not be injected intravenously?

Accepted Answer

Answer reason: Diazepam and ceftriaxone are commonly given IV, whereas diclofenac injection is not for IV bolus administration and is typically given IM; thus it must not be injected intravenously.

Question 16

What does the abbreviation UNG mean?

Accepted Answer

Answer reason: UNG derives from the Latin unguentum, meaning ointment; other choices do not match this abbreviation.

Question 17

A client with angina has been instructed about the use of sublingual nitroglycerin. Which of the following statements made to the nurse indicates a need for FURTHER teaching?

Accepted Answer

Answer reason: Nitroglycerin SL should be taken one tablet at a time, 5 minutes apart, up to three doses; then seek medical care. Taking 2–3 tablets at once is incorrect. Resting after a dose and storing in the dark bottle are correct.

Question 18

A client with atrial fibrillation is receiving digoxin (Lanoxin). It is MOST important for the nurse to?

Accepted Answer

Answer reason: Digoxin can cause bradycardia; the apical pulse must be checked before administration and the dose held if it is below 60 bpm.

Question 19

The nurse is instructing a client with moderate persistent asthma on the proper method for using MDI's (multi-dose inhalers). Which medication should be administered FIRST?

Accepted Answer

Answer reason: Administer the short-acting bronchodilator first to open the airways; this improves delivery of subsequent inhalers such as steroids or other agents.

Question 20

The nurse is teaching a client with asthma about the correct use of the Azmacort (triamcinolone) inhaler. Which of the following statements, if made by the client, would indicate that the teaching was effective?

Accepted Answer

Answer reason: Azmacort (triamcinolone) is an inhaled corticosteroid; rinsing the mouth after use prevents oropharyngeal candidiasis and indicates correct medication technique.

Question 21

The nurse is teaching a client who has a new prescription for sublingual nitroglycerin. Which of the following MUST be emphasized?

Accepted Answer

Answer reason: Sublingual nitroglycerin is taken PRN at the onset of angina; clients must keep it with them at all times for immediate use. It is not scheduled daily, does not require bed rest for an hour, and should be stored in its original light-protected container at room temperature, not refrigerated.

Question 22

The nurse is teaching a parent how to administer oral iron supplements to a 2 year-old child. Which of the following interventions should be included in the teaching?

Accepted Answer

Answer reason: Vitamin C enhances iron absorption and using a straw helps prevent tooth staining. Dark green or black stools are expected; milk/formula and meals decrease absorption.

Question 23

The nurse is planning to administer otic drops to a six year-old child. Which of the following is the correct procedure?

Accepted Answer

Answer reason: For children 3 years and older, the ear canal is straightened by pulling the pinna up and back. Placing drops in the outer ear, inserting cotton routinely, or positioning on the affected side are incorrect and may reduce medication effectiveness.

Question 24

The nurse is teaching administration of albuterol inhalation to an asthmatic adult. The PRIORITY is?

Accepted Answer

Answer reason: Increased need for a short-acting beta-agonist indicates worsening control and requires provider evaluation for adjustment of therapy, making notification the priority teaching point.

Question 25

The nurse enters a 2 year-old child's hospital room in order to administer an oral medication. When the child is asked if he is ready to take his medicine, he immediately says, "No!". What would be the MOST appropriate next action?

Accepted Answer

Answer reason: Toddlers assert autonomy and often refuse when asked yes/no. Avoid power struggles; step out briefly and try again, offering choices later. Do not force, hide in food without orders, or delegate to the parent.

Question 26

The nurse is providing instructions for a client with pneumonia. What is the MOST important information to convey to the client?

Accepted Answer

Answer reason: Finishing the entire antibiotic course ensures eradication of the infection and reduces risk of recurrence and resistance; other instructions are less critical to treatment success.

Question 27

A male client with schizophrenia who is taking fluphenazine decanoate (Prolixin decanoate) is being discharged in the morning. A repeat dose of medication is scheduled for 20 days after discharge. The client tells the nurse that he is going on vacation in the Bahamas and will return in 18 days. Which statement by the client indicates a need for health teaching?

Accepted Answer

Answer reason: The decanoate injection is scheduled for 20 days after discharge; returning in 18 days and immediately going for the injection is two days early and indicates misunderstanding of the dosing schedule. The other statements reflect appropriate teaching: avoid alcohol, report infection signs, and continue benztropine.

Question 28

The nurse is giving instructions to the parents of a child with Cystic Fibrosis. The nurse would emphasize that pancreatic enzymes should be taken?

Accepted Answer

Answer reason: Children with cystic fibrosis have exocrine pancreatic insufficiency; enzyme replacement must be taken with every meal and snack to digest nutrients effectively.

Question 29

The nurse is teaching an elderly client how to use MDI's (multi-dose inhalers). The nurse is concerned that the client is unable to coordinate the release of the medication with the inhalation phase. The nurse's BEST recommendation for the client is?

Accepted Answer

Answer reason: A spacer helps clients who cannot coordinate actuation with inhalation by holding the aerosolized dose for slow inhalation, improving delivery and ease of use. Other options do not directly address the coordination issue.

Question 30

The nurse is reinforcing teaching to a 24 year-old woman receiving acyclovir (Zovirax) for a Herpes Simplex Virus type 2 infection. The nurse should instruct the client to?

Accepted Answer

Answer reason: Acyclovir is suppressive/episodic therapy that reduces severity and duration when started at the first signs of recurrence (prodrome). It does not cure HSV, stopping due to suspected pregnancy is not recommended without provider guidance, and long-term prophylaxis for five years is not standard.

Question 31

When caring for a client receiving warfarin sodium (Coumadin), the nurse would monitor the results of the client's?

Accepted Answer

Answer reason: Warfarin inhibits vitamin K–dependent clotting factors in the extrinsic pathway; effectiveness and dosing are monitored with prothrombin time/INR. PTT monitors heparin, and bleeding/coagulation time are not used for warfarin.

Question 32

The nurse is teaching a client newly diagnosed with asthma how to use the metered-dose inhaler (MDI). The client asks when they will know the canister is empty. The BEST response is?

Accepted Answer

Answer reason: Floating of the MDI canister in water indicates little to no medication remains; the other methods are unreliable for determining emptiness.

Question 33

The nurse is performing a pre-kindergarten physical on a five year-old. The last series of vaccines will be administered. What is the preferred site for injection by the nurse?

Accepted Answer

Answer reason: For young children, the vastus lateralis is the preferred intramuscular injection site because it is well developed and away from major nerves and blood vessels.

Question 34

Which is the correct method of intramuscular injection?

Accepted Answer

Answer reason: IM injections in the gluteal region are given in the upper outer quadrant to avoid the sciatic nerve and major vessels; other quadrants risk injury.

Question 35

A nurse is caring for a patient receiving warfarin therapy. Which nursing assessment is the most important to include?

Accepted Answer

Answer reason: Warfarin has a narrow therapeutic range, and INR levels directly indicate its anticoagulant effect. Monitoring INR ensures the patient remains within the safe therapeutic range, reducing risks of bleeding or clotting. Other assessments are important but do not replace INR monitoring as the primary indicator of drug effectiveness and safety.

Question 36

A nurse is preparing to administer medications to a patient. Which of the following actions demonstrates correct adherence to the Six Rights of medication administration?

Accepted Answer

Answer reason: Verifying the patient’s identity by checking the wristband ensures the “right patient” component of the Six Rights of medication administration. It is the most reliable method, as spoken identifiers may be mistaken or misheard.

Question 37

A nurse is caring for a patient receiving warfarin for atrial fibrillation. Which discharge instruction is most essential for the nurse to include?

Accepted Answer

Answer reason: Warfarin therapy carries a significant risk of bleeding. Noticing and promptly reporting signs such as unusual bruising, black or tarry stools, or bleeding gums is critical for early detection of serious hemorrhage and prevention of life-threatening complications. Other instructions are important but are secondary to recognizing dangerous bleeding.

Question 38

What is the best site for injecting insulin?

Accepted Answer

Answer reason: Insulin is absorbed most rapidly and consistently from the subcutaneous tissue of the abdomen, leading to more predictable glycemic control. Arms have intermediate absorption, while thighs and buttocks tend to absorb more slowly. Therefore, the abdomen is preferred for routine insulin injections, rotating sites within the abdominal area. Avoid injecting within about 2 inches of the umbilicus.

Question 39

Route of measles vaccine administration?

Accepted Answer

Answer reason: The measles (MMR) vaccine is a live attenuated vaccine that is administered subcutaneously, typically in the fatty tissue over the triceps. This route ensures proper uptake and immunogenicity for the licensed formulations. Intramuscular and intradermal routes are not recommended for standard MMR products, and intravenous administration is contraindicated.

Question 40

Insulin injection is given ....?

Accepted Answer

Answer reason: Insulin is routinely administered subcutaneously so it is absorbed gradually from adipose tissue, providing controlled glucose-lowering effects. Common sites include the abdomen, thigh, and upper arm with rotation of sites to prevent lipodystrophy. Intramuscular administration alters absorption and is not recommended, and intravenous insulin is reserved for specific emergencies (e.g., DKA) using regular insulin only. Intramural is not a recognized route of medication administration.

Question 41

Mantoux test is given at what angle?

Accepted Answer

Answer reason: The Mantoux test is administered intradermally using a tuberculin syringe with the bevel up at a shallow angle of about 5–15 degrees to the skin. This ensures deposition of 0.1 mL PPD within the dermis and formation of a small wheal. Angles of 30–90 degrees penetrate deeper into subcutaneous or muscle tissue and are incorrect for intradermal injection.

Question 42

When administering an I.M. injection to an infant, the nurse in charge should use which site?

Accepted Answer

Answer reason: For infants, the preferred IM site is the vastus lateralis (anterolateral thigh) because it has the greatest muscle mass at birth and is free of major nerves and blood vessels. The deltoid has insufficient muscle mass in infants. Dorsogluteal and ventrogluteal sites are not recommended due to underdeveloped gluteal muscles and risk of sciatic nerve injury. Therefore, the vastus lateralis provides the safest and most effective site.

Question 43

Vaccines like tetanus toxoid (IM) are given at?

Accepted Answer

Answer reason: Tetanus toxoid is administered via the intramuscular route, which requires inserting the needle at a 90° angle to ensure delivery into the muscle mass. This angle minimizes subcutaneous deposition and promotes optimal absorption. A 45° angle is used for subcutaneous injections, and 10–15° for intradermal injections.

Question 44

Maximum volume for intradermal injection is?

Accepted Answer

Answer reason: Intradermal injections are placed within the dermis for tests such as PPD and allergy testing, where only very small volumes are appropriate. The recommended maximum is 0.1 mL, which forms a small bleb; larger volumes can leak out, cause tissue irritation, and distort test results. Therefore, 0.1 mL is the correct maximum volume.

Question 45

An insulin injection given......?

Accepted Answer

Answer reason: Routine insulin is administered subcutaneously to allow steady absorption from the subcutaneous tissue, helping maintain controlled glucose levels. Intradermal injections are used for tests like TB and are not appropriate for insulin. Intramuscular or intravenous routes cause much faster absorption and are reserved only for specific situations (e.g., IV regular insulin in DKA), not for standard insulin injections.

Question 46

At what angle is an intradermal injection usually given?

Accepted Answer

Answer reason: Intradermal injections are placed into the dermis just below the epidermis, as for tuberculin testing. To keep the needle tip within this shallow layer, the syringe is inserted with the bevel up at a very shallow angle, typically 5–15 degrees. Among the options, 15° is the correct standard angle. Angles of 30°, 45°, or 90° are used for subcutaneous or intramuscular routes, not intradermal.

Question 47

Oral contraceptive pills are taken?

Accepted Answer

Answer reason: Combined and progestin-only oral contraceptives are designed for daily dosing to maintain consistent hormone levels that suppress ovulation and thicken cervical mucus. Taking the pill at the same time each day maximizes efficacy. Weekly and monthly schedules apply to other contraceptive methods such as the transdermal patch or injections, not oral pills.

Question 48

Which of the following medicine is giving sublingually?

Accepted Answer

Answer reason: Nitroglycerin is administered sublingually for rapid relief of acute angina because it is readily absorbed through the oral mucosa and bypasses first-pass hepatic metabolism, providing a quick onset of action. Digoxin is typically given orally or intravenously and is not used sublingually. Amoxicillin and ibuprofen are standard oral medications taken by swallowing. Therefore, nitroglycerin is the correct sublingual medication.

Question 49

For an intradermal test dose, the needle should be inserted at?

Accepted Answer

Answer reason: Intradermal injections are delivered into the dermis using a very shallow angle, typically 5–15 degrees with the bevel up, to keep the needle tip within the dermal layer and form a small wheal. Using larger angles such as 45°, 60°, or 90° would advance the needle into subcutaneous tissue or muscle, defeating the purpose of a test dose (e.g., TB or allergy testing). Therefore, 15° is the correct insertion angle.

Question 50

The site for Mantoux test is?

Accepted Answer

Answer reason: The Mantoux test (tuberculin skin test) is administered intradermally with 0.1 mL of PPD on the volar aspect of the inner forearm, about 2–4 inches below the antecubital fossa. This site allows easy intradermal injection and later reading of induration. Deltoid and vastus lateralis are intramuscular sites, and the abdomen is commonly used for subcutaneous injections, not intradermal testing.

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