Question 1

Nitroglycerin is given by which route for quick action?

Accepted Answer

Answer reason: For rapid relief of angina, nitroglycerin is administered sublingually, where it is quickly absorbed through the oral mucosa and bypasses first-pass hepatic metabolism. This yields an onset within 1–3 minutes. Oral or rectal routes have slower onset due to gastrointestinal absorption and first-pass effect. Intramuscular administration is not used for nitroglycerin.

Question 2

The ideal angle of insertion of a needle for administering an intra-dermal injection is?

Accepted Answer

Answer reason: Intradermal injections are placed just beneath the epidermis to create a small bleb, as in TB or allergy testing. To avoid entering the subcutaneous tissue, the needle is inserted with the bevel up at a shallow angle of 5–15 degrees. Among the given choices, 10 degrees best represents this technique and minimizes depth while ensuring dermal placement.

Question 3

Tetanus toxoid is given through which route?

Accepted Answer

Answer reason: Tetanus toxoid vaccines (Td/Tdap) are administered intramuscularly to optimize immunogenicity and minimize local irritation. The deltoid is preferred in older children and adults, and the anterolateral thigh in infants. Oral, intradermal, or subcutaneous routes are not recommended for tetanus toxoid and may lead to suboptimal response or more local reactions.

Question 4

Which route provides fastest drug action?

Accepted Answer

Answer reason: Intravenous administration delivers the drug directly into the bloodstream, bypassing absorption barriers and producing the most rapid onset of action. Intramuscular and subcutaneous routes require absorption from tissues, delaying effect. Intradermal administration is primarily for testing and has the slowest systemic onset.
Category reason: The question asks about medication routes and onset, which relates to safe and effective medication administration within Pharmacological and Parenteral Therapies.

Question 5

Dose of the T.T injection?

Accepted Answer

Answer reason: Tetanus toxoid vaccines (TT/Td/Tdap) are administered as a 0.5 mL intramuscular dose per WHO/CDC guidelines. This volume provides the standardized antigen content required for effective immunization in both primary series and boosters. Larger volumes are not recommended and may increase local reactogenicity without added benefit.

Question 6

Site for tetanus toxoid injection is usually?

Accepted Answer

Answer reason: Tetanus toxoid (Td/Tdap) is administered intramuscularly, and the preferred site for adolescents and adults is the deltoid muscle for reliable absorption. The gluteal region is avoided due to variable adipose tissue and risk of sciatic nerve injury, which may reduce immunogenicity. Abdomen and forearm are not standard IM sites for this vaccine (they are used for subcutaneous or intradermal injections). Therefore, the deltoid is the correct site.

Question 7

Insulin injections are usually given in which route?

Accepted Answer

Answer reason: Insulin is typically administered into subcutaneous tissue to allow slow, consistent absorption and predictable glycemic control. Intravenous insulin is reserved for acute situations such as DKA or hyperkalemia and uses regular insulin. Intramuscular administration leads to faster, unpredictable absorption and increased discomfort, and intradermal injections are used for testing rather than therapy.

Question 8

Which of the following medications are Giving sublingually?

Accepted Answer

Answer reason: Nitroglycerin is classically administered sublingually for acute angina due to rapid mucosal absorption and avoidance of first‑pass metabolism. Ergotamine tartrate has a sublingual formulation for acute migraine treatment to achieve quicker onset. Zolpidem also has approved sublingual tablets for insomnia episodes. Therefore, all listed medications can be given sublingually.

Question 9

Which site is commonly used for insulin injection?

Accepted Answer

Answer reason: Insulin is administered subcutaneously, and the abdomen provides the fastest and most consistent absorption compared with other sites. Rotation within the abdominal area helps prevent lipodystrophy while maintaining predictable pharmacokinetics. The deltoid and gluteal regions are primarily intramuscular sites, and the thigh is acceptable but generally has slower absorption than the abdomen.

Question 10

What is the correct angle for intramuscular injection in adults?

Accepted Answer

Answer reason: Intramuscular injections in adults are administered at a 90° angle to ensure the needle passes through subcutaneous tissue and deposits medication deep into muscle. Angles of 10–15° are used for intradermal injections, and 45° (or 30–45°) is used for some subcutaneous injections, not IM. Using 90° optimizes absorption and minimizes subcutaneous deposition.

Question 11

At what angle is a subcutaneous injection usually given?

Accepted Answer

Answer reason: Subcutaneous injections are typically administered at a 45° angle to deposit the medication into the subcutaneous tissue rather than muscle or dermis. In clients with ample adipose tissue or when using shorter needles, a 90° angle may be appropriate, but the standard teaching is 45°. A 15° angle is used for intradermal injections, and 90° is generally for intramuscular injections.

Question 12

At what angle is an intramuscular injection usually given?

Accepted Answer

Answer reason: Intramuscular injections are inserted at a 90° angle so the needle penetrates through the subcutaneous tissue into the muscle for proper deposition and absorption. The perpendicular approach reduces the risk of delivering medication into subcutaneous tissue. By contrast, intradermal injections use 10–15°, and subcutaneous injections typically use 45° (or 90° with short needles and adequate adipose tissue).

Question 13

For subcutaneous injection into the thigh of an infant, the preferred angle is?

Accepted Answer

Answer reason: Subcutaneous injections are delivered into the fatty tissue, typically at a 45° angle to avoid penetrating muscle. This is especially important in infants, whose muscle mass is small and easily entered if the angle is too steep. A 90° angle is used for intramuscular injections, while 15° is for intradermal injections. Therefore, 45° is the preferred angle for an infant’s thigh subcutaneous injection.

Question 14

Maximum volume for intramuscular injection in deltoid is?

Accepted Answer

Answer reason: The deltoid is a relatively small muscle used for IM injections primarily for vaccines and small-volume medications. To minimize pain, tissue distension, and risk of nerve injury, recommended maximum volume for the adult deltoid is about 2 mL. Larger volumes should be given in larger muscles such as the ventrogluteal or vastus lateralis.

Question 15

Subcutaneous injections are given at an angle of?

Accepted Answer

Answer reason: Subcutaneous injections are intended to deposit medication into the adipose tissue below the dermis. The traditional standard technique uses a 45° angle with a 5/8-inch needle when a skin fold is pinched, which helps avoid intramuscular or intradermal placement. A 90° angle may be used in clients with ample adipose tissue or with shorter needles, but the classic single best answer is 45°. By contrast, intradermal injections are given at 15° and intramuscular at 90°.

Question 16

Angle used for giving IM injection is ?

Accepted Answer

Answer reason: Intramuscular injections are intended to deposit medication deep into muscle tissue for rapid, reliable absorption. To ensure the needle passes through subcutaneous tissue and reaches the muscle, the syringe is inserted at a 90-degree angle to the skin. This angle minimizes the risk of depositing the drug in subcutaneous tissue. Needle length and site selection are then adjusted based on patient size and age.

Question 17

You are caring for a patient who is NPO for an EGD today. She is diagnosed with Hashimoto's, Type 2 diabetes, and GERD. Which of the following meds would you make sure to give her this morning.?

Accepted Answer

Answer reason: For NPO patients before procedures, essential daily medications should be continued with a small sip of water. Levothyroxine is a life-sustaining thyroid hormone replacement and is typically taken the morning of procedures. Metformin and other oral hypoglycemics are held when NPO to prevent hypoglycemia, and a multivitamin is nonessential. A PPI like pantoprazole may be deferred; the priority is ensuring necessary hormone replacement.

Question 18

IM injection is given at the Angle of?

Accepted Answer

Answer reason: Intramuscular injections are administered with the needle inserted at a 90-degree angle to ensure the medication is delivered into the muscle tissue. Shallower angles (e.g., 45 degrees) are typically used for subcutaneous injections, and very shallow angles are used for intradermal injections. Using 90 degrees helps achieve proper depth and absorption and reduces the risk of depositing the drug in subcutaneous tissue.

Question 19

A patient with chronic heart failure is experiencing shortness of breath and has gained 5 pounds in the past 3 days. What is the nurse's priority action?

Accepted Answer

Answer reason: Rapid weight gain over 3 days with shortness of breath in chronic heart failure indicates acute fluid volume overload and worsening congestion. The priority nursing action, if an order exists, is to administer the prescribed diuretic to reduce preload, mobilize excess fluid, and improve dyspnea. Increasing oral fluids would worsen overload, and measuring abdominal girth is an assessment that does not treat the immediate problem. The provider should be notified if symptoms persist or worsen, but administering the ordered diuretic is the most immediate corrective intervention.

Question 20

The Z-track method is used for which route of injection?

Accepted Answer

Answer reason: The Z-track technique is an intramuscular (IM) injection method used to prevent medication from leaking back into subcutaneous tissue. By displacing the skin and subcutaneous tissue laterally before needle insertion and releasing afterward, the medication is sealed within the muscle. This reduces irritation and staining, especially with irritating or staining IM drugs (e.g., iron preparations). It is not used for intradermal, subcutaneous, or intravenous routes.

Question 21

Which is the most common site for intramuscular injection in adults?

Accepted Answer

Answer reason: In adults, the deltoid muscle is the most commonly used intramuscular injection site, particularly for routine vaccinations, because it is easily accessible and generally well tolerated. The gluteus maximus is not preferred due to risk of sciatic nerve injury; when the gluteal region is used, the ventrogluteal site is safer. Vastus lateralis is used more commonly in infants/children or when larger muscle mass is needed. The abdomen is typically used for subcutaneous injections, not intramuscular.

Question 22

Which site is commonly used for intradermal injection?

Accepted Answer

Answer reason: Intradermal injections (e.g., tuberculin skin testing and allergy testing) are commonly administered on the inner (volar) surface of the forearm because the dermis is easily accessed and the area allows accurate reading of a wheal/induration. The abdomen is a typical subcutaneous site, and the deltoid is a common intramuscular site. The upper chest may be used for some allergy testing, but the inner forearm is the most commonly used standard site for intradermal injection.

Question 23

Needle length for intramuscular injection in adults is usually?

Accepted Answer

Answer reason: For most adults, a 1 to 1.5 inch needle is typically required to reach the muscle tissue for an intramuscular injection, especially at common sites such as the deltoid or ventrogluteal muscles. Shorter needles (e.g., 1/4–5/8 inch) are more consistent with intradermal or subcutaneous injections and may deposit medication into subcutaneous tissue rather than muscle. Very long needles (2–3 inches) are rarely needed and increase risk of injury. Therefore, the usual adult IM needle length is 1 to 1 1/2 inches.

Question 24

The preferred site for intramuscular injection in infants is?

Accepted Answer

Answer reason: In infants, the vastus lateralis (anterolateral thigh) is the preferred IM injection site because it is well developed and has a lower risk of injury to major nerves and blood vessels. The deltoid is typically reserved for older children when adequate muscle mass is present. The dorsogluteal site is avoided due to higher risk of sciatic nerve injury, and the ventrogluteal site is not the first-choice site in infants compared with the thigh.

Question 25

What is the angle of entry for intramuscular injection?

Accepted Answer

Answer reason: Intramuscular injections are administered at a 90-degree angle to penetrate through subcutaneous tissue and deposit the medication into the muscle. A 45-degree angle is typically used for subcutaneous injections, and 10–15 degrees is commonly used for intradermal injections. Using the correct angle helps ensure appropriate absorption and reduces risk of improper tissue placement.

Question 26

Which injection site is avoided due to risk of sciatic nerve damage?

Accepted Answer

Answer reason: The dorsogluteal IM injection site is avoided because it is close to the sciatic nerve, creating a risk of nerve injury and potential pain, paresthesia, or motor deficits. It is also near major blood vessels and may have variable subcutaneous tissue thickness, increasing the chance of improper needle placement. The ventrogluteal site is preferred for gluteal IM injections because it has fewer major nerves and vessels and provides a reliable muscle mass.

Question 27

The Z-track technique of intramuscular injection is used to?

Accepted Answer

Answer reason: The Z-track technique displaces the skin and subcutaneous tissue laterally before inserting the needle so the tissue layers do not align when released. This creates a sealed, zigzag needle track that prevents medication from tracking back into subcutaneous tissue and leaking onto the skin. It is especially useful for irritating or staining IM medications to reduce irritation and ensure the full dose remains in the muscle. Avoiding nerves/veins depends on correct site selection, not the Z-track method itself.

Question 28

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

Accepted Answer

Answer reason: Intramuscular (IM) injections are administered at a 90° angle to ensure the needle penetrates through the subcutaneous tissue into the muscle, allowing proper medication delivery and absorption. Subcutaneous injections are typically given at a 45° angle (or 90° depending on tissue thickness), while intradermal injections are administered at a shallow angle of about 10–15°.

Question 29

What is the recommended needle size for administering an intramuscular injection in an adult?

Accepted Answer

Answer reason: For most adult intramuscular injections, a 22–25 gauge needle is commonly recommended, with selection based on medication viscosity and patient body habitus. Among the options provided, 22 gauge best matches standard adult IM guidance and is appropriate for many routine IM medications and vaccines. An 18 or 20 gauge needle is generally larger than needed for typical IM injections and may increase tissue trauma. A 25 gauge can be used for some IM injections (especially in smaller adults or for certain vaccines), but 22 gauge is the most broadly recommended single best choice here.

Question 30

Which is the best site for IM injection in adults?

Accepted Answer

Answer reason: The ventrogluteal site is considered the preferred IM injection site in adults because it has a deep muscle mass with relatively few major nerves and blood vessels, reducing risk of injury. It also provides consistent landmarks and can accommodate larger volumes than the deltoid. The dorsogluteal site is avoided due to proximity to the sciatic nerve and superior gluteal artery. Vastus lateralis is commonly used in infants and can be used in adults, but ventrogluteal is generally the safest best-practice choice for adults.

Question 31

Which muscle is preferred for intramuscular injection in children

Accepted Answer

Answer reason: For children younger than 3 years, the vastus lateralis (anterolateral thigh) is the preferred IM injection site because it is well developed and has a large muscle mass with relatively fewer major nerves and blood vessels at risk. The deltoid is typically used only when the child is older and muscle mass is sufficient, and for smaller volumes. Dorsogluteal is generally avoided due to risk of sciatic nerve injury and variable subcutaneous fat, and ventrogluteal is considered safe but is less commonly selected as the preferred site in very young children compared with vastus lateralis.

Question 32

The physician has ordered magnesium sulfate for the client with preeclampsia. Which action should be taken prior to treatment of magnesium sulfate?

Accepted Answer

Answer reason: Before starting magnesium sulfate for preeclampsia, the nurse should ensure accurate monitoring of urine output because magnesium is excreted by the kidneys and oliguria increases the risk of magnesium toxicity. Inserting a Foley catheter allows strict hourly I&O measurement to confirm adequate renal perfusion (commonly at least 30 mL/hr). WBC count and pain medication are not required prerequisites for safe magnesium administration. Darkening the room may help decrease stimulation/seizure risk in preeclampsia, but it does not address the key safety requirement prior to magnesium therapy: monitoring renal function via urine output.

Question 33

A nurse is administering digoxin to a client with heart failure. Which assessment should be performed before giving the medication?

Accepted Answer

Answer reason: Before administering digoxin, the nurse should evaluate risk factors for toxicity and dysrhythmias; hypokalemia increases myocardial sensitivity to digoxin and greatly raises toxicity risk. Monitoring serum potassium helps identify and correct low potassium (often related to diuretic therapy in heart failure) before giving the drug. While oxygen saturation, edema, and blood pressure are useful overall assessments in heart failure, they do not specifically address the major modifiable safety risk tied to digoxin administration in this item.

Question 34

IM injections are given at?

Accepted Answer

Answer reason: Intramuscular (IM) injections are administered at a 90° angle to ensure the needle passes through subcutaneous tissue and deposits medication into the muscle. A 45° angle is typically used for subcutaneous injections, and 15° is used for intradermal injections. Using the correct angle reduces the risk of incorrect tissue placement and improves medication absorption and effect.

Question 35

A nurse is preparing to administer timolol eye drops to a client with glaucoma. What technique should the nurse use to reduce systemic absorption?

Accepted Answer

Answer reason: Timolol is a topical beta-blocker that can be systemically absorbed through the nasolacrimal duct, causing adverse effects such as bradycardia or bronchospasm. Applying gentle pressure to the nasolacrimal duct at the inner canthus (punctal occlusion) for about 1 minute decreases drainage into the nasal mucosa and reduces systemic absorption. Blinking and squeezing the eyelids can increase drainage and absorption, and placing drops in the outer corner is less effective than punctal occlusion.

Question 36

A member of the resuscitation team is preparing to administer medications intravenously to a patient in cardiac arrest. The team member follows each medication administration with a bolus of fluid. How much would the team member give? Select the correct answer to this question?

Accepted Answer

Answer reason: During adult cardiac arrest, IV medications should be followed by a rapid flush to help move the drug from the peripheral IV site into the central circulation and improve the chance it reaches the heart quickly. Standard resuscitation guidance is to flush with about 20 mL of IV fluid, but among the provided options the closest and best match is the largest-volume flush. Therefore, 30 to 40 mL is the best answer choice available.

Question 37

A 4-year-old child with a fever of 102°F is irritable. What intervention is priority?

Accepted Answer

Answer reason: A febrile, irritable child should receive prompt antipyretic therapy to reduce fever and improve comfort, making acetaminophen the priority intervention. Lowering temperature decreases metabolic demand and can reduce the risk of febrile complications. Cool compresses and fluids are supportive but are not as effective or immediate as appropriate antipyretic medication. Monitoring for seizures is important, but without seizure activity the priority is treating the fever and discomfort.

Question 38

If a medication was to be taken "as needed" what abbreviation would be used?

Accepted Answer

Answer reason: PRN is the standard medication-order abbreviation from the Latin "pro re nata," meaning "as needed." STAT indicates an immediate, one-time administration, not symptom-triggered dosing. BID means "twice daily" and reflects a scheduled frequency rather than an as-needed instruction. Therefore, PRN is the correct abbreviation for "as needed.

Question 39

A nurse is preparing to administer an intramuscular (IM) injection of Vitamin K to a newborn. Which site is most appropriate for this injection?

Accepted Answer

Answer reason: For newborns and infants, the vastus lateralis (anterolateral thigh) is the preferred IM injection site because it is well developed and has a lower risk of major nerve or vascular injury. The deltoid is not adequately developed in newborns for reliable IM administration. The dorsogluteal site is avoided due to proximity to the sciatic nerve and inconsistent muscle mass. Ventrogluteal is safer than dorsogluteal but is generally not the first-choice site in newborns compared with the vastus lateralis.

Question 40

When administering intramuscular injection, the nurse should?

Accepted Answer

Answer reason: Intramuscular injections are administered at a 90° angle to penetrate through subcutaneous tissue and deposit the medication into the muscle. A 45° angle is typically used for subcutaneous injections, and 15° is used for intradermal injections. Using an incorrect angle can lead to improper absorption, reduced effectiveness, and increased risk of local tissue injury.

Question 41

Which of the following is a contraindication for digoxin administration?

Accepted Answer

Answer reason: Digoxin slows conduction through the AV node and can further decrease the heart rate, so a pulse/heart rate below 60 bpm is a standard parameter to hold the medication and notify the provider. Administering digoxin in bradycardia increases risk of severe bradyarrhythmias and heart block. A BP of 140/90, HR above 80, and RR above 20 are not typical hold/contraindication parameters for digoxin in the same way bradycardia is.

Question 42

Which site is best for an intramuscular injection in an adult?

Accepted Answer

Answer reason: The vastus lateralis is a large, well-developed muscle with relatively few major nerves and blood vessels in the recommended injection area, making it a safe, reliable IM site. The abdomen is primarily used for subcutaneous injections (e.g., insulin, heparin), not intramuscular. The gluteus maximus is generally avoided for IM injections due to higher risk of sciatic nerve and major vessel injury; gluteal injections, when used, favor the ventrogluteal area instead. The deltoid can be used in adults but is best for small-volume injections and is not considered the best general-purpose IM site compared with the vastus lateralis.

Question 43

A patient is prescribed alendronate sodium (Fosamax) for prevention of worsening osteoporosis. The nurse knows?

Accepted Answer

Answer reason: Alendronate (a bisphosphonate) can cause esophagitis and esophageal ulceration if it refluxes or remains in contact with the esophageal mucosa. To reduce this risk, it should be taken with a full glass of plain water and the patient must remain upright for at least 30 minutes after taking it (and until after the first food of the day). It is typically dosed once weekly (or daily in some regimens), not three times per week, and tyramine restriction applies to MAO inhibitors rather than bisphosphonates.

Question 44

Which nursing action is considered a dependent intervention?

Accepted Answer

Answer reason: Dependent nursing interventions are those that require a provider’s order or prescription before the nurse can carry them out. Administering a medication that has been prescribed by a doctor is a classic dependent intervention because it legally and clinically relies on that order. Teaching deep breathing, repositioning, and counseling are typically independent nursing interventions that can be initiated based on nursing judgment and patient needs.

Question 45

A multipara at 7 cm requests IV opioids for pain. FHR reactive; labor moderate. Which is most appropriate?

Accepted Answer

Answer reason: At 7 cm with a reactive fetal heart rate and moderate labor, IV opioids can be appropriate when ordered to provide analgesia. The key nursing concern is timing relative to birth because opioids cross the placenta and can cause neonatal respiratory depression if delivery is imminent, so close monitoring is required. Withholding all opioids is not indicated solely because the client is in active labor. Epidural analgesia requires informed consent, and nonpharmacologic methods may be offered but should not be the only option if pharmacologic analgesia is appropriate and desired.

Question 46

A child with asthma uses a metered-dose inhaler. What indicates correct use?

Accepted Answer

Answer reason: Correct MDI technique includes shaking the inhaler (especially with suspension formulations), beginning a slow, deep inhalation, and pressing the canister once at the start of inspiration to coordinate drug delivery with airflow. Rapid inhalation decreases lung deposition and increases oropharyngeal deposition. The client should also hold the breath about 10 seconds after inhalation to allow medication to settle in the airways. Taking a puff before shaking can result in inconsistent dosing.

Question 47

A client is admitted with acute pancreatitis. Which intervention should the nurse expect?

Accepted Answer

Answer reason: Acute pancreatitis is typically managed initially with bowel rest (NPO), aggressive IV fluids, and adequate analgesia. Encouraging oral fluids is inappropriate early because oral intake stimulates pancreatic secretion and can worsen inflammation. A high-fat diet is contraindicated because fat stimulates pancreatic enzyme release and can exacerbate symptoms. Opioid analgesics such as morphine are appropriate to control severe pain in acute pancreatitis.

Question 48

A nurse is about to administer digoxin. The apical heart rate is 55 bpm. What is the correct action?

Accepted Answer

Answer reason: Digoxin can further slow the heart rate by increasing vagal tone and slowing AV conduction, so a low apical pulse is a safety concern. Standard nursing practice is to hold digoxin and notify the provider when the adult apical pulse is below the facility parameter (commonly

Question 49

A child with asthma is using a metered-dose inhaler. What instruction is most important?

Accepted Answer

Answer reason: For children using a metered-dose inhaler, a spacer is the most important instruction because it improves delivery of medication to the lungs and reduces oropharyngeal deposition. This increases therapeutic effect and decreases local adverse effects (e.g., throat irritation, oral candidiasis with inhaled corticosteroids). Children often have difficulty coordinating actuation with inhalation, and a spacer reduces the need for precise timing. Other technique steps matter, but a spacer most reliably improves correct medication administration in pediatrics.

Question 50

A pt with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and heparin infusion 1000 units/hr are being administered. The pt did not take ASA because he has a hx of gastritis, which was tx 5 years ago. What is the next action?

Accepted Answer

Answer reason: In acute STEMI, immediate aspirin 160–325 mg (preferably chewed) is a first-line antiplatelet therapy unless there is a true contraindication such as active GI bleeding or a severe aspirin allergy. A remote history of gastritis treated 5 years ago is not a contraindication, and delaying aspirin increases risk of ongoing coronary thrombosis. Clopidogrel is an adjunct or alternative when aspirin is contraindicated, but aspirin remains the priority here. Enteric-coated or rectal formulations delay absorption and are not preferred for urgent antiplatelet effect.

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