Question 1

A client diagnosed with atrial fibrillation is prescribed warfarin. The nurse cautions the client regarding dietary changes which would alter the intake of which food group?

Accepted Answer

Answer reason: Warfarin’s anticoagulant effect is reduced by increased vitamin K intake because vitamin K promotes synthesis of clotting factors. Dark green leafy vegetables (e.g., spinach, kale, collards) are high in vitamin K, so sudden increases or decreases can significantly change INR and bleeding/clotting risk. Teaching focuses on keeping vitamin K intake consistent rather than avoiding these foods completely. The other options are not the primary dietary group that predictably alters warfarin effect.
Category reason: This question tests client education and safe medication management for warfarin (diet-drug interaction affecting INR), which is a nursing pharmacologic responsibility under Medication Administration.

Question 2

Question 871 - IM injections are given at?

Accepted Answer

Answer reason: Intramuscular injections are administered with the needle inserted at a 90° angle to the skin to reliably reach the muscle tissue. This angle helps ensure proper deposition of medication into the muscle and reduces the risk of subcutaneous administration. By contrast, 45° is commonly used for subcutaneous injections and 15° is used for intradermal injections. Therefore, 90° is the single best answer.
Category reason: The question tests correct nursing technique for administering an injection (a patient-care medication administration skill), which falls under Pharmacological and Parenteral Therapies → Medication Administration.

Question 3

What is the preferred site for an intramuscular (IM) injection for adults and children?

Accepted Answer

Answer reason: The ventrogluteal site is the preferred IM injection site in adults and children because it has a deep muscle mass with relatively fewer major nerves and blood vessels, reducing risk of sciatic nerve injury compared with dorsogluteal injections. It also generally allows for safer administration of larger volumes than the deltoid. Vastus lateralis is commonly preferred for infants and is an alternative for children/adults, but ventrogluteal is the best overall preferred site for adults and children.
Category reason: This question tests selection of the safest and most appropriate anatomical site for administering an IM medication, which is a core nursing medication administration skill under Pharmacological and Parenteral Therapies.

Question 4

A child with cystic fibrosis is prescribed pancreatic enzymes. Nurse Brown understands the optimal timing for administering this medication to maximize its effectiveness. When should the nurse administer the pancreatic enzymes?

Accepted Answer

Answer reason: Pancreatic enzyme replacement therapy must be given with meals (and snacks) so the enzymes mix with food in the stomach/duodenum and aid digestion and nutrient absorption. Giving enzymes at bedtime or once daily would not coincide with food intake and would not improve steatorrhea or malabsorption. A standard approach is dosing with each meal, which is best represented by administering three times daily with meals.
Category reason: This item tests nursing knowledge of when to administer a prescribed medication to achieve the desired therapeutic effect, which is a core medication-administration competency.

Question 5

Nurse Amanda is caring for Mrs. Jensen, a patient diagnosed with erosive gastritis who has been prescribed Nexium (esomeprazole). When should Nurse Amanda administer this medication to ensure its effectiveness?

Accepted Answer

Answer reason: Esomeprazole is a proton pump inhibitor that works best when taken before food stimulates acid secretion. Giving it about 30 minutes before a meal allows adequate absorption and activation in parietal cells at the time pumps are being turned on. Administering it with or after meals can reduce effectiveness because fewer active pumps are available for inhibition. Bedtime dosing is not the standard timing for optimal acid suppression related to meals in erosive gastritis.
Category reason: This item tests correct timing of a prescribed medication (a PPI) to maximize therapeutic effect, which is a nursing medication administration responsibility.

Question 6

Nurse Lee is educating Mr. Roberts, who has been admitted with angina and prescribed nitroglycerine. What essential instruction should she provide?

Accepted Answer

Answer reason: Sublingual nitroglycerin is highly sensitive to light, heat, and moisture, so it must be kept in its original dark (brown) glass container with the cap tightly closed to maintain potency. Storing it in other containers or exposed to environmental conditions can inactivate the drug and reduce effectiveness during an angina episode. Option B is incorrect because standard teaching is 1 tablet every 5 minutes up to 3 doses while seeking emergency care if pain persists. Option D is incorrect because sublingual tablets should not be crushed or swallowed; they should dissolve under the tongue for rapid absorption.
Category reason: This item tests patient teaching for safe and effective administration and storage of a prescribed medication (nitroglycerin), which is a Medication Administration competency in Pharmacological and Parenteral Therapies.

Question 7

A client with osteoporosis is prescribed alendronate. Which instruction is most important for the nurse to include?

Accepted Answer

Answer reason: Alendronate (a bisphosphonate) can cause significant esophageal irritation and ulceration if it refluxes or remains in contact with the esophageal mucosa. The key safety instruction is to take it with a full glass of plain water and remain upright for at least 30 minutes to reduce reflux and promote passage into the stomach. Milk and antacids decrease absorption by binding the medication, and taking it at bedtime increases the risk of esophageal injury because the client will be supine.
Category reason: The question tests a nursing teaching/safety instruction for administering a medication (alendronate) to prevent an adverse effect and ensure proper administration, which fits Medication Administration under Pharmacological and Parenteral Therapies.

Question 8

A client with angina is prescribed sublingual nitroglycerin. Which instruction should the nurse include?

Accepted Answer

Answer reason: Sublingual nitroglycerin for acute angina should be taken at the onset of chest pain, and the dose may be repeated every 5 minutes for up to three doses if pain persists. The tablet should dissolve under the tongue rather than being swallowed to ensure rapid absorption and effect. It does not need to be taken with food. Tablets should be kept in their original dark glass container to protect potency; storing in a plastic pill organizer can reduce effectiveness.
Category reason: This item tests safe patient teaching for administering a prescribed medication (sublingual nitroglycerin), which is a nursing medication administration responsibility.

Question 9

What is the preferred site for intramuscular injection in infants?

Accepted Answer

Answer reason: The vastus lateralis (anterolateral thigh) is the preferred IM injection site in infants because it is well developed and allows reliable absorption with lower risk of major nerve or vascular injury. The deltoid is usually reserved for older children when adequate muscle mass is present. The gluteus maximus is avoided in infants due to the risk of sciatic nerve injury and variable fat thickness affecting absorption. The triceps is not a standard recommended IM site for infant immunizations.
Category reason: The item tests safe selection of an intramuscular injection site in a pediatric patient, which is a core nursing medication administration skill.

Question 10

Which of the following is not one of the 5 rights of drug administration?

Accepted Answer

Answer reason: The traditional 5 rights of medication administration are right patient, right medication (drug), right dose, right route, and right time. Assessing allergies is a critical medication-safety check, but it is not one of the original “5 rights” as classically taught. Therefore, among the options listed, “Right allergies” is the best choice as the item not included in the 5 rights.
Category reason: This question tests safe nursing practice in administering medications (verification steps to prevent medication errors), which fits NCLEX Pharmacological and Parenteral Therapies—Medication Administration.

Question 11

A subcutaneous (SUBQ) injection should be given at which angle?

Accepted Answer

Answer reason: Subcutaneous injections are administered into the fatty tissue layer, which is typically accessed at a 45° angle for thinner patients or shorter needles and at a 90° angle when there is adequate subcutaneous tissue or when using a skinfold technique. These angles help ensure the medication is deposited in subcutaneous tissue rather than intradermal (too shallow) or intramuscular (too deep). Angles like 15° are used for intradermal injections, not SUBQ. Therefore, the best answer is 45 or 90 degrees.
Category reason: This item tests correct technique for administering an injectable medication (needle angle selection), which is a nursing medication administration skill under Pharmacological and Parenteral Therapies.

Question 12

Which injection leaves a wheal?

Accepted Answer

Answer reason: Intradermal (ID) injections are administered into the dermis and are intended to create a small raised bleb/wheal at the site, which confirms correct placement. This is commonly used for tests such as tuberculin (PPD) and some allergy testing because the dermis allows a localized reaction. IM and SC injections deliver medication deeper and should not form a wheal, while IV administration goes directly into a vein.
Category reason: The question tests knowledge of injection routes and expected technique/skin findings after administration, which is part of safe medication administration practice.

Question 13

The nurse is preparing to administer digoxin. Which assessment is most important before giving the medication?

Accepted Answer

Answer reason: Digoxin can cause bradycardia and other dysrhythmias due to its effects on cardiac conduction. Therefore the most important pre-administration assessment is the apical pulse (typically counted for a full minute) to determine if it is safe to give the dose. If the pulse is below facility parameters (often

Question 14

Q. 580: Which needle size is commonly used for intramuscular (IM) injections?

Accepted Answer

Answer reason: Intramuscular injections commonly use a larger-bore needle than subcutaneous or intradermal injections to allow medication to pass through subcutaneous tissue and be deposited into muscle. A typical adult IM needle gauge range is about 21G–23G (with length selected based on site and patient body habitus). 25G–26G and 27G–30G are generally used for subcutaneous/intradermal injections, while 18G–19G is usually too large for routine IM administration and is more common for rapid infusion/viscous solutions or drawing up medications.
Category reason: This question tests nursing knowledge needed to safely administer injections (selection of appropriate needle gauge), which is part of Medication Administration under Pharmacological and Parenteral Therapies.

Question 15

Which injection site is safest for infants?

Accepted Answer

Answer reason: The vastus lateralis (anterolateral thigh) is the preferred and safest intramuscular injection site in infants because it is well developed and provides adequate muscle mass. It has a lower risk of injuring major nerves and blood vessels compared with gluteal sites, where the sciatic nerve is a concern and muscle development is insufficient in infants. The deltoid is generally reserved for older children once sufficient muscle mass is present, and the abdomen is typically used for subcutaneous (not IM) injections.
Category reason: This question tests nursing knowledge of safe intramuscular injection site selection in a specific age group, which is part of medication administration practice.

Question 16

Why is Z-track method used in injections?

Accepted Answer

Answer reason: The Z-track technique displaces the skin and subcutaneous tissue laterally before IM injection so that, when released, the tissues seal the needle track. This prevents medication from leaking back into subcutaneous tissue and onto the skin, reducing irritation and staining (e.g., with iron preparations). Its primary purpose is to ensure the drug remains in the muscle for proper delivery rather than to prevent air embolism or slow absorption.
Category reason: This question tests a nursing skill for safe intramuscular injection technique, which is part of medication administration in patient care practice.

Question 17

You are administering Digoxin to a patient. Which of these values should be the most concerning?

Accepted Answer

Answer reason: Digoxin can cause bradycardia and AV block due to increased vagal tone and slowed conduction through the AV node. A heart rate of 50 bpm is concerning and commonly prompts holding the dose and further assessment (apical pulse, ECG, symptoms of dizziness/syncope). The potassium (4.3), sodium (140), and blood pressure (122/84) are within normal/acceptable ranges and are not as immediately concerning for digoxin toxicity as bradycardia.
Category reason: This item tests nursing medication administration judgment—recognizing a vital sign (bradycardia) that requires holding digoxin and assessing for adverse effects/toxicity—so it fits Pharmacological and Parenteral Therapies.

Question 18

A 4.5 yr old boy with cystic fibrosis has a prescription for Viokase pancreatic enzymes to prevent malabsorption. The correct time to give pancreatic enzyme is?

Accepted Answer

Answer reason: In cystic fibrosis, pancreatic enzyme replacement must be taken with all meals and snacks so the enzymes mix with ingested food in the duodenum to aid digestion and reduce steatorrhea/malabsorption. Giving enzymes before or long after meals reduces contact with food and decreases effectiveness. Enzymes are not intended to be taken on an empty stomach because they need dietary fat/protein/carbohydrate present to work and empty-stomach dosing can increase GI irritation without benefit.
Category reason: The question tests nursing knowledge of correct timing/administration of a prescribed medication (pancreatic enzyme replacement) to achieve the intended therapeutic effect and prevent complications of malabsorption.

Question 19

You are a team leader RN working with a student nurse. The student nurse is to teach a patient how to use an MDI without a spacer. Put in the correct order the steps that the student nurse should teach the patient.?

Accepted Answer

Answer reason: Correct MDI technique without a spacer begins by removing the cap and shaking the inhaler to properly mix the medication (especially suspensions). The patient should then exhale fully (often with slight head tilt), position the mouthpiece 1–2 inches from the open mouth, and coordinate actuation with a slow deep inhalation. After inhalation, holding the breath about 10 seconds improves lower-airway deposition, and waiting at least 1 minute between puffs allows better bronchodilation and medication effectiveness.
Category reason: This item tests patient teaching and correct technique for administering an inhaled medication (MDI use), which is a nursing medication-administration skill rather than a foundational science concept.

Question 20

After administering an intramuscular injection, the nurse should?

Accepted Answer

Answer reason: After an IM injection, applying gentle pressure with gauze helps minimize bleeding and bruising at the puncture site without increasing tissue trauma. Vigorous massage can irritate tissue and may alter medication absorption or increase bleeding, especially with anticoagulated clients or certain medications. Routine immediate icing or limb elevation is not standard post-IM care unless specifically indicated for pain or swelling.
Category reason: The question tests the nurse’s correct post-procedure action after giving an intramuscular medication, which is a medication administration technique and safety practice.

Question 21

A patient with Type 1 diabetes is prescribed insulin glargine (Lantus). Which instruction should the nurse provide?

Accepted Answer

Answer reason: Insulin glargine is a long-acting basal insulin designed to provide steady 24-hour coverage, so it should be administered consistently at the same time each day to maintain a stable baseline insulin level. It is not intended for pre-meal (prandial) coverage. Glargine should not be mixed with other insulins because its acidic formulation can alter absorption and action. It is a clear solution and should not be shaken vigorously, which can cause frothing and inaccurate dosing.
Category reason: This question tests nursing instruction and safe administration principles for an insulin medication (timing, mixing compatibility, and handling), which aligns with Medication Administration under Pharmacological and Parenteral Therapies.

Question 22

What should a nurse do before administering digoxin?

Accepted Answer

Answer reason: Digoxin slows AV conduction and can cause bradycardia; therefore the nurse should assess the apical pulse for a full minute immediately before giving the dose. If the pulse is below facility parameters (commonly

Question 23

A nurse is preparing to give a tuberculosis test. The nurse knows this should be injected at what angle?

Accepted Answer

Answer reason: The tuberculin skin test (Mantoux/PPD) is administered intradermally, which requires a very shallow needle angle. Intradermal injections are typically given at about 5–15 degrees with the bevel up to create a wheal in the dermis. Larger angles such as 45–60 degrees (subcutaneous) or 90 degrees (intramuscular) would deposit the medication too deeply and can invalidate technique. Therefore, 5–15 degrees is the correct injection angle for a TB test.
Category reason: The question tests correct nursing technique for administering an intradermal diagnostic injection (PPD), which is a medication/needle administration skill within Pharmacological and Parenteral Therapies.

Question 24

Intradermal injection is givan at?

Accepted Answer

Answer reason: Intradermal injections are administered at a very shallow angle (typically 5–15 degrees) with the bevel up so the medication is deposited within the dermis, creating a wheal (e.g., TB or allergy testing). A 15° angle best matches the standard technique for intradermal administration. Larger angles such as 45° are used for subcutaneous injections, and 90° is used for intramuscular injections.
Category reason: The question tests correct nursing technique for administering injections (angle of insertion), which is a core medication administration skill under Pharmacological and Parenteral Therapies.

Question 25

What does "D/C" mean in medical orders?

Accepted Answer

Answer reason: In medical orders, “D/C” is a common abbreviation meaning “discontinue” (stop a medication/therapy) or “discharge” (release the patient from care), depending on context. This is standard clinical shorthand used in medication and care orders. The other options are not standard meanings for D/C in medical documentation. Correct interpretation helps prevent medication errors and miscommunication.
Category reason: The question tests interpretation of a common abbreviation used in clinical orders, which directly affects safe medication and order processing in patient care, aligning best with Medication Administration.

Question 26

The angle of insertion for subcutaneous injection is?

Accepted Answer

Answer reason: Subcutaneous injections are typically administered at a 45-degree angle to deposit medication into the subcutaneous tissue layer. A 15-degree angle is commonly used for intradermal injections, while 90 degrees is typical for intramuscular injections (and may be used for subcutaneous only in specific circumstances such as short needle/adequate adipose tissue). Therefore, 45 degrees is the best standard answer for the typical subcutaneous injection technique.
Category reason: This item tests correct nursing technique for administering an injection (route and angle), which is a core medication administration skill under Pharmacological and Parenteral Therapies.

Question 27

Which insulin would you draw up first (if required to mix)?

Accepted Answer

Answer reason: When mixing NPH (cloudy) and regular insulin (clear) in the same syringe, draw up regular insulin first. This prevents contaminating the regular insulin vial with NPH (protamine), which could alter the pharmacokinetics and dosing accuracy of the short-acting insulin. The standard safety mnemonic is “clear to cloudy.” After drawing up the clear (regular) dose, then draw up the cloudy (NPH) dose to the total units ordered.
Category reason: This item tests safe medication preparation/administration technique for insulin mixing, which is a nursing task focused on preventing dosing errors and ensuring correct administration.

Question 28

Qu: IM injections are given at?

Accepted Answer

Answer reason: Intramuscular injections are administered at a 90° angle to ensure the needle penetrates through subcutaneous tissue into the muscle. This angle optimizes delivery into the intended tissue and supports appropriate absorption. A 45° angle is typically used for subcutaneous injections, while smaller angles (15–30°) are used for intradermal injections. Therefore, 90° is the correct technique for IM injections.
Category reason: The question tests correct nursing technique for administering injections, which is a medication administration skill under Pharmacological and Parenteral Therapies.

Question 29

A nurse administers ceftriaxone 250mg intramuscularly ino the ventrogluteal muscle of an adult patient. At which angle will the nurse insert the needle?

Accepted Answer

Answer reason: Intramuscular (IM) injections are administered at a 90-degree angle to ensure the needle passes through subcutaneous tissue into the muscle. The ventrogluteal site is a preferred IM site in adults because it provides a large muscle mass and avoids major nerves and blood vessels. Angles such as 15 degrees are used for intradermal injections, while 45 degrees is commonly used for subcutaneous injections, making them incorrect here. Therefore, 90 degrees is the correct insertion angle for an IM injection.
Category reason: This item tests correct nursing technique for administering an intramuscular medication (injection angle and route), which is part of safe medication administration in patient care.

Question 30

The method used for administering medication into the ear is called?

Accepted Answer

Answer reason: Medications administered into the ear canal (otic drops) are given by instillation, meaning drops are placed into a body cavity or passage. Injection and infiltration involve parenteral delivery into tissues, not the ear canal. Inhalation refers to delivery into the respiratory tract via breathing. Therefore, the correct method for ear administration is instillation.
Category reason: This question tests correct nursing terminology for a route/method of drug delivery (otic drops), which aligns with safe and accurate medication administration.

Question 31

Which of the following sites is recommended for adults as a safe for the majority of intramuscular injection?

Accepted Answer

Answer reason: The ventrogluteal site is recommended for most adult IM injections because it is well developed and has fewer major nerves and blood vessels nearby, reducing risk of injury. It also provides consistent muscle thickness and is appropriate for larger-volume injections in adults. The dorsogluteal site is less preferred due to proximity to the sciatic nerve and variable fat thickness. Vastus lateralis and rectus femoris are alternatives, but ventrogluteal is generally considered the safest routine adult site.
Category reason: This question tests correct selection of an intramuscular injection site, which is a nursing medication administration skill focused on safe technique and prevention of complications.

Question 32

What is the correct angle for inserting an intramuscular injection?

Accepted Answer

Answer reason: Intramuscular injections are administered at a 90-degree angle to ensure the needle penetrates through subcutaneous tissue and deposits the medication into the muscle. Shallower angles (15°, 30°, 45°) are used for intradermal or subcutaneous injections and risk placing medication in the wrong tissue layer. Correct angle helps achieve proper absorption and reduces local tissue irritation from misplacement.
Category reason: The question tests correct technique for administering an intramuscular injection, which is a nursing medication administration skill and part of parenteral therapy.

Question 33

: What does the abbreviation "PR" mean in medication administration?

Accepted Answer

Answer reason: In medication administration, the abbreviation PR is the standard Latin-derived route abbreviation for "per rectum," meaning the medication is given via the rectal route. This is distinct from PO (by mouth) and IM/IV/SC injection routes. Correct interpretation of route abbreviations is essential to prevent medication administration errors and ensure the intended delivery method is used.
Category reason: This item tests correct interpretation of a medication administration abbreviation (route of administration), which is a core nursing medication-safety competency under Medication Administration.

Question 34

What is the maximum volume that can be given IM?

Accepted Answer

Answer reason: For routine intramuscular (IM) injections in adults, a common teaching maximum per injection site is about 2 mL (especially for deltoid; larger volumes risk pain, poor absorption, and tissue injury). While some large muscles (e.g., ventrogluteal) may tolerate higher volumes in certain references, nursing exam convention typically tests 2 mL as the safest general maximum when the site is not specified. The other options are either typical smaller limits (0.5–1 mL) or an excessively large single-site volume (6 mL).
Category reason: This question tests safe medication administration technique—specifically IM injection volume limits—which is a nursing skills/safety topic under Medication Administration.

Question 35

The nurse is preparing medication from an ampule. Which of the following steps should the nurse take first?

Accepted Answer

Answer reason:  Check the expiry date of the medication. Before manipulating an ampule or preparing equipment, the nurse should first verify the medication is safe and appropriate to administer, including confirming the expiration date as part of the medication safety checks. Preparing or opening the ampule prior to verification risks wasting medication and may lead to administration of an expired product. Injecting air into an ampule is not done (it applies to vials), and breaking the ampule away from the body and attaching a sterile needle are important steps but come after medication verification.
Category reason: This question tests the correct sequence of nursing actions during preparation of a parenteral medication from an ampule, which is a medication administration safety skill.

Question 36

Which medication should be held if the apical pulse is below 60 bpm?

Accepted Answer

Answer reason:  Digoxin Digoxin slows AV nodal conduction and can cause/worsen bradycardia, so it is commonly held when the apical pulse is

Question 37

Which injection site is safest for self-administered insulin?

Accepted Answer

Answer reason: Abdomen The abdomen is generally the preferred site for self-administered subcutaneous insulin because it is easy to access, has consistent subcutaneous tissue, and provides the most predictable absorption. It also helps reduce the risk of intramuscular injection compared with sites like the upper arm in thin individuals. Rotation within the abdominal area (avoiding a 2-inch radius around the umbilicus) helps prevent lipohypertrophy and absorption variability.
Category reason: This item tests safe medication administration technique for insulin injections (site selection and safety), which is a nursing medication-administration competency rather than pure physiology.

Question 38

A nurse is administering digoxin (Lanoxin) to a patient with heart failure. Which of the following findings should prompt the nurse to withhold the medication and notify the provider?

Accepted Answer

Answer reason: Heart rate of 55 bpm Digoxin can cause or worsen bradycardia due to its effects on the AV node, so nurses typically hold the dose and notify the provider if the apical pulse is below about 60 bpm in adults (per common nursing parameters/orders). A heart rate of 55 bpm suggests excessive cardiac slowing and increased risk of symptomatic bradycardia or heart block. The other findings listed are within expected ranges and do not by themselves warrant holding digoxin.
Category reason: This is a patient-care medication safety decision (whether to administer or withhold digoxin based on assessment findings), which fits NCLEX Medication Administration under Pharmacological and Parenteral Therapies.

Question 39

A client with type 1 diabetes mellitus who takes insulin is prescribed exenatide. Which is the most appropriate action for the nurse to take?

Accepted Answer

Answer reason: Withhold the medication and question the order with the provider. Exenatide is a GLP-1 receptor agonist indicated for type 2 diabetes and is not appropriate for clients with type 1 diabetes, who lack endogenous insulin production. Administering it in type 1 diabetes does not address the underlying insulin deficiency and may expose the client to unnecessary risk (e.g., hypoglycemia when used with insulin, significant GI effects). The safest nursing action is to hold the medication and clarify the prescription with the provider before administration.
Category reason: This item primarily tests safe nursing action related to administering/withholding a prescribed medication when the indication is inappropriate, which falls under Medication Administration within Pharmacological and Parenteral Therapies.

Question 40

Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction should the nurse provide?

Accepted Answer

Answer reason: Drink 3000 mL of fluid daily. Allopurinol decreases uric acid production, and adequate hydration helps prevent uric acid renal stone formation and supports renal excretion of uric acid and its metabolites. Teaching also includes taking it with food if GI upset occurs (so “empty stomach” is not correct) and that therapeutic effects are not immediate. Lip swelling suggests angioedema/hypersensitivity and is not a normal expected response; it requires urgent evaluation.
Category reason: This item tests client teaching about safe administration and expected responses/adverse effects of a prescribed medication, which is nursing medication-administration judgment rather than foundational biomedical science.

Question 41

The nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heart failure. Which vital sign is most important for the nurse to check before administering the medication?

Accepted Answer

Answer reason: A. Heart rate. Digoxin can cause or worsen bradycardia and AV block, so the apical pulse/heart rate must be assessed before each dose. If the heart rate is below the facility/provider parameter (commonly

Question 42

Which instruction should the nurse give to a client taking iron supplements?

Accepted Answer

Answer reason: B. Take with food if GI upset occurs Oral iron commonly causes gastrointestinal irritation (nausea, epigastric discomfort, constipation), and taking it with food can improve tolerance and adherence. Although iron is best absorbed on an empty stomach, patient comfort and continued use are priorities when GI upset occurs. Milk and calcium decrease iron absorption, and vitamin C enhances absorption, so advising avoidance of vitamin C-rich foods is incorrect.
Category reason: This item tests nursing teaching about safe and effective administration of an oral medication (iron), which fits Medication Administration under Pharmacological and Parenteral Therapies.

Question 43

Which of the following nursing intervention is incorrect when using the Z-Track method of injection?

Accepted Answer

Answer reason: After injected the medicine rub the injection site vigorously With the Z-track IM technique, the tissue is displaced to seal the medication in the muscle and prevent tracking into subcutaneous tissue, reducing irritation and staining. Rubbing or massaging the site can force medication back through the needle track, increasing pain, tissue irritation, and leakage. Instead, the nurse should release the displaced skin after withdrawing the needle and apply gentle pressure if needed without massage. The other steps (skin antisepsis and appropriate needle length) align with standard IM administration; aspiration may vary by policy/site but is not the key contraindicated step for Z-track.
Category reason: This item tests correct nursing technique for administering an intramuscular medication using the Z-track method, which is a patient-care procedure under safe medication administration.

Question 44

The nurse is planning to administer amlodipine (Norvasc) to a client. The nurse should plan to check which before giving the medication?

Accepted Answer

Answer reason: Blood pressure and heart rate. Amlodipine is a dihydropyridine calcium channel blocker that lowers systemic vascular resistance, which can cause hypotension; therefore blood pressure must be assessed before administration. It can also produce reflex tachycardia (and less commonly bradycardia), making heart rate an important pre-administration check. Respiratory rate and level of consciousness are not the primary safety parameters for this antihypertensive unless other clinical concerns exist.
Category reason: This is a nursing medication-administration safety question requiring assessment of vital signs before giving a cardiovascular drug, which fits NCLEX Pharmacological and Parenteral Therapies—Medication Administration.

Question 45

The client with a gastric ulcer has a prescription for sucralfate (Carafate) 1 g by mouth four times daily. The nurse should schedule the medication for which times?

Accepted Answer

Answer reason: One hour before meals and at bedtime. Sucralfate forms a protective barrier over the ulcer and needs to contact the gastric mucosa in an acidic environment, so it is best taken on an empty stomach. Standard scheduling is before meals and at bedtime (often 1 hour before meals) to maximize coating and protection during periods of acid secretion. Giving it with meals or after meals reduces its ability to bind effectively to the ulcer surface and may decrease therapeutic effect. It can also interfere with absorption of other medications, so spacing is important.
Category reason: This question tests nursing timing/administration of a prescribed medication to achieve the intended therapeutic effect, which is a medication administration decision in patient care.

Question 46

What is the correct angle for IM injection IM?

Accepted Answer

Answer reason: 90° Intramuscular injections are administered at a 90-degree angle to ensure the needle penetrates through subcutaneous tissue into the muscle. Using 45° or 15° is typically associated with subcutaneous or intradermal injections, which deposit medication too superficially for IM delivery. A perpendicular approach also improves consistency of depth and absorption when the appropriate needle length is selected for the patient and site.
Category reason: This question tests correct technique for administering an injectable medication (angle of IM injection), which is a nursing medication administration skill under Pharmacological and Parenteral Therapies.

Question 47

The nurse is teaching a client how to self-administer enoxaparin. Which of the following statements by the client would require follow-up?

Accepted Answer

Answer reason: "I should expel the air bubble in the syringe before administering the injection." Enoxaparin prefilled syringes contain a small air bubble that should not be expelled; it helps ensure the full dose is delivered and can reduce medication tracking into subcutaneous tissue (which may worsen bruising). Proper technique includes injecting subcutaneously (often at a 90-degree angle with adequate tissue), pinching an abdominal skin fold, and selecting a site at least 2 inches from the umbilicus. Therefore, stating they will expel the air bubble indicates misunderstanding and requires follow-up teaching.
Category reason: This item tests safe patient self-administration technique for a parenteral anticoagulant (enoxaparin), which is a nursing medication-administration teaching and safety task.

Question 48

A client's medication sheet contains a prescription for sertraline (Zoloft). To ensure safe administration of the medication, how should the nurse administer the dose?

Accepted Answer

Answer reason: At the same time each evening. Sertraline is typically administered once daily, and taking it at the same time each day promotes consistent therapeutic blood levels and improves adherence. It is not a PRN medication and does not provide immediate relief of depressive symptoms, so it should not be given “as needed.” “Evenly spaced around the clock” implies multiple daily dosing, which is not standard for sertraline, and taking it on an empty stomach is not required for safe administration.
Category reason: This question tests safe nursing administration timing for a prescribed medication (sertraline), which is a medication administration decision rather than foundational science.

Question 49

The nurse prepares to administer digoxin (Lanoxin) to a 3-year-old with a diagnosis of heart failure and notes that the apical heart rate is 120 beats per minute. Which nursing action is appropriate?

Accepted Answer

Answer reason: Administer the digoxin. For pediatric clients, digoxin is typically held for significant bradycardia (commonly

Question 50

Cycloserine (Seromycin) is added to the medication regimen for a client with tuberculosis. Which instruction should the nurse reinforce in the client-teaching plan regarding this medication?

Accepted Answer

Answer reason: To return to the clinic weekly for serum drug-level testing. Cycloserine is a second-line antitubercular medication with a narrow therapeutic window and notable toxicity risk, especially neurotoxicity (e.g., CNS effects and seizures), so monitoring levels and close follow-up are important to reduce harm. Teaching should emphasize adherence to prescribed monitoring and reporting adverse effects promptly. The other options are unsafe or inaccurate: alcohol should be avoided due to increased CNS toxicity, and rash should be reported; timing with meals is not the key safety teaching point compared with monitoring.
Category reason: This is a patient-care teaching question about safe use and monitoring of a prescribed medication, which aligns with NCLEX Pharmacological and Parenteral Therapies (Medication Administration).

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