Question 1

The nurse is caring for a client who is taking metoprolol (Lopressor). The nurse measures the client's blood pressure (BP) and apical pulse immediately before administration. The client's BP is 122/78 mm/Hg and the apical pulse is 58 beats per minute. Based on this data, which is the appropriate action?

Accepted Answer

Answer reason: Withhold the medication. Metoprolol is a beta-blocker that can further decrease heart rate by slowing AV nodal conduction. An apical pulse of 58 bpm is below common nursing hold parameters for beta-blockers (often

Question 2

Which nursing action is most important when giving insulin aspart (NovoLog)?

Accepted Answer

Answer reason: Give immediately before or with meals Insulin aspart is a rapid-acting insulin with onset in minutes, so it should be timed to food intake to prevent hypoglycemia. Administering it immediately before eating (or with the meal) matches its quick onset and peak effect. Giving it 30 minutes before a meal is more consistent with regular insulin, not rapid-acting analogs. It is not a bedtime-only insulin, and mixing guidance is not the primary key safety action compared with correct meal timing.
Category reason: This question tests safe administration timing of a medication (rapid-acting insulin) to prevent adverse effects like hypoglycemia, which fits NCLEX Pharmacological and Parenteral Therapies—Medication Administration.

Question 3

A patient with diabetes mellitus is receiving insulin aspart. The nurse should instruct the patient to administer the insulin?

Accepted Answer

Answer reason: Immediately before meals Insulin aspart is a rapid-acting insulin with onset in about 10–20 minutes, so it should be taken right before eating (or with the first bites) to match postprandial glucose rise. Giving it 30 minutes before meals increases the risk of hypoglycemia if the meal is delayed. Administering it after meals can allow postprandial hyperglycemia before the insulin takes effect.
Category reason: This question tests nursing teaching about timing of a prescribed medication (rapid-acting insulin) in relation to meals, which is a Medication Administration decision in Pharmacological and Parenteral Therapies.

Question 4

Alendronate (Fosamax) is prescribed for a client with osteoporosis and the nurse is providing instructions on administration of the medication. Which instruction should the nurse reinforce?

Accepted Answer

Answer reason: Take the medication with a full glass of water after rising in the morning. Alendronate should be taken first thing in the morning with a full glass of plain water to maximize absorption and reduce the risk of esophageal irritation. The client should remain upright (sitting/standing) for at least 30 minutes and avoid food, beverages, or other medications during that time. Bedtime dosing, taking it with breakfast, or lying down after dosing increases the risk of esophagitis and decreases effectiveness.
Category reason: This item tests nurse-provided patient teaching on the safe and correct administration of a prescribed medication (timing, water, and positioning), which is a Medication Administration competency.

Question 5

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement?

Accepted Answer

Answer reason: I will take the medication on an empty stomach. Diphenhydramine commonly causes GI upset, and clients are typically instructed to take it with food or milk if stomach upset occurs rather than routinely on an empty stomach. The other statements reflect appropriate teaching: avoiding alcohol due to additive CNS depression, avoiding activities requiring alertness due to sedation, and managing anticholinergic dry mouth with sugarless gum/candy or rinses. Therefore, taking it on an empty stomach indicates the need for further instruction.
Category reason: This item tests safe client teaching about administering a prescribed medication and managing/avoiding common adverse effects and interactions, which aligns with Medication Administration under Pharmacological and Parenteral Therapies.

Question 6

The nurse provides medication instructions to an older hypertensive client who is taking 20 mg of lisinopril (Prinivil) orally daily. The nurse evaluates the need for further teaching when the client makes which statement?

Accepted Answer

Answer reason: I can skip a dose once a week. Lisinopril is an ACE inhibitor intended for consistent daily dosing to control blood pressure; skipping doses can lead to uncontrolled hypertension and increased cardiovascular risk. Client teaching should emphasize adherence and taking the medication at the same time each day. The other statements reflect appropriate teaching: orthostatic precautions, taking with/after breakfast for routine, and reporting severe headache as a possible sign of dangerously elevated blood pressure.
Category reason: This question tests nursing evaluation of medication teaching and adherence/safety instructions for an antihypertensive, which aligns with medication administration in Pharmacological and Parenteral Therapies.

Question 7

True or False: Diabetic patients should rotate insulin injection sites.?

Accepted Answer

Answer reason: True Rotating insulin injection sites helps prevent lipohypertrophy and lipoatrophy, which can occur with repeated injections into the same area. These tissue changes can cause unpredictable insulin absorption and lead to variable glycemic control. Teaching patients to rotate within the same general anatomical region (e.g., different spots on the abdomen) supports more consistent absorption while still protecting tissue integrity.
Category reason: This question tests safe insulin injection technique and patient teaching related to administering a medication, which aligns with Medication Administration in Pharmacological and Parenteral Therapies.

Question 8

What intervention will the nurse implement to reduce a client's pain after a burn injury?

Accepted Answer

Answer reason: Administering morphine 4 mg intravenously. Acute burn pain is typically severe and requires rapid, titratable analgesia; IV opioids provide the fastest and most reliable onset. Intramuscular injections are avoided in burn patients due to unreliable absorption from altered tissue perfusion, especially with hypovolemia/edema. Applying ice can worsen tissue injury and cause vasoconstriction, and avoiding tactile stimulation alone is insufficient to control significant burn pain.
Category reason: This is a nursing intervention question focusing on selecting the safest and most effective analgesic route/medication administration approach for a burn patient, which fits NCLEX Pharmacological and Parenteral Therapies.

Question 9

True or False: All medications should be crushed for patients with swallowing difficulties.?

Accepted Answer

Answer reason: False Not all medications are safe to crush because altering certain formulations (e.g., extended-release, enteric-coated) can cause dose dumping, toxicity, or loss of therapeutic effect. Some drugs are also hazardous if crushed (e.g., teratogenic or cytotoxic medications), posing exposure risk to staff and caregivers. For dysphagia, the nurse should verify with pharmacy/medication references and consider alternatives such as liquid formulations, smaller tablets, or different routes (e.g., transdermal) rather than routinely crushing all pills.
Category reason: This item tests safe nursing practice in administering medications to a patient with swallowing difficulty, including knowledge of formulations that must not be crushed and selecting safer administration alternatives—core to Medication Administration.

Question 10

Insulin should always be administered via IV in diabetic patients.?

Accepted Answer

Answer reason: False Insulin is commonly administered subcutaneously for routine diabetes management, and some formulations are not appropriate for IV use. IV insulin is typically reserved for acute situations requiring rapid titration (e.g., diabetic ketoacidosis, hyperosmolar hyperglycemic state, or perioperative critical care). Therefore, it is incorrect to state that insulin should always be given intravenously in diabetic patients.
Category reason: This item tests safe and correct administration routes of a medication (insulin) and when IV versus subcutaneous administration is indicated, which fits Medication Administration under Pharmacological and Parenteral Therapies.

Question 11

The nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (two puffs), by metered-dose inhaler. How should the nurse administer these medications?

Accepted Answer

Answer reason: C. Have the client alternate a single puff of each, beginning with the albuterol. Albuterol is a short-acting bronchodilator that should be administered first to open the airways, improving delivery of the inhaled corticosteroid (beclomethasone) to the lower airways. When multiple puffs are ordered, giving one puff at a time (with appropriate spacing between puffs) is recommended; alternating after starting with the bronchodilator maintains the correct sequence while allowing proper technique and deposition. Starting with the steroid (option D) is less effective because bronchoconstriction can limit steroid penetration. Option B is not an administration method, and option A does not address best practice for spacing/sequence of multiple puffs from different MDIs.
Category reason: This item tests correct nursing administration technique and sequencing for prescribed inhaled medications (bronchodilator before inhaled corticosteroid) using an MDI, which is a Medication Administration decision.

Question 12

True or False: Antibiotics should always be taken until symptoms resolve.?

Accepted Answer

Answer reason: False Antibiotics should be taken exactly as prescribed for the full intended duration, not stopped when symptoms improve, because symptoms can resolve before the infection is fully eradicated. Stopping early increases the risk of treatment failure/relapse and can promote antimicrobial resistance by leaving partially suppressed bacteria to regrow. Patient teaching emphasizes adherence to the prescribed regimen and contacting the provider if adverse effects occur rather than self-discontinuing.
Category reason: This item tests patient teaching and safe medication-taking behavior (adherence to prescribed antibiotic course), which is a nursing medication administration responsibility.

Question 13

The nurse at a college campus is preparing to medicate several students who have been exposed to meningococcal meningitis. Which would the nurse most likely administer?

Accepted Answer

Answer reason: B. Ciprofloxacin Post-exposure prophylaxis for close contacts of meningococcal disease is recommended to eradicate nasopharyngeal carriage and prevent secondary cases. Common regimens include a fluoroquinolone (single-dose), rifampin (multi-dose), or ceftriaxone (single IM dose) depending on patient factors and local resistance patterns. Among the listed options, the fluoroquinolone choice best matches standard prophylaxis for exposed students in an outbreak/close-contact setting. The other antibiotics listed are primarily used for treatment of various infections rather than routine meningococcal contact prophylaxis.
Category reason: This item tests a nursing medication decision for exposed contacts (post-exposure prophylaxis selection), which is a patient-care pharmacotherapy judgment aligned with safe medication administration rather than foundational microbiology alone.

Question 14

A nurse should always aspirate before administering an intramuscular injection.?

Accepted Answer

Answer reason: False Current evidence-based practice does not recommend routine aspiration for most IM injections because it adds discomfort without improving safety when appropriate sites are used. Many commonly used IM sites (e.g., deltoid, vastus lateralis, ventrogluteal) have no large blood vessels, making aspiration unnecessary when landmarks are correct. Additionally, for vaccines, guidelines specifically advise against aspiration. Aspiration may be considered only in select situations per institutional policy, medication type, and site-specific risk.
Category reason: This question tests a nursing procedural decision during IM medication delivery, which is a direct medication-administration safety practice rather than foundational science.

Question 15

Which action is most important when administering IV calcium gluconate for hypocalcaemia?

Accepted Answer

Answer reason: Rapid IV calcium can precipitate serious dysrhythmias, bradycardia, hypotension, and cardiac arrest, so controlled, slow infusion is the key safety action. Using an IV pump helps ensure a precise rate and reduces the risk of inadvertent bolus dosing. Calcium salts are also irritating to veins and can cause tissue injury with extravasation, so slow administration supports safer monitoring during infusion.
Category reason: This question tests safe administration of an IV medication (rate/route considerations and prevention of adverse events), which is a nursing medication-administration judgment within Pharmacological and Parenteral Therapies.

Question 16

Which instruction should the nurse give a client with osteoporosis starting alendronate?

Accepted Answer

Answer reason: Alendronate can irritate the esophagus and must be taken first thing in the morning with a full glass of plain water to ensure it reaches the stomach quickly and is absorbed properly. The client should remain upright for at least 30 minutes after taking it and avoid food, beverages (other than water), and other medications during that period because they reduce absorption and increase GI adverse effects. Taking it with a meal decreases bioavailability, and taking calcium at the same time interferes with absorption due to binding/chelation.
Category reason: This question tests nursing teaching for safe administration of a medication (bisphosphonate) to prevent complications and ensure effectiveness, which aligns with Medication Administration under Pharmacological and Parenteral Therapies.

Question 17

A nurse is educating a client with newly diagnosed hypertension. Which statement indicates poor understanding?

Accepted Answer

Answer reason: Antihypertensive medications often must be taken long-term even when the client feels well because hypertension is frequently asymptomatic. Stopping therapy can lead to rebound hypertension or loss of blood pressure control, increasing risk for stroke, myocardial infarction, and kidney damage. The other statements reflect appropriate lifestyle changes and self-monitoring that support blood pressure control.
Category reason: This question tests patient teaching and safe medication use/adherence for a prescribed antihypertensive, which aligns with nursing management of medication administration.

Question 18

A nurse is preparing to administer IV calcium gluconate. What is a priority assessment?

Accepted Answer

Answer reason: IV calcium gluconate can affect myocardial conduction and contractility and may precipitate dysrhythmias, especially if infused too rapidly. Baseline and ongoing ECG monitoring helps detect bradycardia, heart block, or other rhythm changes early so the infusion can be slowed or stopped. This is the most immediate life-threatening risk compared with other routine assessments such as temperature or bowel sounds. Monitoring is particularly important in patients with cardiac disease or those receiving digoxin.
Category reason: This item tests safe nursing care during IV medication administration, focusing on the priority assessment/monitoring needed to prevent and detect serious adverse effects.

Question 19

A nurse is preparing to administer digoxin. Which action is most important?

Accepted Answer

Answer reason: Digoxin can cause bradycardia and other dysrhythmias, so the most critical pre-administration assessment is an accurate heart rate and rhythm assessment. The apical pulse auscultated for a full minute is the most reliable method, especially if the rhythm is irregular. If the pulse is below the facility’s/ordered hold parameter (commonly

Question 20

A client on digoxin reports nausea and blurred vision. What should the nurse do first?

Accepted Answer

Answer reason: Nausea and blurred/yellow vision are classic early signs of digoxin toxicity, which can rapidly progress to dangerous bradycardia and dysrhythmias. The priority nursing action is to prevent further exposure by withholding the next dose and immediately assessing apical pulse (and rhythm) to determine hemodynamic risk. After holding and assessing, the nurse should notify the provider and anticipate checking a digoxin level and electrolytes (especially potassium) and obtaining an ECG. Documenting or treating nausea alone delays addressing the potentially life-threatening cardiac effects.
Category reason: This is a patient-care medication safety decision requiring immediate nursing action in response to suspected adverse drug effects, aligning with Medication Administration under Pharmacological and Parenteral Therapies.

Question 21

Which teaching point is important for a client prescribed nitroglycerin sublingual tablets?

Accepted Answer

Answer reason: d." Nitroglycerin sublingual tablets are designed for rapid absorption through the oral mucosa to provide quick relief of angina. Chewing or swallowing reduces and delays absorption due to gastrointestinal metabolism, decreasing effectiveness. Proper administration also includes allowing it to dissolve completely and avoiding eating/drinking until it dissolves to maintain mucosal contact. The 15-minute interval is incorrect; standard teaching is 1 tablet every 5 minutes up to 3 doses while seeking emergency care if pain persists.
Category reason: This item tests safe patient teaching on how to administer a prescribed medication for desired therapeutic effect, which fits Medication Administration under Pharmacological and Parenteral Therapies.

Question 22

A nurse teaches a client with type 1 diabetes about insulin management. Which action indicates understanding?

Accepted Answer

Answer reason: Rotating sites within the same anatomical region helps maintain consistent insulin absorption while preventing lipohypertrophy and skin breakdown from repeated injections. Taking extra insulin when skipping meals increases the risk of hypoglycemia due to reduced carbohydrate intake. Insulin should not be frozen because freezing can denature the protein and reduce potency. Most insulins should be gently rolled rather than shaken, because shaking can create bubbles and affect dosing accuracy (and some formulations should not be agitated).
Category reason: This question tests safe patient teaching and correct technique for administering insulin injections, which is a nursing medication administration competency rather than basic biomedical knowledge.

Question 23

What is the recommended angle for subcutaneous injection?

Accepted Answer

Answer reason: This technique helps deposit medication into the subcutaneous tissue rather than intradermal or intramuscular layers. Needle angle selection is based on the depth of the target tissue and the patient’s subcutaneous fat; 45° is commonly taught as the standard for subcutaneous injections when tissue depth is limited. Using too shallow an angle risks intradermal placement and reduced absorption, while too steep an angle increases the chance of intramuscular injection. Proper angle supports consistent absorption and reduces tissue injury.
Category reason: This question tests correct injection technique for administering medications, which is a nursing medication administration skill under Pharmacological and Parenteral Therapies.

Question 24

Which site is preferred for intradermal injection?

Accepted Answer

Answer reason: The inner forearm is the preferred site for intradermal injections because the skin is thin and relatively hairless, making it easier to create and observe a wheal for tests such as TB screening and allergy testing. It also allows clear visualization of local reactions (erythema, induration) for accurate measurement. Other listed sites are more commonly used for subcutaneous or intramuscular injections and are less ideal for consistent intradermal technique and assessment.
Category reason: This item tests correct technique and site selection for administering an injection, which is a nursing medication administration skill under Pharmacological and Parenteral Therapies.

Question 25

A nurse is teaching a parent about administering ear drops to a child. Which statement indicates the parent understands?

Accepted Answer

Answer reason: d." In children younger than 3 years, the ear canal is best straightened by pulling the pinna down and back to allow drops to reach the canal effectively. Pulling the ear up and back is the technique for older children and adults. Ear drops should be warmed to room temperature to reduce discomfort and vestibular stimulation. The child is typically positioned on the side with the affected ear up rather than flat on the back to help the medication stay in the ear canal.
Category reason: This item tests correct nursing technique for administering otic medication, which is a patient-care skill under medication administration.

Question 26

A nurse is caring for a patient taking hydroxychloroquine. The patient complains of an upset stomach. What teaching can the nurse provide this patient?

Accepted Answer

Answer reason: Hydroxychloroquine commonly causes gastrointestinal irritation (e.g., nausea, abdominal discomfort). Taking the medication with food or milk can improve tolerance by reducing direct gastric irritation and slowing absorption slightly. Taking it on an empty stomach typically worsens symptoms. Large amounts of water and vitamin C are not standard measures to prevent this medication-related GI upset.
Category reason: This is a patient-teaching question about how to administer a prescribed medication to reduce an adverse effect, which is a nursing medication-administration/judgment task.

Question 27

What should a nurse do first before injecting any medication?

Accepted Answer

Answer reason: Medication safety starts with ensuring the right patient, medication, dose, route, and time to prevent administration errors that can cause significant harm. Other steps like checking expiry, cleaning the site, and wearing gloves are important but occur after confirming the fundamental safety checks. Verifying the rights also prompts the nurse to cross-check the order, MAR, and patient identifiers before proceeding. This is the highest-priority “first” action because it addresses the greatest risk: giving the wrong drug or giving it to the wrong person.
Category reason: This item tests a nursing action and prioritization for safe medication injection, which is a core Medication Administration competency under Pharmacological and Parenteral Therapies.

Question 28

What is the priority assessment before administering digoxin?

Accepted Answer

Answer reason: Digoxin can cause clinically significant bradycardia and other dysrhythmias by slowing AV nodal conduction. Therefore, an apical pulse should be assessed prior to administration and the dose held (and provider notified per protocol) if the rate is below the ordered/age-specific threshold (commonly

Question 29

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents?

Accepted Answer

Answer reason: Liquid iron commonly stains teeth; using a straw helps minimize contact with tooth enamel and reduces discoloration. Iron is best absorbed on an empty stomach, and mixing it with foods (like cereal) or formula can reduce absorption. If gastrointestinal upset occurs, it may be taken with a small amount of food, but the key teaching is to avoid practices that decrease absorption and to prevent tooth staining. After dosing, rinsing the mouth/teeth also helps prevent staining.
Category reason: This item tests nursing teaching on how to safely and effectively administer a prescribed medication (liquid oral iron) to a child, which fits medication administration within Pharmacological and Parenteral Therapies.

Question 30

A patient is taking amiloride hydrochloride (Midamor) daily. At what time should the nurse instruct the patient to take the medication?

Accepted Answer

Answer reason: As a potassium-sparing diuretic, dosing earlier in the day reduces the risk of nocturia and sleep disruption. Taking it with food can reduce gastrointestinal upset and support consistent absorption. Bedtime dosing increases nighttime urination risk, and taking it on an empty stomach is not preferred when a with-food schedule is recommended for tolerability.
Category reason: This is a patient-teaching question about when to take a prescribed medication, which is a nursing medication administration responsibility under Pharmacological and Parenteral Therapies.

Question 31

Which drug should NOT be crushed before administration?

Accepted Answer

Answer reason: Crushing enteric-coated formulations destroys the protective coating designed to prevent dissolution in the stomach. This can increase gastric irritation/bleeding risk and also alter where and how the drug is absorbed, leading to unpredictable therapeutic effect. Immediate-release tablets like many paracetamol and losartan products may be crushable if not modified-release, but enteric-coated products should be swallowed whole unless an approved alternative formulation is used.
Category reason: This question tests safe medication administration practices (whether a dosage form can be crushed), which is a nursing medication-safety decision rather than underlying biomedical mechanism.

Question 32

Before administering Theo-Dur (theophylline), the nurse should check the patient's?

Accepted Answer

Answer reason: Theophylline is a methylxanthine bronchodilator that can cause cardiac stimulation, including tachycardia and dysrhythmias, especially if serum levels are high. Checking the apical pulse helps establish a baseline and identify clinically significant tachycardia that may warrant holding the dose and notifying the provider. This is a key pre-administration assessment because the medication’s toxicity is closely tied to cardiovascular and CNS adverse effects.
Category reason: This item tests a nursing pre-administration assessment for a medication and monitoring for adverse effects, which fits Medication Administration within Pharmacological and Parenteral Therapies.

Question 33

A patient with bulimia nervosa was started on fluoxetine hydrochloride (Prozac) 10 mg daily 3 days ago. The patient calls the clinic and reports feeling nauseous after taking the medication. What instruction should the nurse provide the patient?

Accepted Answer

Answer reason: Nausea is a common early gastrointestinal adverse effect of SSRIs such as fluoxetine and is often managed with administration alongside food or milk to improve tolerance. This is an appropriate first-line nursing instruction when symptoms are mild and there are no red-flag findings (e.g., severe vomiting, dehydration, serotonin syndrome). Stopping the drug abruptly or self-discontinuation is not advised without prescriber input, and routine provider notification is unnecessary for mild, expected nausea.
Category reason: This item tests a nursing intervention/teaching decision for managing a common medication side effect, which fits NCLEX Pharmacological and Parenteral Therapies under safe medication administration guidance.

Question 34

The RN is preparing medications for a client with bipolar disorder and notices that the client discontinued antipsychotic medication for several days. Which medication should also be discontinued?

Accepted Answer

Answer reason: Benztropine is commonly prescribed to treat or prevent extrapyramidal symptoms caused by antipsychotic medications. If the antipsychotic has been stopped for several days, continuing an anticholinergic like benztropine is generally unnecessary and increases risk for adverse effects such as urinary retention, constipation/ileus, tachycardia, blurred vision, and confusion. The priority is safe medication management by avoiding an unneeded adjunct medication when the causative agent is no longer being taken.
Category reason: This item tests nursing medication-management judgment about which ordered drug should be held when the related primary therapy (antipsychotic) is discontinued, aligning with Medication Administration.

Question 35

A nurse is teaching a client who has a new prescription for a nitroglycerin transdermal patch. Which of the following instructions should the nurse include?

Accepted Answer

Answer reason: Continuous nitrate exposure leads to tolerance, so transdermal nitroglycerin is typically scheduled with a daily “nitrate-free” interval (often at night) to restore effectiveness. Removing it before sleep helps maintain therapeutic response during daytime activity when angina is more likely. Headache is a common expected effect and is not a reason to stop therapy abruptly. Chest pain should be treated per the prescribed rescue plan (often sublingual nitroglycerin and emergency evaluation), not by applying an extra patch.
Category reason: This item tests patient teaching for correct use and scheduling of a prescribed medication (nitroglycerin patch), which is a medication administration competency in nursing care.

Question 36

A nurse is teaching a client who is pregnant about a new prescription for iron supplements. Which of the following instructions should the nurse include in the teaching?

Accepted Answer

Answer reason: Vitamin C enhances non-heme iron absorption in the gastrointestinal tract, improving effectiveness of supplementation during pregnancy. Taking extra doses after a missed dose increases risk of adverse GI effects without improving safe adherence. Dark/black stools are a common, expected effect of oral iron and typically do not require reporting unless accompanied by other signs of bleeding. Milk/calcium can decrease iron absorption, so it should not be taken with the medication.
Category reason: This item tests client teaching for safe and effective use of a prescribed medication (oral iron), which aligns with medication administration and counseling in nursing care.

Question 37

Before administering beta blockers, the nurse must check:

Accepted Answer

Answer reason: Beta-blockers decrease heart rate and myocardial contractility and can lower blood pressure, so assessing for bradycardia and hypotension is essential before giving the dose. Many protocols include holding the medication and notifying the provider if heart rate or systolic blood pressure are below facility thresholds. Checking only respiratory rate or temperature does not address the primary immediate hemodynamic risks. Blood glucose may be relevant in diabetics (masking hypoglycemia symptoms), but it is not the universal pre-administration safety check compared with vital signs.
Category reason: This is a nursing medication-safety question about pre-administration assessment for a cardiovascular drug, which fits NCLEX Pharmacological and Parenteral Therapies—Medication Administration.

Question 38

A patient with liver cirrhosis presents with confusion, asterixis, and elevated ammonia levels. Which nursing intervention is most effective in reducing ammonia absorption?

Accepted Answer

Answer reason: Lactulose acidifies the colon and traps ammonia (NH3) as ammonium (NH4+), reducing intestinal absorption into the bloodstream. It also acts as an osmotic laxative to speed stool transit, decreasing time for ammonia production and uptake. This directly treats hepatic encephalopathy manifestations such as confusion and asterixis. The other options are either ineffective for reducing ammonia absorption or are incomplete/unsafe as primary management.
Category reason: This item tests a nursing action involving administration of a prescribed medication to manage hepatic encephalopathy, making it primarily a patient-care pharmacologic intervention category.

Question 39

The nurse has a prescription to give a client albuterol (Proventil HFA) (two puffs) and beclomethasone dipropionate (Qvar) (two puffs), by metered-dose inhaler. How should the nurse administer these medications?

Accepted Answer

Answer reason: A short-acting beta2-agonist is administered before an inhaled corticosteroid to rapidly bronchodilate and improve airway patency. This allows the subsequent steroid doses to penetrate deeper into the lungs for better anti-inflammatory effect. Giving the steroid first can reduce its deposition in the lower airways due to ongoing bronchoconstriction, lowering therapeutic benefit. Standard MDI sequencing also supports using bronchodilators prior to maintenance inhalers when both are prescribed together.
Category reason: This item tests correct sequencing of inhaled medications and administration technique by a nurse, which is a medication administration competency within NCLEX Pharmacological and Parenteral Therapies.

Question 40

Case: A patient with asthma is prescribed fluticasone-salmeterol. Question: What is the most important counseling point for this inhaler?

Accepted Answer

Answer reason: This combination inhaler contains an inhaled corticosteroid, which can deposit in the oropharynx and predispose to local adverse effects such as oral candidiasis and dysphonia. Rinsing and spitting after each dose reduces residual steroid in the mouth and lowers infection risk. It is a maintenance controller medication and should not be reserved for acute attacks, which require a rapid-acting bronchodilator. Proper technique matters, but preventing steroid-related thrush is the key high-yield counseling point.
Category reason: This question tests safe patient education for administering a prescribed inhaled medication and preventing medication-related adverse effects, which fits NCLEX medication administration.

Question 41

Saquinavir (Invirase) is prescribed for the client with a human immunodeficiency virus seropositive. The nurse reinforces medication instructions and tells the client to?

Accepted Answer

Answer reason: This protease inhibitor commonly causes gastrointestinal adverse effects such as nausea, vomiting, and diarrhea; minimizing dietary fat can help reduce GI upset and improve tolerance. Taking it on an empty stomach can worsen GI symptoms and may reduce absorption for some antiretrovirals. Avoiding sun exposure is more characteristic teaching for drugs associated with photosensitivity, and low-calorie foods are not a standard instruction for this medication.
Category reason: This question tests client teaching about how to take a prescribed antiretroviral medication and manage expected side effects, which is a nursing medication-administration responsibility.

Question 42

A nurse is preparing to administer digoxin 0.125 mg orally to a client. Which action should the nurse take first?

Accepted Answer

Answer reason: Digoxin can cause clinically significant bradycardia and heart block, so assessing the apical pulse before administration is a key safety step. If the pulse is below the facility’s parameter (commonly

Question 43

A client is prescribed digoxin. What should the nurse monitor before administration?

Accepted Answer

Answer reason: Digoxin can cause bradycardia and other dysrhythmias, so an apical pulse should be assessed prior to dosing and the medication held per protocol if the rate is low (commonly

Question 44

A nurse is teaching a client about self-administering insulin. What should be included in the teaching?

Accepted Answer

Answer reason: Repeated injections into the same area can cause lipohypertrophy or lipoatrophy, which leads to erratic insulin absorption and unstable glycemic control. Teaching should emphasize rotating sites within the same general anatomical region to keep absorption more consistent while preventing tissue changes. The other options are unsafe: using the same site increases complications, insulin should not be stored at room temperature indefinitely, and vigorous shaking can damage insulin (especially suspensions) and create bubbles that affect dosing accuracy.
Category reason: This question tests client education on safe insulin injection technique and handling, which is a nursing medication-administration competency in Pharmacological and Parenteral Therapies.

Question 45

A patient is prescribed metformin 500 mg PO twice daily for type 2 diabetes. What should the nurse instruct the patient to do?

Accepted Answer

Answer reason: Metformin commonly causes gastrointestinal adverse effects such as nausea, abdominal discomfort, and diarrhea, and taking it with food decreases these symptoms and improves tolerance. Patients should not skip doses solely due to mild nausea; instead they should take it with meals and notify the prescriber if symptoms persist. Metformin does not typically cause weight gain (it is generally weight-neutral or associated with modest weight loss). Taking it on an empty stomach increases the likelihood of GI upset.
Category reason: This question tests nursing teaching about how to take a prescribed antidiabetic medication to reduce side effects and promote adherence, which is a medication administration responsibility.

Question 46

Which site is preferred for subcutaneous injection in adults?

Accepted Answer

Answer reason: The abdominal area is typically preferred for adult subcutaneous injections because it has consistent subcutaneous tissue and generally provides more predictable absorption (commonly used for insulin and heparin). It is also easier to access and has fewer large nerves and blood vessels when appropriate landmarks and rotation are used. Other listed sites can be used, but they may have more variable absorption or are less commonly preferred as the first-choice site in adults.
Category reason: This item tests a nursing skill decision about selecting an appropriate injection site, which is part of safe medication administration practice.

Question 47

Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item?

Accepted Answer

Answer reason: Vitamin C enhances absorption of non-heme iron in the gastrointestinal tract by keeping iron in a more absorbable form. Dairy products like milk can decrease iron absorption (and also commonly cause GI upset/constipation when combined with iron), making them a poor choice. Water does not improve absorption, and apple juice lacks the vitamin C content that more effectively supports iron uptake. Giving iron with a vitamin C–rich beverage is a standard nursing teaching point to improve therapeutic response.
Category reason: This question tests nursing teaching on how to administer an oral medication to optimize absorption and effectiveness, which aligns with Medication Administration.

Question 48

The nurse is observing a newly hired administrator a client's transdermal patch. The nurse should intervene if the newly hired nurse is observed?

Accepted Answer

Answer reason: C. initiating the patch and writing the date and time the patch was applied on the patch Transdermal systems should be labeled with date/time and often initials on the outer backing or tape per facility policy, not written directly on the medication-containing patch surface, because this can compromise the integrity of the delivery system and affect dose delivery. Writing on the patch may puncture or alter layers, potentially leading to medication leakage or unpredictable absorption. Appropriate practice is to document date/time and site in the medical record and ensure the patch is applied to clean, dry, intact skin with site rotation.
Category reason: This item tests safe nursing technique and documentation for administering a transdermal medication, which is a Medication Administration competency under Pharmacological and Parenteral Therapies.

Question 49

A nurse is preparing to administer 0.5 mL of oral single-dose liquid medication to a client. which of the following actions should the nurse take?

Accepted Answer

Answer reason: D. verify the dosage by measuring the liquid before administering it Small-volume oral liquids (0.5 mL) require careful measurement using an appropriate device (e.g., oral syringe) to ensure accuracy and prevent under- or overdosing. This aligns with medication administration safety principles (right dose) and is the priority action compared with positioning or transferring between containers. Shaking is only indicated for suspensions per label directions and is not universally required. Transferring to a medicine cup can increase measurement error at such a small volume.
Category reason: This item tests a nursing medication-administration safety action (accurate dose measurement) during a patient-care task, which fits NCLEX Medication Administration.

Question 50

Which site is preferred for intramuscular injection in adults?

Accepted Answer

Answer reason: It is a large, well-developed muscle with consistent landmarks and typically fewer major nerves and blood vessels at risk, which makes it a safer, reliable IM site. It can accommodate typical IM medication volumes in adults and provides good absorption due to muscle mass and vascularity. In contrast, the dorsogluteal area is avoided because of proximity to the sciatic nerve and variable fat thickness, and the abdomen is generally used for subcutaneous injections rather than IM.
Category reason: This question tests safe technique for administering an intramuscular medication, which is a nursing medication-administration skill within Pharmacological and Parenteral Therapies.

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