Injections

Question 1

The nurse has selected a finger as the puncture site to measure the blood glucose level of a female patient with type 2 diabetes mellitus and peripheral vascular disease (PVD). Although all of the actions listed below are appropriate, which one would be of particular benefit to this patient given her medical history?

a. ) Reviewing her current medications
b. ) Inspecting the selected finger for bruising
c. ) Following standard precautions
d. ) Keeping the finger in a dependent position during the puncture

Answer 1

D,The nurse would keep the finger in a dependent position to encourage blood flow to the intended puncture site. Blood flow to the extremities is compromised in patients with PVD.

Question 2

For which patient can the nurse delegate to nursing assistive personnel (NAP) the task of routine blood glucose monitoring?

a. ) Patient with non–insulin-dependent diabetes for whom steroid therapy has been ordered
b. ) Patient with type 2 diabetes who required insulin coverage at the last testing
c. ) Patient with type 1 diabetes who has had nausea and vomiting for 24 hours
d. ) Patient with type 2 diabetes who has had a closed reduction of a fracture of the right wrist

Answer 2

D,This patient’s condition would affect his or her ability to self-perform blood glucose testing but would not affect his or her blood glucose level. The skill of blood glucose testing may therefore be delegated to NAP.

Question 3

For which situation would the procedure of glucose testing be interrupted?

a. ) The reagent strip code matches the code on the vial.
b. ) An unused lancet is not available.
c. ) The glucose meter beeps.
d) A drop of blood forms on the patient’s skin after it is punctured.

Answer 3

B,The unavailability of an unused lancet would preclude proceeding with blood glucose testing. A used lancet can never be reused, because of the risk for infection. The nurse must locate an unused lancet for the procedure.

Question 4

A patient with type 2 diabetes mellitus tells the nurse that he has been testing his own blood glucose level six times per day for the past 3 years. What is the most appropriate action for the nurse to take?

a. ) Observe the patient’s testing technique for accuracy.
b. ) Advise the patient that he is not permitted to perform his own blood glucose testing.
c. ) Check with the patient’s health care provider concerning the patient’s self-testing.
d. ) Explain to the patient that a nurse must complete blood glucose testing.

Answer 4

A

Question 5

Which action would the nurse carry out first when performing a blood glucose test on a patient with type 1 diabetes mellitus?

a. ) Apply clean gloves to minimize the risk for contamination.
b. ) Assess the patient’s skin for possible puncture sites.
c. ) Ask the patient to wash his or her hands and forearms with warm, soapy water.
d. ) Determine the patient’s preferred puncture site.

Answer 5

B

Question 6

When preparing to administer a new medication, what would the nurse do first to ensure the patient’s safety?

a. ) Perform hand hygiene.
b. ) Compare the written order with the medication administration record (MAR).
c. ) Inform the patient about the medication.
d. ) Review appropriate nursing considerations.

Answer 6

B, Comparing the written order with the medication administration record (MAR) helps ensure that the medication order has been transcribed correctly into the medication dispensing system.

Question 7

What is the most important step the nurse can take to ensure that the patient is getting the correct medication?

a. ) Assess the patient’s ability to swallow oral medications without difficulty.
b. ) Question the patient about his or her experience with this or similar medications.
c. ) Compare the medication label with the MAR three times.
d. ) Evaluate the patient’s understanding of the safety issues related to the specific drug.

Answer 7

C

Question 8

Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in medication administration?

a. ) “Does the patient need her pain medication?”
b. ) “Let me know if she complains of any nausea.”
c. ) “What is the quality of her pain now?”
d. ) “Tell her she doesn’t have an order for the drug she’s asking for.”

Answer 8

B, NAP can report symptoms

Question 9

As the nurse is administering medication to a patient, the patient states, “I’ve never seen that pill before.” What is the nurse’s most appropriate response?

a. ) Reassure the patient that the pharmacy sent the right medication.
b. ) Tell the patient that it is probably a different brand than what he takes at home and not to worry.
c. ) Tell the patient that you will review the physician’s order to clarify any discrepancies.
d. ) Tell the patient that the doctor probably ordered a new medication.

Answer 9

C, If a patient questions a medication, it is important to review the medication orders and revisit the six rights of medication administration.

Question 10

What is the nurse’s best response after noticing that the route of administration has been omitted from a medication order?

a. ) Ask which route the patient prefers.
b. ) Immediately notify the prescriber to request that the order be completed.
c. ) Refer to a current drug book to determine the most commonly prescribed route.
d. ) Contact the pharmacy to determine the most appropriate route for this patient.

Answer 10

B, The prescriber is required to include all pertinent information on the prescription and should be notified immediately if it is incomplete.

Question 11

How might the nurse safely administer an extended-release capsule to a patient with dysphagia?

a. ) Encourage the patient to drink plenty of water when swallowing the capsule.
b. ) Open the capsule, and place the contents into 90 mL (3 fl. oz.) of juice.
c. ) Place the capsule in a spoonful of the patient’s applesauce.
d. ) Save the capsule to be administered last.

Answer 11

C

Question 12

The nurse is preparing to administer several oral medications when the patient says he would like to take his pills with orange juice. What is the nurse’s best response?

a. ) Determine whether the patient’s prescribed diet includes orange juice.
b. ) Establish whether the medications may be taken with orange juice.
c. ) Ask the dietary aide to order extra orange juice for the unit.
d. ) Administer the pills with orange juice.

Answer 12

B

Question 13

Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in administering oral medications?

a. ) “Does the patient need her pain medication?”
b. ) “Please make sure the patient has plenty of fresh water to take with her pills.”
c. ) “How much did the pain medication improve her pain?”
d. ) “Stay with the patient until he swallows all the pills.”

Answer 13

B

Question 14

The nurse has provided a patient with a prn oral analgesic that may be repeated as needed every 6 to 8 hours. What is the most appropriate follow-up action to ensure appropriate pain management?

a. ) Reassess the patient’s pain in 30 to 40 minutes.
b. ) Document the patient’s request for pain medication.
c. ) Administer the pain medication again in 6 hours.
d. ) Include the patient’s pain history in the end-of-shift nursing report.

Answer 14

A

Question 15

A patient with a history of nighttime confusion is to receive several oral medications at bedtime. What is the best way for the nurse to ensure that the patient has swallowed the medication?

a. ) Administer each tablet individually.
b. ) Observe the patient closely as he swallows the tablets.
c. ) Ask the patient to open his mouth after swallowing each tablet.
d. ) Ask the patient to swallow a full glass of water with the tablets.

Answer 15

C

Question 16

Which example reflects effective documentation of medication administration by a nurse?

a. ) Comparing the written order with the medication administration record (MAR) three times
b. ) Providing patient education regarding a medication
c. ) Obtaining a BP before giving a blood pressure medication
d. ) Including the location of an injection site on the medication administration record

Answer 16

D

Question 17

What is the best way for the nurse to ensure that a patient receives the correct dose of a medication?

a. ) Compare the prescriber’s order with the medication administration record before dispensing the medication
b. ) Ask the patient if he would like a larger dose of pain medication
c. ) Assess the patient’s ability to swallow oral medications without difficulty
d. ) Check the name of the medication three times against the medication administration record

Answer 17

A

Question 18

Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in documenting medication administration?

a. ) “Make a note that the patient just received her pm dose of pain medication.”
b. ) “Let me know if she says her nausea is getting worse.”
c. ) “Can you check the MAR and see when this patient had her pain med last?”
d. ) “Ask the patient if I need to get another order from the provider.”

Answer 18

B

Question 19

The patient refuses the scheduled dose of an antibiotic, saying that the medication makes him feel nauseated. What it the nurse’s best response?

a. ) Informing the patient why the medication is necessary
b. ) Notifying the prescriber of the patient’s reason for refusing the medication
c. ) Offering to administer the medication with the patient’s favorite snack food
d. ) Noting the patient’s refusal in the medication administration record (MAR)

Answer 19

B, The provider must treat the infectious process for which the antibiotic was ordered. The provider may, for example, offer the patient an agent to alleviate the nausea associated with the medication or order a different agent that produces less nausea, such as an extended-release antibiotic.

Question 20

While reviewing a new medication order, the nurse notes that the frequency of administration has been omitted. What is the nurse’s best response?

a. ) Immediately contacting the prescriber to complete the order
b. ) Referring to a current drug book for the most commonly prescribed dosage
c. ) Calling the pharmacy to determine the frequency
d. ) Asking a registered nurse who is familiar with the prescriber to identify the usual frequency ordered

Answer 20

A

Question 21

As the nurse is at the bedside preparing to administer a new medication, the patient mentions that he is allergic to the drug. What will the nurse do first?

a. ) Notify the physician
b. ) Withhold the medication
c. ) Check to see if the patient is wearing a red allergy ID band
d. ) Review the medication administration record (MAR) for allergies

Answer 21

B

Question 22

As the nurse prepares to administer oral acetaminophen, the patient refuses to accept the drug because it doesn’t look like the Tylenol she takes at home. After verifying that the medication and dosage are correct, what is the nurse’s best response?

a. ) Informing the patient that the medication is a form of Tylenol
b. ) Explaining that she will probably have increased pain if she refuses the medication
c. ) Showing the patient a picture of the medication
d. ) Explaining that drugs often come in different physical forms, depending on the manufacturer

Answer 22

D, Explaining that drugs often come in different shapes, sizes, and colors gives the patient information that directly addresses her concern.

Question 23

What is the nurse’s first response when a patient requests another dose of narcotic pain medication before it is time for the next dose?

a. ) Consulting with the physical therapy department to arrange for a visit with the patient
b. ) Working with the patient to find alternative nonpharmacologic means of pain management
c. ) Contacting the patient’s provider to request an order for additional pain medication
d. ) Giving the patient a detailed explanation of the need to limit the amount of narcotic medication she takes

Answer 23

B, If it is too early to administer the next dose of the patient’s analgesic, the nurse would work with the patient to explore nonpharmacologic means of pain relief.

Question 24

The patient has requested a PRN medication for nausea. Which of the following should the nurse do first?

a. ) Offer dry crackers and ice chips if not contraindicated
b. ) Ask the patient about his allergies
c. ) Explain the specific purpose of the medication
d. ) Check to see when the medication was given last and make sure the time interval is up

Answer 24

D

Question 25

After requesting a narcotic pain medication, the patient refuses it after the nurse prepares the injection. What is the nurse’s best initial response?

a. ) Ask the patient the reason for his refusal
b. ) Notify the physician and asking for a different type of pain medication
c. ) Have another registered nurse witness the proper discarding of the drug
d. ) Explain to the patient the need to manage pain effectively

Answer 25

A

Question 26

When is a patient at a higher risk for a medication administration error?

a. ) During a care transition point, such as transfer to another unit
b. ) While on a hospital unit for an extended length of time
c. ) On the third postoperative day
d. ) When taking an active role in self-administration of insulin

Answer 26

A, Medication errors are more likely to occur during care transition points, such as at admission or discharge or just after transfer to a new unit.

Question 27

As the nurse is giving a patient his medications, he remarks, “I’ve never seen this blue pill before.” What is the nurse’s correct response?

a. ) “I’m sure the doctor knows what he’s doing. Don’t worry.”
b. ) “Our pharmacy probably sent a generic form of what you’re used to taking.”
c. ) “What color pill are you used to seeing?”
d. ) “Don’t take it. Let me double-check the doctor’s order to make sure this is the correct medication for you.”

Answer 27

D, An alert patient or family caregiver will know whether a medication is different from those he or she has received before. To prevent a possible error, such a concern should be explored, not simply dismissed.

Question 28

What is the best way for the nurse to ensure that the patient does not receive the wrong dose because of a calculation error?

a. ) Ask the pharmacy to calculate the correct dosage.
b. ) Consult a current drug book to determine the new dosage.
c. ) Defer the calculation process to the provider.
d. ) Ask another registered nurse to verify the calculation.

Answer 28

D

Question 29

Which of the following nursing actions will reduce the risk of “wrong route” when administering a medication?

a. ) Only splitting pills or tablets that have been prescored by the manufacturer
b. ) Using an oral dosing syringe when administering oral liquid medication
c. ) Transcribing a fractional dose of less than one with a leading zero (e.g., 0.5 mg)
d. ) Crushing an oral medication that is difficult to swallow

Answer 29

B, Using a parenteral syringe to administer an oral medication may result in an oral medication being given parenterally, as an injection. Such a mistake would indeed be a “wrong route” medication error.

Question 30

What is the most appropriate way for the nurse to split an unscored tablet?

a. ) Use a pill-splitting device to split an unscored pill in half.
b. ) Ask the pharmacy if it is appropriate to split the pill and if so, ask them to split and repackage it with the adjusted dose given on the label.
c. ) Use scissors to cut the pill in half.
d. ) Administer a whole pill every other day instead of every day.

Answer 30

B, Unscored tablets may not be appropriate to split. Asking the pharmacy if the tablet can be safely split and having them split it if indicated is the safest way to ensure accurate dosing.

Question 31

What is the nurse’s first step in preparing to administer a prescribed medication using an automated medication dispensing system?

a. ) Establish the patient’s ID using two identifiers
b. ) Review the medication administration record (MAR)
c. ) Provide patient education
d. ) Review applicable nursing considerations

Answer 31

B, Reviewing the medication administration record (MAR) helps ensure that the medication order has been correctly transcribed into the dispensing system.

Question 32

Which precaution should the nurse observe to ensure patient safety when using an automated medication dispensing system?

a. ) Assess the patient’s ability to swallow oral medications without difficulty
b. ) Ask the patient about his or her experience with this or similar medications
c. ) Prepare medications for one patient at a time
d. ) Evaluate the patient’s understanding of the safety issues related to the specific drug

Answer 32

C

Question 33

Which action by a nurse is most important in protecting the safety of patients and staff when using an automated medication dispensing system?

a.) Refusing to share his or her individual security log-in code for the dispensing system
b.) Having another registered nurse check his or her mathematical calculations
Reviewing a current drug book for dosing information
Using two different mathematical formulas to cross-check a dosage calculation

Answer 33

A, A personal log-in code is issued to each person authorized to use the automated medication dispensing system at a facility, and that code may not be shared. Doing so may result in unauthorized use of the system and access to medications. A nurse must refuse to share his or her log-in code if asked to do so, even by another staff member.

Question 34

While preparing a patient’s oral medication dispensed from an automatic system, the nurse realizes that the pill dispensed is twice the required dose. What is the nurse’s best response?

a. ) Notify the health care provider and ask if the higher dose could be given
b. ) Access the dispenser again for the appropriate dose
c. ) Notify the pharmacy to determine if the accurate dose is available
d. ) Splitting the pill in half

Answer 34

C

Question 35

The nurse is preparing to apply a topical oil-based medication to a patient’s forearms. What should the nurse do to minimize the risk of contamination during the application?

a. ) Encourage the patient to self-apply the medication
b. ) Wear treatment gloves during the entire application process
c. ) Change gloves between prepping the skin and applying the medication
d. ) Perform effective hand hygiene before and after application

Answer 35

C

Question 36

Which of the following discharge instructions would be most important in ensuring the safety of a patient who will need to apply a dermal patch daily at home?

a. ) Apply sufficient pressure to the edges of the patch to ensure adequate adherence.
b. ) Avoid using a heating pad on or near the application site.
c. ) Pat the application site dry before applying the patch.
d. ) Reapply the patch to the same site each time to enhance absorption.

Answer 36

B, The application of heat will alter and often increase the rate of absorption of the medication. To achieve optimal effectiveness with minimal side effects, the medication must be absorbed at the rate intended by the manufacturer.

Question 37

Which of the following is not taken into consideration when determining the appropriate amount of a topical medication to be applied to the skin?

a. ) Size of the skin site
b. ) Other medications the patient is taking
c. ) Manufacturer’s instructions for application of the product
d. ) Health care provider’s order

Answer 37

B

Question 38

The nurse is preparing to discharge a patient after instructing her in self-application of a topical medication. What is the best way for the nurse to ensure that the patient understands the instructions?

a. ) Discuss with the patient the most common errors in application
b. ) Review the material several times with the patient and family
c. ) Allow the patient to apply the topical medication and provide feedback on technique
d. ) Give the patient printed materials for later reference

Answer 38

C

Question 39

The nurse is applying a topical antibiotic and dressing to a burn on the hand of a patient being treated as an outpatient. What is the most important thing the nurse can do to minimize the risk of infection?

a. ) Evaluate the patient’s ability to recognize the signs and symptoms of infection
b. ) Perform effective hand hygiene before and after the application
c. ) Instruct the patient not to change the dressing between visits
d. ) Apply the medication using sterile technique

Answer 39

D

Question 40

Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in applying an estrogen patch?

a. ) “Let me know when it’s time to change the patient’s patch.”
b. ) “Take care not to apply the patch over breast tissue.”
c. ) “Please apply lotion to the site from which the old patch was removed.”
d. ) “Make a note of where the patch is now before you remove it.”

Answer 40

C

Question 41

The nurse is preparing to apply an estrogen patch to a patient who will be discharged with a prescription for the medication. What would the nurse do to ensure the patient is able to apply the medication patch?

a. ) Determine the patient’s physical ability to grasp the patch
b. ) Assess the patient’s skin for appropriate application sites
c. ) Assess the patient’s understanding of the medication’s purpose
d. ) Determine the patient’s ability to recognize the medication’s possible side effects

Answer 41

A

Question 42

Which statement best illustrates the nurse’s understanding of appropriate sites for the application of an estrogen patch?

a. ) “I’ll check to see if the patient has pendulous breasts.”
b. ) “I need to assess the skin on the patient’s thighs.”
c. ) “I need to encourage her to wear elastic waistbands.”
d. ) “I’ll tell her to wear blouses and shirts with loose sleeves.”

Answer 42

B

Question 43

Why would the nurse avoid placing nitroglycerin ointment over a scar on an otherwise suitable area of the upper arm?

a. ) The ointment will stick to the scar tissue.
b. ) The ointment is likely to irritate the scar tissue.
c. ) The ointment may cause the scar to become hypertrophic.
d. ) Scar tissue may interfere with absorption.

Answer 43

D, Medication cannot be absorbed through scar tissue. The nurse would select a skin site at which absorption could be reliably predicted.

Question 44

What is the best way for the nurse to minimize the risk of contaminating the patient’s eye during the instillation of eye drops?

a. ) Encourage the patient to self-apply the medication.
b. ) Wear gloves during the entire application process.
c. ) Introduce the medication onto the inner canthus of the eye.
d. ) Perform effective hand hygiene before and after the instillation.

Answer 44

B

Question 45

Which instruction should be given to a patient to ensure safety when self-applying an antibiotic ointment?

a. ) It is not necessary to allow refrigerated eye medication to warm to room temperature before administration.
b. ) Do not apply pressure directly to the eyeball when removing excess medication.
c. ) When cleaning the eye before administration, gently wash from the outer to the inner canthus.
d. ) Apply a warm, damp washcloth to the eye for several minutes to remove any crusted discharge.

Answer 45

B

Question 46

Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the instillation of eye medications?

a. ) “Did you let the eye medication warm to room temperature?”
b. ) “Do you think the patient is capable of instilling his own eyedrops?”
c. ) “Be sure to slightly hyperextend her neck when instilling the medication.”
d. ) “Her vision may be temporarily impaired, so please help her to the bathroom.”

Answer 46

D, NAP may provide supportive care to a patient receiving eye medication.

Question 47

After instructing a patient in the self-administration of antibiotic eyedrops, what is the nurse’s highest priority assessment?

a. ) The patient’s understanding of the medication’s purpose
b. ) The patient’s hand grasp, strength, coordination, and ability to manipulate the applicator
c. ) The patient’s comprehension of the dosage instructions provided with the medication
d. ) The patient’s ability to recognize the signs of an allergic reaction to the medication

Answer 47

B

Question 48

When placing an intraocular disk, the nurse recognizes that it is in the correct position by assessing what?

a. ) Visibility of the disk over the cornea
b. ) Lack of visibility of the disk as it is placed under the lower eyelid
c. ) Lack of visibility as it is placed under the upper eyelid
d. ) Visibility of a small portion of the disk extending slightly above the lower eyelid

Answer 48

B, When placed correctly against the sclera under the lower eyelid, the intraocular disk should not be visible.

Question 49

What is the best way to minimize discomfort caused by the instillation of ear medication?

a. ) Warm the ear drops to room temperature before instillation
b. ) Wear treatment gloves during the application process
c. ) Ask the patient to sit while introducing the medication
d. ) Use a cotton-tipped applicator to remove any visible cerumen

Answer 49

A, Warming the medication to room temperature minimizes the risk of vertigo and/or nausea from instillation of eardrops.

Question 50

Which instruction would help ensure the maximum therapeutic response when a patient self-administers ear medication?

a. ) Remain in the lateral position (unaffected side) for a few minutes after instillation
b. ) Bring refrigerated ear medication to room temperature before instillation
c. ) Place a cotton ball firmly into the ear canal for 30 minutes after instillation
d. ) Apply a warm, damp washcloth to the external ear to remove any crusted discharge

Answer 50

A, Remaining in the lateral position for a few minutes after instillation allows the medication to remain in contact with the tissues of the ear canal.

Question 51

A nurse is preparing to help a patient administer a mucolytic agent using a metered-dose inhaler (MDI). What will the nurse do first in order to evaluate the medication’s effectiveness?

a. ) Assess the patient’s respiratory status before administration.
b. ) Warn against overuse of the inhaler.
c. ) Discuss the side effects of the particular drug.
d. ) Verify the patient’s identification according to agency policy.

Answer 51

A, Assessing the patient’s respiratory status before administration will provide a baseline against which the respiratory status can be compared after administration.

Question 52

Which discharge instruction would help to ensure that the patient achieves maximum therapeutic delivery of the medication when using a metered-dose inhaler (MDI)?

a. ) Make sure to report any adverse effects after using your inhaler.
b. ) Prime the inhaler if it is new or has not been used for several days.
c. ) Hold your breath for 60 seconds after the medication is delivered.
d. ) Use the inhaler while sitting up in a chair at 90-degree angle.

Answer 52

B

Question 53

Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the use of a metered-dose inhaler?

a. ) “Be sure to let me know if she starts coughing again.”
b. ) “Show the patient how to clean the spacer chamber after she’s finished with the inhaler.”
c. ) “Offer the patient her inhaler if it looks like she’s short of breath.”
d. ) “Please tell her the inhaler is to be used no more than three times per day.”

Answer 53

A

Question 54

The nurse is instructing a patient who is to receive both a bronchodilator and a steroid medication delivered by means of a metered-dose inhaler (MDI). Which instruction is necessary for the safe administration of both agents?

a. ) “Make sure to use the steroid medication before the bronchodilator.”
b. ) “Make sure to use the bronchodilator before the steroid medication.”
c. ) “Rinse your mouth with warm water before using the MDI to administer either medication.”
d. ) “Make sure you wait at least 30 seconds between administering the bronchodilator and administering the steroid medication.”

Answer 54

B

Question 55

To make sure the drug is delivered properly, what discharge instructions might the nurse give a patient who is being discharged with a dry powder inhaler (DPI)?

a. ) Rinse your mouth out with water after using the inhaler.
b. ) Use the inhaler while sitting up in bed.
c. ) Keep track of the dosage using the counter on the inhaler.
d. ) After inhaling the medication, hold your breath for at least 10 seconds before exhaling.

Answer 55

D

Question 56

When instructing a patient in the use of a dry powder inhaler (DPI), which statement is accurate?

a. ) It is important to shake the DPI before administering the medication.
b. ) It is important to exhale while the lips are still around mouthpiece.
c. ) It is important to read the manufacturer’s instructions to determine how quickly to inhale the medication.
d. ) It is important for the patient to hold his or her breath for at least 60 seconds after inhaling the medication.

Answer 56

C, DPIs differ regarding how quickly the medication should be inhaled. The manufacturer’s instructions should include this information.

Question 57

A female nurse is preparing to administer a rectal suppository to a male patient. The patient says, “This is so embarrassing. Is this really necessary?” What is the most appropriate response?

a. ) “I can see if the doctor will order an oral medication.”
b. ) “How about if I show you how to insert the suppository yourself?”
c. ) “I will make sure that you are well covered. I promise.”
d. ) “This will make you feel so much better.”

Answer 57

B

Question 58

The nurse is preparing to administer a rectal suppository to an elderly patient. Which step best protects the patient’s safety?

a. ) Ask the patient to take deep, slow breaths as the suppository is being inserted.
b. ) Insert the suppository two inches into the rectum.
c. ) Place the patient in the left side-lying position with the top leg flexed.
d. ) Instruct the patient to use the call button for assistance to the bathroom.

Answer 58

D, Reminding the patient to use the call button and making sure it is within reach will help minimize the patient’s risk of falling while trying to walk to the bathroom unassisted. Should be inserted 4 inches not two

Question 59

After administering a rectal suppository for constipation, the nurse will monitor for all of the following responses except which one?

a. ) Low platelet count
b. ) Rectal pain
c. ) Bradycardia
d. ) Evacuation of stool

Answer 59

A, The nurse must assess for low platelet count before administration of a suppository, not afterward.

Question 60

The nurse should question a provider’s order to insert a suppository into the rectum of a patient with which condition?

a. ) Watery diarrhea
b. ) Rectal inflammation
c. ) External hemorrhoids
d. ) Internal hemorrhoids

Answer 60

A , can affect absorption

Question 61

When preparing an injection from an ampule, what will the nurse do if liquid is trapped in the neck of the ampule?

a. ) Check the medication cabinet for an extra ampule of the medication.
b. ) Notify the pharmacy that an additional ampule of medication will be needed.
c. ) Use quick, light finger taps on the top of the ampule to move the liquid.
d. ) Shake the medication out of the neck of the ampule.

Answer 61

A

Question 62

What is the greatest safety concern when withdrawing medication from an ampule?

a. ) Not wearing gloves when preparing medication
b. ) Selecting an inappropriate needle size
c. ) Withdrawing glass particles into the syringe
d. ) Withdrawing bubbles into the syringe

Answer 62

C

Question 63

How does the nurse minimize the risk of patient infection when preparing medication from an ampule?

a. ) Using a filter needle to draw up the medication
b. ) Preparing the medication in the patient’s room
c. ) Applying clean gloves while preparing the medication
d. ) Preserving the sterility of the needle while preparing the medication

Answer 63

D

Question 64

Which action minimizes the risk of introducing glass particles into the syringe when drawing medication from an ampule?

a. ) Using minimal force to snap the neck of the ampule
b. ) Using gauze to cover the top of the ampule when snapping it
c. ) Using a filter needle or straw to draw the medication from the ampule
d. ) Allowing the medication to settle after the ampule has been snapped open

Answer 64

C

Question 65

Which action might the nurse take when drawing up medication from an ampule?

a. ) Hold the ampule upside down while inserting the filter needle.
b. ) Inject air into the ampule before withdrawing the medication.
c. ) Hold the ampule horizontally while inserting the filter needle.
d. ) Expel air bubbles from the syringe while the filter needle is still inside the ampule.

Answer 65

A

Question 66

A nurse is preparing to withdraw medication from an open multidose vial. After confirming that the vial contains the appropriate medication and checking the expiration date, what would the nurse do next?

a. ) Apply clean gloves.
b. ) Vigorously shake the vial.
c. ) Wipe the rubber seal of the vial with an alcohol swab.
d. ) Introduce air equal to the amount of medication needed.

Answer 66

C

Question 67

What would the nurse do to remove air trapped in a syringe before withdrawing the syringe from the vial?

a. ) Position the tip of the needle in the vial’s airspace, and tap the barrel of the syringe.
b. ) Position the tip of the needle below the fluid line, and tap the vial.
c. ) Position the vial on a flat surface, and tap the syringe.
d. ) Position the syringe above the vial, and tap the vial.

Answer 67

A

Question 68

How can the nurse prevent negative pressure from building up in the vial when preparing an injection?

a. ) Inject an amount of air into the vial equivalent to the volume of medication to be withdrawn.
b. ) Insert the needle through the center of the rubber seal.
c. ) Keep the tip of the needle below the level of fluid in the vial.
d. ) Tap the barrel of the syringe to dislodge air bubbles.

Answer 68

A

Question 69

How can the nurse ensure that medication from a single-dose vial is used appropriately?

a. ) Check to see when the medication vial was opened initially.
b. ) Write the date and his or her initials on the label when opening the vial.
c. ) Draw the entire amount of medication from the vial into the syringe.
d. ) Discard the vial and any remaining medication in the vial directly after use.

Answer 69

D

Question 70

What will the nurse do after opening a multidose vial and withdrawing a dose of medication from it?

a. ) Discard the unused portion of the medication.
b. ) Wipe the entire vial with an antiseptic swab.
c. ) Send the unused portion back to the pharmacy.
d. ) Label the vial with the date it was opened and your initials.

Answer 70

d, The medication in an open multidose vial is perishable. Labeling the vial with the date on which it is opened will prevent administration of medication that has expired or lost its efficacy.

Question 71

How can the nurse best ensure the patient’s safety when preparing insulin for administration?

a. ) Obtain the patient’s current blood glucose level.
b. ) Clean the injection site with an antibacterial swab.
c. ) Apply clean gloves.
d. ) Wipe the rubber seal of the vial with alcohol.

Answer 71

A

Question 72

How would the nurse prepare insulin to ensure its efficacy?

a. ) Do not allow refrigerated insulin to warm up before administering it.
b. ) Follow aseptic technique during the entire process.
c. ) Roll the vial of insulin suspension between the palms prior to drawing up the medication.
d. ) Monitor the patient’s blood glucose level before administering the injection.

Answer 72

C, Rolling the vial of insulin suspension before drawing up the medication ensures that particles of suspension are adequately distributed into the solution, ensuring efficacy.

Question 73

When will a patient’s blood glucose levels be most affected by a short-acting insulin injection, such as Humulin-R?

a. ) In 2 to 3 hours
b. ) For the next 12 hours
c. ) During unplanned exercise
d. ) When the patient eats carbohydrates

Answer 73

A

Question 74

Which of the following statements is accurate regarding insulin administration?

a. ) Vials of insulin may be stored in the freezer to extend their shelf life.
b. ) If the rapid-acting insulin ordered is unavailable, it is safe to substitute an alternative rapid-acting insulin.
c. ) Vials of insulin must be inspected before each use for changes in appearance.
d. ) All insulin must be shaken before use to redistribute particles within the suspension.

Answer 74

C

Question 75

To prevent hypoglycemia and enhance efficacy, it is appropriate to give rapid-acting insulin how many minutes before the next meal?

a. ) 5 to 15 minutes
b. ) 30 to 40 minutes
c. ) 60 to 90 minutes
d. ) The timing of insulin around meals is not necessary.

Answer 75

A

Question 76

The nurse is preparing to mix short- and intermediate-acting insulins to administer to a patient. Which action best preserves the insulin’s effectiveness?

a. ) Determining the patient’s blood glucose level
b. ) Refraining from injecting the intermediate-acting insulin into the short-acting vial
c. ) Applying clean gloves when administering the medication
d. ) Having another registered nurse verify the dose of both types of insulins

Answer 76

B, Refraining from injecting the intermediate-acting insulin into the short-acting vial will prevent the short-acting insulin vial from being contaminated with intermediate-acting insulin.

Question 77

The patient is to receive both Lantus® (insulin glargine) and regular insulin. To ensure the proper action of the insulins, what would the nurse do when preparing these two types of insulin for administration?

a. ) Mix the insulins in one syringe for a single injection.
b. ) Prepare the insulins in two syringes for separate injections.
c. ) Roll each vial between the palms to disperse the medication within the suspension.
d. ) Have another registered nurse verify the dose of the insulins.

Answer 77

B, Lantus is not to be mixed with other insulins. Separate injections are required.

Question 78

When preparing an injection that contains both short- and intermediate-acting insulins, what is the first step the nurse would take to ensure the effectiveness of the injection?

a. ) Insert air into the intermediate-acting insulin.
b. ) Warm the vials to room temperature.
c. ) Shake the vials to disperse the medication within the suspension.
d. ) Withdraw the prescribed amount of short-acting insulin after the intermediate-acting insulin.

Answer 78

A, Air is injected into the intermediate-acting insulin before it is injected into the short-acting insulin. short acting is drawn up before intermediate insulin

Question 79

When preparing an injection of mixed insulin that includes 12 units of NPH and 5 units of regular insulin, how does the nurse initially confirm the proper dosage in the syringe?

a. ) By noting when 5 units of clear insulin is visible in the syringe
b. ) By noting when 12 units of cloudy insulin is visible in the syringe
c. ) By having another registered nurse verify the presence of 17 units of insulin
d. ) By verifying that the prescription confirms the medication administration record (MAR)

Answer 79

A, Because it is clear, regular insulin will be drawn into the syringe first, so it is the first thing the nurse will verify as she draws the proper dosage.

Question 80

Which action would the nurse take when mixing intermediate- and long-acting insulins together in one syringe?

a. ) Draw the intermediate-acting insulin into the syringe first.
b. ) Draw the long-acting insulin into the syringe first.
c. ) Prepare two injections.
d. ) Draw either the intermediate- or the long-acting insulin into the syringe first.

Answer 80

C, You would need to prepare two injections because you never mix long-acting insulin with any other insulins.

Question 81

When administering an intradermal injection, which outcome would require the nurse to withdraw the needle and begin again?

a. ) Aspiration of blood prior to injecting the medication
b. ) Inability to feel resistance when injecting the medication
c. ) Formation of a 6-mm bleb at the injection site
d. ) Appearance of a lesion resembling a mosquito bite at the injection site

Answer 81

B

Question 82

Which finding tells the nurse that a patient may have had a positive reaction to a tuberculin test?

a. ) A raised wheal the size of a mosquito bite
b. ) A bruised area 10 mm or greater in diameter
c. ) A hard, raised area 15 mm or greater in diameter
d. ) A flat, reddened area 5 mm or greater in diameter

Answer 82

C, An indurated area 15 mm in diameter or larger is considered a positive response in anyone with no known risk factors for tuberculosis, such as immunosuppression or exposure to tuberculosis.

Question 83

In which site would it be inappropriate to administer an intradermal injection?

a. ) Lower abdomen of an obese patient
b. ) Upper back of a patient who is on bed rest
c. ) Right deltoid of a high school softball pitcher
d. ) Left forearm of a patient with right-sided weakness

Answer 83

C

Question 84

How can the nurse determine that the needle tip for an intradermal injection is in the dermis?

a. ) A bleb the size of a mosquito bite will appear.
b. ) The needle will enter at a 5- to 15-degree angle.
c. ) The bulge of the needle tip will be visible through the skin.
d. ) The needle will penetrate through the epidermis to a depth of about ⅛ inch.

Answer 84

C

Question 85

Which action would the nurse take to diminish tissue irritation when administering a subcutaneous injection to a patient of average size?

a. ) Massage the site after administration.
b. ) Make sure the volume of the medication is less than 2 mL.
c. ) Administer the injection at a 45- to 90-degree angle.
d. ) Wear clean gloves while administering the injection.

Answer 85

B

Question 86

Which needle would be most appropriate for the nurse to use when giving a subcutaneous injection to a patient of average height and weight?

a. ) 20-gauge, ½-inch
b. ) 22-gauge, 1-inch
c. ) 25-gauge, ⅜-inch
d. ) 27-gauge, 1-inch

Answer 86

C

Question 87

What can the nurse do to minimize the discomfort of a subcutaneous injection?

a. ) Inject the medication rapidly.
b. ) Massage the injection site.
c. ) Cover the injection site with gauze pad after withdrawing the needle.
d. ) Inject the medication without pinching the skin.

Answer 87

C

Question 88

When preparing to administer heparin or insulin subcutaneously, which site is preferred?

a) Abdomen
b. ) Scapula
c. ) Deltoid muscle
d. ) Back of the upper arm

Answer 88

A

Question 89

What can the nurse do to ensure proper site selection for subcutaneous insulin injection?

a. ) Insert the needle at a 30-degree angle.
b. ) Select a different anatomical region for each injection.
c. ) Ask the patient to relax before inserting the needle.
d. ) Systematically rotate sites within the same anatomical location or area.

Answer 89

D

Question 90

Which action by the nurse ensures patient safety when administering an intramuscular injection?

a. ) Putting on clean gloves before administration
b. ) Rotating injection sites
c. ) Aspirating for blood return when administering a vaccine
d. ) Injecting the medication quickly

Answer 90

B

Question 91

When preparing an intramuscular injection, what can the nurse do to reduce the patient’s risk for infection?

a. ) Wear clean gloves.
b. ) Use a 3-mL syringe.
c. ) Clean the injection site with an alcohol swab.
d. ) Massage the injection site.

Answer 91

C

Question 92

What can the nurse do to minimize the patient’s risk for injury when delivering an intramuscular injection?

a. ) Instruct the patient to relax.
b. ) Insert the needle at a 45-degree angle.
c. ) Pull back on the plunger after inserting the needle.
d. ) Pull the skin taut at the injection site when inserting the needle.

Answer 92

C, Pulling back on the plunger will allow the nurse to determine if the needle is in a blood vessel, rather than in muscle tissue.

Question 93

Which action by the nurse helps to ensure that the medication is delivered into the muscle when administering an intramuscular injection?

a. ) Using a 1-inch needle
b. ) Inserting the needle at a 45- to 60-degree angle
c. ) Withdrawing the needle immediately after delivering the medication
d. ) Aspirating for blood return before injection medication

Answer 93

D