FUNDAMENTALS EXAM 3 (Med Admin NCLEX style questions)

The nurse is preparing to administer a medication. Which of the following is one of the "7 rights" of medication administration:

A. Right diagnosis

B. Right equipment

C. Right time

D. Right education

C-right time

The nurse is giving an oral medication to a patient who is NPO for a procedure. What should the nurse do next?

A. Crush the medication and mix with applesauce

B. Give the medication with a small sip of water

C. Change the route to IV and administer

D. Hold the medication and notify the provider

D-hold the medication and notify the provider

Rationale: NPO means nothing by mouth—the nurse should clarify with provider before administering

The nurse is preparing to give an IM injection to a 2 month old infant. Which site is most appropriate?

A. Vastus Lateralis

B. Dorsogluteal

C. Deltoid

D. Ventrogluteal

A-Vastus Lateralis

Rationale: This is the preferred IM site for infants due to muscle size and safety from major nerves

While preparing to give a subcutaneous enoxaparin (lovenox) injection using a prefilled syringe, the nurse notes an air bubble. What should the nurse do?

A. Tap the syringe to remove the bubble

B. Expel the air bubble before injecting

C. Inject the medication as is

D. Waste the dose and get a new syringe

C- inject the medication as is

Rationale: lovenox is given with the air bubble to help seal the medication in the tissue and reduce bruising

The nurse is scheduled to give a medication via the sublingual route. What should the nurse do?

A. Crush tablet and mix with water

B. Place tablet under the tongue

C. Place tablet between the cheek and gum

D. Swallow the tablet with a full glass of water

B- place tablet under the tongue

Rationale: sublingual medications dissolve under the tongue for rapid absorption into the bloodstream. They should not be swallowed

When should the nurse perform medication reconciliation? (Select all that apply)

A. At admission

B. When transferring the patient to another unit

C. During morning med pass

D. At discharge

E. When administering IV meds

A, B, D

Rationale: medication reconciliation is done at every transition of care— admission, transfer, discharge, or before surgery to ensure accuracy and prevent errors

The nurse is administering medication through a nasogastric (NG) tube. What is the nurses priority action before giving the medication?

A.flush the tube with normal saline

B. Check the residual volume

C. Verify tube placement

D. Crush and mix all meds together

C. Verify tube placement

Rationale: always check that the NG tube is correctly placed in the stomach using pH paper, auscultate, aspirate, or X-ray confirmation before giving meds to prevent aspiration

What of the following statements by a nursing student indicates understanding of insulin administration?

A. "Ill give R insulin and NPH in two separate syringes"

B. "Ill draw up NPH first then regular insulin"

C. "Ill roll the NPH vial gently before drawing it up"

D. "Ill shake the insulin vial to mix it"

C

Rationale: NPH is a cloudy insulin and should be rolled to mix-never shaken. Also regular (clear) insulin is drawn up before NPH when mixing in one syringe

Which of the following is considered a high alert medication?

A. Heparin

B. Acetaminophen

C. Ibuprofen

D. Loratadine

B-Hepain

Rationale: heparin is a high alert med due to its high risk for causing bleeding if misdosed. It requires extra verification and monitoring

The provider orders a medication to be given once daily at 8:00 am. It is now 9:30 am. What should the nurse do?

A. Skip the dose and document

B. Give the medication and document the actual time

C. Call the provider for a new order

D. Double the dose to make up for the delay

B

Rationale: most meds have a safe window (usually 1 hr before or after scheduled time) but 930 is still reasonable. Never double the dose.

The nurse is giving ear drops to a 2 year old. How should the nurse position the ear?

A. Pull the pinna up and back

B. Pull the pinna straight out

C.pull the pinna down and back

D. Leave the ear alone and place drops near cannula

C. Pull pinna down and back

Rationale: For children under 3 pull the ear down and back. For adults its up and back

A nurse realizes they gave the wrong dose of a medication. What is the first action the nurse should take?

A. Notify the provider

B. Complete an incident report

C. Inform the supervisor

D. Assess the patient

D- Assess the patient

Rationale: Patient safety is the first priority. After assessing for adverse effects, then notify the provider and document per policy

Which of the following is the correct technique for giving eye drops?

A. Place drops directly on the cornea

B. Instill drops in the inner canthus

C. Pull down the lower lid and drop into the conjunctival sac

D. Have the patient squeeze their eyes tightly shut afterwards

C. Pull down the lower lid and drop into the conjunctive sac

Rationale: this is the correct and least irritating location for eye drops administration

The nurse is applying a new fentanyl transdermal patch. What is the nurses priority action

A. Remove the old patch before applying the new one

B. Apply lotion to the skin first

C. Shave the area and place the patch

D. Place the new patch over the old one for stronger effect

A

Rationale: failing to remove old patches can cause overdose due to stacking doses. Never double patches

At what angle should the nurse insert the needle for Intramuscular (IM) injections?

A. 15 degrees

B. 30 degrees

C. 45 degrees

D. 90 degrees

D- 90 degrees

Rationale: I'm injections go deep into the muscle, requiring 90 degree angle

Which of the following is an appropriate site for a subcutaneous injection?

A. Vastus Lateralis

B. Abdomen

C. Deltoid

D. Dorsogluteal

B-abdomen

Rationale: common SQ sites:abdomen, upper outer arm, anterior thigh. The abdomen is most often used for insulin and heparin

What is the typical needle length and gauge for a standard adult IM injection?

A. 5/8, 27 gauge

B. 1-1.5 in, 22-25 gauge

C. 2 in, 16 gauge

D. 1/2 in, 30 gauge

B

Rationale:IM injections require longer, thicker needles than SQ. The deltoid may only need 1 in; gluteal muscles often need 1.5 in

What is the purpose of the Z-track technique for IM injections?

A. To speed up absorption

B. To reduce pain at the site

C. To prevent medication from leaking into the subcutaneous tissue

D. To minimize bruising

C

Rationale: Z track creates a zig zag path that seals off the med deep in the muscle

At what angle should the nurse insert a subcutaneous injection for a thin patient with little subcutaneous tissue?

A. 15 degrees

B. 30 degrees

C. 90 degree

D. 45 degree

D-45 degree

Rationale: subcutaneous can go in at 45-90 degree depending on the patients body size and needle length. Use 45 degree for thin patients

The patient refuses a scheduled medication. What is the most appropriate action?

A. Leave the med at the bedside

B. Document "patient refused" and walk away

C. Ask the reason, educate if appropriate, and notify provider

D. Try again in one hour without telling anyone

C

Rationale: patients have the right to refuse but the nurse should assess the reason and ensure the provider is aware of the

The order says to give morphine 2 mg IV. The nurse gives it IM by mistake. Which medication right was violated?

A. Right route

B. Right drug

C. Right documentation

D. Right patient

A-right route

Rationale: the route must match the order exactly. IV and IM have different onset times and absorptions

After giving a scheduled dose of digoxin, the nurse forgets to document it. What is the most concerning risk?

A. The patient will miss their next dose

B. The nurse will have to complete an incident report

C. Another nurse may give a duplicate dose

D. The patient may experience low blood pressure

C

Rationale: failure to document can lead to double-dosing, a serious medical error

The nurse grabs a medication from the drawer labeled "hydralazine", but the vial says "hydroxyzine". What should the nurse do?

A. Give the med anyway- the names are similar

B. Double check with the patient before giving it

C. Administer only half the dose to be safe

D. Return the medication and report the error

D

Rationale: look alike sound alike (LASA) drugs are a major cause of med errors- always verify right drug before administering

Which scenario demonstrates the nurse checking the "right reason" for a medication?

A. The nurse gives acetaminophen because the patient asks for it

B. The nurse administers insulin without checking the blood sugar

C. The nurse checks the MAR and confirms the med is ordered

D. The nurse holds an anti hypertensive because the patients BP is low

D

Rationale: ensuring the med is appropriate for the patients current condition is part of the right reason and ensure

Which of the following orders should the nurse administer first?

A. Zofran 4mg IV PRN for nausea

B. Furosemide 40 mg IV STAT

C. Acetominophen 650 mg PO scheduled

D. Lorazepam 1 mg IV on call to procedure

B

Rationale: STAT orders are emergency, immediately so they take priority over PRN or routine orders