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2023 NGN Questions & Case Scenarios | Get A
Level 2 or Higher (Guarantee Pass)
SECTION 1: Pharmacological Principles & Safe Medication Administration
(Questions 1–25)
Question 1
A nurse is preparing to administer a medication to a client. Which action should
the nurse take FIRST to ensure safe medication administration?
A) Document the medication administration
B) Perform the three checks of medication administration
C) Verify the client's identity using two identifiers
D) Review the client's medication administration record
Correct Answer: C
Rationale: The nurse should first verify the client's identity using at least
two client identifiers (e.g., name and date of birth) before administering any
medication. This is the foundational step in the "Rights" of medication
administration and ensures the right client receives the medication. After
verification, the nurse performs the three checks, reviews the MAR, and
documents.
Question 2
A nurse is preparing to administer a medication via the IM route. Which angle
should the nurse use?
A) 15-degree angle
B) 45-degree angle
C) 90-degree angle
D) 10-degree angle
, Correct Answer: C
Rationale: Intramuscular (IM) injections are administered at a 90-degree
angle to ensure the medication is deposited into the muscle tissue. Subcutaneous
injections are given at a 45- or 90-degree angle depending on the amount of
subcutaneous tissue. Intradermal injections are given at a 5- to 15-degree angle.
Question 3
A medication has a half-life of 8 hours. Approximately how much of the
medication remains after 16 hours?
A) 75%
B) 50%
C) 25%
D) 12.5%
Correct Answer: C
Rationale: After one half-life (8 hours), 50% remains. After two half-lives
(16 hours), approximately 25% remains. This principle is essential for
understanding dosing intervals and steady-state concentrations.
Question 4
Which pharmacokinetic process describes the movement of a medication from
the bloodstream into tissues and organs?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: B
Rationale: Distribution is the movement of medication from the
circulation to tissues and organs. Absorption refers to movement from the site of
administration into the bloodstream. Metabolism (biotransformation) occurs
,primarily in the liver. Excretion eliminates medications through the kidneys, lungs,
or other routes.
Question 5
A client has severe hepatic impairment. Which medication process is most likely
affected?
A) Absorption
B) Distribution
C) Metabolism
D) Elimination through the lungs
Correct Answer: C
Rationale: The liver is the major site of medication metabolism
(biotransformation). Hepatic dysfunction can prolong medication effects and
increase the risk of toxicity because the liver cannot adequately metabolize drugs
into inactive or excretable forms.
Question 6
A nurse should question an order for an extended-release tablet when the
prescription instructs the nurse to:
A) Administer it with water
B) Give it once daily
C) Crush the tablet
D) Administer it at the same time each day
Correct Answer: C
Rationale: Crushing extended-release medications can release the drug
too rapidly, causing toxicity. Extended-release formulations are designed to
release medication slowly over time. Crushing, chewing, or splitting these tablets
destroys the delivery mechanism.
, Question 7
Which route generally produces the fastest systemic medication effect?
A) Oral
B) Subcutaneous
C) Intramuscular
D) Intravenous
Correct Answer: D
Rationale: IV administration delivers medication directly into the
bloodstream, bypassing absorption barriers. This results in the fastest onset of
action. Oral medications must undergo dissolution, absorption, and first-pass
metabolism.
Question 8
A nurse is preparing to administer a medication through an IV line. Which
assessment is MOST important during administration?
A) Hair color
B) IV site for infiltration or phlebitis
C) Appetite
D) Bowel pattern
Correct Answer: B
Rationale: IV medications can cause serious tissue injury if infiltration or
extravasation occurs. The nurse must assess the IV site for signs of infiltration
(swelling, coolness, pain) and phlebitis (redness, warmth, tenderness) before and
during administration.
Question 9
A client is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 68 bpm
B) Nausea and yellow-green halos
2023 NGN Questions & Case Scenarios | Get A
Level 2 or Higher (Guarantee Pass)
SECTION 1: Pharmacological Principles & Safe Medication Administration
(Questions 1–25)
Question 1
A nurse is preparing to administer a medication to a client. Which action should
the nurse take FIRST to ensure safe medication administration?
A) Document the medication administration
B) Perform the three checks of medication administration
C) Verify the client's identity using two identifiers
D) Review the client's medication administration record
Correct Answer: C
Rationale: The nurse should first verify the client's identity using at least
two client identifiers (e.g., name and date of birth) before administering any
medication. This is the foundational step in the "Rights" of medication
administration and ensures the right client receives the medication. After
verification, the nurse performs the three checks, reviews the MAR, and
documents.
Question 2
A nurse is preparing to administer a medication via the IM route. Which angle
should the nurse use?
A) 15-degree angle
B) 45-degree angle
C) 90-degree angle
D) 10-degree angle
, Correct Answer: C
Rationale: Intramuscular (IM) injections are administered at a 90-degree
angle to ensure the medication is deposited into the muscle tissue. Subcutaneous
injections are given at a 45- or 90-degree angle depending on the amount of
subcutaneous tissue. Intradermal injections are given at a 5- to 15-degree angle.
Question 3
A medication has a half-life of 8 hours. Approximately how much of the
medication remains after 16 hours?
A) 75%
B) 50%
C) 25%
D) 12.5%
Correct Answer: C
Rationale: After one half-life (8 hours), 50% remains. After two half-lives
(16 hours), approximately 25% remains. This principle is essential for
understanding dosing intervals and steady-state concentrations.
Question 4
Which pharmacokinetic process describes the movement of a medication from
the bloodstream into tissues and organs?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Correct Answer: B
Rationale: Distribution is the movement of medication from the
circulation to tissues and organs. Absorption refers to movement from the site of
administration into the bloodstream. Metabolism (biotransformation) occurs
,primarily in the liver. Excretion eliminates medications through the kidneys, lungs,
or other routes.
Question 5
A client has severe hepatic impairment. Which medication process is most likely
affected?
A) Absorption
B) Distribution
C) Metabolism
D) Elimination through the lungs
Correct Answer: C
Rationale: The liver is the major site of medication metabolism
(biotransformation). Hepatic dysfunction can prolong medication effects and
increase the risk of toxicity because the liver cannot adequately metabolize drugs
into inactive or excretable forms.
Question 6
A nurse should question an order for an extended-release tablet when the
prescription instructs the nurse to:
A) Administer it with water
B) Give it once daily
C) Crush the tablet
D) Administer it at the same time each day
Correct Answer: C
Rationale: Crushing extended-release medications can release the drug
too rapidly, causing toxicity. Extended-release formulations are designed to
release medication slowly over time. Crushing, chewing, or splitting these tablets
destroys the delivery mechanism.
, Question 7
Which route generally produces the fastest systemic medication effect?
A) Oral
B) Subcutaneous
C) Intramuscular
D) Intravenous
Correct Answer: D
Rationale: IV administration delivers medication directly into the
bloodstream, bypassing absorption barriers. This results in the fastest onset of
action. Oral medications must undergo dissolution, absorption, and first-pass
metabolism.
Question 8
A nurse is preparing to administer a medication through an IV line. Which
assessment is MOST important during administration?
A) Hair color
B) IV site for infiltration or phlebitis
C) Appetite
D) Bowel pattern
Correct Answer: B
Rationale: IV medications can cause serious tissue injury if infiltration or
extravasation occurs. The nurse must assess the IV site for signs of infiltration
(swelling, coolness, pain) and phlebitis (redness, warmth, tenderness) before and
during administration.
Question 9
A client is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 68 bpm
B) Nausea and yellow-green halos
