NR 224: Fundamentals of Nursing Practice Skills The Essential Exam Readiness and Study Manual: Complete Test Bank Review, Advanced Practice Questions, Comprehensive Study Guide, and Final Preparation Assessment

A nurse is evaluating whether a patient understands instructions for daily subcutaneous insulin administration. Which statement demonstrates correct knowledge of injectionsite care? A. “I will use the same abdominal site because it provides consistent absorption.” B. “I will rotate injection sites within the recommended anatomical areas.” C. “I will massage the injection site vigorously after each injection.” D. “I will inject into areas that feel firm because they are easier to locate.” Correct Answer: B. “I will rotate injection sites within the recommended anatomical areas.” Rationale: Rotating injection sites helps prevent lipohypertrophy, tissue damage, and inconsistent insulin absorption. Repeatedly using the same location can cause hardened or fatty tissue. Vigorous massage may alter absorption and increase bruising. Firm or abnormal tissue should be avoided because medication absorption may be unreliable. Question 2 A patient is scheduled to receive a deep intramuscular medication and reports that the previous injection left a dark stain on the skin. Which technique should the nurse consider? A. Intradermal injection B. Air-lock injection C. Z-track injection D. Subcutaneous injection Correct Answer: C. Z-track injection Rationale: The Z-track technique displaces the skin and subcutaneous tissue before an intramuscular injection and creates a seal when the tissue is released. This technique is particularly useful for irritating or staining medications. Intradermal and subcutaneous injections deliver medication into more superficial tissues, while the air-lock technique does not provide the same tissue seal. Question 3 A nurse is irrigating the ear of a 2-year-old child. Which action correctly straightens the external auditory canal? A. Pull the auricle upward and backward. B. Pull the auricle downward and backward. C. Pull the auricle directly outward. D. Pull the tragus upward and forward. Correct Answer: B. Pull the auricle downward and backward. Rationale: In children younger than approximately 3 years, the auditory canal is straightened by gently pulling the auricle downward and backward. In older children and adults, the auricle is pulled upward and backward. Pulling directly outward or manipulating the tragus does not adequately straighten the canal. Question 4 A patient is prescribed 10 units of U-50 insulin, but only a U-100 insulin syringe is available. At which calibration would 0.2 mL appear on the U-100 syringe? A. 5-unit mark B. 10-unit mark C. 20-unit mark D. 50-unit mark Correct Answer: C. 20-unit mark Rationale: U-50 insulin contains 50 units/mL. Therefore: 10 units ÷ 50 units/mL = 0.2 mL On a U-100 syringe, 0.2 mL corresponds to the 20-unit calibration. Because mismatching insulin concentrations and syringes can cause serious medication errors, the nurse should obtain the appropriate device or follow an approved, independently verified protocol. Question 5 A patient is prescribed 20 units of U-50 insulin. What volume contains the prescribed dose? A. 0.2 mL B. 0.4 mL C. 0.5 mL D. 2 mL Correct Answer: B. 0.4 mL Rationale: The volume is calculated by dividing the prescribed dose by the concentration: 20 units ÷ 50 units/mL = 0.4 mL A volume of 0.2 mL contains only 10 units, while 0.5 mL contains 25 units. Two millilitres would contain 100 units and could result in a dangerous overdose. Question 6 A patient receives phenytoin daily at 0900, and the provider orders a serum trough level. When should the nurse collect the specimen? A. At 0830, shortly before the scheduled dose B. At 0900, immediately after administering the dose C. At 1000, one hour after the dose D. At 1200, halfway between scheduled doses Correct Answer: A. At 0830, shortly before the scheduled dose Rationale: A trough level represents the lowest serum concentration and is collected immediately before the next scheduled dose. Collecting the specimen after administration could produce a rising or peak-related concentration and would not accurately represent the trough level. Question 7 A patient has received intermittent chemotherapy through a peripheral IV catheter. A high dose of vancomycin is subsequently prescribed through the same catheter. Which concern should the nurse address first? A. Chemotherapy may have damaged the vein and increased the risk of infiltration or phlebitis. B. Vancomycin becomes inactive when administered after chemotherapy. C. Chemotherapy prevents vancomycin from entering the bloodstream. D. Vancomycin must always be administered through an arterial catheter. Correct Answer: A. Chemotherapy may have damaged the vein and increased the risk of infiltration or phlebitis. Rationale: Chemotherapy agents can irritate vascular tissue and compromise the integrity of a peripheral vein. Vancomycin can also irritate the vein and requires a patent, carefully monitored IV site. The medications do not necessarily inactivate one another, and vancomycin is administered intravenously rather than through an arterial catheter. Question 8 A provider prescribes 1,000 mL of normal saline to infuse at 50 mL/hr. If the infusion begins at 0800 and continues without interruption, when will the bag be empty? A. 1600 the same day B. 2000 the same day C. 0400 the following day D. 0800 the following day Correct Answer: C. 0400 the following day Rationale: Infusion time is calculated as: 1,000 mL ÷ 50 mL/hr = 20 hours Twenty hours after 0800 is 0400 the following day. The other options represent different infusion durations and would not deliver the prescribed volume at the prescribed rate. Question 9 A 55-kg adult is prescribed a 0.5-mL intramuscular rabies vaccine in the deltoid. The nurse plans to stretch the skin tightly without bunching it. Which needle may be appropriate? A. 18 gauge × 2 inches B. 21 gauge × 1½ inches C. 25 gauge × ⅝ inch D. 27 gauge × ¼ inch Correct Answer: C. 25 gauge × ⅝ inch Rationale: Intramuscular vaccines are commonly administered with a 22- to 25-gauge needle. A ⅝-inch needle may be considered for an adult weighing less than 60 kg when the skin is stretched tightly and the tissue is not bunched. Needle selection should consider patient size, injection site, and technique. Question 10 A nurse is preparing to administer an intramuscular vaccine at the recommended deltoid site. Which action reflects current vaccine-administration guidance? A. Aspirate for blood for at least 10 seconds before injecting. B. Aspirate only when administering a live vaccine. C. Inject the vaccine without aspiration. D. Aspirate and redirect the needle if blood appears. Correct Answer: C. Inject the vaccine without aspiration. Rationale: Aspiration is not recommended when vaccines are administered at approved intramuscular sites because major blood vessels are not located in the recommended injection areas. Avoiding aspiration also reduces procedure time and discomfort. Correct landmark identification, appropriate needle length and angle, and proper tissue penetration remain essential for safe administration.