NSG 434 Level 1-4 Medication
Administration Preparation Worksheet | 2026
Update with complete solutions - GCU.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
143 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses the Level 1-4 medication administration competencies for pre-licensure nursing students,
covering dosage calculation, safe administration practices, high-alert medications, and documentation. It
integrates the 2026 updates to the nursing curriculum, emphasizing current standards from the Joint
Commission, ISMP, and QSEN. Items require application of the 'rights' of medication administration, clinical
judgment, and error prevention.
STUDY GUIDE
Recommended duration: 2 hours. Passing target: 80%.
HIGHP - Page 1 of 48
,1. A nurse is preparing to administer subcutaneous insulin. Which action best reflects the
2026 updated guideline for preventing insulin pen misuse?
[ ] A. Always prime the pen with 2 units before each injection.
[ ] B. Use the same pen for multiple patients if a new needle is attached.
[ ] C. Store the pen with the needle attached to maintain sterility.
[ ] D. Shake the pen vigorously to ensure even suspension before injection.
CORRECT: A. Always prime the pen with 2 units before each injection.
Current guidelines require priming insulin pens with 2 units to ensure patency and remove air, which is critical
for accurate dosing. Using the same pen for multiple patients is a violation of infection control standards.
Storing the pen with the needle attached can lead to air introduction and contamination. Shaking is only
appropriate for certain suspensions, but vigorous shaking is incorrect; insulin pens should be gently rolled if
needed.
2. A patient is prescribed 0.5 mg of digoxin IV push. The vial is labeled 0.25 mg/mL. How
many mL will the nurse administer?
[ ] A. 0.5 mL
[ ] B. 1 mL
[ ] C. 2 mL
[ ] D. 2.5 mL
CORRECT: C. 2 mL
Desired dose is 0.5 mg. Concentration is 0.25 mg/mL. Set up: (0.5 mg / 0.25 mg) × 1 mL = 2 mL. Options A,
B, and D are incorrect because they miscalculate the ratio, leading to under- or overdose.
3. Which statement best describes the current (2026) Joint Commission National Patient
Safety Goal for medication administration?
[ ] A. Use only verbal orders for high-alert medications to ensure rapid administration.
[ ] B. Implement standardized concentrations for IV medications and limit the number of drug
concentrations.
[ ] C. Allow nurses to transcribe medication orders without verification to save time.
[ ] D. Require patients to self-administer all medications to reduce nursing errors.
CORRECT: B. Implement standardized concentrations for IV medications and limit the number of
drug concentrations.
The Joint Commission emphasizes standardizing concentrations for IV medications and limiting the variety of
concentrations to reduce errors. Verbal orders are discouraged except in emergencies. Independent
double-check is required for high-alert medications, not transcription without verification. Patient
self-administration is not a safety goal; it may be appropriate in some settings but not a universal
requirement.
HIGHP - Page 2 of 48
,4. A nurse is administering a high-alert medication via a smart infusion pump. Which
action is essential to prevent a programming error?
[ ] A. Override the drug library alert if the dose seems reasonable.
[ ] B. Use the hospital's standard concentration and activate the drug library.
[ ] C. Bypass the pump's safety software to expedite administration.
[ ] D. Program the pump without verifying the rate with a second nurse.
CORRECT: B. Use the hospital's standard concentration and activate the drug library.
Using the hospital's standard concentration and activating the drug library ensures the pump's safety
software can catch programming errors. Overriding alerts without verification increases risk. Bypassing safety
software is unsafe. Independent double-check is required for high-alert medications, so not verifying with a
second nurse is incorrect.
5. A patient is prescribed 1,000 mL of 0.9% NaCl to infuse over 8 hours. The drop factor is
15 gtt/mL. What is the flow rate in drops per minute? (Round to the nearest whole
number.)
[ ] A. 31 gtt/min
[ ] B. 32 gtt/min
[ ] C. 33 gtt/min
[ ] D. 34 gtt/min
CORRECT: A. 31 gtt/min
Total volume 1000 mL over 8 hours = 125 mL/hr. Flow rate = (125 mL/hr × 15 gtt/mL) / 60 min = 31.25
gtt/min, rounded to 31 gtt/min. Options B, C, and D are incorrect due to rounding errors or miscalculation.
6. Which of the following is a correct technique for administering a subcutaneous
injection of heparin?
[ ] A. Aspirate before injecting to check for blood return.
[ ] B. Massage the site after injection to enhance absorption.
[ ] C. Insert the needle at a 90-degree angle and do not aspirate.
[ ] D. Use a 1-inch needle and inject into the deltoid muscle.
CORRECT: C. Insert the needle at a 90-degree angle and do not aspirate.
For subcutaneous heparin, the needle is inserted at a 90-degree angle (or 45 if thin patient) and aspiration is
not performed to avoid hematoma. Massaging is contraindicated as it increases bruising. A 1-inch needle is
too long for subcutaneous; deltoid is for IM injections.
7. A nurse is preparing to administer a medication via a nasogastric tube. Which action is
most appropriate to ensure patient safety?
[ ] A. Administer the medication with the patient in a supine position.
HIGHP - Page 3 of 48
, [ ] B. Mix all medications together to simplify administration.
[ ] C. Verify tube placement by aspirating gastric contents and checking pH.
[ ] D. Flush the tube with 5 mL of water before and after each medication.
CORRECT: C. Verify tube placement by aspirating gastric contents and checking pH.
Verifying tube placement by aspirating gastric contents and checking pH (typically 5.5) is essential to prevent
administration into the lungs. Supine position increases aspiration risk; head of bed should be elevated.
Mixing medications can cause interactions or precipitation. Flushing with 5 mL may be insufficient; typically
15-30 mL is recommended.
8. Which statement accurately reflects the 2026 ISMP guideline for safe use of
look-alike/sound-alike (LASA) medications?
[ ] A. Store LASA medications next to each other to facilitate comparison.
[ ] B. Use tall man lettering on labels to differentiate LASA medications.
[ ] C. Allow verbal orders for LASA medications to avoid spelling errors.
[ ] D. Rely on the patient's knowledge to identify the correct medication.
CORRECT: B. Use tall man lettering on labels to differentiate LASA medications.
ISMP recommends tall man lettering (e.g., DOBUTamine vs. DOPamine) to highlight differences in LASA
drug names. Storing them together increases risk. Verbal orders are discouraged. Patient knowledge is not a
reliable safety strategy.
9. A nurse is documenting medication administration in the electronic health record
(EHR). Which action best adheres to current documentation standards?
[ ] A. Document the medication as given before actually administering it.
[ ] B. Chart the dose and time after administration, including any patient response.
[ ] C. Use a personal shorthand to save time, as long as it's understood by colleagues.
[ ] D. Omit documentation if the medication was refused by the patient.
CORRECT: B. Chart the dose and time after administration, including any patient response.
Documentation should occur immediately after administration and include dose, time, route, site, and patient
response. Pre-charting is unsafe. Shorthand may be misinterpreted. Refusals must be documented, along
with the reason and notification of the provider.
10. A nurse is preparing to administer a medication via the intramuscular route. Which
landmark is most appropriate for identifying the ventrogluteal site in an adult patient?
[ ] A. The greater trochanter, anterior superior iliac spine, and iliac crest
[ ] B. The acromion process and deltoid tuberosity of the humerus
[ ] C. The posterior superior iliac spine and the sciatic nerve
[ ] D. The rectus femoris and vastus lateralis of the thigh
HIGHP - Page 4 of 48
Administration Preparation Worksheet | 2026
Update with complete solutions - GCU.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
143 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses the Level 1-4 medication administration competencies for pre-licensure nursing students,
covering dosage calculation, safe administration practices, high-alert medications, and documentation. It
integrates the 2026 updates to the nursing curriculum, emphasizing current standards from the Joint
Commission, ISMP, and QSEN. Items require application of the 'rights' of medication administration, clinical
judgment, and error prevention.
STUDY GUIDE
Recommended duration: 2 hours. Passing target: 80%.
HIGHP - Page 1 of 48
,1. A nurse is preparing to administer subcutaneous insulin. Which action best reflects the
2026 updated guideline for preventing insulin pen misuse?
[ ] A. Always prime the pen with 2 units before each injection.
[ ] B. Use the same pen for multiple patients if a new needle is attached.
[ ] C. Store the pen with the needle attached to maintain sterility.
[ ] D. Shake the pen vigorously to ensure even suspension before injection.
CORRECT: A. Always prime the pen with 2 units before each injection.
Current guidelines require priming insulin pens with 2 units to ensure patency and remove air, which is critical
for accurate dosing. Using the same pen for multiple patients is a violation of infection control standards.
Storing the pen with the needle attached can lead to air introduction and contamination. Shaking is only
appropriate for certain suspensions, but vigorous shaking is incorrect; insulin pens should be gently rolled if
needed.
2. A patient is prescribed 0.5 mg of digoxin IV push. The vial is labeled 0.25 mg/mL. How
many mL will the nurse administer?
[ ] A. 0.5 mL
[ ] B. 1 mL
[ ] C. 2 mL
[ ] D. 2.5 mL
CORRECT: C. 2 mL
Desired dose is 0.5 mg. Concentration is 0.25 mg/mL. Set up: (0.5 mg / 0.25 mg) × 1 mL = 2 mL. Options A,
B, and D are incorrect because they miscalculate the ratio, leading to under- or overdose.
3. Which statement best describes the current (2026) Joint Commission National Patient
Safety Goal for medication administration?
[ ] A. Use only verbal orders for high-alert medications to ensure rapid administration.
[ ] B. Implement standardized concentrations for IV medications and limit the number of drug
concentrations.
[ ] C. Allow nurses to transcribe medication orders without verification to save time.
[ ] D. Require patients to self-administer all medications to reduce nursing errors.
CORRECT: B. Implement standardized concentrations for IV medications and limit the number of
drug concentrations.
The Joint Commission emphasizes standardizing concentrations for IV medications and limiting the variety of
concentrations to reduce errors. Verbal orders are discouraged except in emergencies. Independent
double-check is required for high-alert medications, not transcription without verification. Patient
self-administration is not a safety goal; it may be appropriate in some settings but not a universal
requirement.
HIGHP - Page 2 of 48
,4. A nurse is administering a high-alert medication via a smart infusion pump. Which
action is essential to prevent a programming error?
[ ] A. Override the drug library alert if the dose seems reasonable.
[ ] B. Use the hospital's standard concentration and activate the drug library.
[ ] C. Bypass the pump's safety software to expedite administration.
[ ] D. Program the pump without verifying the rate with a second nurse.
CORRECT: B. Use the hospital's standard concentration and activate the drug library.
Using the hospital's standard concentration and activating the drug library ensures the pump's safety
software can catch programming errors. Overriding alerts without verification increases risk. Bypassing safety
software is unsafe. Independent double-check is required for high-alert medications, so not verifying with a
second nurse is incorrect.
5. A patient is prescribed 1,000 mL of 0.9% NaCl to infuse over 8 hours. The drop factor is
15 gtt/mL. What is the flow rate in drops per minute? (Round to the nearest whole
number.)
[ ] A. 31 gtt/min
[ ] B. 32 gtt/min
[ ] C. 33 gtt/min
[ ] D. 34 gtt/min
CORRECT: A. 31 gtt/min
Total volume 1000 mL over 8 hours = 125 mL/hr. Flow rate = (125 mL/hr × 15 gtt/mL) / 60 min = 31.25
gtt/min, rounded to 31 gtt/min. Options B, C, and D are incorrect due to rounding errors or miscalculation.
6. Which of the following is a correct technique for administering a subcutaneous
injection of heparin?
[ ] A. Aspirate before injecting to check for blood return.
[ ] B. Massage the site after injection to enhance absorption.
[ ] C. Insert the needle at a 90-degree angle and do not aspirate.
[ ] D. Use a 1-inch needle and inject into the deltoid muscle.
CORRECT: C. Insert the needle at a 90-degree angle and do not aspirate.
For subcutaneous heparin, the needle is inserted at a 90-degree angle (or 45 if thin patient) and aspiration is
not performed to avoid hematoma. Massaging is contraindicated as it increases bruising. A 1-inch needle is
too long for subcutaneous; deltoid is for IM injections.
7. A nurse is preparing to administer a medication via a nasogastric tube. Which action is
most appropriate to ensure patient safety?
[ ] A. Administer the medication with the patient in a supine position.
HIGHP - Page 3 of 48
, [ ] B. Mix all medications together to simplify administration.
[ ] C. Verify tube placement by aspirating gastric contents and checking pH.
[ ] D. Flush the tube with 5 mL of water before and after each medication.
CORRECT: C. Verify tube placement by aspirating gastric contents and checking pH.
Verifying tube placement by aspirating gastric contents and checking pH (typically 5.5) is essential to prevent
administration into the lungs. Supine position increases aspiration risk; head of bed should be elevated.
Mixing medications can cause interactions or precipitation. Flushing with 5 mL may be insufficient; typically
15-30 mL is recommended.
8. Which statement accurately reflects the 2026 ISMP guideline for safe use of
look-alike/sound-alike (LASA) medications?
[ ] A. Store LASA medications next to each other to facilitate comparison.
[ ] B. Use tall man lettering on labels to differentiate LASA medications.
[ ] C. Allow verbal orders for LASA medications to avoid spelling errors.
[ ] D. Rely on the patient's knowledge to identify the correct medication.
CORRECT: B. Use tall man lettering on labels to differentiate LASA medications.
ISMP recommends tall man lettering (e.g., DOBUTamine vs. DOPamine) to highlight differences in LASA
drug names. Storing them together increases risk. Verbal orders are discouraged. Patient knowledge is not a
reliable safety strategy.
9. A nurse is documenting medication administration in the electronic health record
(EHR). Which action best adheres to current documentation standards?
[ ] A. Document the medication as given before actually administering it.
[ ] B. Chart the dose and time after administration, including any patient response.
[ ] C. Use a personal shorthand to save time, as long as it's understood by colleagues.
[ ] D. Omit documentation if the medication was refused by the patient.
CORRECT: B. Chart the dose and time after administration, including any patient response.
Documentation should occur immediately after administration and include dose, time, route, site, and patient
response. Pre-charting is unsafe. Shorthand may be misinterpreted. Refusals must be documented, along
with the reason and notification of the provider.
10. A nurse is preparing to administer a medication via the intramuscular route. Which
landmark is most appropriate for identifying the ventrogluteal site in an adult patient?
[ ] A. The greater trochanter, anterior superior iliac spine, and iliac crest
[ ] B. The acromion process and deltoid tuberosity of the humerus
[ ] C. The posterior superior iliac spine and the sciatic nerve
[ ] D. The rectus femoris and vastus lateralis of the thigh
HIGHP - Page 4 of 48
