NR 224 Fundamentals Final UPDATED
ACTUAL Questions and CORRECT
Answers
A nurse knows that patient education has been effective when the patient states - CORRECT
ANSWER - "I will rotate the location where I give myself injections."
Which statement by the patient is an indication to use the Z-track method? - CORRECT
ANSWER - "The last shot like that turned my skin colors."
A 2-year-old child is ordered to have ear irrigation performed daily. The nurse correctly
performs the procedure by - CORRECT ANSWER - Pulling the auricle down and back to
straighten the ear canal.
A patient has an order to receive 10 units of U-50 insulin. The nurse is using a U-100 syringe.
How many units should the nurse draw up in the syringe and administer? - CORRECT
ANSWER - 20 units
A patient has an order to receive 20 units of U-50 insulin. The nurse is using a U-100 syringe.
How many units should the nurse draw up in the syringe and administer? - CORRECT
ANSWER - 0.4 mL
The patient is to receive phenytoin (Dilantin) at 0900. The nurse knows that the ideal time to
draw a trough level is - CORRECT ANSWER - 0830.
A patient who has been receiving intermittent chemotherapy through a peripheral IV site is
ordered to receive a high dose of vancomycin through the same vein. Why does this concern the
nurse? - CORRECT ANSWER - Chemotherapy is irritating to the vascular system and
may cause the vein to infiltrate.
A physician orders 1000 mL of normal saline to infuse at a rate of 50 mL/hr. The nurse plans on
hanging a new bag at what time? - CORRECT ANSWER - 20 hours
,The nurse is preparing to administer a 0.5-mL rabies vaccine into the deltoid muscle of a patient.
Which needle size is best for the procedure? - CORRECT ANSWER - 25 gauge x 5/8 inch
The nurse knows that the purpose of aspiration on IM injections is to - CORRECT
ANSWER - Ensure proper placement of the needle.
The nurse is giving an IM injection. Upon aspiration, the nurse notices blood return in the
syringe. What should the nurse do? - CORRECT ANSWER - Withdraw the needle and
prepare the injection again.
The nurse is planning to administer a tuberculin test with a 27-gauge, 3/8-inch needle. The nurse
should insert the needle at an angle of _____ degrees. - CORRECT ANSWER - 15
The nurse knows to assess for signs of medication toxicity within older adults because of which
physiological change? - CORRECT ANSWER - Reduced glomerular filtration
A registered nurse interprets that a scribbled medication order reads 25 mg. The nurse
administers 25 mg of the medication to a patient, and then discovers that the dose was incorrectly
interpreted and should have been 15 mg. Who is ultimately responsible for the error? -
CORRECT ANSWER - Nurse
A patient is to receive medication through a nasogastric tube. What is the most important nursing
action to ensure effective absorption? - CORRECT ANSWER - Clamp suction for 30 to 60
minutes after medication administration.
Aspirin is an analgesic, antipyretic, antiplatelet, and anti-inflammatory agent. A physician writes
for aspirin 650 mg every 4 to 6 hours prn: febrile. For which patient would this order be
appropriate? - CORRECT ANSWER - 62-year-old female with pneumonia
A patient is in need of immediate pain relief for a severe headache. The nurse knows that which
medication will be absorbed the quickest? - CORRECT ANSWER - Hydromorphone
(Dilaudid) 4 mg IV
, A drug requires a low pH to be metabolized. Knowing this, the nurse anticipates that the
medication will be administered by which route? - CORRECT ANSWER - Oral
The nurse knows that an idiosyncratic event with the stimulant pseudoephedrine (Sudafed) is
occurring when the patient - CORRECT ANSWER - Falls asleep during daily activities.
An order is written for (phenytoin) Dilantin 500 mg IM q3-4h prn for pain. The nurse recognizes
that treatment of pain is not a standard therapeutic indication for this drug. The nurse believes
that the prescriber meant to write for hydromorphone (Dilaudid). What should the nurse do? -
CORRECT ANSWER - Call the prescriber to clarify and justify the order.
A patient needs assistance excreting a gaseous medication. What is the correct nursing action? -
CORRECT ANSWER - Encourage the patient to cough and deep-breathe.
A nurse has withdrawn a narcotic from the medication dispenser. Upon checking the drug
against the medication administration record, the nurse notices that the narcotic order has
expired. What should be the nurse's first action? - CORRECT ANSWER - Return the
medication to the medication dispenser according to protocol.
The nurse knows that patient education about a buccal medication has been effective when the
patient states - CORRECT ANSWER - "I should let the medication dissolve completely."
What is the nurse's priority action to protect a patient from medication error? - CORRECT
ANSWER - Requesting that the prescriber write out an order, rather than giving a verbal
order
The patient is in severe pain and is requesting a prn medication before the prn time interval has
elapsed. The nurse's priority is to - CORRECT ANSWER - Call the prescriber and request
a stat order.
A patient is at risk for aspiration. What nursing action is most appropriate? - CORRECT
ANSWER - Have the patient self-administer the medication.
ACTUAL Questions and CORRECT
Answers
A nurse knows that patient education has been effective when the patient states - CORRECT
ANSWER - "I will rotate the location where I give myself injections."
Which statement by the patient is an indication to use the Z-track method? - CORRECT
ANSWER - "The last shot like that turned my skin colors."
A 2-year-old child is ordered to have ear irrigation performed daily. The nurse correctly
performs the procedure by - CORRECT ANSWER - Pulling the auricle down and back to
straighten the ear canal.
A patient has an order to receive 10 units of U-50 insulin. The nurse is using a U-100 syringe.
How many units should the nurse draw up in the syringe and administer? - CORRECT
ANSWER - 20 units
A patient has an order to receive 20 units of U-50 insulin. The nurse is using a U-100 syringe.
How many units should the nurse draw up in the syringe and administer? - CORRECT
ANSWER - 0.4 mL
The patient is to receive phenytoin (Dilantin) at 0900. The nurse knows that the ideal time to
draw a trough level is - CORRECT ANSWER - 0830.
A patient who has been receiving intermittent chemotherapy through a peripheral IV site is
ordered to receive a high dose of vancomycin through the same vein. Why does this concern the
nurse? - CORRECT ANSWER - Chemotherapy is irritating to the vascular system and
may cause the vein to infiltrate.
A physician orders 1000 mL of normal saline to infuse at a rate of 50 mL/hr. The nurse plans on
hanging a new bag at what time? - CORRECT ANSWER - 20 hours
,The nurse is preparing to administer a 0.5-mL rabies vaccine into the deltoid muscle of a patient.
Which needle size is best for the procedure? - CORRECT ANSWER - 25 gauge x 5/8 inch
The nurse knows that the purpose of aspiration on IM injections is to - CORRECT
ANSWER - Ensure proper placement of the needle.
The nurse is giving an IM injection. Upon aspiration, the nurse notices blood return in the
syringe. What should the nurse do? - CORRECT ANSWER - Withdraw the needle and
prepare the injection again.
The nurse is planning to administer a tuberculin test with a 27-gauge, 3/8-inch needle. The nurse
should insert the needle at an angle of _____ degrees. - CORRECT ANSWER - 15
The nurse knows to assess for signs of medication toxicity within older adults because of which
physiological change? - CORRECT ANSWER - Reduced glomerular filtration
A registered nurse interprets that a scribbled medication order reads 25 mg. The nurse
administers 25 mg of the medication to a patient, and then discovers that the dose was incorrectly
interpreted and should have been 15 mg. Who is ultimately responsible for the error? -
CORRECT ANSWER - Nurse
A patient is to receive medication through a nasogastric tube. What is the most important nursing
action to ensure effective absorption? - CORRECT ANSWER - Clamp suction for 30 to 60
minutes after medication administration.
Aspirin is an analgesic, antipyretic, antiplatelet, and anti-inflammatory agent. A physician writes
for aspirin 650 mg every 4 to 6 hours prn: febrile. For which patient would this order be
appropriate? - CORRECT ANSWER - 62-year-old female with pneumonia
A patient is in need of immediate pain relief for a severe headache. The nurse knows that which
medication will be absorbed the quickest? - CORRECT ANSWER - Hydromorphone
(Dilaudid) 4 mg IV
, A drug requires a low pH to be metabolized. Knowing this, the nurse anticipates that the
medication will be administered by which route? - CORRECT ANSWER - Oral
The nurse knows that an idiosyncratic event with the stimulant pseudoephedrine (Sudafed) is
occurring when the patient - CORRECT ANSWER - Falls asleep during daily activities.
An order is written for (phenytoin) Dilantin 500 mg IM q3-4h prn for pain. The nurse recognizes
that treatment of pain is not a standard therapeutic indication for this drug. The nurse believes
that the prescriber meant to write for hydromorphone (Dilaudid). What should the nurse do? -
CORRECT ANSWER - Call the prescriber to clarify and justify the order.
A patient needs assistance excreting a gaseous medication. What is the correct nursing action? -
CORRECT ANSWER - Encourage the patient to cough and deep-breathe.
A nurse has withdrawn a narcotic from the medication dispenser. Upon checking the drug
against the medication administration record, the nurse notices that the narcotic order has
expired. What should be the nurse's first action? - CORRECT ANSWER - Return the
medication to the medication dispenser according to protocol.
The nurse knows that patient education about a buccal medication has been effective when the
patient states - CORRECT ANSWER - "I should let the medication dissolve completely."
What is the nurse's priority action to protect a patient from medication error? - CORRECT
ANSWER - Requesting that the prescriber write out an order, rather than giving a verbal
order
The patient is in severe pain and is requesting a prn medication before the prn time interval has
elapsed. The nurse's priority is to - CORRECT ANSWER - Call the prescriber and request
a stat order.
A patient is at risk for aspiration. What nursing action is most appropriate? - CORRECT
ANSWER - Have the patient self-administer the medication.
