NURS 104L: Medication Administration Skills Competency (Oral, IM,
SQ) 2026 |WCU
1. When administering a medication via the Z-track method, what is the primary
rationale for this specific technique?
A. To prevent the medication from leaking back into the subcutaneous tissue
B. To ensure the medication enters the subcutaneous tissue layer
C. To decrease the speed of absorption for long-acting medications
D. To eliminate the need for aspiration during the injection
Answer: A
Rationale: The Z-track method is used in IM injections to prevent medication from leaking
into the subcutaneous tissue, which reduces skin irritation and ensures the full dose
remains in the muscle.
2. Which landmark is used to identify the Ventrogluteal injection site?
A. The acromion process and the axillary line
B. The posterior superior iliac spine and the coccyx
C. The lateral femoral condyle and the greater trochanter
D. The greater trochanter, anterior superior iliac spine, and iliac crest
Answer: D
Rationale: To locate the Ventrogluteal site, place the palm over the greater trochanter, the
index finger on the anterior superior iliac spine, and extend the middle finger toward the
iliac crest.
,3. A nurse is preparing to administer 0.5 mL of a non-irritating medication to a
well-developed 25-year-old adult. Which needle gauge and length is most
appropriate for a Deltoid IM injection?
A. 25-gauge, 5/8 inch
B. 23-gauge, 1 to 1.5 inch
C. 18-gauge, 1.5 inch
D. 27-gauge, 1/2 inch
Answer: B
Rationale: For an adult IM injection in the deltoid, a 23-25 gauge needle that is 1 to 1.5
inches long is standard to ensure the medication reaches the muscle mass.
4. When mixing Rapid-acting insulin and Intermediate-acting insulin in one
syringe, which step is performed first?
A. Inject air into the Intermediate-acting (Cloudy) insulin vial
B. Inject air into the Rapid-acting (Clear) insulin vial
C. Draw up the Intermediate-acting (Cloudy) insulin
D. Draw up the Rapid-acting (Clear) insulin
Answer: A
Rationale: The correct sequence is air into Cloudy, air into Clear, draw up Clear, draw up
Cloudy (‘Clear before Cloudy’).
5. What is the maximum volume of medication that should be administered in a
single Subcutaneous injection for an adult?
A. 0.5 mL
B. 5.0 mL
C. 3.0 mL
D. 1.5 mL
Answer: D
, Rationale: Subcutaneous tissue is sensitive to volume; typically, no more than 1.5 mL
should be injected at a single site to prevent tissue damage and pain.
6. A nurse is preparing to administer Heparin subcutaneously. Which action by
the nurse is correct?
A. Massage the site after injection to speed absorption
B. Inject into the abdomen at least 2 inches away from the umbilicus
C. Aspirate for blood return before injecting
D. Use a 1.5-inch needle at a 90-degree angle
Answer: B
Rationale: Heparin should be injected into the abdominal fat pad, avoiding the area within
2 inches of the umbilicus. Massaging and aspiration are contraindicated as they increase
hematoma risk.
7. Which of the following oral medications can be safely crushed for a patient
with dysphagia?
A. Immediate-release Acetaminophen
B. Sustained-release (SR) Morphine
C. Extended-release (XL) Wellbutrin
D. Enteric-coated Aspirin
Answer: A
Rationale: Only immediate-release tablets should be crushed. Enteric-coated (EC),
sustained-release (SR), and extended-release (XL/XR) medications must remain intact to
maintain their pharmacokinetics.
SQ) 2026 |WCU
1. When administering a medication via the Z-track method, what is the primary
rationale for this specific technique?
A. To prevent the medication from leaking back into the subcutaneous tissue
B. To ensure the medication enters the subcutaneous tissue layer
C. To decrease the speed of absorption for long-acting medications
D. To eliminate the need for aspiration during the injection
Answer: A
Rationale: The Z-track method is used in IM injections to prevent medication from leaking
into the subcutaneous tissue, which reduces skin irritation and ensures the full dose
remains in the muscle.
2. Which landmark is used to identify the Ventrogluteal injection site?
A. The acromion process and the axillary line
B. The posterior superior iliac spine and the coccyx
C. The lateral femoral condyle and the greater trochanter
D. The greater trochanter, anterior superior iliac spine, and iliac crest
Answer: D
Rationale: To locate the Ventrogluteal site, place the palm over the greater trochanter, the
index finger on the anterior superior iliac spine, and extend the middle finger toward the
iliac crest.
,3. A nurse is preparing to administer 0.5 mL of a non-irritating medication to a
well-developed 25-year-old adult. Which needle gauge and length is most
appropriate for a Deltoid IM injection?
A. 25-gauge, 5/8 inch
B. 23-gauge, 1 to 1.5 inch
C. 18-gauge, 1.5 inch
D. 27-gauge, 1/2 inch
Answer: B
Rationale: For an adult IM injection in the deltoid, a 23-25 gauge needle that is 1 to 1.5
inches long is standard to ensure the medication reaches the muscle mass.
4. When mixing Rapid-acting insulin and Intermediate-acting insulin in one
syringe, which step is performed first?
A. Inject air into the Intermediate-acting (Cloudy) insulin vial
B. Inject air into the Rapid-acting (Clear) insulin vial
C. Draw up the Intermediate-acting (Cloudy) insulin
D. Draw up the Rapid-acting (Clear) insulin
Answer: A
Rationale: The correct sequence is air into Cloudy, air into Clear, draw up Clear, draw up
Cloudy (‘Clear before Cloudy’).
5. What is the maximum volume of medication that should be administered in a
single Subcutaneous injection for an adult?
A. 0.5 mL
B. 5.0 mL
C. 3.0 mL
D. 1.5 mL
Answer: D
, Rationale: Subcutaneous tissue is sensitive to volume; typically, no more than 1.5 mL
should be injected at a single site to prevent tissue damage and pain.
6. A nurse is preparing to administer Heparin subcutaneously. Which action by
the nurse is correct?
A. Massage the site after injection to speed absorption
B. Inject into the abdomen at least 2 inches away from the umbilicus
C. Aspirate for blood return before injecting
D. Use a 1.5-inch needle at a 90-degree angle
Answer: B
Rationale: Heparin should be injected into the abdominal fat pad, avoiding the area within
2 inches of the umbilicus. Massaging and aspiration are contraindicated as they increase
hematoma risk.
7. Which of the following oral medications can be safely crushed for a patient
with dysphagia?
A. Immediate-release Acetaminophen
B. Sustained-release (SR) Morphine
C. Extended-release (XL) Wellbutrin
D. Enteric-coated Aspirin
Answer: A
Rationale: Only immediate-release tablets should be crushed. Enteric-coated (EC),
sustained-release (SR), and extended-release (XL/XR) medications must remain intact to
maintain their pharmacokinetics.
