NURS 104L Fundamentals of Nursing Skills Lab - Week 12
Comprehensive Assessment 2026 |WCU
1. When administering an intramuscular (IM) injection using the Z-track
method, what is the primary purpose of this technique?
A. To ensure the medication reaches the subcutaneous layer
B. To increase the rate of absorption of the medication
C. To prevent the medication from leaking back into the subcutaneous tissue
D. To reduce the need for aspirating before the injection
Answer: C
Rationale: The Z-track method creates a zigzag path that seals the medication in the
muscle tissue, preventing irritation and leakage into the subcutaneous layer.
2. A nurse is preparing to administer 0.5 mL of a vaccine to an infant. Which site
is the most appropriate for this injection?
A. Deltoid muscle
B. Vastus lateralis muscle
C. Dorsogluteal muscle
D. Ventrogluteal muscle
Answer: B
Rationale: The vastus lateralis is the preferred site for intramuscular injections in infants
and toddlers because it is the most developed muscle at that age.
,3. Which of the following actions is a critical step during the ‘Third Check’ of
medication administration?
A. Comparing the medication label with the MAR at the patient’s bedside
B. Checking the expiration date while pulling the drug from the Pyxis
C. Documenting the administration immediately after the first check
D. Verifying the patient’s room number against the MAR
Answer: A
Rationale: The third check occurs at the bedside immediately before administering the
medication to ensure the right patient receives the right drug.
4. When mixing NPH and Regular insulin in the same syringe, what is the correct
sequence of actions?
A. Withdraw NPH, then withdraw Regular, then inject air into the vials
B. Inject air into Regular, then inject air into NPH, then withdraw NPH, then withdraw Regular
C. Withdraw Regular, then withdraw NPH, then inject air into both
D. Inject air into NPH, then inject air into Regular, then withdraw Regular, then withdraw NPH
Answer: D
Rationale: The correct sequence is air into cloudy (NPH), air into clear (Regular), draw
clear, then draw cloudy. This prevents contaminating the clear insulin with the cloudy
protein.
5. A patient is prescribed a sublingual medication. Which instruction should the
nurse provide?
A. Chew the tablet thoroughly before swallowing
B. Place the tablet between the cheek and the gum
C. Place the tablet under the tongue and let it dissolve completely
D. Drink a full glass of water immediately after placing the tablet
Answer: C
, Rationale: Sublingual medications must dissolve under the tongue for systemic absorption
via the capillary network; swallowing or drinking water would bypass this route.
6. Which needle gauge and length are most appropriate for a subcutaneous
injection in a normal-weight adult?
A. 18 gauge, 1.5 inch
B. 25 gauge, 5/8 inch
C. 22 gauge, 1 inch
D. 20 gauge, 1/2 inch
Answer: B
Rationale: Subcutaneous injections require shorter, finer needles, typically 25 to 27 gauge
and 3/8 to 5/8 inch in length.
7. The nurse is monitoring a peripheral IV site and notes coolness, pallor, and
swelling. Which complication is most likely?
A. Phlebitis
B. Extravasation of a vesicant
C. Thrombosis
D. Infiltration
Answer: D
Rationale: Infiltration is characterized by coolness and swelling as non-vesicant fluid
enters the surrounding tissue. Phlebitis would present with warmth and redness.
8. To locate the ventrogluteal site, the nurse places the palm over the greater
trochanter and the index finger on which landmark?
A. Posterior superior iliac spine
B. Anterior superior iliac spine
C. Iliac crest
D. Ischial tuberosity
Answer: B
Comprehensive Assessment 2026 |WCU
1. When administering an intramuscular (IM) injection using the Z-track
method, what is the primary purpose of this technique?
A. To ensure the medication reaches the subcutaneous layer
B. To increase the rate of absorption of the medication
C. To prevent the medication from leaking back into the subcutaneous tissue
D. To reduce the need for aspirating before the injection
Answer: C
Rationale: The Z-track method creates a zigzag path that seals the medication in the
muscle tissue, preventing irritation and leakage into the subcutaneous layer.
2. A nurse is preparing to administer 0.5 mL of a vaccine to an infant. Which site
is the most appropriate for this injection?
A. Deltoid muscle
B. Vastus lateralis muscle
C. Dorsogluteal muscle
D. Ventrogluteal muscle
Answer: B
Rationale: The vastus lateralis is the preferred site for intramuscular injections in infants
and toddlers because it is the most developed muscle at that age.
,3. Which of the following actions is a critical step during the ‘Third Check’ of
medication administration?
A. Comparing the medication label with the MAR at the patient’s bedside
B. Checking the expiration date while pulling the drug from the Pyxis
C. Documenting the administration immediately after the first check
D. Verifying the patient’s room number against the MAR
Answer: A
Rationale: The third check occurs at the bedside immediately before administering the
medication to ensure the right patient receives the right drug.
4. When mixing NPH and Regular insulin in the same syringe, what is the correct
sequence of actions?
A. Withdraw NPH, then withdraw Regular, then inject air into the vials
B. Inject air into Regular, then inject air into NPH, then withdraw NPH, then withdraw Regular
C. Withdraw Regular, then withdraw NPH, then inject air into both
D. Inject air into NPH, then inject air into Regular, then withdraw Regular, then withdraw NPH
Answer: D
Rationale: The correct sequence is air into cloudy (NPH), air into clear (Regular), draw
clear, then draw cloudy. This prevents contaminating the clear insulin with the cloudy
protein.
5. A patient is prescribed a sublingual medication. Which instruction should the
nurse provide?
A. Chew the tablet thoroughly before swallowing
B. Place the tablet between the cheek and the gum
C. Place the tablet under the tongue and let it dissolve completely
D. Drink a full glass of water immediately after placing the tablet
Answer: C
, Rationale: Sublingual medications must dissolve under the tongue for systemic absorption
via the capillary network; swallowing or drinking water would bypass this route.
6. Which needle gauge and length are most appropriate for a subcutaneous
injection in a normal-weight adult?
A. 18 gauge, 1.5 inch
B. 25 gauge, 5/8 inch
C. 22 gauge, 1 inch
D. 20 gauge, 1/2 inch
Answer: B
Rationale: Subcutaneous injections require shorter, finer needles, typically 25 to 27 gauge
and 3/8 to 5/8 inch in length.
7. The nurse is monitoring a peripheral IV site and notes coolness, pallor, and
swelling. Which complication is most likely?
A. Phlebitis
B. Extravasation of a vesicant
C. Thrombosis
D. Infiltration
Answer: D
Rationale: Infiltration is characterized by coolness and swelling as non-vesicant fluid
enters the surrounding tissue. Phlebitis would present with warmth and redness.
8. To locate the ventrogluteal site, the nurse places the palm over the greater
trochanter and the index finger on which landmark?
A. Posterior superior iliac spine
B. Anterior superior iliac spine
C. Iliac crest
D. Ischial tuberosity
Answer: B
