CPNRE 5TH EDITION WITH QUESTIONS
AND ANSWERS 2025 UPDATE.
The nurse is administering heparin via the subcutaneous route. Which intervention should the
nurse implement?
a. Prepare the medication using a 25-gauge, ½ inch needle
b. After injecting the needle, aspirate and observe for blood
c. After removing the needle, massage the area gently
d. Administer the medication in the client's "love handles" - ANS a
The nurse is administering morning medications on a medical floor. Which medication should
the nurse administer first?
a. Regular insulin sliding scale to an elderly client diagnosed with Type 1 diabetes mellitus
b. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus
c. Morphine, a narcotic analgesic, to a client diagnosed with AIDS
d. Lasix, a diuretic, to a client with hypertension - ANS a
Which data would indicate that the antibiotic therapy has been successful for a client diagnosed
with bacterial pneumonia?
a. The client's hematocrit is within normal range
b. The client is expectorating thick green sputum
c. The client's lung sounds are clear to ausculatation
d. The client has complaints of pleuritic chest pain. - ANS c
The nurse is administering Humalog at 0730 to a client diagnosed with Type 1 diabetes. Which
intervention should the nurse implement?
a. Ensure the client eats at least 90% of the lunch tray
b. Do not administer unless the breakfast tray is in the client's room
c. Check the client's blood glucose level 1 hour after receiving the insulin
d. Have 50% dextrose in water at the bedside for emergency use. - ANS b
The client has a severe anaphylactic reaction to insect bites. What priority discharge intervention
should the nurse discuss with the client?
a. Wear an insect repellent on exposed skin
b. Keep prescribed antihistamines on their person
c. Keep an EpiPen in the refrigerator at all times
d. Wear a MedicAlert identification bracelet - ANS d
,The client's mother contacts the clinic regarding medication administration stating, "My daughter
cannot swallow this capsule. It's too large." Investigation reveals that the medication is a capsule
marked SR. The nurse should instruct the mother to:
a. Open the capsule and mix the medication with apple sauce
b. Crush the medication and administer it with a glass of liquid
c. Call the pharmacist and request a change to a different medication
d. Stop the medication and inform the physician - ANS d
The client calls the nursing station and requests pain medication. When the nurse enters the room
with the narcotic medication, the nurse finds the client laughing and talking with visitors. Which
action should the nurse administer first?
a. Administer the client's prescribed pain medication
b. Assess the client's perception of pain on a 1-10 scale
c. Wait until the visitors leave to administer any medication
d. Check the MAR to see if there is a nonnarcotic medication ordered - ANS b
The client in hypovolemic shock is receiving normal saline by rapid intravenous infusion. Which
assessment data would warrant immediate intervention by the nurse?
a. The client's blood pressure is 89/48
b. The client's pulse oximeter reading is 95%
c. The client's lung sounds are clear bilaterally
d. The client's urine output is 120 mL in 3 hours - ANS a
Which intervention should the nurse implement when administering a medication via the
intradermal route?
a. Insert the needle with the bevel up at 15-degree angle in the skin
b. Prepare the medication in a 3-mL syringe using a 23-gauge 1-inch needle
c. Bunch the skin between the thumb and index finger of the nondominant hand
d. Quickly inject the medication as to not form a wheal or bleb - ANS a
The charge nurse is observing the primary nurse administering otic drops to a 2-year-old child by
pulling down and back on the auricle. Which action should the charge nurse take?
a. Stop the primary nurse and ask the nurse to step out of the room
b. Demonstrate inserting the otic drops by pulling up and back on the auricle
c. Take no action because this is the correct way to administer the ear drops
d. Allow the nurse to administer the otic drops and then discuss the technique with the nurse -
ANS c
The nurse prepared 2 mg of morphine for a client who is complaining of pain. When the nurse
enters the room the client tells the nurse, "I don't want to take a shot. I would like to have a pain
pill." Which action should the nurse take?
,a. Explain that the medication must be administered because it has been drawn up
b. Ask another nurse to watch the medication being wasted into the sink
c. Place the syringe in the sharps container in the client's room—
d. Notify the pharmacy that a narcotic was not administered to the client - ANS b
The nurse is preparing to adminster 3 mL of a medication intramuscularly to an adult client in
the clinic. Which muscle is the best site to administer the medication?
a. The deltoid muscle
b. The dorsogluteal muscle
c. The ventrogluteal muscle
d. The vastus lateralis muscle - ANS c
The nurse is administering medications through a gastrostomy tube (GT). Which intervention
should the nurse implement first?
a. Place the crushed pills in the gastrostomy tube.
b. Flush the gastrostomy with at least 30 mL of tap water
c. Use the plunger to push the medication into the GT
d. Clamp the gastrostomy tube closed. - ANS b
The charge nurse is making rounds on the clients and notices the primary nurse left a medication
cup with three tablets at the client's bedside. Which action should the charge nurse implement?
a. Administer the client's medications
b. Remove the medication cup from the room
c. Request the primary nurse come to the room
d. Leave the cup at the bedside and talk to the primary nurse - ANS b
1. The client in end-stage renal disease is receiving oral Kayexalate. Which assessment data
indicates the medication is not effective?
a. The client's serum potassium level is 5.8 mEq/L
b. The client's serum sodium level is 135 mEq/L
c. The client's serum postassium level is 4.2 mEq/L
d. The client's serum sodium level is 147 mEq/L - ANS a
Which of the following interventions would be a priority in the plan of care for the person with
pulmonary emphysema? (Select all that apply)
a. Low flow oxygen via face mask
b. Intravenous aminophylline
c. Maintain hydration status
d. Both B and C - ANS d
, The practical nurse enters Mrs. Stem's room to administer the 0800 Hours insulin dose. Mrs.
Stem states , "That is not my usual dose of insulin. " How should the nurse respond to Mrs.
Stem?
a. "Let me check the medication order again and I'll be back in a few minutes."
b. "I'll check with my colleague, who is right here to see if this is the right dose."
c. "I saw your insulin order about 1 hour ago and this what the physician ordered."
d. "Mrs. Stem, I know what I am doing and you should trust me, this is the correct dose." - ANS
a
Mrs. Soh, 65 years old, is 3 days postoperative. She is experiencing nausea and vomiting. What
should the nurse do?
a. Place bed in semi-Fowler's (45 degrees)
b. Document client condition
c. Auscultate bowel sounds
d. Provide a glass of water - ANS c
A 19-year-old with acute asthma has come into the E.R in acute respiratory distress. His breath
rate is 44 breaths/minute. Which of the following interventions should the nurse anticipate first?
a. Obtain a complete health history
b. Administer bronchodilator via nebulizer
c. Provide emotional support to the client
d. Apply a cardiac monitor to the client - ANS b
Which one of the following best describes the concept of Routine Precautions (formerly
Standard Precautions?
a. It is a method of infection control used only when the client tests positive for a communicable
disease.
b. It is a method of sterilization that is followed in emergency and high-risk clinical situations.
c. It is a process where soiled articles are separated from clean hospital supplies.
d. It is a system of generic infection control practices for all clients. - ANS d
Mrs. Albiani, 72 years old, has pneumonia. What assessment should the nurse expect to find
during auscultation?
a. Wheezing
b. Tactile fremitus
c. Crackles
d. Hyperresonance - ANS c
What action is best when the nurse observes that a client's drug dosage for an antihypertensive
medication is twice the recommended dose for that medication?
AND ANSWERS 2025 UPDATE.
The nurse is administering heparin via the subcutaneous route. Which intervention should the
nurse implement?
a. Prepare the medication using a 25-gauge, ½ inch needle
b. After injecting the needle, aspirate and observe for blood
c. After removing the needle, massage the area gently
d. Administer the medication in the client's "love handles" - ANS a
The nurse is administering morning medications on a medical floor. Which medication should
the nurse administer first?
a. Regular insulin sliding scale to an elderly client diagnosed with Type 1 diabetes mellitus
b. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus
c. Morphine, a narcotic analgesic, to a client diagnosed with AIDS
d. Lasix, a diuretic, to a client with hypertension - ANS a
Which data would indicate that the antibiotic therapy has been successful for a client diagnosed
with bacterial pneumonia?
a. The client's hematocrit is within normal range
b. The client is expectorating thick green sputum
c. The client's lung sounds are clear to ausculatation
d. The client has complaints of pleuritic chest pain. - ANS c
The nurse is administering Humalog at 0730 to a client diagnosed with Type 1 diabetes. Which
intervention should the nurse implement?
a. Ensure the client eats at least 90% of the lunch tray
b. Do not administer unless the breakfast tray is in the client's room
c. Check the client's blood glucose level 1 hour after receiving the insulin
d. Have 50% dextrose in water at the bedside for emergency use. - ANS b
The client has a severe anaphylactic reaction to insect bites. What priority discharge intervention
should the nurse discuss with the client?
a. Wear an insect repellent on exposed skin
b. Keep prescribed antihistamines on their person
c. Keep an EpiPen in the refrigerator at all times
d. Wear a MedicAlert identification bracelet - ANS d
,The client's mother contacts the clinic regarding medication administration stating, "My daughter
cannot swallow this capsule. It's too large." Investigation reveals that the medication is a capsule
marked SR. The nurse should instruct the mother to:
a. Open the capsule and mix the medication with apple sauce
b. Crush the medication and administer it with a glass of liquid
c. Call the pharmacist and request a change to a different medication
d. Stop the medication and inform the physician - ANS d
The client calls the nursing station and requests pain medication. When the nurse enters the room
with the narcotic medication, the nurse finds the client laughing and talking with visitors. Which
action should the nurse administer first?
a. Administer the client's prescribed pain medication
b. Assess the client's perception of pain on a 1-10 scale
c. Wait until the visitors leave to administer any medication
d. Check the MAR to see if there is a nonnarcotic medication ordered - ANS b
The client in hypovolemic shock is receiving normal saline by rapid intravenous infusion. Which
assessment data would warrant immediate intervention by the nurse?
a. The client's blood pressure is 89/48
b. The client's pulse oximeter reading is 95%
c. The client's lung sounds are clear bilaterally
d. The client's urine output is 120 mL in 3 hours - ANS a
Which intervention should the nurse implement when administering a medication via the
intradermal route?
a. Insert the needle with the bevel up at 15-degree angle in the skin
b. Prepare the medication in a 3-mL syringe using a 23-gauge 1-inch needle
c. Bunch the skin between the thumb and index finger of the nondominant hand
d. Quickly inject the medication as to not form a wheal or bleb - ANS a
The charge nurse is observing the primary nurse administering otic drops to a 2-year-old child by
pulling down and back on the auricle. Which action should the charge nurse take?
a. Stop the primary nurse and ask the nurse to step out of the room
b. Demonstrate inserting the otic drops by pulling up and back on the auricle
c. Take no action because this is the correct way to administer the ear drops
d. Allow the nurse to administer the otic drops and then discuss the technique with the nurse -
ANS c
The nurse prepared 2 mg of morphine for a client who is complaining of pain. When the nurse
enters the room the client tells the nurse, "I don't want to take a shot. I would like to have a pain
pill." Which action should the nurse take?
,a. Explain that the medication must be administered because it has been drawn up
b. Ask another nurse to watch the medication being wasted into the sink
c. Place the syringe in the sharps container in the client's room—
d. Notify the pharmacy that a narcotic was not administered to the client - ANS b
The nurse is preparing to adminster 3 mL of a medication intramuscularly to an adult client in
the clinic. Which muscle is the best site to administer the medication?
a. The deltoid muscle
b. The dorsogluteal muscle
c. The ventrogluteal muscle
d. The vastus lateralis muscle - ANS c
The nurse is administering medications through a gastrostomy tube (GT). Which intervention
should the nurse implement first?
a. Place the crushed pills in the gastrostomy tube.
b. Flush the gastrostomy with at least 30 mL of tap water
c. Use the plunger to push the medication into the GT
d. Clamp the gastrostomy tube closed. - ANS b
The charge nurse is making rounds on the clients and notices the primary nurse left a medication
cup with three tablets at the client's bedside. Which action should the charge nurse implement?
a. Administer the client's medications
b. Remove the medication cup from the room
c. Request the primary nurse come to the room
d. Leave the cup at the bedside and talk to the primary nurse - ANS b
1. The client in end-stage renal disease is receiving oral Kayexalate. Which assessment data
indicates the medication is not effective?
a. The client's serum potassium level is 5.8 mEq/L
b. The client's serum sodium level is 135 mEq/L
c. The client's serum postassium level is 4.2 mEq/L
d. The client's serum sodium level is 147 mEq/L - ANS a
Which of the following interventions would be a priority in the plan of care for the person with
pulmonary emphysema? (Select all that apply)
a. Low flow oxygen via face mask
b. Intravenous aminophylline
c. Maintain hydration status
d. Both B and C - ANS d
, The practical nurse enters Mrs. Stem's room to administer the 0800 Hours insulin dose. Mrs.
Stem states , "That is not my usual dose of insulin. " How should the nurse respond to Mrs.
Stem?
a. "Let me check the medication order again and I'll be back in a few minutes."
b. "I'll check with my colleague, who is right here to see if this is the right dose."
c. "I saw your insulin order about 1 hour ago and this what the physician ordered."
d. "Mrs. Stem, I know what I am doing and you should trust me, this is the correct dose." - ANS
a
Mrs. Soh, 65 years old, is 3 days postoperative. She is experiencing nausea and vomiting. What
should the nurse do?
a. Place bed in semi-Fowler's (45 degrees)
b. Document client condition
c. Auscultate bowel sounds
d. Provide a glass of water - ANS c
A 19-year-old with acute asthma has come into the E.R in acute respiratory distress. His breath
rate is 44 breaths/minute. Which of the following interventions should the nurse anticipate first?
a. Obtain a complete health history
b. Administer bronchodilator via nebulizer
c. Provide emotional support to the client
d. Apply a cardiac monitor to the client - ANS b
Which one of the following best describes the concept of Routine Precautions (formerly
Standard Precautions?
a. It is a method of infection control used only when the client tests positive for a communicable
disease.
b. It is a method of sterilization that is followed in emergency and high-risk clinical situations.
c. It is a process where soiled articles are separated from clean hospital supplies.
d. It is a system of generic infection control practices for all clients. - ANS d
Mrs. Albiani, 72 years old, has pneumonia. What assessment should the nurse expect to find
during auscultation?
a. Wheezing
b. Tactile fremitus
c. Crackles
d. Hyperresonance - ANS c
What action is best when the nurse observes that a client's drug dosage for an antihypertensive
medication is twice the recommended dose for that medication?
