CCRI Nursing 1010 Exam #3 | Fundamentals of Nursing Study Guide
• A client has a bleeding tendency due to hemophilia. What route of drug administration is appropriate
for this client? - (answer)The route of administration appropriate for a client with a bleeding tendency is
the oral route, as it does not involve the use of needles. Any mode of administration that uses needles
may increase the risk of bleeding. Therefore, intradermal, intramuscular, and subcutaneous routes
should be avoided in this client's case to prevent bleeding.
• A client has to be given a bladder irrigation with 100 ml of medicated solution with 1/1000 dilution.
How much of the medication should the nurse dissolve in 100 ml of solvent? Record your answer using a
whole number. ___ mg. - (answer)A: 1/1000 solution means presence of 1 gram of the medication in
1000 ml of solution. This means that each ml of the solution contains 1 mg of the medication. Since the
nurse has to prepare 100 ml of the solution, the nurse should dissolve 100 mg of medication in 100 ml of
solvent.
• A client is prescribed a sublingual nitroglycerin drug. What instructions should the nurse provide to the
client? Select all that apply: - (answer)Do not swallow the medication; Place the medication under the
tongue. When administering medications through the sublingual route, the medication has to be placed
under the tongue until it fully dissolves. The medication should not be swallowed. Swallowing can make
the medication ineffective. The medication should not be spit out to prevent irritation; however, it may
be spit out if the desired therapeutic effect is attained. The medication should not be taken with water,
as this can alter its effectiveness. Sublingual medication should be administered under the tongue, not
between the tongue and cheeks.
• A client is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of
200 puffs. The client takes 2 puffs every 4 hours. How many days will the pMDI last? Record your answer
using a whole number. _____ days: - (answer)Two puffs × 6 times a day = 12 puffs per day; 200 puffs/12
puffs per day = 16.67 days, or about 16 days. This cannot be rounded up since the inhaler will not last a
total of 17 days.
• A diabetic client has been switched from oral antidiabetic drugs to insulin. What information would
help the client to ensure correct self-administration of insulin? Select all that apply. - (answer)Insulin is
given as a subcutaneous injection for slower absorption. The rate of absorption of insulin differs in
various sites. The abdomen has the quickest absorption. The recommended sites of insulin injection
include upper arms, anterior and lateral part of thighs, buttocks, and abdomen. These sites have
appropriate amount of subcutaneous tissue for absorption of insulin. The injection site should not be
chosen again for a month. The injection site should be rotated with each injection. Repeated injection at
the same site may lead to lipodystrophy.
,CCRI Nursing 1010 Exam #3 | Fundamentals of Nursing Study Guide
What should be emphasized during patient teaching with regards to antibiotics? - (answer)• A full
prescription of antibiotics should be completed to ensure the therapeutic effect. An incomplete course
of antibiotics may worsen the condition being treated, and also lead to development of resistance to the
antibiotic. Treatment has to be taken fully even if the client attains early symptomatic relief. If the
client's condition does not improve with full treatment, then treatment should be discontinued.
• A nurse has been asked to prepare a 1% solution of medication in distilled water. How much of the
medication should the nurse dissolve in 100 ml of distilled water? Record your answer using a whole
number. ___ mg - (answer)A: A 1% solution contains 1 gram of the medication dissolved in 100 ml of the
solution. Since the unit is mg, and 1 gram is 1000 mg, the nurse should dissolve 1000 mg of the
medication in 100 ml of water.
• A nurse is teaching self-administration of insulin to a client. What instruction should the nurse include
in the teaching? - (answer)Roll the insulin between your palms if the preparation is cloudy. Cloudy
insulin preparations should be rolled between the palms to re-suspend them before drawing into
injections. The insulin vial should not be shaken, because shaking can create bubbles that can interfere
with correct dosage administration. Regular insulin is given subcutaneously, not intramuscularly. If
insulin is taken after meals, it cannot control the rise of blood sugar levels that occurs due to food
intake.
• A nurse working in a neonatal ward finds it difficult to establish an IV (intravenous) line for an infant.
What route of medication administration is suitable for this clinical situation? - (answer)In the
intraosseous route, the medication is directly administered into the bone marrow; this route is suitable
for infants for whom securing an IV line is difficult. The intrapleural route is used for performing
pleurodesis in clients with persistent pleural effusion. The intraarterial route is suitable for breaking
clots within the arteries. The intraperitoneal route is suitable for administering insulin and antibiotics.
A doctor has ordered the nurse to insert a rectal suppository on an adult. What is the correct positioning
of the suppository? - (answer)• A rectal suppository for an adult should be placed against the rectal wall
about 10 cm into the rectum. For children and infants, the suppository should be placed 5 cm deep into
the rectum against the rectal wall. The inner aspect of the anal orifice is not the right position for
suppository administration. The suppository has to be placed past the internal anal sphincter.
• After seeing a client, the physician gives a nursing student a verbal order for a new medication. What
should the student nurse do next? - (answer)The nursing student first needs to explain to the physician
that the order needs to be given to a registered nurse. Reason: Nursing students cannot take orders.
,CCRI Nursing 1010 Exam #3 | Fundamentals of Nursing Study Guide
• An elderly obese client who has undergone total hip replacement surgery has been put on low
molecular weight heparin (LMWH) enoxaparin. What complications of subcutaneous injections should
the nurse monitor for? Select all that apply: - (answer)Pain, Hypertrophy of the skin, and Sterile abscess.
Subcutaneous injections may be painful with irritating medication or if a large volume of medications is
injected. Repeated injections at the same site may cause hypertrophy of the skin. The injected
medication may collect at the site causing sterile abscess. Phlebitis is the inflammation of the veins.
Infiltration happens when the intravenous fluid or medication accidently enters extravascular space.
• A nurse accidently gives a client a medication at the wrong time. The nurse's first priority is to: -
(answer)Assess the client for adverse effects because client safety and assessing the client are priorities
when a medication error occurs.
• A nurse has to administer a subcutaneous injection to a client. What precautions should the nurse
follow when administering the subcutaneous injection? Select all that apply: - (answer)Inject medication
slowly; Pinch skin with the nondominant hand. The technique of administering subcutaneous injection
for an average-size client involves pinching the skin with the nondominant hand and injecting the needle
quickly and firmly at a 45- to 90-degree angle. The medication has to be injected slowly to minimize
pain. The skin is pinched with the nondominant hand, because the dominant hand is used for
administering the injection. Piercing a blood vessel during a subcutaneous injection is very rare, so
aspiration is not necessary. Injecting the needle should be quick. Inserting the needle with bevel up at a
5- to 15-degree angle is done for intradermal injection.
• A nurse has to administer an alkaline medication to a client. What is the preferred route of
administration of this medication? - (answer)Intravenous! Alkaline and other irritant medications are
usually administered through the intravenous route, as this causes less discomfort. Intradermal,
intramuscular, and subcutaneous administration of alkaline medications may irritate the tissues and
cause the client discomfort.
• A nurse is administering medications to a 4-year-old client. After he or she explains which medications
are being given, the mother states, "I don't remember my child having that medication before." What is
the nurse's next action? - (answer)Withhold the medications and verify the medication orders. Do not
ignore client or caregiver concerns; always verify orders whenever a medication is questioned before
administering it. Test-Taking Tip: For medication questions, ask yourself, "What is the safest response?"
• A nurse is responsible for the storage and safe usage of drugs. What guidelines should the nurse follow
for the safe use of narcotics? Select all that apply. - (answer)Store narcotics in locked containers;
Frequently count narcotics, especially during shift change; Client details should be documented and
recorded. All narcotics should be stored in a locked, secure cabinet or container to ensure safe storage.
, CCRI Nursing 1010 Exam #3 | Fundamentals of Nursing Study Guide
The narcotics should be counted with the opening of narcotic drawers and/or at shift change to ensure
that narcotics are not missing. The client's name, date, time of medication administration, name of
medication, dose, and signature of the nurse dispensing the medication should be recorded.
Documentation is necessary to keep a proper count of drug usage. Discrepancies in narcotic counts
should be immediately reported as they may be a result of theft or illegal drug use. Unused portion
should be disposed to prevent abuse.
• A nurse works the night shift. For which client is obtaining a verbal order from the prescriber
contraindicated? - (answer)A client with malignancy. Obtaining a verbal order is not permitted for
managing malignancy because antineoplastic medications are not administered in emergency or urgent
situations. In addition, these drugs have a narrow margin of safety. A verbal order should be taken for
providing immediate care to clients with angina, asthma, and stroke, as a delay in managing these
situations is life threatening.
• A nursing student takes a client's antibiotic to his room. The client asks the nursing student what it is
and why he should take it. Which information does the nursing student include when replying to the
client? - (answer)The student provides the name of the medication and a description of its desired
effect. Clients need to know information about their medications so they can take them correctly and
safely.
• An elderly obese client who has undergone total hip replacement surgery has been put on low
molecular weight heparin (LMWH) enoxaparin. What is the proper technique the nurse should use to
administer enoxaparin? Select all that apply. - (answer)The needle should be injected at a 90-degree
angle because the client is obese. Enoxaparin is injected subcutaneously for gradual absorption. The
injection site is pinched as the needle is inserted to ensure that the drug is injected into the
subcutaneous tissues. Enoxaparin should be injected on the right or left site of the abdomen at least 2
inches from the umbilicus. The air bubble should not be expelled to avoid loss of drug.
What nursing intervention could possibly prevent buccal irritation of a buccal medication (one dissolved
through the mouth's membrane)? - (answer)• Buccal administration of medication may lead to buccal
irritation by erosion of the mucus membrane. This may be very uncomfortable for the client. Buccal
irritation can be minimized by alternating the placement of the medication with each subsequent dose
so that a single area is not affected. Buccal medications are not to be chewed, swallowed, or taken with
any liquids, as the rate of absorption may be affected.
A nurse has been asked by a doctor to administer ear drops for a 4-year-old client. What is the proper
method? - (answer)• Eardrops are administered with the ear positioned upward and outward for clients
• A client has a bleeding tendency due to hemophilia. What route of drug administration is appropriate
for this client? - (answer)The route of administration appropriate for a client with a bleeding tendency is
the oral route, as it does not involve the use of needles. Any mode of administration that uses needles
may increase the risk of bleeding. Therefore, intradermal, intramuscular, and subcutaneous routes
should be avoided in this client's case to prevent bleeding.
• A client has to be given a bladder irrigation with 100 ml of medicated solution with 1/1000 dilution.
How much of the medication should the nurse dissolve in 100 ml of solvent? Record your answer using a
whole number. ___ mg. - (answer)A: 1/1000 solution means presence of 1 gram of the medication in
1000 ml of solution. This means that each ml of the solution contains 1 mg of the medication. Since the
nurse has to prepare 100 ml of the solution, the nurse should dissolve 100 mg of medication in 100 ml of
solvent.
• A client is prescribed a sublingual nitroglycerin drug. What instructions should the nurse provide to the
client? Select all that apply: - (answer)Do not swallow the medication; Place the medication under the
tongue. When administering medications through the sublingual route, the medication has to be placed
under the tongue until it fully dissolves. The medication should not be swallowed. Swallowing can make
the medication ineffective. The medication should not be spit out to prevent irritation; however, it may
be spit out if the desired therapeutic effect is attained. The medication should not be taken with water,
as this can alter its effectiveness. Sublingual medication should be administered under the tongue, not
between the tongue and cheeks.
• A client is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of
200 puffs. The client takes 2 puffs every 4 hours. How many days will the pMDI last? Record your answer
using a whole number. _____ days: - (answer)Two puffs × 6 times a day = 12 puffs per day; 200 puffs/12
puffs per day = 16.67 days, or about 16 days. This cannot be rounded up since the inhaler will not last a
total of 17 days.
• A diabetic client has been switched from oral antidiabetic drugs to insulin. What information would
help the client to ensure correct self-administration of insulin? Select all that apply. - (answer)Insulin is
given as a subcutaneous injection for slower absorption. The rate of absorption of insulin differs in
various sites. The abdomen has the quickest absorption. The recommended sites of insulin injection
include upper arms, anterior and lateral part of thighs, buttocks, and abdomen. These sites have
appropriate amount of subcutaneous tissue for absorption of insulin. The injection site should not be
chosen again for a month. The injection site should be rotated with each injection. Repeated injection at
the same site may lead to lipodystrophy.
,CCRI Nursing 1010 Exam #3 | Fundamentals of Nursing Study Guide
What should be emphasized during patient teaching with regards to antibiotics? - (answer)• A full
prescription of antibiotics should be completed to ensure the therapeutic effect. An incomplete course
of antibiotics may worsen the condition being treated, and also lead to development of resistance to the
antibiotic. Treatment has to be taken fully even if the client attains early symptomatic relief. If the
client's condition does not improve with full treatment, then treatment should be discontinued.
• A nurse has been asked to prepare a 1% solution of medication in distilled water. How much of the
medication should the nurse dissolve in 100 ml of distilled water? Record your answer using a whole
number. ___ mg - (answer)A: A 1% solution contains 1 gram of the medication dissolved in 100 ml of the
solution. Since the unit is mg, and 1 gram is 1000 mg, the nurse should dissolve 1000 mg of the
medication in 100 ml of water.
• A nurse is teaching self-administration of insulin to a client. What instruction should the nurse include
in the teaching? - (answer)Roll the insulin between your palms if the preparation is cloudy. Cloudy
insulin preparations should be rolled between the palms to re-suspend them before drawing into
injections. The insulin vial should not be shaken, because shaking can create bubbles that can interfere
with correct dosage administration. Regular insulin is given subcutaneously, not intramuscularly. If
insulin is taken after meals, it cannot control the rise of blood sugar levels that occurs due to food
intake.
• A nurse working in a neonatal ward finds it difficult to establish an IV (intravenous) line for an infant.
What route of medication administration is suitable for this clinical situation? - (answer)In the
intraosseous route, the medication is directly administered into the bone marrow; this route is suitable
for infants for whom securing an IV line is difficult. The intrapleural route is used for performing
pleurodesis in clients with persistent pleural effusion. The intraarterial route is suitable for breaking
clots within the arteries. The intraperitoneal route is suitable for administering insulin and antibiotics.
A doctor has ordered the nurse to insert a rectal suppository on an adult. What is the correct positioning
of the suppository? - (answer)• A rectal suppository for an adult should be placed against the rectal wall
about 10 cm into the rectum. For children and infants, the suppository should be placed 5 cm deep into
the rectum against the rectal wall. The inner aspect of the anal orifice is not the right position for
suppository administration. The suppository has to be placed past the internal anal sphincter.
• After seeing a client, the physician gives a nursing student a verbal order for a new medication. What
should the student nurse do next? - (answer)The nursing student first needs to explain to the physician
that the order needs to be given to a registered nurse. Reason: Nursing students cannot take orders.
,CCRI Nursing 1010 Exam #3 | Fundamentals of Nursing Study Guide
• An elderly obese client who has undergone total hip replacement surgery has been put on low
molecular weight heparin (LMWH) enoxaparin. What complications of subcutaneous injections should
the nurse monitor for? Select all that apply: - (answer)Pain, Hypertrophy of the skin, and Sterile abscess.
Subcutaneous injections may be painful with irritating medication or if a large volume of medications is
injected. Repeated injections at the same site may cause hypertrophy of the skin. The injected
medication may collect at the site causing sterile abscess. Phlebitis is the inflammation of the veins.
Infiltration happens when the intravenous fluid or medication accidently enters extravascular space.
• A nurse accidently gives a client a medication at the wrong time. The nurse's first priority is to: -
(answer)Assess the client for adverse effects because client safety and assessing the client are priorities
when a medication error occurs.
• A nurse has to administer a subcutaneous injection to a client. What precautions should the nurse
follow when administering the subcutaneous injection? Select all that apply: - (answer)Inject medication
slowly; Pinch skin with the nondominant hand. The technique of administering subcutaneous injection
for an average-size client involves pinching the skin with the nondominant hand and injecting the needle
quickly and firmly at a 45- to 90-degree angle. The medication has to be injected slowly to minimize
pain. The skin is pinched with the nondominant hand, because the dominant hand is used for
administering the injection. Piercing a blood vessel during a subcutaneous injection is very rare, so
aspiration is not necessary. Injecting the needle should be quick. Inserting the needle with bevel up at a
5- to 15-degree angle is done for intradermal injection.
• A nurse has to administer an alkaline medication to a client. What is the preferred route of
administration of this medication? - (answer)Intravenous! Alkaline and other irritant medications are
usually administered through the intravenous route, as this causes less discomfort. Intradermal,
intramuscular, and subcutaneous administration of alkaline medications may irritate the tissues and
cause the client discomfort.
• A nurse is administering medications to a 4-year-old client. After he or she explains which medications
are being given, the mother states, "I don't remember my child having that medication before." What is
the nurse's next action? - (answer)Withhold the medications and verify the medication orders. Do not
ignore client or caregiver concerns; always verify orders whenever a medication is questioned before
administering it. Test-Taking Tip: For medication questions, ask yourself, "What is the safest response?"
• A nurse is responsible for the storage and safe usage of drugs. What guidelines should the nurse follow
for the safe use of narcotics? Select all that apply. - (answer)Store narcotics in locked containers;
Frequently count narcotics, especially during shift change; Client details should be documented and
recorded. All narcotics should be stored in a locked, secure cabinet or container to ensure safe storage.
, CCRI Nursing 1010 Exam #3 | Fundamentals of Nursing Study Guide
The narcotics should be counted with the opening of narcotic drawers and/or at shift change to ensure
that narcotics are not missing. The client's name, date, time of medication administration, name of
medication, dose, and signature of the nurse dispensing the medication should be recorded.
Documentation is necessary to keep a proper count of drug usage. Discrepancies in narcotic counts
should be immediately reported as they may be a result of theft or illegal drug use. Unused portion
should be disposed to prevent abuse.
• A nurse works the night shift. For which client is obtaining a verbal order from the prescriber
contraindicated? - (answer)A client with malignancy. Obtaining a verbal order is not permitted for
managing malignancy because antineoplastic medications are not administered in emergency or urgent
situations. In addition, these drugs have a narrow margin of safety. A verbal order should be taken for
providing immediate care to clients with angina, asthma, and stroke, as a delay in managing these
situations is life threatening.
• A nursing student takes a client's antibiotic to his room. The client asks the nursing student what it is
and why he should take it. Which information does the nursing student include when replying to the
client? - (answer)The student provides the name of the medication and a description of its desired
effect. Clients need to know information about their medications so they can take them correctly and
safely.
• An elderly obese client who has undergone total hip replacement surgery has been put on low
molecular weight heparin (LMWH) enoxaparin. What is the proper technique the nurse should use to
administer enoxaparin? Select all that apply. - (answer)The needle should be injected at a 90-degree
angle because the client is obese. Enoxaparin is injected subcutaneously for gradual absorption. The
injection site is pinched as the needle is inserted to ensure that the drug is injected into the
subcutaneous tissues. Enoxaparin should be injected on the right or left site of the abdomen at least 2
inches from the umbilicus. The air bubble should not be expelled to avoid loss of drug.
What nursing intervention could possibly prevent buccal irritation of a buccal medication (one dissolved
through the mouth's membrane)? - (answer)• Buccal administration of medication may lead to buccal
irritation by erosion of the mucus membrane. This may be very uncomfortable for the client. Buccal
irritation can be minimized by alternating the placement of the medication with each subsequent dose
so that a single area is not affected. Buccal medications are not to be chewed, swallowed, or taken with
any liquids, as the rate of absorption may be affected.
A nurse has been asked by a doctor to administer ear drops for a 4-year-old client. What is the proper
method? - (answer)• Eardrops are administered with the ear positioned upward and outward for clients
