1.

The nurse is administering an injectable medication for a client who is unconscious and
unable to swallow oral medications. What are other reasons that injectable medications
may be ordered? Select all answers that apply.
A) The medication is more effective by injection.
B) The client needs the desired action slowly.
C) The medication is not available by any other route.
D) The client must obtain the entire dose.
E) The digestive system absorbs the drug too quickly.
F) The client is nauseated or vomiting.
Ans: A, C, D, F
Feedback:
A medication may be administered by injection for the following reasons: the
medication is most effective by injection, the medication is unavailable in any other
form of administration, the client needs the desired action quickly, dosage accuracy is
critical; the client must obtain the entire dose, the client is nauseated or vomiting and
cannot retain oral medications, the client's mental or physical condition renders him or
her unable or unwilling to swallow oral medications, or the digestive system cannot
absorb the drug.

2. The nurse is teaching a student nurse how to draw medications into a syringe. In what
part of the syringe would the medications be drawn?
A) Tip
B) Barrel
C) Plunger
D) Needle
Ans: B
Feedback:
Syringes consist of three parts: tip, barrel, and plunger. The barrel is clearly marked with
a calibrated measurement scale. When preparing an injection, the nurse would draw the
medication into the barrel section. The tip is the portion of the syringe attached to the
needle or needleless adaptor. The plunger is the inner portion that fits inside the barrel.
Syringes may be equipped with a needle or one may be attached.

3. The nurse is choosing the gauge and length of a needle for a subcutaneous injection of
vitamin B12 for a client who has pernicious anemia. Which of the following types of
needles would be the best choice?
A) 25-G, 3/8 inch
B) 23-G, 1 inch
C) 18-G, 3/8 inch
D) 18-G, 2 inches
Ans: A
Feedback:
The needle's gauge and length are both important when choosing the correct type for
injection. The gauge (G) is the needle's inner diameter (bore), through which medication

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 is administered. The gauge is stated using numbers. A 25-G needle has a very small
opening and would be used for subcutaneous or intradermal injections; a 23-G needle,
which has a larger bore, may be used for IM injections of more viscous (thicker) liquids;
an 18-G needle has a very large bore and may be used for IV injection of large amounts
of medication. Needles commonly used range in length from ⅜ to 2 inches. A
subcutaneous injection is given with a short needle (usually ⅜ inch in length); an IM
injection requires a longer needle, with a larger bore, to ensure delivery into the muscle
tissue.

4. Nurses know that a needlestick injury can cause serious infections or other disabilities.
Which of the following is a recommended guideline to prevent needlestick injuries
when injecting clients?
A) If using a safety syringe, following an injection, the nurse should push in the sheath and
twist until it clicks.
B) If using a safety syringe with an articulated type sheath, following an injection the nurse
should use the thumb to push the sheath over the needle.
C) If using a safety syringe, the nurse should recap the needle using the "scoop method" in
which the fingers do not touch the needle.
D) If a safety syringe is not available, the needle can be injected into a special cap, the
Point-Loc device, which locks the tip of the needle in place.
Ans: D
Feedback:
If a safety syringe is not available, the needle can be injected into a special cap, the
Point-Loc device, which locks the tip of the needle in place, to prevent needlestick
injuries. After giving an injection with a safety syringe, the nurse should pull out the
sheath and twist until it clicks to lock it in place. After the injection is given with a
safety syringe with an articulated type sheath, the nurse uses the index finger to push the
sheath over the needle. Recapping of needles, even with the “scoop method,” in which
the fingers do not touch the needle, is no longer recommended, because of the danger of
an accidental needlestick.

5. A nurse injecting a client who has HIV/AIDS accidentally sticks herself with the needle.
What is the protocol when this type of incident occurs?
A) The employer must be notified in writing within 3 days.
B) An incident report must be filed immediately.
C) The nurse must receive treatment for the infection within 1 week.
D) Blood tests for the nurse should be repeated in 3 months.
Ans: B
Feedback:
If a nurse or environmental worker has a needlestick, this must be reported immediately
to the employee health service and an incident report filed. The staff member and
involved client will require blood tests. If the client has an infection, such as HIV or
MRSA, the healthcare worker may require immediate treatment. Blood tests will be
repeated in 6 months, to make sure there is no ensuing infection.

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 6. The nurse is giving an IM corticosteroid injection to a client with rheumatoid arthritis.
What type of syringe and needle would the nurse use for this injection?
A) 2- to 3-mL syringe with 1- to 2-inch needle
B) 1-mL tuberculin syringe with 3/8-inch bevel
C) 2- to 3-mL syringe with 1- to 1½-inch needle
D) 1- to 2-mL syringe with 3/8- to 1-inch needle
Ans: C
Feedback:
Depending on the type and amount of medication, IM injections usually require 2- to 3-
mL syringes with 1- to 1½-inch needles. Intradermal injections typically are given using
1-mL tuberculin syringes. Needles should be 25- to 26-G with a ⅜-inch intradermal
bevel. Subcutaneous injections usually are given using 1- or 2-mL syringes with ⅝- to
1-inch needles.

7. A nurse is preparing to administer Xylocaine to a client. The medication is packaged in

an ampule. What should the nurse do with the unused portion of the Xylocaine?
A) Prepare a second injection for the second use.
B) Cap the ampule and keep refrigerated for the next injection.
C) Label the ampule with client ID and place in medication cart.
D) Discard any unused portion of the Xylocaine in the ampule.
Ans: D
Feedback:
The nurse should discard any unused portion of an ampule's contents because no way
exists to prevent contamination of an open ampule.

8. The nurse is preparing a syringe using medication from a vial. Which of the following is
a recommended guideline for this procedure?
A) Remove the cover from the vial and clean with soapy water.
B) Draw an amount of air into the syringe equal to medication needed.
C) Insert needle through side of stopper and draw medication into the barrel.
D) Pull back on the syringe's plunger and fill the barrel completely with the medication.
Ans: B
Feedback:
The steps in this procedure include (1) Remove the metal or plastic cover from the vial
and cleanse the rubber port with an alcohol swab to disinfect it. (2) Remove the needle
cap and draw an amount of air into the syringe that is equal to the amount of medication
that will be withdrawn from the vial. (3) Insert the needle through the center of the
rubber stopper and inject air into the vial, keeping the needle above the solution. Invert
the vial. (4) Steady the vial and syringe in the nondominant hand at eye level. Brace the
little finger against the plunger. (5) Move the needle into the solution. (6) Use the
dominant hand to pull back on the syringe's plunger. (7) Withdraw an accurate dose into
the syringe. Remove the needle from the vial.

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 9. The nurse is administering a tuberculin test (PPD skin test) to a client. What method
would the nurse use for this type of testing?
A) Intradermal
B) Subcutaneous
C) Intramuscular
D) Intravenous
Ans: A
Feedback:
Intradermal injections, often used for diagnostic testing (“skin tests”), are shallow
injections given just beneath the epidermis. Subcutaneous injections are used for small
amounts of medication that require slow, systemic absorption. Intramuscular injection is
the best technique when medications given less deeply irritate the client's tissues or
when large amounts of medication are necessary. IV fluids are administered via the
circulatory system to correct or to prevent fluid and electrolyte imbalance in the client.

10. A nurse is performing an allergy skin test for a client who has flu-like symptoms since
recently adopting a cat. What guidelines should the nurse follow when performing a
skin test to determine sensitivity?
A) Choose an injection site that is taut and heavily pigmented.
B) Withdraw the needle at the same angle at which it was inserted.
C) Place the needle, bevel down, on the skin surface at about a 45-degree angle.
D) Ask the client to rub the insertion site after withdrawing the needle.
Ans: B
Feedback:
The nurse should withdraw the needle at the same angle at which it was inserted, to
minimize skin damage. The skin over the injection site should be taut, but not heavily
pigmented because it may interfere with assessment of the site after injection. The nurse
should place the needle, bevel down, on the skin surface at approximately a 10-degree
angle, not at a 45-degree angle. The nurse should instruct the client not to rub the site
because this increases absorption, and intradermal medications are to be absorbed
slowly.

11. A client is ordered heparin following open heart surgery. What method would the nurse
use to administer this medication?
A) Intradermal
B) Subcutaneous
C) Intramuscular
D) Intravenous
Ans: B
Feedback:
Subcutaneous injections are administered into subcutaneous or adipose (fatty) tissues
located below the dermis. Common subcutaneous medications are insulin and heparin.

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 Intradermal injections are commonly used for skin testing and intramuscular injections
are used when medications given less deeply irritate the client's tissues or when large
amounts of medication are necessary. IV fluids are administered via the circulatory
system to correct or to prevent fluid and electrolyte imbalance in the client.

12. A nurse is administering an IM injection of diphtheria-tetanus with pertussis (DTaP) to a

4-month old infant. What would be the appropriate site for this injection?
A) Dorsal gluteal
B) Ventrogluteal
C) Deltoid
D) Vastus lateralis
Ans: D
Feedback:
The vastus lateralis is a thick muscle located on the anterior, lateral area of the thigh.
This muscle may be used for IM injections in infants and children younger than 3 years
because it is the largest muscle mass in this age group. Little risk of injury exists with
this site because no large nerves or arteries surround the area. The other sites are not
recommended for infants.

13. The nurse is administering an iron medication to a client via the Z-track method. Which
of the following are recommended guidelines/steps for this procedure? Select all
answers that apply
A) Use the Z-track method only in the deltoid site.
B) Pinch the skin of the injection site to raise the site.
C) Insert the needle, aspirate, and inject the medication.
D) Quickly remove the needle after injecting the medication.
E) Do not massage the injection site.
F) Allow the skin to return to its original position slowly, while removing the needle.
Ans: C, E, F
Feedback:
Use the Z-track method only in the gluteal muscles. To administer a medication by Z-
track, pull the skin of the injection site to one side. Insert the needle, aspirate, and inject
the medication. Keep the skin taut and pulled to one side; wait a few seconds before
withdrawing the needle. Allow the skin to return to its original position slowly, while
removing the needle. As the tissues slide past each other, they close the needle track. Do
not massage the injection site when using the Z-track administration method.

14. When planning the administration of fluids/medications for clients on an ICU, the nurse
chooses appropriate IV catheters. Which of the following clients would be the best
candidate for using a peripherally placed catheter?
A) A client who is receiving chemotherapy infusions for breast cancer
B) An unconscious client receiving TPN for the past 2 weeks
C) A client who is receiving fluids postoperatively

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D) A client with end stage lung cancer who is receiving morphine for pain
Ans: C
Feedback:
Peripherally placed catheters are used for short-term administration of fluids and
nutrients, such as administering fluids postoperatively. Central lines are used for longer-
term administration and for certain products that cannot be administered through a
peripheral line. Examples include administering chemotherapy, pain medication long
term, and long-term TPN.

15. The nurse is explaining to the student nurse the purposes of IV administration. Which of
the following are accurate descriptions of this procedure? Select all answers that apply.
A) A primary infusion consists of one IV line plus a smaller bag.
B) In tandem infusion, the smaller bag is connected at the same level as the primary bag.
C) In nearly all cases, IV solutions are supplied in glass bottles.
D) Medications are absorbed more rapidly via the IV route than any other route.
E) Large quantities of a solution may be given IV by way of an infusion.
F) If blood is administered via IV, the procedure is referred to as a blood infusion.
Ans: B, D, E
Feedback:
The IV infusion may be run as a primary infusion, one IV line running continuously. An
IV may also be run in tandem, that is, a primary infusion plus a smaller bag. The smaller
bag is connected at the same level as the primary bag. In this case, both the primary and
the tandem bag infuse in at the same time. Medications are absorbed more rapidly via
the IV route than any other commonly used route. Large quantities of a solution may be
given IV by way of an infusion. In nearly all cases, IV solutions are supplied in plastic
bags. Glass bottles are used only if the IV solution would be unstable in a plastic bag. If
blood or blood products are administered IV, the procedure is referred to as a
transfusion.

16. The nurse is preparing to administer an IV infusion to a client. Which of the following is
a recommended step in this procedure?
A) Place the client in a side-lying position.
B) Invert the bag and spike it with the IV tubing.
C) Prime the tubing and squeeze the drip chamber until it is full of IV fluid.
D) When blood enters the venous access device, advance the needle to half its length.
Ans: B
Feedback:
When initiating an IV line, the nurse should inspect the IV solution, to make sure there
are no impurities, and unwrap it. Invert the bag and spike it with the IV tubing. The
client should be in a low Fowler's position. The nurse should also prime the tubing and
squeeze the drip chamber until it is half-full of IV fluid. When blood enters the venous
access device, the nurse should advance the needle to almost its full length.

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 17. A nurse at a rehabilitation center is required to administer medications to clients via
enteral and parenteral routes. Which of the following should the nurse be aware of with
reference to enteral and parenteral administration?
A) Parenteral administration means medication administration through the digestive tract.
B) Intradermal indicates an enteral method of medication administration.
C) Absorption rate of oral medications given via the enteral method is rapid.
D) Among parenteral injections, intravenous medications are most rapidly absorbed.
Ans: D
Feedback:
The nurse should be aware that of all the parenteral injection methods, intravenous
medications are most rapidly absorbed. Enteral, not parenteral, indicates medication
administration by way of the digestive tract. The intradermal method of administration
is an example of parenteral administration by injection. The absorption rate of oral
medications given via enteral methods is slower, which results in a slowed onset of
action.

18. A nurse is administering medication to a client using an intravenous (IV) infusion. What
considerations should be kept in mind when using infusion pumps?
A) Infusion pumps use gravity to maintain the flow of IV fluids at a preset rate.
B) Infusion pumps are used in clients with kidney disease to prevent fluid overload.
C) Infusion pumps automatically regulate the rate and amount of IV fluid.
D) Infusion pumps do not pump fluids when the catheter is displaced from the vein.
Ans: C
Feedback:
The nurse should know that infusion pumps control the rate and amount of IV fluid,
automatically regulating IV infusions. Pumps use positive pressure, not gravity, to
deliver a preset fluid volume. Microdrip setup devices, not infusion pumps, are used in
clients with kidney disease to prevent fluid overload. One of the disadvantages of pumps
is that they continue to pump fluids even if the catheter may have been displaced from
the vein.

19. The nurse who is monitoring an IV site for a client receiving normal saline watches out
for the signs and symptoms of infiltration. Which of the following is a sign of this
adverse condition?
A) Swelling
B) Skin hot to the touch
C) Feeling of softness in the area
D) No fluid evident around the catheter
Ans: A
Feedback:
Signs of infiltration include swelling or puffiness, coolness, pain at the insertion site
(sometimes), feeling of hardness in the area, and possible leaking of fluid evident
around the catheter. The area feels cool, because IV solutions are typically at room
temperature, which is cooler than body temperature. The fluid may be leaking around

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 the site, even though the catheter is in the vein; this can indicate that the flow of fluid is
too fast.

20. Which of the following medications would not be delivered via PCA or portable pump?
A) Morphine
B) Fentanyl
C) Insulin
D) Vancomycin
Ans: D
Feedback:
Sometimes, the client with chronic or intractable pain controls his or her own PCA
device. Medications commonly administered in this manner include morphine, fentanyl,
and hydromorphone, as well as a combination of drugs called BAD (Benadryl, Ativan,
and Decadron). In other situations, clients are also allowed to manage their own
medication pumps. This includes the insulin pump for diabetics and a pump containing
an antiemetic, such as metoclopramide (Reglan) or ondansetron (Zofran) for the client
undergoing cancer chemotherapy or who has hyperemesis of pregnancy. Vancomycin is
an antibiotic and its administration would not be controlled by the patient.

21. The nurse is ordered to infuse 1,000 mL of normal saline in 8 hours. What would the
nurse calculate to be the drops per minute?
A) 75
B) 100
C) 125
D) 150
Ans: C
Feedback:
Drops per minute =
volume (in mL) × drip factor (drops per mL)
time (in minutes)
1 000 mL × 60 (drops per mL)
480 minutes (8 hours × 60 minutes)
Drops per minute = 60,000/480 =125 drops per minute

22. The nurse is monitoring an IV line for a client who is receiving IV antibiotics. Which of
the following is a recommended guideline when caring for the client receiving IV
therapy?
A) If signs of infiltration exist, remove the device and use a new IV setup.
B) Be sure to replace IV bags before they are totally empty.
C) Irrigate the IV to determine patency.
D) Write on an IV bags with a felt tip marker or pen to label the date/time.
Ans: B
Feedback:

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 It is important for the designated nurse to replace IV bags before they become totally
empty because it is hazardous for the client if air has collected in the tubing. If signs of
infiltration exist, the nurse should stop the infusion and report the situation immediately;
the provider will determine if the infusion should continue or be discontinued. The IV is
not irrigated to determine patency because if a clogged or stopped IV has caused a blood
clot in the vein, the clot could be dislodged, which would be life threatening. The nurse
should not write on an IV bag with a felt tip marker or pen because the ink may
penetrate the plastic bag and contaminate the IV fluid or the tip of a pen could pierce the
bag.

23. A nurse is caring for several clients receiving fluids through central venous catheters.
For which of the following clients could a Broviac tunneled central venous catheter be
used?
A) A client who needs a blood transfusion
B) A client who needs a saline infusion
C) A client who needs TPN
D) A client who is receiving CPN
Ans: B
Feedback:
The Broviac is small and can only be used for intravenous infusions. The Hickman may
have one, two, or three lumens. It is large enough to draw blood, as well as to infuse
fluids. Another type, the double-lumen catheter, may be used to deliver nutrients, such
as TPN or CPN, through a smaller lumen.

24. A nurse is caring for a client with pancreatic disease. The client is receiving total
parenteral nutrition (TPN) to help maintain adequate levels of carbohydrates, proteins,
fats, vitamins, minerals, water, and electrolytes. Which of the following measures
should the nurse follow when providing TPN?
A) Perform insertion of a central line under aseptic conditions.
B) Check the client's vital signs for evidence of developing infection.
C) Avoid folding the tape over when securing the catheter.
D) Measure the blood glucose level at the end of the day.
Ans: B
Feedback:
The nurse should check the client's vital signs frequently for evidence of developing
infection. The nurse should stop the infusion and report immediately if the client
develops signs of infiltration, such as redness, swelling, and pain. Only physicians
should insert a central line under aseptic conditions because insertion of a catheter into
the subclavian vein requires great skill owing to the vein's proximity to the lung. When
securing the catheter at the insertion site, the end of each piece of the tape is folded over.
This facilitates easy removal of the tape when changing the dressing frequently. Because
TPN solutions contain a high concentration of glucose, the client's blood glucose level is
measured several times a day, and not only at the end of the day.

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 25. The nurse is converting a client's continuous IV infusion to a saline lock. Which of
following is a recommended guideline for this procedure?
A) Stop the infusion and unclamp the tube to allow air to flow out of the line.
B) Replace the primary IV tubing with a PICC line.
C) Flush the lock with 2 to 3 mL of heparin every 4 hours to prevent clogging.
D) Flush the lock with 2 to 3 mL of saline every 8 hours or as ordered.
Ans: D
Feedback:
To reduce the possibility of clotting, the lock may be flushed with 2 to 3 mL of saline
every 8 hours or as ordered. Heparin is no longer used to flush the lock. When
converting to the lock, first, the infusion is stopped and the tube clamped with the slide
clamp and the roller clamp to prevent air from entering the line and blood from
escaping. Then the nurse removes the primary IV tubing from the extension device,
unclamps the extension tube and flushes with the prescribed solution, reclamps the
extension tube and removes the syringe. Finally, the nurse inserts the lock cap device
firmly into the extension tubing and tapes it firmly in place.

26. A client has pneumonia that is worsening and needs an antibiotic administered rapidly.
The client is also at risk for fluid overload. Which of the following IV devices would
most likely be used for this client?
A) IV piggyback (IVPB)
B) Volume-controlled infusion
C) IV bolus
D) Saline lock
Ans: C
Feedback:
Medications may be given by IV “push,” also called a bolus. This injection is given in a
short period of time and is not intermittent. The IV push only requires a small amount of
fluid. Thus, it is often recommended for a client who is at risk for fluid overload. IV
piggyback (IVPB) infuses two medications at scheduled intervals. With volume-
controlled infusion, solution used to dilute mediations is supplied in a small bag and
hung on an IV pole with a volume-control device hung below it. The saline lock is an IV
catheter inserted in a vein and left in place, either for intermittent administration of
medication or to provide an open line in case of an emergency.

27. The nurse is performing venipuncture on a client to obtain blood for ordered tests.
Which of the following is a recommended guideline for this procedure?
A) Apply the tourniquet about 4 to 6 inches above the proposed site.
B) Check for the presence of an apical pulse and locate a peripheral vein.
C) Ask the client to open and close the fist, ending with an open fist.
D) If a vein is difficult to access, raise the arm above the level of the heart.
Ans: A
Feedback:

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The correct procedure for venipuncture is to check for presence of a radial pulse. Locate
a peripheral vein, apply the tourniquet about 4 to 6 inches above the proposed insertion
site, and ask the client alternately to open and close the fist, ending with a closed fist. If
a vein is difficult to locate, the nurse should lower the arm below the level of the heart
and/or tap or stroke the area, while gently moving away from the heart.

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