A nurse dilutes IV phenytoin in 5% dextrose for a patient in status epilepticus, and fine crystals appear in the bag. What is the correct action?

Discard it and prepare a fresh dose in normal saline

Infuse it as it is through an in-line 0.2 micron filter

Warm the bag in hot water until clear, then infuse it

Shake the bag well until all the crystals dissolve

Infection control, medication administration and first aid

40 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Infection control, medication administration and first aid, part of Fundamentals of Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
Which of these intravenous fluids is hypotonic to plasma?
1. A3% sodium chloride
2. B0.45% sodium chloride
3. CRinger's lactate
4. D0.9% sodium chloride
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Answer: B · 0.45% sodium chloride
Half-strength saline has an osmolarity of about 154 mOsm/L, well below plasma (about 290 mOsm/L), so water moves from it into the cells. It is used to treat cellular dehydration such as hypernatraemia. Because it can cause cell swelling, it is avoided in raised intracranial pressure and given with care. Normal saline and Ringer's lactate are isotonic; 3% saline is hypertonic.
- A: 3% saline is hypertonic and draws water out of cells.
- C: Ringer's lactate is close to isotonic with plasma.
- D: 0.9% saline is isotonic, about 308 mOsm/L.
Question 2 · Hard
A nurse dilutes IV phenytoin in 5% dextrose for a patient in status epilepticus, and fine crystals appear in the bag. What is the correct action?
1. AInfuse it as it is through an in-line 0.2 micron filter
2. BWarm the bag in hot water until clear, then infuse it
3. CDiscard it and prepare a fresh dose in normal saline
4. DShake the bag well until all the crystals dissolve
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Answer: C · Discard it and prepare a fresh dose in normal saline
Phenytoin is very alkaline and precipitates in dextrose solutions, so it is diluted only in 0.9% sodium chloride. A bag with crystals must never be given, because the particles can embolise and the dose is unknown. The fresh infusion is given no faster than 50 mg/minute in adults, with ECG and blood pressure monitoring, because rapid infusion causes hypotension and arrhythmias. The line is flushed with saline before and after.
- A: A filter removes particles but the remaining dose is unknown and incompatible.
- B: Heating does not make phenytoin compatible with dextrose.
- D: Shaking does not redissolve the precipitate and the dose stays uncertain.
Question 3 · Medium
Once a multi-dose vial of insulin is opened and in use, it may usually be kept at room temperature (below about 25-30 °C) for:
1. AUntil the printed expiry date
2. B7 days
3. C28 days
4. D3 months
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Answer: C · 28 days
Most insulin vials and pens in use stay potent for about 28 days at room temperature, which also makes injections less painful than cold insulin. The date of opening is written on the vial, and it is discarded after the period the maker states, even if insulin remains. Unopened stock goes in the refrigerator at 2-8 °C and must never freeze. Heat and direct sunlight destroy insulin.
- A: The printed expiry date applies only to unopened, refrigerated stock.
- B: Seven days is too short; most products allow about four weeks.
- D: Three months exceeds the in-use stability of opened insulin.
Question 4 · Easy
A drug order says 'Tab. pantoprazole 40 mg a.c.' The abbreviation 'a.c.' tells the nurse to give it:
1. AWhen required
2. BAt bedtime
3. CAfter meals
4. DBefore meals
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Answer: D · Before meals
'a.c.' stands for ante cibum, before food. Pantoprazole and other proton pump inhibitors work best when taken about 30-60 minutes before a meal, when the proton pumps are activated. 'p.c.' means after meals, 'h.s.' at bedtime and 'p.r.n.' when required. Many hospitals now prefer writing the timing in full to avoid errors.
- A: When required is 'p.r.n.'.
- B: At bedtime is 'h.s.'.
- C: After meals is 'p.c.' (post cibum).
Question 5 · Hard
A boy weighing 44 lb (20 kg) needs a drug whose usual adult dose is 300 mg. Applying Clark's weight rule, his dose is:
1. A132 mg
2. B88 mg
3. C176 mg
4. D40 mg
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Answer: B · 88 mg
Clark's rule: child dose = (weight in pounds ÷ 150) × adult dose. Here 44 ÷ 150 = 0.293, and 0.293 × 300 mg = 88 mg. The 150 lb in the formula is the average adult weight, so the weight must be in pounds. Rules like this are rough; a dose per kilogram from the drug literature is preferred whenever one is given.
- A: 132 mg comes from dividing by 100 instead of 150.
- C: 176 mg comes from dividing by 75 instead of 150.
- D: 40 mg comes from putting the weight in kilograms (20) into a formula built for pounds.
Question 6 · Medium
A farmer in Kerala is bitten on the ankle by a snake. Which first aid follows the Indian national snakebite protocol?
1. ATie a tight tourniquet just above the bite
2. BCut across the wound and suck out the venom
3. CApply ice packs to the bite and wait at home
4. DImmobilise the limb and take him to hospital
Answer and explanation in LearnFree account
Question 7 · Hard
A malnourished patient receives 500 mL of 10% dextrose. Taking 3.4 kcal per gram of hydrated dextrose, how much energy does this bag supply?
1. A85 kcal
2. B50 kcal
3. C170 kcal
4. D200 kcal
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Question 8 · Easy
For an adult, the largest volume usually given as a single intramuscular injection into the deltoid muscle is about:
1. A3 mL
2. B0.1 mL
3. C5 mL
4. D1 mL
Answer and explanation in LearnFree account
Question 9 · Hard
A drug has a half-life of 6 hours. Its plasma level is 80 µg/mL when it is stopped. Assuming first-order elimination, what is the level 18 hours later?
1. A10 µg/mL
2. B20 µg/mL
3. C26.7 µg/mL
4. D40 µg/mL
Answer and explanation in LearnFree account
Question 10 · Medium
Half an hour after a new bag of IV fluid is hung, a patient has rigors, a temperature of 39.4 °C and BP 92/60 mmHg; the cannula site looks normal. What should the nurse do first?
1. AContinue the fluid and recheck the temperature in an hour
2. BStop the infusion and keep the bag and set for culture
3. CSlow the infusion and give oral paracetamol
4. DRemove the cannula and resite it in the other arm
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Question 11 · Hard
A nurse has a deep needle-stick from a patient with HIV on treatment. Following NACO guidance, which post-exposure prophylaxis should she start, and for how long?
1. AZidovudine alone for 14 days
2. BTenofovir and lamivudine for 7 days
3. CTenofovir, lamivudine and dolutegravir for 28 days
4. DNevirapine single dose immediately
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Question 12 · Medium
In the classic 'three checks' of drug administration, the label of the drug container is read:
1. AAt the start, the middle and the end of each shift
2. BOnce by the nurse and then twice by the pharmacist
3. CWhen it is ordered, when dispensed and when discarded
4. DOn taking it out, before preparing, on putting it back
Answer and explanation in LearnFree account
Question 13 · Medium
Before pouring sterile saline into a bowl on a sterile field, the nurse pours a little into a waste receiver first. This is done to:
1. ATest that the seal of the bottle is intact
2. BRinse organisms off the lip of the bottle
3. CCheck that the saline is warm enough
4. DMeasure the exact volume that is needed
Answer and explanation in LearnFree account
Question 14 · Easy
By the international colour code for peripheral IV cannulas, a blue cannula is:
1. A22 G
2. B20 G
3. C24 G
4. D18 G
Answer and explanation in LearnFree account
Question 15 · Easy
The hot air oven is the method of choice for sterilising:
1. ARubber catheters and plastic tubing
2. BGlassware, oils and dusting powders
3. CLinen gowns and cotton drapes
4. DFibre-optic endoscopes
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Question 16 · Easy
Adrenaline labelled '1:1000' contains how much drug per millilitre?
1. A0.1 mg
2. B10 mg
3. C100 micrograms
4. D1 mg
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Question 17 · Easy
The standard holding cycle for steam sterilisation in a gravity autoclave is:
1. A160 °C for 2 hours in dry heat
2. B100 °C for 30 minutes at normal pressure
3. C134 °C for 30 minutes at 5 psi
4. D121 °C for 15 minutes at 15 psi
Answer and explanation in LearnFree account
Question 18 · Easy
A known diabetic at an office is sweaty, shaky and confused but can swallow. His glucometer reads 52 mg/dL. The first-aider should first give:
1. AA large meal rich in protein and fat
2. BAbout 15 g of quick-acting sugar by mouth
3. CHis usual dose of insulin by injection
4. DNothing by mouth until he is in hospital
Answer and explanation in LearnFree account
Question 19 · Medium
A unit of packed red cells is collected from the blood bank. The transfusion should be:
1. AKept in the ward refrigerator until it is needed
2. BWarmed for an hour in hot water before starting
3. CStarted within 30 minutes and finished within 4 hours
4. DStarted within 4 hours and finished within 8 hours
Answer and explanation in LearnFree account
Question 20 · Medium
A motorcyclist lies on the road after a crash with neck pain and tingling in both arms. How should he be moved?
1. ASat up to make breathing easier
2. BAsked to stand and walk if he can
3. CLog-rolled onto a spinal board, head kept in line
4. DLifted by the arms and legs to a car seat
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Question 21 · Hard
A 9-year-old was bitten on the calf by a stray dog; the wound is deep and bleeding. He has never had rabies vaccine. Which management is correct?
1. ASuture the wound tightly, then start the vaccine
2. BWash the wound and give the rabies vaccine course only
3. CWash the wound, give rabies vaccine and immunoglobulin
4. DObserve the dog for 10 days before starting anything
Answer and explanation in LearnFree account
Question 22 · Easy
Chlorhexidine gluconate is preferred over plain alcohol for surgical hand antisepsis mainly because chlorhexidine:
1. ABinds to skin and keeps acting for hours
2. BKills bacterial spores on the hands
3. CDoes not need any contact time to act
4. DWorks even when hands are visibly soiled
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Question 23 · Medium
A farmer is brought in drowsy and drooling, with pinpoint pupils; his clothes smell of an insecticide he was spraying. What should the nurse do first, after putting on gloves?
1. ACover him in a blanket in his own clothes
2. BMake him vomit by putting a finger in his throat
3. CRemove his clothes and wash his skin with soap
4. DGive him milk to drink to neutralise the poison
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Question 24 · Medium
Under the BMW Rules 2016, deep burial of anatomical waste is allowed only:
1. AFor small clinics with fewer than ten beds
2. BIn rural or remote areas with no access to a common facility
3. CIn any hospital that has land on its own campus
4. DWhen the incinerator in the city is down for repair
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Question 25 · Medium
For an adult with a well-functioning peripheral IV cannula and no signs of phlebitis, CDC guidance says the cannula need not be replaced more often than every:
1. A12 hours
2. B72-96 hours
3. C7 days
4. D24 hours
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15 more Infection control, medication administration and first aid questions

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Study Fundamentals of Nursing

Infection control, medication administration and first aid

Which of these intravenous fluids is hypotonic to plasma?

A nurse dilutes IV phenytoin in 5% dextrose for a patient in status epilepticus, and fine crystals appear in the bag. What is the correct action?

Once a multi-dose vial of insulin is opened and in use, it may usually be kept at room temperature (below about 25-30 °C) for:

A drug order says 'Tab. pantoprazole 40 mg a.c.' The abbreviation 'a.c.' tells the nurse to give it:

A boy weighing 44 lb (20 kg) needs a drug whose usual adult dose is 300 mg. Applying Clark's weight rule, his dose is:

A farmer in Kerala is bitten on the ankle by a snake. Which first aid follows the Indian national snakebite protocol?

A malnourished patient receives 500 mL of 10% dextrose. Taking 3.4 kcal per gram of hydrated dextrose, how much energy does this bag supply?

For an adult, the largest volume usually given as a single intramuscular injection into the deltoid muscle is about:

A drug has a half-life of 6 hours. Its plasma level is 80 µg/mL when it is stopped. Assuming first-order elimination, what is the level 18 hours later?

Half an hour after a new bag of IV fluid is hung, a patient has rigors, a temperature of 39.4 °C and BP 92/60 mmHg; the cannula site looks normal. What should the nurse do first?

A nurse has a deep needle-stick from a patient with HIV on treatment. Following NACO guidance, which post-exposure prophylaxis should she start, and for how long?

In the classic 'three checks' of drug administration, the label of the drug container is read:

Before pouring sterile saline into a bowl on a sterile field, the nurse pours a little into a waste receiver first. This is done to:

By the international colour code for peripheral IV cannulas, a blue cannula is:

The hot air oven is the method of choice for sterilising:

Adrenaline labelled '1:1000' contains how much drug per millilitre?

The standard holding cycle for steam sterilisation in a gravity autoclave is:

A known diabetic at an office is sweaty, shaky and confused but can swallow. His glucometer reads 52 mg/dL. The first-aider should first give:

A unit of packed red cells is collected from the blood bank. The transfusion should be:

A motorcyclist lies on the road after a crash with neck pain and tingling in both arms. How should he be moved?

A 9-year-old was bitten on the calf by a stray dog; the wound is deep and bleeding. He has never had rabies vaccine. Which management is correct?

Chlorhexidine gluconate is preferred over plain alcohol for surgical hand antisepsis mainly because chlorhexidine:

A farmer is brought in drowsy and drooling, with pinpoint pupils; his clothes smell of an insecticide he was spraying. What should the nurse do first, after putting on gloves?

Under the BMW Rules 2016, deep burial of anatomical waste is allowed only:

For an adult with a well-functioning peripheral IV cannula and no signs of phlebitis, CDC guidance says the cannula need not be replaced more often than every: