Medication administration, calculations and IV therapy

60 NCLEX-RN practice questions on Medication administration, calculations and IV therapy, part of Pharmacological and Parenteral Therapies. 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 · Medium · Matrix
For each IV solution, indicate its tonicity compared with plasma.
For each row, choose: Isotonic / Hypotonic / Hypertonic
1. 3% sodium chloride
2. 0.9% sodium chloride
3. Lactated Ringer's solution
4. 10% dextrose in water
5. 0.45% sodium chloride
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Answer:
- 3% sodium chloride: Hypertonic
- 0.9% sodium chloride: Isotonic
- Lactated Ringer's solution: Isotonic
- 10% dextrose in water: Hypertonic
- 0.45% sodium chloride: Hypotonic
Analyze cues: isotonic fluids expand the extracellular space, hypotonic fluids move water into cells, and hypertonic fluids pull water out of cells. Hypertonic saline needs close monitoring of sodium and neurologic status.
- 3% sodium chloride: Concentrated saline is hypertonic and used for severe hyponatremia.
- 0.9% sodium chloride: Normal saline is isotonic.
- Lactated Ringer's solution: LR is isotonic.
- 10% dextrose in water: D10W is hypertonic.
- 0.45% sodium chloride: Half-strength saline is hypotonic.
Question 2 · Easy · Select all that apply
The nurse is preparing a subcutaneous injection for an adult. Which sites are appropriate?
1. AWithin 1 inch of the umbilicus
2. BOver a bruise from a previous dose
3. CAbdomen, at least 2 inches from the umbilicus
4. DVentrogluteal muscle
5. EFront of the thigh
6. FBack of the upper arm
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Answer: C, E, F
Take action: subcutaneous sites are the abdomen away from the umbilicus, the back of the upper arm and the anterior thigh, rotated to prevent lipohypertrophy. Bruised or scarred skin is avoided.
- A: The area close to the umbilicus is avoided.
- B: Bruised, scarred or inflamed skin absorbs unpredictably.
- D: This is an intramuscular site.
Question 3 · Hard · Select all that apply
A 2-year-old is receiving maintenance IV fluids. Which actions should the nurse take?
1. ARun the infusion on an electronic pump
2. BCover the site completely with opaque tape
3. CUse a volume-control chamber holding no more than 1 to 2 hours of fluid
4. DCheck the IV site at least every hour
5. EAdd the prescribed potassium to the bag already hanging
6. FRun the fluid by gravity with a macrodrip set
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Answer: A, C, D
Generate solutions: young children have little fluid reserve, so pediatric IV safety depends on a pump, a volume-control chamber and frequent site checks. Sites stay visible and drugs are added only to new bags.
- B: The site must stay visible for hourly checks.
- E: Adding to a hanging bag mixes poorly and risks a bolus.
- F: Gravity sets are imprecise for small volumes.
Question 4 · Hard · Select all that apply
A client with type A negative blood needs packed red blood cells. Which units are compatible?
1. AA negative
2. BB negative
3. CO negative
4. DAB negative
5. EA positive
6. FO positive
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Answer: A, C
Analyze cues: a group A client has anti-B, so only A or O red cells are ABO-compatible; Rh-negative clients receive Rh-negative cells unless supply is critical. The nurse still completes the two-person bedside check.
- B: B cells react with the client's anti-B.
- D: AB cells carry the B antigen, which the client's anti-B attacks.
- E: Rh-positive cells may sensitize an Rh-negative client.
- F: Rh-positive cells may sensitize an Rh-negative client.
Question 5 · Medium · Select all that apply
A client is receiving parenteral nutrition through a central line. Which actions should the nurse include in the plan of care?
1. APiggyback IV antibiotics into the nutrition line
2. BWeigh the client daily
3. CCheck capillary blood glucose every 4 to 6 hours
4. DKeep the same bag hanging for up to 72 hours
5. EIncrease the rate to catch up when the infusion falls behind
6. FInfuse the solution through a dedicated lumen
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Answer: B, C, F
Generate solutions: parenteral nutrition is infused at a steady rate through a dedicated lumen with glucose checks and daily weights. Tubing and bags are changed at least every 24 hours. Falling behind is reported, not corrected by speeding up.
- A: Other drugs must not be added to the nutrition line.
- D: A bag hangs no longer than 24 hours to limit bacterial growth.
- E: Catching up can cause hyperglycemia and fluid overload.
Question 6 · Medium · Matrix
The nurse is reviewing intramuscular injection technique. For each choice, indicate whether it is appropriate or not appropriate.
For each row, choose: Appropriate / Not appropriate
1. Dorsogluteal site as the first choice
2. Vastus lateralis for an infant's vaccine
3. Deltoid for a 3 mL injection in an adult
4. Aspirating before giving an IM vaccine
5. Needle inserted at a 90-degree angle
6. Ventrogluteal site for a 2.5 mL injection in an adult
Answer and explanation in LearnFree account
Question 7 · Medium · Select all that apply
A client with dysphagia takes medications crushed in applesauce. Which medications should the nurse avoid crushing?
1. AEnteric-coated aspirin
2. BNifedipine XL tablet
3. CLisinopril tablet
4. DAcetaminophen regular-strength tablet
5. EFurosemide tablet
6. FMetoprolol succinate extended-release tablet
Answer and explanation in LearnFree account
Question 8 · Medium · Select all that apply
The nurse is choosing a site and technique to start a peripheral IV in an adult. Which actions are appropriate?
1. AReplace the catheter routinely every 24 hours
2. BShave hair at the site with a razor
3. CChoose a vein on the forearm of the nondominant arm
4. DAvoid the arm on the side of a mastectomy with lymph node removal
5. EAvoid areas of flexion such as the wrist and antecubital fossa
6. FClean the skin with chlorhexidine-alcohol and let it dry
Answer and explanation in LearnFree account
Question 9 · Medium · Matrix
A nursing student lists several dosage conversions. For each, indicate whether it is correct.
For each row, choose: Correct / Incorrect
1. 100 mcg = 0.01 mg
2. 0.25 mg = 250 mcg
3. 1 teaspoon = 15 mL
4. 44 lb = 20 kg
5. 2.5 g = 250 mg
Answer and explanation in LearnFree account
Question 10 · Hard · Matrix
The nurse is caring for clients with central venous catheters. For each finding, indicate the most likely complication.
For each row, choose: Catheter occlusion / Bloodstream infection / Air embolism
1. Sudden dyspnea and hypotension after the cap fell off the line
2. No blood return and resistance when flushing
3. Purulent drainage at the exit site and WBC 15,800/mm3
4. Fever and chills an hour after the line is flushed
5. Repeated high-pressure pump alarms with clamps open
Answer and explanation in LearnFree account
Question 11 · Hard · Matrix
A child who weighs 39.6 lb has several new prescriptions. Each safe range is shown. For each, indicate whether the dose is within the safe range.
For each row, choose: Within safe range / Outside safe range
1. Gentamicin 40 mg IV every 8 hours (2 to 2.5 mg/kg/dose)
2. Amoxicillin 400 mg orally every 12 hours (25 to 45 mg/kg/day)
3. Acetaminophen 400 mg orally every 4 hours (10 to 15 mg/kg/dose)
4. Ondansetron 4 mg IV once (0.1 to 0.15 mg/kg/dose)
5. Ibuprofen 150 mg orally every 6 hours (5 to 10 mg/kg/dose)
Answer and explanation in LearnFree account
Question 12 · Hard · Matrix
A new nurse calculates several infusion rates. For each, indicate whether the calculated rate is correct.
For each row, choose: Correct / Incorrect
1. Cefazolin 2 g in 100 mL over 30 minutes by pump: 200 mL/h
2. Heparin 25,000 units in 250 mL at 1,000 units/h: 100 mL/h
3. 1,000 mL 0.9% sodium chloride over 8 hours by pump: 125 mL/h
4. 500 mL lactated Ringer's over 4 hours, 20 gtt/mL set: 42 gtt/min
5. Dobutamine 250 mg in 250 mL at 5 mcg/kg/min for a 70-kg client: 2.1 mL/h
Answer and explanation in LearnFree account
Question 13 · Hard · Select all that apply
The nurse is preparing to transfuse packed red blood cells to an adult. Which actions are correct?
1. AUse an 18- to 20-gauge catheter
2. BWarm the unit in a microwave
3. CComplete the unit within 4 hours of spiking
4. DTake baseline vital signs before starting
5. EUse a blood administration set with a filter
6. FStay with the client for the first 15 minutes
Answer and explanation in LearnFree account
Question 14 · Medium · Select all that apply
The nurse is giving several medications through an adult client's gastrostomy tube. Which actions are correct?
1. AMix all the medications into the feeding bag
2. BCheck tube placement and residual per policy before giving drugs
3. CGive each medication separately, with water between doses
4. DCrush an enteric-coated tablet and give it through the tube
5. EPush the medications quickly with force if the tube is sluggish
6. FFlush with 15 to 30 mL of water before and after the medications
Answer and explanation in LearnFree account
Question 15 · Medium · Matrix
The nurse is supervising care of clients with central venous catheters. For each action, indicate whether it is indicated or contraindicated.
For each row, choose: Indicated / Contraindicated
1. Change a transparent dressing every 7 days and when soiled
2. Clean the site with chlorhexidine-alcohol at dressing changes
3. Flush a PICC with a 3 mL syringe
4. Take blood pressure on the arm with the PICC
5. Force the flush when resistance is felt
6. Scrub the hub with an antiseptic before each access
Answer and explanation in LearnFree account
Question 16 · Medium · Select all that apply
The nurse is giving an IV push drug through a peripheral saline lock. Which actions are correct?
1. AMix two drugs in one syringe without checking compatibility
2. BFlush first and check for blood return or easy flow
3. CTime the push against the drug guide's recommended rate
4. DCheck compatibility of the drug with the flush solution
5. EFlush after the drug at the same rate as the push
6. FPush faster than recommended if the client is anxious
Answer and explanation in LearnFree account
Question 17 · Hard · Matrix
The charge nurse observes medication practices on the unit. For each action, indicate whether it is safe or unsafe.
For each row, choose: Safe practice / Unsafe practice
1. Scanning the wristband and drug barcode at the bedside
2. Reading back a telephone order to the prescriber
3. Giving an injection drawn up by another nurse
4. Charting a medication before giving it
5. Leaving a dose on the tray for the client to take after a shower
Answer and explanation in LearnFree account
Question 18 · Hard · Select all that apply
A vesicant drug is infusing through a peripheral IV when the client reports burning and the site is swelling. Which actions should the nurse take?
1. AMark the area and document its size and appearance
2. BFlush the catheter with saline to dilute the drug
3. CRemove the catheter before trying to aspirate
4. DNotify the health care provider
5. EDisconnect the tubing and aspirate residual drug from the catheter
6. FStop the infusion
Answer and explanation in LearnFree account
Question 19 · Easy · Matrix
The nurse assesses several peripheral IV sites. For each finding, indicate what it represents.
For each row, choose: Infiltration / Phlebitis / No complication
1. Cool, pale, swollen skin around the site
2. Dry site under an intact transparent dressing, no redness
3. Taut skin with the infusion slowing
4. Hard, cord-like vein above the site
5. Red streak along the vein, warm and tender
Answer and explanation in LearnFree account
Question 20 · Hard · Matrix
For each client situation, indicate whether the nurse should stop the infusion now or continue and monitor.
For each row, choose: Stop the infusion now / Continue and monitor
1. Red streak and tenderness along the vein above the IV
2. Temperature rises by 0.3 °F during a transfusion, other vital signs unchanged
3. Peripheral IV site is cool, swollen and pale
4. Back pain and chills 10 minutes into a red cell transfusion
5. Glucose 165 mg/dL in a client on parenteral nutrition
Answer and explanation in LearnFree account
Question 21 · Medium · Select all that apply
The nurse is completing medication reconciliation for a client admitted from home. Which actions are correct?
1. ADiscard the home list once admission orders are written
2. BRecord each drug's dose and the time it was last taken
3. CList every prescription, over-the-counter and herbal product the client takes
4. DCompare the home list with the admission prescriptions
5. ERely on the pharmacy record alone
Answer and explanation in LearnFree account
Question 22 · Easy · Select all that apply
Which actions should the nurse take at the bedside before giving a scheduled oral medication?
1. AConfirm the client's name and date of birth
2. BUse the room number to confirm identity
3. CCheck the client's allergy status
4. DLeave the dose for the client to take later
5. ECompare the drug label with the MAR
Answer and explanation in LearnFree account
Question 23 · Medium · Select all that apply
Which practices reduce errors when the nurse runs IV infusions by smart pump?
1. ATrace each line from the bag to the client at handoff
2. BProgram the pump using its drug library
3. COverride a hard-limit alert to save time
4. DSilence a repeating occlusion alarm without checking the line
5. EProgram by rate only, bypassing the library
Answer and explanation in LearnFree account
Question 24 · Medium · Select all that apply
The nurse is giving medications on a pediatric unit. Which actions support accurate weight-based dosing?
1. AUse an oral syringe for liquid doses
2. BCalculate the safe dose range before giving the drug
3. CWeigh the child in kilograms on admission
4. DHave a second nurse check high-alert doses independently
5. ERecord the weight in kilograms only
6. FUse the weight recorded at a clinic visit 6 months ago
Answer and explanation in LearnFree account
Question 25 · Medium
Acetaminophen 15 mg/kg orally is prescribed for a child who weighs 22 lb. The liquid contains 160 mg/5 mL. How many milliliters should the nurse give?
1. A2.3 mL
2. B6.3 mL
3. C4.7 mL
4. D10.3 mL
Answer and explanation in LearnFree account

35 more Medication administration, calculations and IV therapy questions

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Medication administration, calculations and IV therapy

For each IV solution, indicate its tonicity compared with plasma.

The nurse is preparing a subcutaneous injection for an adult. Which sites are appropriate?

A 2-year-old is receiving maintenance IV fluids. Which actions should the nurse take?

A client with type A negative blood needs packed red blood cells. Which units are compatible?

A client is receiving parenteral nutrition through a central line. Which actions should the nurse include in the plan of care?

The nurse is reviewing intramuscular injection technique. For each choice, indicate whether it is appropriate or not appropriate.

A client with dysphagia takes medications crushed in applesauce. Which medications should the nurse avoid crushing?

The nurse is choosing a site and technique to start a peripheral IV in an adult. Which actions are appropriate?

A nursing student lists several dosage conversions. For each, indicate whether it is correct.

The nurse is caring for clients with central venous catheters. For each finding, indicate the most likely complication.

A child who weighs 39.6 lb has several new prescriptions. Each safe range is shown. For each, indicate whether the dose is within the safe range.

A new nurse calculates several infusion rates. For each, indicate whether the calculated rate is correct.

The nurse is preparing to transfuse packed red blood cells to an adult. Which actions are correct?

The nurse is giving several medications through an adult client's gastrostomy tube. Which actions are correct?

The nurse is supervising care of clients with central venous catheters. For each action, indicate whether it is indicated or contraindicated.

The nurse is giving an IV push drug through a peripheral saline lock. Which actions are correct?

The charge nurse observes medication practices on the unit. For each action, indicate whether it is safe or unsafe.

A vesicant drug is infusing through a peripheral IV when the client reports burning and the site is swelling. Which actions should the nurse take?

The nurse assesses several peripheral IV sites. For each finding, indicate what it represents.

For each client situation, indicate whether the nurse should stop the infusion now or continue and monitor.

The nurse is completing medication reconciliation for a client admitted from home. Which actions are correct?

Which actions should the nurse take at the bedside before giving a scheduled oral medication?

Which practices reduce errors when the nurse runs IV infusions by smart pump?

The nurse is giving medications on a pediatric unit. Which actions support accurate weight-based dosing?

Acetaminophen 15 mg/kg orally is prescribed for a child who weighs 22 lb. The liquid contains 160 mg/5 mL. How many milliliters should the nurse give?