NCLEX-PN Test #5 2 — Questions and Answers
Question 1: A client is prescribed morphine sulfate 4 mg IV every 4 hours PRN for pain. The medication on hand is morphine 10 mg/mL. How many mL should the nurse administer?
- 0.2 mL
- 0.4 mL (Correct answer)
- 0.8 mL
- 4.0 mL
Correct answer: 0.4 mL
Using the formula: Dose desired ÷ Dose on hand × Volume = 4 mg ÷ 10 mg × 1 mL = 0.4 mL. This is a critical calculation — administering the wrong volume of a concentrated opioid can cause respiratory depression and death.
Question 2: A client is taking warfarin (Coumadin) for atrial fibrillation. Which dietary instruction is most important?
- Avoid all green leafy vegetables permanently
- Maintain a consistent intake of vitamin K-rich foods (Correct answer)
- Take warfarin with a high-fat meal for better absorption
- Increase protein intake to enhance drug metabolism
Correct answer: Maintain a consistent intake of vitamin K-rich foods
Warfarin's anticoagulant effect is inversely related to vitamin K intake. Clients do NOT need to eliminate vitamin K foods but must keep intake consistent. Dramatic changes in vitamin K intake cause INR fluctuations and bleeding risk or subtherapeutic anticoagulation. Complete avoidance is unnecessary and can be harmful.
Question 3: A client is prescribed phenytoin (Dilantin) for seizure management. Which side effect is a sign of toxicity and requires immediate action?
- Mild gingival hyperplasia
- Nystagmus and ataxia (Correct answer)
- Drowsiness during initial therapy
- Skin rash that is mild and transient
Correct answer: Nystagmus and ataxia
Nystagmus (involuntary eye movement) and ataxia (loss of coordination) are signs of phenytoin toxicity (therapeutic range 10–20 mcg/mL). They indicate serum levels are too high. Gingival hyperplasia and drowsiness are common side effects, not toxicity. A severe skin rash may indicate Stevens-Johnson syndrome and also requires immediate action.
Question 4: Which "five rights" of medication administration is the nurse checking when scanning the client's armband and medication barcode?
- Right medication and right dose
- Right client and right medication (Correct answer)
- Right time and right route
- Right client and right documentation
Correct answer: Right client and right medication
Barcode medication administration (BCMA) systems verify the right client (by matching the armband ID) and the right medication (by scanning the drug barcode). The nurse is responsible for all five rights, but BCMA technology specifically addresses client identification and medication verification.
Question 5: A client with type 2 diabetes is started on glipizide (a sulfonylurea). What is the most important safety teaching?
- Take medication only when blood sugar is above 200 mg/dL
- Monitor for hypoglycemia, especially if meals are delayed or skipped (Correct answer)
- Drink extra fluids to prevent kidney damage
- The medication can be safely combined with unlimited alcohol
Correct answer: Monitor for hypoglycemia, especially if meals are delayed or skipped
Sulfonylureas stimulate the pancreas to release insulin regardless of blood glucose level, making hypoglycemia a significant risk — especially if a meal is delayed, skipped, or inadequate. Clients must be taught to recognize and treat hypoglycemia (glucose tablets, juice) and eat consistently.
Question 6: A client is prescribed amoxicillin 500 mg PO three times daily. The available tablets are 250 mg each. How many tablets should the nurse administer per dose?
- 1 tablet
- 2 tablets (Correct answer)
- 3 tablets
- ½ tablet
Correct answer: 2 tablets
Desired dose ÷ dose on hand = 500 mg ÷ 250 mg = 2 tablets per dose. The client would receive 2 tablets three times daily for a total daily dose of 1,500 mg.
NCLEX-PN Test #5 2
A client is prescribed morphine sulfate 4 mg IV every 4 hours PRN for pain.
The medication on hand is morphine 10 mg/mL.
How many mL should the nurse administer?