RPN Safe Medication Administration 4 — Questions and Answers
Question 1: An RPN is administering an IM injection to an adult patient. Which is the preferred site for a large-volume IM injection?
- Deltoid muscle
- Ventrogluteal site (Correct answer)
- Dorsogluteal site
- Vastus lateralis in the thigh
Correct answer: Ventrogluteal site
The ventrogluteal site is preferred for large-volume IM injections in adults because it is free of major nerves and blood vessels.
Question 2: Which of the following is an example of a pharmacokinetic drug interaction?
- Two drugs with opposite therapeutic effects canceling each other out
- One drug altering the metabolism of another drug in the liver (Correct answer)
- Combining two sedatives causing additive CNS depression
- A drug binding to the same receptor as another drug
Correct answer: One drug altering the metabolism of another drug in the liver
Pharmacokinetic interactions involve one drug altering the absorption, distribution, metabolism, or excretion of another drug.
Question 3: A nurse must administer 250 mg of a medication available as 125 mg/5 mL. How many mL should be administered?
- 5 mL
- 10 mL (Correct answer)
- 2.5 mL
- 15 mL
Correct answer: 10 mL
Using the formula: (desired dose ÷ available dose) × volume = (250 ÷ 125) × 5 = 10 mL.
Question 4: When using the Z-track technique for IM injection, what is the primary purpose?
- Reduce pain at the injection site
- Prevent leakage of irritating medication into subcutaneous tissue (Correct answer)
- Increase the rate of drug absorption
- Avoid hitting a nerve during injection
Correct answer: Prevent leakage of irritating medication into subcutaneous tissue
The Z-track technique seals the medication in the muscle by displacing the skin and subcutaneous tissue, preventing irritating drugs from tracking back through the needle path.
Question 5: A patient on digoxin reports nausea, visual disturbances, and seeing yellow-green halos. The nurse's priority action is to:
- Administer the next scheduled dose and monitor symptoms
- Hold the dose, assess heart rate, and notify the prescriber (Correct answer)
- Give an antiemetic and reassess in 30 minutes
- Encourage fluid intake to enhance renal excretion
Correct answer: Hold the dose, assess heart rate, and notify the prescriber
These are classic signs of digoxin toxicity; the nurse must withhold the dose, check the apical pulse, and promptly notify the prescriber.
Question 6: Which action is required when wasting a controlled substance that was not fully administered?
- Dispose of it in a regular sharps container alone
- Document the amount wasted and have a second nurse witness and co-sign (Correct answer)
- Return unused portion to the pharmacy without documentation
- Flush the remainder and document independently
Correct answer: Document the amount wasted and have a second nurse witness and co-sign
Controlled substance wasting must be witnessed and co-signed by a second authorized nurse to ensure accountability and prevent diversion.
Question 7: The nurse is applying a transdermal nitroglycerin patch. Which instruction to the patient is most important?
- Apply the patch to the same location every day
- Remove the old patch before applying the new one (Correct answer)
- Apply the patch directly over the chest for best effect
- Keep the patch in place during showering by covering with tape
Correct answer: Remove the old patch before applying the new one
The old transdermal patch must be removed before applying a new one to prevent cumulative dosing and potential hypotension or toxicity.
RPN Safe Medication Administration 4
An RPN is administering an IM injection to an adult patient.
Which is the preferred site for a large-volume IM injection?