1. A patient has been prescribed a metered-dose inhaler (MDI) containing 200 doses of a bronchodilator. The patient has been instructed to take two puffs of the medication three times daily. At this dosage, how long will the MDI last?

1. 100 days
2. 50 days
3. 66 days
4. 33 days

2. Before discharge, the nurse shows a patient how to use a dry powder inhaler (DPI). What should the nurse now assess?

1. Patient’s understanding of the purpose of the medication
2. Patient’s ability to handle, manipulate, and activate the DPI
3. Adequacy of the patient’s planned daily medication schedule
4. Patient’s awareness of the signs of an allergic reaction to the medication

3. To ensure proper distribution of ear medication after instillation, what will the nurse instruct an adult patient to do?

1. Have a family member instill the medication
2. Avoid contaminating the medication's applicator tip
3. Instill the medication at the time ordered by the provider
4. Instill the medication after gently pulling the ear up and back

4. Which of the following discharge instructions would be most important in ensuring the safety of a patient who will need to apply a dermal patch daily at home?

1. Apply sufficient pressure to the edges of the patch to ensure adequate adherence.
2. Avoid using a heating pad on or near the application site.
3. Pat the application site dry before applying the patch.
4. Reapply the patch to the same site each time to enhance absorption.

5. A female nurse is preparing to administer a rectal suppository to a male patient. The patient says, "This is so embarrassing. Is this really necessary?” What is the most appropriate response?

1. "I can see if the doctor will order an oral medication."
2. "How about if I show you how to insert the suppository yourself?"
3. "I will make sure that you are well covered. I promise."
4. "This will make you feel so much better.”

6. The nurse is applying a topical antibiotic and dressing to a burn on the hand of a patient being treated as an outpatient. What is the most important thing the nurse can do to minimize the risk of infection?

1. Evaluate the patient's ability to recognize the signs and symptoms of infection
2. Perform effective hand hygiene before and after the application
3. Instruct the patient not to change the dressing between visits
4. Apply the medication using sterile technique

7. Which statement best illustrates the nurse’s understanding of appropriate sites for the application of an estrogen patch?

1. "I’ll check to see if the patient has pendulous breasts."
2. "I need to assess the skin on the patient's thighs."
3. "I need to encourage her to wear elastic waistbands."
4. "I’ll tell her to wear blouses and shirts with loose sleeves.”

8. The nurse is preparing to help a patient use a dry powder inhaler. What will the nurse do first in order to evaluate the medication’s effectiveness?

1. Assess the patient’s respiratory status.
2. Warn the patient against overuse of the inhaler.
3. Discuss the side effects of the particular drug.
4. Verify the patient’s identity according to agency policy.

9. Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the instillation of ear medications?

1. "Did you let the ear medication warm to room temperature?"
2. "Do you think the patient is capable of instilling her own ear drops?"
3. "Please tell the patient that the medication may make him dizzy when he stands up."
4. "Be sure to keep the patient on her side for a few minutes, because I just administered her ear drops."

10. After administering a rectal suppository for constipation, the nurse will monitor for all of the following responses except which one?

1. Low platelet count
2. Rectal pain
3. Bradycardia
4. Evacuation of stool

11. Which statement made by a nurse best illustrates an understanding of the role of nursing assistive personnel (NAP) in administering a rectal suppository?

1. "Find out whether the patient is capable of inserting the suppository."
2. "Please tell the patient to report if any rectal bleeding occurs."
3. "Be sure to let me know if the patient has a bowel movement."
4. "Remember to lubricate the suppository."

12. What is the best way for the nurse to minimize the risk of contaminating the patient’s eye during the instillation of eye drops?

1. Encourage the patient to self-apply the medication.
2. Wear gloves during the entire application process.
3. Introduce the medication onto the inner canthus of the eye.
4. Perform effective hand hygiene before and after the instillation.

13. Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the use of a dry powder inhaler (DPI)?

1. “Be sure to let me know if the patient starts coughing again.”
2. “Did you shake the inhaler well before giving it to the patient?”
3. “Do you think the patient is capable of using the inhaler independently?”
4. “Please tell the patient that the inhaler is to be used only when she is having trouble breathing.”

14. When placing an intraocular disk, the nurse recognizes that it is in the correct position by assessing what?

1. Visibility of the disk over the cornea
2. Lack of visibility of the disk as it is placed under the lower eyelid
3. Lack of visibility as it is placed under the upper eyelid
4. Visibility of a small portion of the disk extending slightly above the lower eyelid

15. Which discharge instruction would help to ensure that the patient achieves maximum therapeutic delivery of the medication when using a metered-dose inhaler (MDI)?

1. Make sure to report any adverse effects after using your inhaler.
2. Prime the inhaler if it is new or has not been used for several days.
3. Hold your breath for 60 seconds after the medication is delivered.
4. Use the inhaler while sitting up in a chair at 90-degree angle.

16. Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the use of a metered-dose inhaler?

1. “Be sure to let me know if she starts coughing again.”
2. “Show the patient how to clean the spacer chamber after she’s finished with the inhaler.”
3. “Offer the patient her inhaler if it looks like she’s short of breath.”
4. “Please tell her the inhaler is to be used no more than three times per day.”

17. Why would the nurse avoid placing nitroglycerin ointment over a scar on an otherwise suitable area of the upper arm?

1. The ointment will stick to the scar tissue.
2. The ointment is likely to irritate the scar tissue.
3. The ointment may cause the scar to become hypertrophic.
4. Scar tissue may interfere with absorption.

18. What is the best way to minimize discomfort caused by the instillation of ear medication?

1. Warm the ear drops to room temperature before instillation
2. Wear treatment gloves during the application process
3. Ask the patient to sit while introducing the medication
4. Use a cotton-tipped applicator to remove any visible cerumen

19. Which statement or question best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in the instillation of eye medications?

1. “Did you let the eye medication warm to room temperature?”
2. “Do you think the patient is capable of instilling his own eyedrops?”
3. “Be sure to slightly hyperextend her neck when instilling the medication.”
4. “Her vision may be temporarily impaired, so please help her to the bathroom.”

20. Which of the following is not taken into consideration when determining the appropriate amount of a topical medication to be applied to the skin?

1. Size of the skin site
2. Other medications the patient is taking
3. Manufacturer’s instructions for application of the product
4. Health care provider’s order

21. When instructing a patient in the use of a dry powder inhaler (DPI), which statement is accurate?

1. It is important to shake the DPI before administering the medication.
2. It is important to exhale while the lips are still around mouthpiece.
3. It is important to read the manufacturer’s instructions to determine how quickly to inhale the medication.
4. It is important for the patient to hold his or her breath for at least 60 seconds after inhaling the medication.

22. A nurse is preparing to help a patient administer a mucolytic agent using a metered-dose inhaler (MDI). What will the nurse do first in order to evaluate the medication’s effectiveness?

1. Assess the patient’s respiratory status before administration.
2. Warn against overuse of the inhaler.
3. Discuss the side effects of the particular drug.
4. Verify the patient’s identification according to agency policy.

23. After instructing a patient in the self-administration of antibiotic eyedrops, what is the nurse's highest priority assessment?

1. The patient’s understanding of the medication’s purpose
2. The patient’s hand grasp, strength, coordination, and ability to manipulate the applicator
3. The patient’s comprehension of the dosage instructions provided with the medication
4. The patient’s ability to recognize the signs of an allergic reaction to the medication

24. The nurse is preparing to discharge a patient after instructing her how to apply her own estrogen patch. What is the best way for the nurse to follow up?

1. Tell the patient what the most common errors in application are
2. Review the material with the patient and family
3. Evaluate the patient's ability to apply the patch.
4. Give the patient printed materials for later reference

25. The nurse is preparing to apply a topical oil-based medication to a patient's forearms. What should the nurse do to minimize the risk of contamination during the application?

1. Encourage the patient to self-apply the medication
2. Wear treatment gloves during the entire application process
3. Change gloves between prepping the skin and applying the medication
4. Perform effective hand hygiene before and after application

26. The nurse is preparing to apply an estrogen patch to a patient who will be discharged with a prescription for the medication. What would the nurse do to ensure the patient is able to apply the medication patch?

1. Determine the patient's physical ability to grasp the patch
2. Assess the patient's skin for appropriate application sites
3. Assess the patient's understanding of the medication's purpose
4. Determine the patient's ability to recognize the medication's possible side effects

27. The nurse is preparing to administer a rectal suppository to an elderly patient. Which step best protects the patient's safety?

1. Ask the patient to take deep, slow breaths as the suppository is being inserted.
2. Insert the suppository two inches into the rectum.
3. Place the patient in the left side-lying position with the top leg flexed.
4. Instruct the patient to use the call button for assistance to the bathroom.

28. To make sure the drug is delivered properly, what discharge instructions might the nurse give a patient who is being discharged with a dry powder inhaler (DPI)?

1. Rinse your mouth out with water after using the inhaler.
2. Use the inhaler while sitting up in bed.
3. Keep track of the dosage using the counter on the inhaler.
4. After inhaling the medication, hold your breath for at least 10 seconds before exhaling.

29. The nurse is instructing a patient who is to receive both a bronchodilator and a steroid medication delivered by means of a metered-dose inhaler (MDI). Which instruction is necessary for the safe administration of both agents?

1. “Make sure to use the steroid medication before the bronchodilator.”
2. “Make sure to use the bronchodilator before the steroid medication.”
3. “Rinse your mouth with warm water before using the MDI to administer either medication.”
4. “Make sure you wait at least 30 seconds between administering the bronchodilator and administering the steroid medication.”

30. Which instruction should be given to a patient to ensure safety when self-applying an antibiotic ointment?

1. It is not necessary to allow refrigerated eye medication to warm to room temperature before administration.
2. Do not apply pressure directly to the eyeball when removing excess medication.
3. When cleaning the eye before administration, gently wash from the outer to the inner canthus.
4. Apply a warm, damp washcloth to the eye for several minutes to remove any crusted discharge.

31. Which statement best illustrates the nurse’s understanding of the role of nursing assistive personnel (NAP) in applying an estrogen patch?

1. "Let me know when it's time to change the patient's patch."
2. “Take care not to apply the patch over breast tissue."
3. "Please apply lotion to the site from which the old patch was removed.”
4. “Make a note of where the patch is now before you remove it.”

32. The nurse should question a provider's order to insert a suppository into the rectum of a patient with which condition?

1. Watery diarrhea
2. Rectal inflammation
3. External hemorrhoids
4. Internal hemorrhoids

33. Which instruction would help ensure the maximum therapeutic response when a patient self-administers ear medication?

1. Remain in the lateral position (unaffected side) for a few minutes after instillation
2. Bring refrigerated ear medication to room temperature before instillation
3. Place a cotton ball firmly into the ear canal for 30 minutes after instillation
4. Apply a warm, damp washcloth to the external ear to remove any crusted discharge

34. After instructing a patient in the self-administration of antibiotic ear drops, what must come first in the nurse’s assessment?

1. Patient’s understanding of the medication's purpose
2. Patient’s hand grasp, strength, coordination, and ability to manipulate the applicator
3. Patient’s comprehension of the dosage instructions provided with the medication
4. Patient’s ability to recognize the signs of an allergic reaction to the medication

35. The nurse is preparing to discharge a patient after instructing her in self-application of a topical medication. What is the best way for the nurse to ensure that the patient understands the instructions?

1. Discuss with the patient the most common errors in application
2. Review the material several times with the patient and family
3. Allow the patient to apply the topical medication and provide feedback on technique
4. Give the patient printed materials for later reference