1. How can the nurse best ensure the patient’s safety when preparing insulin for administration?

1. Obtain the patient’s current blood glucose level.
2. Clean the injection site with an antibacterial swab.
3. Apply clean gloves.
4. Wipe the rubber seal of the vial with alcohol.

2. When preparing an intramuscular injection, what can the nurse do to reduce the patient’s risk for infection?

1. Wear clean gloves.
2. Use a 3-mL syringe.
3. Clean the injection site with an alcohol swab.
4. Massage the injection site.

3. Which action would the nurse take when mixing intermediate- and long-acting insulins together in one syringe?

1. Draw the intermediate-acting insulin into the syringe first.
2. Draw the long-acting insulin into the syringe first.
3. Prepare two injections.
4. Draw either the intermediate- or the long-acting insulin into the syringe first.

4. When will a patient’s blood glucose levels be most affected by a short-acting insulin injection, such as Humulin-R?

1. In 2 to 3 hours
2. For the next 12 hours
3. During unplanned exercise
4. When the patient eats carbohydrates

5. Which site is most commonly used for intramuscular injections?

1. Ventrogluteal
2. Abdominal
3. Deltoid
4. Dorsogluteal

6. What is the greatest safety concern when withdrawing medication from an ampule?

1. Not wearing gloves when preparing medication
2. Selecting an inappropriate needle size
3. Withdrawing glass particles into the syringe
4. Withdrawing bubbles into the syringe

7. In which site would it be inappropriate to administer an intradermal injection?

1. Lower abdomen of an obese patient
2. Upper back of a patient who is on bed rest
3. Right deltoid of a high school softball pitcher
4. Left forearm of a patient with right-sided weakness

8. Which action by the nurse helps to ensure that the medication is delivered into the muscle when administering an intramuscular injection?

1. Using a 1-inch needle
2. Inserting the needle at a 45- to 60-degree angle
3. Withdrawing the needle immediately after delivering the medication
4. Aspirating for blood return before injection medication

9. Which finding tells the nurse that a patient may have had a positive reaction to a tuberculin test?

1. A raised wheal the size of a mosquito bite
2. A bruised area 10 mm or greater in diameter
3. A hard, raised area 15 mm or greater in diameter
4. A flat, reddened area 5 mm or greater in diameter

10. What will the nurse do after opening a multidose vial and withdrawing a dose of medication from it?

1. Discard the unused portion of the medication.
2. Wipe the entire vial with an antiseptic swab.
3. Send the unused portion back to the pharmacy.
4. Label the vial with the date it was opened and your initials.

11. How can the nurse ensure that medication from a single-dose vial is used appropriately?

1. Check to see when the medication vial was opened initially.
2. Write the date and his or her initials on the label when opening the vial.
3. Draw the entire amount of medication from the vial into the syringe.
4. Discard the vial and any remaining medication in the vial directly after use.

12. A nurse is preparing to withdraw medication from an open multidose vial. After confirming that the vial contains the appropriate medication and checking the expiration date, what would the nurse do next?

1. Apply clean gloves.
2. Vigorously shake the vial.
3. Wipe the rubber seal of the vial with an alcohol swab.
4. Introduce air equal to the amount of medication needed.

13. What can the nurse do to ensure proper site selection for subcutaneous insulin injection?

1. Insert the needle at a 30-degree angle.
2. Select a different anatomical region for each injection.
3. Ask the patient to relax before inserting the needle.
4. Systematically rotate sites within the same anatomical location or area.

14. Which action minimizes the risk of introducing glass particles into the syringe when drawing medication from an ampule?

1. Using minimal force to snap the neck of the ampule
2. Using gauze to cover the top of the ampule when snapping it
3. Using a filter needle or straw to draw the medication from the ampule
4. Allowing the medication to settle after the ampule has been snapped open

15. Which action by the nurse ensures patient safety when administering an intramuscular injection?

1. Putting on clean gloves before administration
2. Rotating injection sites
3. Aspirating for blood return when administering a vaccine
4. Injecting the medication quickly

16. To prevent hypoglycemia and enhance efficacy, it is appropriate to give rapid-acting insulin how many minutes before the next meal?

1. 5 to 15 minutes
2. 30 to 40 minutes
3. 60 to 90 minutes
4. The timing of insulin around meals is not necessary.

17. What would the nurse do to remove air trapped in a syringe before withdrawing the syringe from the vial?

1. Position the tip of the needle in the vial’s airspace, and tap the barrel of the syringe.
2. Position the tip of the needle below the fluid line, and tap the vial.
3. Position the vial on a flat surface, and tap the syringe.
4. Position the syringe above the vial, and tap the vial.

18. What can the nurse do to minimize the patient’s risk for injury when delivering an intramuscular injection?

1. Instruct the patient to relax.
2. Insert the needle at a 45-degree angle.
3. Pull back on the plunger after inserting the needle.
4. Pull the skin taut at the injection site when inserting the needle.

19. When preparing to administer heparin or insulin subcutaneously, which site is preferred?

1. Abdomen
2. Scapula
3. Deltoid muscle
4. Back of the upper arm

20. When preparing an injection of mixed insulin that includes 12 units of NPH and 5 units of regular insulin, how does the nurse initially confirm the proper dosage in the syringe?

1. By noting when 5 units of clear insulin is visible in the syringe
2. By noting when 12 units of cloudy insulin is visible in the syringe
3. By having another registered nurse verify the presence of 17 units of insulin
4. By verifying that the prescription confirms the medication administration record (MAR)

21. How would the nurse prepare insulin to ensure its efficacy?

1. Do not allow refrigerated insulin to warm up before administering it.
2. Follow aseptic technique during the entire process.
3. Roll the vial of insulin suspension between the palms prior to drawing up the medication.
4. Monitor the patient’s blood glucose level before administering the injection.

22. When preparing an injection that contains both short- and intermediate-acting insulins, what is the first step the nurse would take to ensure the effectiveness of the injection?

1. Insert air into the intermediate-acting insulin.
2. Warm the vials to room temperature.
3. Shake the vials to disperse the medication within the suspension.
4. Withdraw the prescribed amount of short-acting insulin after the intermediate-acting insulin.

23. When preparing an injection from an ampule, what will the nurse do if liquid is trapped in the neck of the ampule?

1. Check the medication cabinet for an extra ampule of the medication.
2. Notify the pharmacy that an additional ampule of medication will be needed.
3. Use quick, light finger taps on the top of the ampule to move the liquid.
4. Shake the medication out of the neck of the ampule.

24. Which action would the nurse take to diminish tissue irritation when administering a subcutaneous injection to a patient of average size?

1. Massage the site after administration.
2. Make sure the volume of the medication is less than 2 mL.
3. Administer the injection at a 45- to 90-degree angle.
4. Wear clean gloves while administering the injection.

25. How can the nurse determine that the needle tip for an intradermal injection is in the dermis?

1. A bleb the size of a mosquito bite will appear.
2. The needle will enter at a 5- to 15-degree angle.
3. The bulge of the needle tip will be visible through the skin.
4. The needle will penetrate through the epidermis to a depth of about ⅛ inch.

26. Which needle would be most appropriate for the nurse to use when giving a subcutaneous injection to a patient of average height and weight?

1. 20-gauge, ½-inch
2. 22-gauge, 1-inch
3. 25-gauge, ⅜-inch
4. 27-gauge, 1-inch

27. When administering an intradermal injection, which outcome would require the nurse to withdraw the needle and begin again?

1. Aspiration of blood prior to injecting the medication
2. Inability to feel resistance when injecting the medication
3. Formation of a 6-mm bleb at the injection site
4. Appearance of a lesion resembling a mosquito bite at the injection site

28. Which statement might the nurse make to nursing assistive personnel (NAP) when caring for a patient who is prescribed an intradermal injection?

1. “Be sure to wear clean gloves during the injection.”
2. “Tell him it’s OK; the site should look like a mosquito bite.”
3. “Immediately report any patient complaints of itching or dyspnea.”
4. “Remind the patient to come back in 48 to 72 hours so we can evaluate the site.”

29. How can the nurse prevent negative pressure from building up in the vial when preparing an injection?

1. Inject an amount of air into the vial equivalent to the volume of medication to be withdrawn.
2. Insert the needle through the center of the rubber seal.
3. Keep the tip of the needle below the level of fluid in the vial.
4. Tap the barrel of the syringe to dislodge air bubbles.

30. The nurse is preparing to mix short- and intermediate-acting insulins to administer to a patient. Which action best preserves the insulin’s effectiveness?

1. Determining the patient’s blood glucose level
2. Refraining from injecting the intermediate-acting insulin into the short-acting vial
3. Applying clean gloves when administering the medication
4. Having another registered nurse verify the dose of both types of insulins

31. Which action might the nurse take when drawing up medication from an ampule?

1. Hold the ampule upside down while inserting the filter needle.
2. Inject air into the ampule before withdrawing the medication.
3. Hold the ampule horizontally while inserting the filter needle.
4. Expel air bubbles from the syringe while the filter needle is still inside the ampule.

32. What can the nurse do to minimize the discomfort of a subcutaneous injection?

1. Inject the medication rapidly.
2. Massage the injection site.
3. Cover the injection site with gauze pad after withdrawing the needle.
4. Inject the medication without pinching the skin.

33. The patient is to receive both Lantus® (insulin glargine) and regular insulin. To ensure the proper action of the insulins, what would the nurse do when preparing these two types of insulin for administration?

1. Mix the insulins in one syringe for a single injection.
2. Prepare the insulins in two syringes for separate injections.
3. Roll each vial between the palms to disperse the medication within the suspension.
4. Have another registered nurse verify the dose of the insulins.

34. Which of the following statements is accurate regarding insulin administration?

1. Vials of insulin may be stored in the freezer to extend their shelf life.
2. If the rapid-acting insulin ordered is unavailable, it is safe to substitute an alternative rapid-acting insulin.
3. Vials of insulin must be inspected before each use for changes in appearance.
4. All insulin must be shaken before use to redistribute particles within the suspension.

35. How does the nurse minimize the risk of patient infection when preparing medication from an ampule?

1. Using a filter needle to draw up the medication
2. Preparing the medication in the patient’s room
3. Applying clean gloves while preparing the medication
4. Preserving the sterility of the needle while preparing the medication