Pharmacological Therapies NCLEX-PN practice questions

Rationale

In children younger than 3 years, the ear canal is straighter and shorter; pulling the pinna downward and backward straightens the canal sufficiently to allow drops to reach the tympanic membrane. In adults and children 3 years and older, the pinna is pulled upward and backward. Option B: Ear drops should be warmed to room temperature by holding the bottle in the hand for a few minutes , not placed in hot water, which can overheat the solution, cause burns to the canal, or alter the medication's efficacy. Option C: Pulling the pinna upward and backward is the correct technique for adults and children 3 years of age or older; it does not adequately straighten the ear canal in a 2-year-old. Option D: After instillation, the child should remain lying with the treated ear facing upward for approximately 2 to 5 minutes to allow the drops to reach the canal; sitting upright allows gravity to drain the drops out immediately.

Answer: A

Rationale

Sudden low back pain, fever, and flushing occurring early during a blood transfusion are classic signs of an acute hemolytic transfusion reaction, a life-threatening emergency. The practical nurse must stop the transfusion immediately to halt further exposure to incompatible blood, then notify the RN without delay. Stopping the infusion is the essential first action. Option B: Administering acetaminophen does not address the underlying cause of the reaction and delays the critical intervention of stopping the transfusion. Option C: Waiting 30 minutes before rechecking vital signs is dangerous; a hemolytic transfusion reaction can progress rapidly and requires immediate intervention. Option D: Slowing but continuing the transfusion prolongs exposure to potentially incompatible blood and increases the risk of serious complications such as renal failure and cardiovascular collapse.

Answer: A

Rationale

Intradermal injections are administered at a 5- to 15-degree angle with the bevel up into the ventral (inner) forearm. Correct placement produces a visible pale bleb of approximately 6–10 mm. No aspiration is performed and the site must not be massaged, as this could disperse the antigen and invalidate the test result. Option B: A 45-degree angle is used for subcutaneous injections, not intradermal; aspiration is not required for intradermal injections, and the outer upper arm is not the standard site for a PPD. Option C: The bevel must face up (not down) to ensure the injection remains within the dermis; 45 degrees is incorrect for an intradermal route, and firm pressure is contraindicated after a PPD. Option D: A 90-degree angle is used for intramuscular injections; the abdomen is not an appropriate site for a PPD test, and massaging after an intradermal injection disperses the antigen.

Answer: A

Rationale

For an immediate-release tablet given via G-tube, the correct technique is to crush the tablet to a fine powder, dissolve it completely in 15–30 mL of water, administer the solution through the tube, and follow with a 15–30 mL water flush to ensure the full dose is delivered and the tube lumen is cleared. Water is the standard diluent because it avoids drug-nutrient interactions and pH-related instability. Option B: Medications must never be mixed directly into tube feeding formula; doing so risks drug-nutrient incompatibilities, altered bioavailability, and tube occlusion, and makes it impossible to confirm the full dose was actually received. Option C: Orange juice is acidic (pH ≈ 3.5) and can affect the stability or absorption of certain medications; water is the recommended and safest universal diluent for G-tube medication administration unless pharmacy specifies otherwise. Option D: A whole tablet cannot pass through the lumen of a G-tube and would cause an obstruction; all solid oral medications must be crushed or dissolved before enteral tube administration.

Answer: A

Rationale

The right patient requires verification using two identifiers; in an outpatient setting without an armband, the child's name and date of birth confirmed with the parent fulfill this requirement. The right drug and right dose require comparing the medication label against the prescription order before administration. The right route requires giving the medication by the oral route as prescribed and not substituting another route. Option A: The right time requires administering a medication at or within an acceptable window of the scheduled time; giving a dose 2 hours early violates this right and can disrupt therapeutic drug levels or lead to double-dosing. Option B: The right documentation requires recording in the medication administration record after administration, not before. Pre-documenting is a safety violation because it does not accurately reflect whether the medication was actually given. Option F: Medications must not be pre-poured, left unattended, or handed off to a non-licensed individual for delivery. The practical nurse retains responsibility for safe, witnessed administration of prescribed medications.

Answer: C, D, E