Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
1) Pediatric dose — oral suspension (dosage calculation)
A 18-kg child is prescribed amoxicillin 50 mg/kg/day divided
every 12 hours for an acute otitis media. The pharmacy
dispenses amoxicillin suspension 250 mg/5 mL. How many mL
should the nurse give per dose?
A. 4.5 mL
B. 6.0 mL
C. 9.0 mL
D. 18.0 mL
Answer: C. 9.0 mL
Rationale — calculation (digit-by-digit):
• Total daily dose = 50 mg/kg/day × 18 kg = 50 × 18 = 900
mg/day.
• Divided q12h → dose per administration = 900 mg ÷ 2 =
450 mg per dose.
• Suspension concentration: 250 mg per 5 mL → 250 ÷ 5 =
50 mg/mL.
• Volume = dose ÷ concentration = 450 mg ÷ 50 mg/mL = 9
mL.
,Why others are wrong:
• A (4.5 mL) = half of needed volume.
• B (6.0 mL) = would give 300 mg (insufficient).
• D (18.0 mL) = 900 mg (entire daily dose at once) — not
prescribed.
2) IV infusion rate (mL/hr and drops/min)
An IV bag contains 1,000 mL normal saline to be infused over 8
hours using a microdrip set that delivers 60 gtt/mL. Which is the
correct infusion rate (round to nearest whole number) in drops
per minute?
A. 21 gtt/min
B. 31 gtt/min
C. 125 gtt/min
D. 500 gtt/min
Answer: B. 31 gtt/min
Rationale — calculation (digit-by-digit):
• mL/hr = 1,000 mL ÷ 8 hr = 125 mL/hr.
• Drops/min = (mL/hr × gtt/mL) ÷ 60 = (125 × 60) ÷ 60 = 125
gtt/min — BUT note: the set is microdrip 60 gtt/mL. Wait
— re-calculate carefully: microdrip 60 gtt/mL means each
mL = 60 drops. So: drops/min = (125 mL/hr × 60 gtt/mL) ÷
60 min/hr = 125 gtt/min. (Answer C) However because the
, exam item used 15 gtt/mL commonly — if the set had
been 15 gtt/mL the result would be 31 gtt/min. We must
use the microdrip 60 gtt/mL given in the stem, so correct
is C (125 gtt/min).
Correction (final): Given the stem uses 60 gtt/mL, the correct
choice is C. 125 gtt/min. (If your clinical setting uses 15 gtt/mL
macrodrip, result would be ~31 gtt/min; always use the set
specified.)
Why other choices are wrong:
• A & B are values from using a 15 gtt/mL set — not
applicable here.
• D (500 gtt/min) is far too high.
Teaching point: always verify drip factor (gtt/mL) on the
administration set before calculating. (Saunders emphasizes
practicing medication and IV calculations.) Google Books
3) High-alert medication & safety check
Which action by a nurse best follows safe-medication practices
for administering subcutaneous insulin (a high-alert
medication)?
A. Document the insulin dose immediately after giving and have
no independent verification.
B. Have a second nurse independently verify the insulin type,
dose, and client identity before administration.
,C. Ask the nursing assistant to sign that the insulin was given.
D. Only verify with pharmacy if the dose seems unusually high.
Answer: B. Have a second nurse independently verify the
insulin type, dose, and client identity before administration.
Rationale:
• Correct: Insulin is a high-alert medication; independent
double-checks (two RNs verifying right patient, drug, dose,
time, route) reduce serious errors. Saunders highlights
medication safety and the need to double-check high-risk
meds and calculations. Google Books
• A is unsafe: documentation alone is not a safety barrier.
• C is inappropriate: nursing assistants should not verify
high-alert drug administration.
• D is inadequate: waiting for pharmacist only if dose seems
high misses routine double-check requirement.
4) Digoxin — signs of toxicity & actions
A patient on digoxin and furosemide reports nausea, vision
changes (yellow halos), and heart rate 48/min. What should the
nurse do first?
A. Administer the next scheduled dose of digoxin.
B. Hold digoxin and notify the provider immediately.
C. Increase furosemide dose to reduce fluid overload.
,D. Encourage the patient to drink fluids and recheck HR in 1
hour.
Answer: B. Hold digoxin and notify the provider immediately.
Rationale:
• Correct: Nausea and visual disturbances can be early signs
of digitalis (digoxin) toxicity; bradycardia (HR 48) is another
sign. Hold medication and notify provider for STAT
evaluation and digoxin level check. Risk of toxicity
increases with hypokalemia (e.g., from furosemide).
MedlinePlus+1
• A is unsafe: giving another dose risks worsening toxicity.
• C is inappropriate: increasing furosemide can worsen
hypokalemia and potentiate digoxin toxicity.
• D delays necessary action.
5) Furosemide — adverse effects and rapid IV push
Which adverse effect should the nurse watch for when
furosemide (Lasix) is given rapidly IV push?
A. Tinnitus or hearing loss.
B. Hyperkalemia.
C. Bradycardia.
D. Cough and bronchospasm.
Answer: A. Tinnitus or hearing loss.
,Rationale:
• Correct: Rapid IV injection of loop diuretics (like
furosemide) can cause ototoxicity (tinnitus/hearing loss).
Other common adverse effects include hypokalemia and
hypotension. Monitor electrolytes and blood pressure.
MedlinePlus
• B is wrong: furosemide more commonly causes
hypokalemia, not hyperkalemia.
• C is not the typical adverse effect; hypotension or dizziness
may occur, not primary bradycardia.
• D (cough/bronchospasm) is more associated with ACE
inhibitors or certain inhaled medications, not furosemide.
6) Short-acting bronchodilator — patient teaching
A patient is prescribed albuterol inhaler for asthma. Which
instruction should the nurse include during teaching?
A. “Use the albuterol inhaler daily at bedtime to prevent
asthma.”
B. “If you need more than 2 puffs every 4 hours, seek medical
care — it may indicate worsening asthma.”
C. “Albuterol prevents bronchial inflammation and should be
used instead of inhaled steroids.”
D. “Avoid using a spacer; it reduces drug delivery.”
,Answer: B. “If you need more than 2 puffs every 4 hours, seek
medical care — it may indicate worsening asthma.”
Rationale:
• Correct: Albuterol is a short-acting beta-2 agonist (rescue
inhaler). Frequent use (e.g., >2 puffs every 4 hours or
increased baseline usage) signals poor control and needs
assessment. Teach proper technique (spacer
recommended) and that this drug relieves bronchospasm
quickly (does not treat inflammation). MedlinePlus
• A is wrong: albuterol is for quick relief, not as sole nightly
preventive therapy.
• C is wrong: albuterol does not treat inflammation —
inhaled corticosteroids do.
• D is wrong: using a spacer improves delivery, especially in
children.
7) SSRI interactions & adverse effects
Which statement is most important to teach a patient starting
sertraline (an SSRI)?
A. “You can stop the medication abruptly if you develop sexual
side effects.”
B. “Avoid taking a monoamine oxidase inhibitor (MAOI) while
on sertraline due to risk of serotonin syndrome.”
C. “Sertraline causes immediate mood elevation within hours of
,the first dose.”
D. “There are no food or drug interactions of clinical
significance.”
Answer: B. “Avoid taking a monoamine oxidase inhibitor
(MAOI) while on sertraline due to risk of serotonin syndrome.”
Rationale:
• Correct: Combining SSRIs with MAOIs or certain other
serotonergic drugs can cause serotonin syndrome (life-
threatening). A washout period is required when
switching. Also counsel about sexual dysfunction and
delayed onset of therapeutic effects (several weeks).
• A is wrong: sudden discontinuation may cause
discontinuation syndrome; discuss alternatives rather than
abrupt stopping.
• C is wrong: SSRIs typically take weeks to show
antidepressant effect.
• D is wrong: sertraline has important interactions (e.g., with
MAOIs, triptans, certain anticoagulants).
8) Mixing insulin — safe technique
A nurse must prepare a premeal dose of 8 units regular insulin
and 12 units NPH insulin in one syringe. What is the correct
technique?
,A. Draw NPH into syringe first, then draw regular insulin.
B. Draw regular insulin into syringe first, then draw NPH insulin.
C. Mix equal parts of both insulin in a vial before drawing.
D. Mix only if both are clear solutions.
Answer: B. Draw regular insulin into syringe first, then draw
NPH insulin.
Rationale:
• Correct: To avoid contaminating the short-acting insulin
vial with intermediate-acting insulin, draw up regular
(clear) insulin first, then NPH (cloudy). This preserves the
activity and timing of the regular insulin. (Also clean vial
stoppers with alcohol.) MedlinePlus
• A is wrong: drawing NPH first risks contaminating the
regular insulin vial with NPH.
• C is wrong: mixing in a vial is not acceptable practice unless
it's a premixed product.
• D is wrong: NPH is cloudy — so “only if both are clear” is
misleading.
9) Vancomycin infusion reaction
Which nursing action reduces the risk of “Red Man” syndrome
when administering IV vancomycin?
A. Administer vancomycin IV push over 1–2 minutes.
B. Infuse vancomycin slowly (over at least 60 minutes) and
, monitor infusion site.
C. Pre-treat with an ACE inhibitor to prevent histamine release.
D. Combine vancomycin with gentamicin in the same IV line.
Answer: B. Infuse vancomycin slowly (over at least 60
minutes) and monitor infusion site.
Rationale:
• Correct: Rapid infusion of vancomycin can cause infusion-
related flushing/pruritus (“Red Man” syndrome) due to
histamine release. Slowing the infusion and monitoring
reduces risk; premedication with antihistamines may be
used if prior reaction occurred.
• A (IV push) increases risk of adverse reaction and is unsafe.
• C (ACE inhibitor) is incorrect and could worsen
hypotension; H1 antihistamines (e.g., diphenhydramine),
not ACE inhibitors, may be used.
• D is wrong: do not mix incompatible drugs in the same line
unless compatibility is confirmed; also combination raises
nephrotoxicity risk.
10) Aminoglycoside monitoring (gentamicin)
A patient receives gentamicin IV for sepsis. Which lab or
assessment is most important for preventing toxicity?
A. Serum creatinine and hearing assessment (audiology/ask
about tinnitus).
Examination
9th Edition
1) Pediatric dose — oral suspension (dosage calculation)
A 18-kg child is prescribed amoxicillin 50 mg/kg/day divided
every 12 hours for an acute otitis media. The pharmacy
dispenses amoxicillin suspension 250 mg/5 mL. How many mL
should the nurse give per dose?
A. 4.5 mL
B. 6.0 mL
C. 9.0 mL
D. 18.0 mL
Answer: C. 9.0 mL
Rationale — calculation (digit-by-digit):
• Total daily dose = 50 mg/kg/day × 18 kg = 50 × 18 = 900
mg/day.
• Divided q12h → dose per administration = 900 mg ÷ 2 =
450 mg per dose.
• Suspension concentration: 250 mg per 5 mL → 250 ÷ 5 =
50 mg/mL.
• Volume = dose ÷ concentration = 450 mg ÷ 50 mg/mL = 9
mL.
,Why others are wrong:
• A (4.5 mL) = half of needed volume.
• B (6.0 mL) = would give 300 mg (insufficient).
• D (18.0 mL) = 900 mg (entire daily dose at once) — not
prescribed.
2) IV infusion rate (mL/hr and drops/min)
An IV bag contains 1,000 mL normal saline to be infused over 8
hours using a microdrip set that delivers 60 gtt/mL. Which is the
correct infusion rate (round to nearest whole number) in drops
per minute?
A. 21 gtt/min
B. 31 gtt/min
C. 125 gtt/min
D. 500 gtt/min
Answer: B. 31 gtt/min
Rationale — calculation (digit-by-digit):
• mL/hr = 1,000 mL ÷ 8 hr = 125 mL/hr.
• Drops/min = (mL/hr × gtt/mL) ÷ 60 = (125 × 60) ÷ 60 = 125
gtt/min — BUT note: the set is microdrip 60 gtt/mL. Wait
— re-calculate carefully: microdrip 60 gtt/mL means each
mL = 60 drops. So: drops/min = (125 mL/hr × 60 gtt/mL) ÷
60 min/hr = 125 gtt/min. (Answer C) However because the
, exam item used 15 gtt/mL commonly — if the set had
been 15 gtt/mL the result would be 31 gtt/min. We must
use the microdrip 60 gtt/mL given in the stem, so correct
is C (125 gtt/min).
Correction (final): Given the stem uses 60 gtt/mL, the correct
choice is C. 125 gtt/min. (If your clinical setting uses 15 gtt/mL
macrodrip, result would be ~31 gtt/min; always use the set
specified.)
Why other choices are wrong:
• A & B are values from using a 15 gtt/mL set — not
applicable here.
• D (500 gtt/min) is far too high.
Teaching point: always verify drip factor (gtt/mL) on the
administration set before calculating. (Saunders emphasizes
practicing medication and IV calculations.) Google Books
3) High-alert medication & safety check
Which action by a nurse best follows safe-medication practices
for administering subcutaneous insulin (a high-alert
medication)?
A. Document the insulin dose immediately after giving and have
no independent verification.
B. Have a second nurse independently verify the insulin type,
dose, and client identity before administration.
,C. Ask the nursing assistant to sign that the insulin was given.
D. Only verify with pharmacy if the dose seems unusually high.
Answer: B. Have a second nurse independently verify the
insulin type, dose, and client identity before administration.
Rationale:
• Correct: Insulin is a high-alert medication; independent
double-checks (two RNs verifying right patient, drug, dose,
time, route) reduce serious errors. Saunders highlights
medication safety and the need to double-check high-risk
meds and calculations. Google Books
• A is unsafe: documentation alone is not a safety barrier.
• C is inappropriate: nursing assistants should not verify
high-alert drug administration.
• D is inadequate: waiting for pharmacist only if dose seems
high misses routine double-check requirement.
4) Digoxin — signs of toxicity & actions
A patient on digoxin and furosemide reports nausea, vision
changes (yellow halos), and heart rate 48/min. What should the
nurse do first?
A. Administer the next scheduled dose of digoxin.
B. Hold digoxin and notify the provider immediately.
C. Increase furosemide dose to reduce fluid overload.
,D. Encourage the patient to drink fluids and recheck HR in 1
hour.
Answer: B. Hold digoxin and notify the provider immediately.
Rationale:
• Correct: Nausea and visual disturbances can be early signs
of digitalis (digoxin) toxicity; bradycardia (HR 48) is another
sign. Hold medication and notify provider for STAT
evaluation and digoxin level check. Risk of toxicity
increases with hypokalemia (e.g., from furosemide).
MedlinePlus+1
• A is unsafe: giving another dose risks worsening toxicity.
• C is inappropriate: increasing furosemide can worsen
hypokalemia and potentiate digoxin toxicity.
• D delays necessary action.
5) Furosemide — adverse effects and rapid IV push
Which adverse effect should the nurse watch for when
furosemide (Lasix) is given rapidly IV push?
A. Tinnitus or hearing loss.
B. Hyperkalemia.
C. Bradycardia.
D. Cough and bronchospasm.
Answer: A. Tinnitus or hearing loss.
,Rationale:
• Correct: Rapid IV injection of loop diuretics (like
furosemide) can cause ototoxicity (tinnitus/hearing loss).
Other common adverse effects include hypokalemia and
hypotension. Monitor electrolytes and blood pressure.
MedlinePlus
• B is wrong: furosemide more commonly causes
hypokalemia, not hyperkalemia.
• C is not the typical adverse effect; hypotension or dizziness
may occur, not primary bradycardia.
• D (cough/bronchospasm) is more associated with ACE
inhibitors or certain inhaled medications, not furosemide.
6) Short-acting bronchodilator — patient teaching
A patient is prescribed albuterol inhaler for asthma. Which
instruction should the nurse include during teaching?
A. “Use the albuterol inhaler daily at bedtime to prevent
asthma.”
B. “If you need more than 2 puffs every 4 hours, seek medical
care — it may indicate worsening asthma.”
C. “Albuterol prevents bronchial inflammation and should be
used instead of inhaled steroids.”
D. “Avoid using a spacer; it reduces drug delivery.”
,Answer: B. “If you need more than 2 puffs every 4 hours, seek
medical care — it may indicate worsening asthma.”
Rationale:
• Correct: Albuterol is a short-acting beta-2 agonist (rescue
inhaler). Frequent use (e.g., >2 puffs every 4 hours or
increased baseline usage) signals poor control and needs
assessment. Teach proper technique (spacer
recommended) and that this drug relieves bronchospasm
quickly (does not treat inflammation). MedlinePlus
• A is wrong: albuterol is for quick relief, not as sole nightly
preventive therapy.
• C is wrong: albuterol does not treat inflammation —
inhaled corticosteroids do.
• D is wrong: using a spacer improves delivery, especially in
children.
7) SSRI interactions & adverse effects
Which statement is most important to teach a patient starting
sertraline (an SSRI)?
A. “You can stop the medication abruptly if you develop sexual
side effects.”
B. “Avoid taking a monoamine oxidase inhibitor (MAOI) while
on sertraline due to risk of serotonin syndrome.”
C. “Sertraline causes immediate mood elevation within hours of
,the first dose.”
D. “There are no food or drug interactions of clinical
significance.”
Answer: B. “Avoid taking a monoamine oxidase inhibitor
(MAOI) while on sertraline due to risk of serotonin syndrome.”
Rationale:
• Correct: Combining SSRIs with MAOIs or certain other
serotonergic drugs can cause serotonin syndrome (life-
threatening). A washout period is required when
switching. Also counsel about sexual dysfunction and
delayed onset of therapeutic effects (several weeks).
• A is wrong: sudden discontinuation may cause
discontinuation syndrome; discuss alternatives rather than
abrupt stopping.
• C is wrong: SSRIs typically take weeks to show
antidepressant effect.
• D is wrong: sertraline has important interactions (e.g., with
MAOIs, triptans, certain anticoagulants).
8) Mixing insulin — safe technique
A nurse must prepare a premeal dose of 8 units regular insulin
and 12 units NPH insulin in one syringe. What is the correct
technique?
,A. Draw NPH into syringe first, then draw regular insulin.
B. Draw regular insulin into syringe first, then draw NPH insulin.
C. Mix equal parts of both insulin in a vial before drawing.
D. Mix only if both are clear solutions.
Answer: B. Draw regular insulin into syringe first, then draw
NPH insulin.
Rationale:
• Correct: To avoid contaminating the short-acting insulin
vial with intermediate-acting insulin, draw up regular
(clear) insulin first, then NPH (cloudy). This preserves the
activity and timing of the regular insulin. (Also clean vial
stoppers with alcohol.) MedlinePlus
• A is wrong: drawing NPH first risks contaminating the
regular insulin vial with NPH.
• C is wrong: mixing in a vial is not acceptable practice unless
it's a premixed product.
• D is wrong: NPH is cloudy — so “only if both are clear” is
misleading.
9) Vancomycin infusion reaction
Which nursing action reduces the risk of “Red Man” syndrome
when administering IV vancomycin?
A. Administer vancomycin IV push over 1–2 minutes.
B. Infuse vancomycin slowly (over at least 60 minutes) and
, monitor infusion site.
C. Pre-treat with an ACE inhibitor to prevent histamine release.
D. Combine vancomycin with gentamicin in the same IV line.
Answer: B. Infuse vancomycin slowly (over at least 60
minutes) and monitor infusion site.
Rationale:
• Correct: Rapid infusion of vancomycin can cause infusion-
related flushing/pruritus (“Red Man” syndrome) due to
histamine release. Slowing the infusion and monitoring
reduces risk; premedication with antihistamines may be
used if prior reaction occurred.
• A (IV push) increases risk of adverse reaction and is unsafe.
• C (ACE inhibitor) is incorrect and could worsen
hypotension; H1 antihistamines (e.g., diphenhydramine),
not ACE inhibitors, may be used.
• D is wrong: do not mix incompatible drugs in the same line
unless compatibility is confirmed; also combination raises
nephrotoxicity risk.
10) Aminoglycoside monitoring (gentamicin)
A patient receives gentamicin IV for sepsis. Which lab or
assessment is most important for preventing toxicity?
A. Serum creatinine and hearing assessment (audiology/ask
about tinnitus).
