Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Digoxin and potassium
A client with atrial fibrillation is taking digoxin. The nurse notes
a serum potassium of 3.0 mEq/L (normal 3.5–5.0). Which action
is the priority?
A. Administer the scheduled morning dose of digoxin.
B. Hold the digoxin and notify the provider.
C. Give a bolus of IV potassium and administer the digoxin.
D. Give oral potassium chloride and administer the digoxin
when potassium is normal.
Answer: B
Rationale (correct — B): Hypokalemia increases the risk of
digoxin toxicity because low serum K⁺ enhances digoxin binding
to the Na⁺/K⁺-ATPase receptor in cardiac myocytes. Holding
digoxin and notifying the provider until potassium is corrected
is the safe priority action. (Saunders emphasizes withholding
drugs that increase risk until labs are corrected.) Elsevier Health
,Rationale (incorrect):
A — Administering digoxin with hypokalemia can precipitate
life-threatening toxicity (arrhythmias).
C — IV potassium bolus is not appropriate without provider
order and cardiac monitoring; the nurse should hold the digoxin
and notify the provider.
D — Oral KCl may be appropriate, but it’s not the immediate
nursing priority over holding the digoxin and notifying the
provider.
2 — Heparin monitoring & reversal
A client on a continuous unfractionated heparin infusion has an
aPTT that is 1.8 times the control (therapeutic range for this
client is 1.5–2.5× control). The client shows no bleeding. What
should the nurse do?
A. Stop the infusion immediately and prepare protamine.
B. Continue the infusion as ordered and recheck aPTT at the
next scheduled time.
C. Reduce the infusion rate per protocol and notify the provider.
D. Hold heparin for one hour then restart at same rate.
Answer: B
Rationale (correct — B): An aPTT of 1.8× control is within the
therapeutic range specified (1.5–2.5×). If the client has no
bleeding, the correct action is to continue the infusion and
recheck aPTT per protocol. Saunders and standard protocols
,teach adjustment only when outside therapeutic parameters.
Elsevier Health
Rationale (incorrect):
A — Stopping heparin and giving protamine is indicated only for
severe bleeding or critical high aPTT.
C — Reducing rate is for supratherapeutic aPTT beyond the
protocol limits.
D — Holding without a protocol and restarting at same rate may
lead to subtherapeutic anticoagulation risk.
3 — Beta-blocker selection for asthma patient
A 58-year-old male with history of asthma and hypertension is
prescribed a beta-blocker. Which choice is safest to minimize
bronchospasm risk?
A. Propranolol PO twice daily.
B. Metoprolol PO once daily.
C. Atenolol IV every 6 hours.
D. Nadolol PO once daily.
Answer: B
Rationale (correct — B): Metoprolol is a beta-1 selective
blocker (cardioselective) and has less bronchoconstrictive effect
at usual doses than nonselective agents. In patients with
reactive airway disease, a cardioselective agent is preferred if a
beta-blocker is indicated. (Saunders cautions using
, cardioselective agents when necessary and monitoring
respiratory status.) Elsevier Health
Rationale (incorrect):
A & D — Propranolol and nadolol are nonselective β-blockers
and increase risk of bronchospasm in asthma.
C — Atenolol is cardioselective but IV every 6 hours is atypical
dosing; metoprolol once daily is the best practical choice.
4 — Acetaminophen overdose (calculation + antidote)
A client ingested 12 g of acetaminophen 6 hours ago. The
provider asks the nurse to prepare N-acetylcysteine (NAC).
Which statement about NAC is correct?
A. NAC is ineffective if given later than 4 hours after ingestion.
B. NAC acts by directly neutralizing acetaminophen in the
stomach.
C. NAC replenishes glutathione and reduces liver injury risk.
D. NAC is contraindicated if the acetaminophen serum level is
low.
Answer: C
Rationale (correct — C): NAC replenishes hepatic glutathione
reserves, allowing detoxification of the toxic metabolite (NAPQI)
and reducing liver injury even when given up to 8–10 hours and
sometimes later. Saunders and toxicology guidance emphasize
NAC as the antidote to prevent hepatic necrosis. Elsevier Health
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Digoxin and potassium
A client with atrial fibrillation is taking digoxin. The nurse notes
a serum potassium of 3.0 mEq/L (normal 3.5–5.0). Which action
is the priority?
A. Administer the scheduled morning dose of digoxin.
B. Hold the digoxin and notify the provider.
C. Give a bolus of IV potassium and administer the digoxin.
D. Give oral potassium chloride and administer the digoxin
when potassium is normal.
Answer: B
Rationale (correct — B): Hypokalemia increases the risk of
digoxin toxicity because low serum K⁺ enhances digoxin binding
to the Na⁺/K⁺-ATPase receptor in cardiac myocytes. Holding
digoxin and notifying the provider until potassium is corrected
is the safe priority action. (Saunders emphasizes withholding
drugs that increase risk until labs are corrected.) Elsevier Health
,Rationale (incorrect):
A — Administering digoxin with hypokalemia can precipitate
life-threatening toxicity (arrhythmias).
C — IV potassium bolus is not appropriate without provider
order and cardiac monitoring; the nurse should hold the digoxin
and notify the provider.
D — Oral KCl may be appropriate, but it’s not the immediate
nursing priority over holding the digoxin and notifying the
provider.
2 — Heparin monitoring & reversal
A client on a continuous unfractionated heparin infusion has an
aPTT that is 1.8 times the control (therapeutic range for this
client is 1.5–2.5× control). The client shows no bleeding. What
should the nurse do?
A. Stop the infusion immediately and prepare protamine.
B. Continue the infusion as ordered and recheck aPTT at the
next scheduled time.
C. Reduce the infusion rate per protocol and notify the provider.
D. Hold heparin for one hour then restart at same rate.
Answer: B
Rationale (correct — B): An aPTT of 1.8× control is within the
therapeutic range specified (1.5–2.5×). If the client has no
bleeding, the correct action is to continue the infusion and
recheck aPTT per protocol. Saunders and standard protocols
,teach adjustment only when outside therapeutic parameters.
Elsevier Health
Rationale (incorrect):
A — Stopping heparin and giving protamine is indicated only for
severe bleeding or critical high aPTT.
C — Reducing rate is for supratherapeutic aPTT beyond the
protocol limits.
D — Holding without a protocol and restarting at same rate may
lead to subtherapeutic anticoagulation risk.
3 — Beta-blocker selection for asthma patient
A 58-year-old male with history of asthma and hypertension is
prescribed a beta-blocker. Which choice is safest to minimize
bronchospasm risk?
A. Propranolol PO twice daily.
B. Metoprolol PO once daily.
C. Atenolol IV every 6 hours.
D. Nadolol PO once daily.
Answer: B
Rationale (correct — B): Metoprolol is a beta-1 selective
blocker (cardioselective) and has less bronchoconstrictive effect
at usual doses than nonselective agents. In patients with
reactive airway disease, a cardioselective agent is preferred if a
beta-blocker is indicated. (Saunders cautions using
, cardioselective agents when necessary and monitoring
respiratory status.) Elsevier Health
Rationale (incorrect):
A & D — Propranolol and nadolol are nonselective β-blockers
and increase risk of bronchospasm in asthma.
C — Atenolol is cardioselective but IV every 6 hours is atypical
dosing; metoprolol once daily is the best practical choice.
4 — Acetaminophen overdose (calculation + antidote)
A client ingested 12 g of acetaminophen 6 hours ago. The
provider asks the nurse to prepare N-acetylcysteine (NAC).
Which statement about NAC is correct?
A. NAC is ineffective if given later than 4 hours after ingestion.
B. NAC acts by directly neutralizing acetaminophen in the
stomach.
C. NAC replenishes glutathione and reduces liver injury risk.
D. NAC is contraindicated if the acetaminophen serum level is
low.
Answer: C
Rationale (correct — C): NAC replenishes hepatic glutathione
reserves, allowing detoxification of the toxic metabolite (NAPQI)
and reducing liver injury even when given up to 8–10 hours and
sometimes later. Saunders and toxicology guidance emphasize
NAC as the antidote to prevent hepatic necrosis. Elsevier Health
