Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) (Medication administration / safety)
A nurse prepares to give a scheduled oral dose of an ACE
inhibitor (lisinopril) to a client with hypertension. The client tells
the nurse they feel lightheaded when they stand and had a
salty-tasting metallic taste yesterday. Which action should the
nurse take first?
A. Administer the lisinopril with a full glass of water.
B. Hold the dose and assess the client's blood pressure and
orthostatic vitals.
C. Ask the client if they have been taking any potassium
supplements.
D. Notify the provider to request an order for a diuretic instead.
Correct answer: B. Hold the dose and assess the client's blood
pressure and orthostatic vitals.
Rationale:
• B (correct): Lightheadedness and reports of orthostatic
symptoms suggest hypotension — immediate assessment
, of blood pressure/orthostatic vitals is required prior to
giving an antihypertensive. Holding to assess safety is
priority. (Saunders emphasizes verifying stability before
administering cardiovascular drugs.) Evolve
• A: Administering without assessing could put the client at
risk for syncope if hypotensive.
• C: Asking about potassium is reasonable (ACE inhibitors
can cause hyperkalemia), but assessing hemodynamic
status has higher immediate priority given the
lightheadedness.
• D: Changing therapy is a provider decision after
assessment and labs; not a first nursing action.
2) (Dosage calculation — oral medication)
Order: Amoxicillin 250 mg PO q8h. Available: amoxicillin
suspension labeled 500 mg/5 mL. How many mL will the nurse
give per dose? (Show calculation.)
A. 1.25 mL
B. 2.5 mL
C. 5 mL
D. 10 mL
Correct answer: B. 2.5 mL
Calculation & Rationale:
Concentration: 500 mg ÷ 5 mL = 100 mg/mL.
,Dose required: 250 mg.
Volume = dose ÷ concentration = 250 mg ÷ 100 mg/mL = 2.5
mL.
• B (correct): matches calculation.
• A: 1.25 mL would be 125 mg.
• C: 5 mL would be 500 mg (double).
• D: 10 mL would be 1000 mg.
3) (IV infusion calculation)
Order: Infuse 1,000 mL NS over 8 hours using a macrodrip
tubing with a drop factor of 20 gtt/mL. What is the infusion rate
in gtt/min? (Show calculation.)
A. 42 gtt/min
B. 83 gtt/min
C. 125 gtt/min
D. 167 gtt/min
Correct answer: B. 83 gtt/min
Calculation & Rationale:
Formula: (Volume (mL) × drop factor (gtt/mL)) ÷ time (min) =
gtt/min.
Time in minutes = 8 hr × 60 = 480 min.
(1,000 mL × 20 gtt/mL) ÷ 480 min = 20,000 ÷ 480 = 41.666... ≈
42 gtt/min.
Wait — check carefully (digit-by-digit): 20,000/480 = (20,000 ÷
, 48) ÷ 10 = 416.666… ÷10 = 41.666… So the correct value is ≈42
gtt/min.
Correction: I made an error in choice mapping; the correct
answer is A. 42 gtt/min (rounded to nearest whole gtt/min).
• A (correct): ~42 gtt/min.
• B, C, D: Incorrect based on calculation.
(Note: Round per facility policy; always confirm
rounding/tracking with facility standards.)
4) (Safe medication practices / high-alert drugs)
A client is prescribed warfarin (Coumadin). Which instruction
should the nurse include in the client teaching? (Select the
single best answer.)
A. “You may stop taking aspirin while on warfarin; it does not
interact.”
B. “Maintain a consistent intake of leafy green vegetables; avoid
sudden large changes.”
C. “If you miss a dose, double the next dose to catch up.”
D. “No laboratory monitoring is needed unless you have signs of
bleeding.”
Correct answer: B. “Maintain a consistent intake of leafy green
vegetables; avoid sudden large changes.”
Rationale:
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) (Medication administration / safety)
A nurse prepares to give a scheduled oral dose of an ACE
inhibitor (lisinopril) to a client with hypertension. The client tells
the nurse they feel lightheaded when they stand and had a
salty-tasting metallic taste yesterday. Which action should the
nurse take first?
A. Administer the lisinopril with a full glass of water.
B. Hold the dose and assess the client's blood pressure and
orthostatic vitals.
C. Ask the client if they have been taking any potassium
supplements.
D. Notify the provider to request an order for a diuretic instead.
Correct answer: B. Hold the dose and assess the client's blood
pressure and orthostatic vitals.
Rationale:
• B (correct): Lightheadedness and reports of orthostatic
symptoms suggest hypotension — immediate assessment
, of blood pressure/orthostatic vitals is required prior to
giving an antihypertensive. Holding to assess safety is
priority. (Saunders emphasizes verifying stability before
administering cardiovascular drugs.) Evolve
• A: Administering without assessing could put the client at
risk for syncope if hypotensive.
• C: Asking about potassium is reasonable (ACE inhibitors
can cause hyperkalemia), but assessing hemodynamic
status has higher immediate priority given the
lightheadedness.
• D: Changing therapy is a provider decision after
assessment and labs; not a first nursing action.
2) (Dosage calculation — oral medication)
Order: Amoxicillin 250 mg PO q8h. Available: amoxicillin
suspension labeled 500 mg/5 mL. How many mL will the nurse
give per dose? (Show calculation.)
A. 1.25 mL
B. 2.5 mL
C. 5 mL
D. 10 mL
Correct answer: B. 2.5 mL
Calculation & Rationale:
Concentration: 500 mg ÷ 5 mL = 100 mg/mL.
,Dose required: 250 mg.
Volume = dose ÷ concentration = 250 mg ÷ 100 mg/mL = 2.5
mL.
• B (correct): matches calculation.
• A: 1.25 mL would be 125 mg.
• C: 5 mL would be 500 mg (double).
• D: 10 mL would be 1000 mg.
3) (IV infusion calculation)
Order: Infuse 1,000 mL NS over 8 hours using a macrodrip
tubing with a drop factor of 20 gtt/mL. What is the infusion rate
in gtt/min? (Show calculation.)
A. 42 gtt/min
B. 83 gtt/min
C. 125 gtt/min
D. 167 gtt/min
Correct answer: B. 83 gtt/min
Calculation & Rationale:
Formula: (Volume (mL) × drop factor (gtt/mL)) ÷ time (min) =
gtt/min.
Time in minutes = 8 hr × 60 = 480 min.
(1,000 mL × 20 gtt/mL) ÷ 480 min = 20,000 ÷ 480 = 41.666... ≈
42 gtt/min.
Wait — check carefully (digit-by-digit): 20,000/480 = (20,000 ÷
, 48) ÷ 10 = 416.666… ÷10 = 41.666… So the correct value is ≈42
gtt/min.
Correction: I made an error in choice mapping; the correct
answer is A. 42 gtt/min (rounded to nearest whole gtt/min).
• A (correct): ~42 gtt/min.
• B, C, D: Incorrect based on calculation.
(Note: Round per facility policy; always confirm
rounding/tracking with facility standards.)
4) (Safe medication practices / high-alert drugs)
A client is prescribed warfarin (Coumadin). Which instruction
should the nurse include in the client teaching? (Select the
single best answer.)
A. “You may stop taking aspirin while on warfarin; it does not
interact.”
B. “Maintain a consistent intake of leafy green vegetables; avoid
sudden large changes.”
C. “If you miss a dose, double the next dose to catch up.”
D. “No laboratory monitoring is needed unless you have signs of
bleeding.”
Correct answer: B. “Maintain a consistent intake of leafy green
vegetables; avoid sudden large changes.”
Rationale:
