Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Multiple choice (Dosage calculation; medication
administration)
A nurse is preparing to administer enoxaparin (lovenox) 1
mg/kg subcutaneously q12h to a patient who weighs 176 lb.
Available: enoxaparin 100 mg/1 mL prefilled syringe. How many
mL should the nurse administer per dose? (Round to nearest
tenth.)
A. 0.8 mL
B. 1.0 mL
C. 1.6 mL (correct)
D. 2.0 mL
Answer: C — 1.6 mL
Rationale:
• Calculation: 176 lb ÷ 2.2 = 80 kg. Dose = 1 mg × 80 kg = 80
mg per dose. Concentration = 100 mg/1 mL → volume = 80
, mg ÷ (100 mg/mL) = 0.8 mL. (Correction: careful — check
math step-by-step)
— Wait — re-calculate digit-by-digit: 176 ÷ 2.2 = 80.0 kg. 1
mg/kg = 80 mg. Prefilled syringe is 100 mg per 1 mL → 80
mg = 0.8 mL. Therefore correct answer is 0.8 mL (A).
Note (important arithmetic check): On step-by-step rework we
find 0.8 mL is the correct volume. The initial selection above
(1.6 mL) was incorrect because of a doubling error. The accurate
dose volume is 0.8 mL.
Correct choice (final): A — 0.8 mL.
(Rationale explanation)
• Correct: 0.8 mL is the mathematically correct volume.
Always convert lbs → kg first (divide by 2.2), multiply by
mg/kg, then divide by concentration (mg/mL). This reflects
safe medication calculation practice emphasized in
Saunders. Elsevier Health
• Incorrect choices: B (1.0 mL), C (1.6 mL), D (2.0 mL) are all
based on miscalculation or incorrect unit conversion and
would result in under- or overdosing.
2 — Multiple choice (Medication safety / high-alert)
A hospitalized client is prescribed sublingual nitroglycerin 0.4
mg for chest pain. Which instruction is most important for the
nurse to teach the client before administration?
,A. “Take a sip of water and swallow the tablet.”
B. “Place the tablet under the tongue and keep the mouth
closed.” (correct)
C. “Expect it to take 30–45 minutes to work.”
D. “Avoid sitting up for 2 hours after taking it.”
Answer: B — Place under tongue and keep mouth closed.
Rationale:
• Correct: Sublingual nitroglycerin must be placed under the
tongue for rapid absorption through mucosa; keeping the
mouth closed prevents loss of the dose and ensures rapid
onset. Saunders emphasizes correct route and client
teaching for nitrates. Elsevier Health
• A is wrong: Swallowing destroys sublingual route and
delays absorption.
• C is wrong: Sublingual onset is rapid (minutes), not 30–45
minutes.
• D is wrong: Positioning does not require lying flat after SL
nitroglycerin; client should sit or lie down if hypotension or
dizziness occurs.
3 — NGN-style (Clinical judgment; prioritization)
A 68-year-old client with chronic heart failure is started on
lisinopril. Which assessment finding requires the nurse to hold
the next dose and notify the provider immediately?
, Select the single best response.
A. BP 124/70 mm Hg, HR 76 bpm
B. Sudden swelling of lips and tongue with hoarseness
(correct)
C. Dry cough reported for 2 days
D. Serum potassium 4.8 mEq/L
Answer: B — Sudden swelling of lips and tongue with
hoarseness.
Rationale:
• Correct: Angioedema (facial/tongue swelling, airway
compromise, hoarseness) is a potentially life-threatening
adverse reaction of ACE inhibitors and requires immediate
discontinuation and emergency response. StatPearls and
Saunders highlight angioedema as an urgent
contraindication for continued ACE inhibitor use. NCBI+1
• A is wrong: Vital signs are acceptable and do not require
holding lisinopril.
• C is wrong: A persistent dry cough is a common adverse
effect of ACE inhibitors and may prompt medication review
but is not an immediate airway threat—still report but not
emergent like angioedema. NCBI
• D is wrong: K⁺ of 4.8 mEq/L is within acceptable range
(though ACE inhibitors can cause hyperkalemia, immediate
holding isn't required at this value).
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Multiple choice (Dosage calculation; medication
administration)
A nurse is preparing to administer enoxaparin (lovenox) 1
mg/kg subcutaneously q12h to a patient who weighs 176 lb.
Available: enoxaparin 100 mg/1 mL prefilled syringe. How many
mL should the nurse administer per dose? (Round to nearest
tenth.)
A. 0.8 mL
B. 1.0 mL
C. 1.6 mL (correct)
D. 2.0 mL
Answer: C — 1.6 mL
Rationale:
• Calculation: 176 lb ÷ 2.2 = 80 kg. Dose = 1 mg × 80 kg = 80
mg per dose. Concentration = 100 mg/1 mL → volume = 80
, mg ÷ (100 mg/mL) = 0.8 mL. (Correction: careful — check
math step-by-step)
— Wait — re-calculate digit-by-digit: 176 ÷ 2.2 = 80.0 kg. 1
mg/kg = 80 mg. Prefilled syringe is 100 mg per 1 mL → 80
mg = 0.8 mL. Therefore correct answer is 0.8 mL (A).
Note (important arithmetic check): On step-by-step rework we
find 0.8 mL is the correct volume. The initial selection above
(1.6 mL) was incorrect because of a doubling error. The accurate
dose volume is 0.8 mL.
Correct choice (final): A — 0.8 mL.
(Rationale explanation)
• Correct: 0.8 mL is the mathematically correct volume.
Always convert lbs → kg first (divide by 2.2), multiply by
mg/kg, then divide by concentration (mg/mL). This reflects
safe medication calculation practice emphasized in
Saunders. Elsevier Health
• Incorrect choices: B (1.0 mL), C (1.6 mL), D (2.0 mL) are all
based on miscalculation or incorrect unit conversion and
would result in under- or overdosing.
2 — Multiple choice (Medication safety / high-alert)
A hospitalized client is prescribed sublingual nitroglycerin 0.4
mg for chest pain. Which instruction is most important for the
nurse to teach the client before administration?
,A. “Take a sip of water and swallow the tablet.”
B. “Place the tablet under the tongue and keep the mouth
closed.” (correct)
C. “Expect it to take 30–45 minutes to work.”
D. “Avoid sitting up for 2 hours after taking it.”
Answer: B — Place under tongue and keep mouth closed.
Rationale:
• Correct: Sublingual nitroglycerin must be placed under the
tongue for rapid absorption through mucosa; keeping the
mouth closed prevents loss of the dose and ensures rapid
onset. Saunders emphasizes correct route and client
teaching for nitrates. Elsevier Health
• A is wrong: Swallowing destroys sublingual route and
delays absorption.
• C is wrong: Sublingual onset is rapid (minutes), not 30–45
minutes.
• D is wrong: Positioning does not require lying flat after SL
nitroglycerin; client should sit or lie down if hypotension or
dizziness occurs.
3 — NGN-style (Clinical judgment; prioritization)
A 68-year-old client with chronic heart failure is started on
lisinopril. Which assessment finding requires the nurse to hold
the next dose and notify the provider immediately?
, Select the single best response.
A. BP 124/70 mm Hg, HR 76 bpm
B. Sudden swelling of lips and tongue with hoarseness
(correct)
C. Dry cough reported for 2 days
D. Serum potassium 4.8 mEq/L
Answer: B — Sudden swelling of lips and tongue with
hoarseness.
Rationale:
• Correct: Angioedema (facial/tongue swelling, airway
compromise, hoarseness) is a potentially life-threatening
adverse reaction of ACE inhibitors and requires immediate
discontinuation and emergency response. StatPearls and
Saunders highlight angioedema as an urgent
contraindication for continued ACE inhibitor use. NCBI+1
• A is wrong: Vital signs are acceptable and do not require
holding lisinopril.
• C is wrong: A persistent dry cough is a common adverse
effect of ACE inhibitors and may prompt medication review
but is not an immediate airway threat—still report but not
emergent like angioedema. NCBI
• D is wrong: K⁺ of 4.8 mEq/L is within acceptable range
(though ACE inhibitors can cause hyperkalemia, immediate
holding isn't required at this value).
