Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Multiple Choice (Medication administration principles)
A nurse is preparing to administer 0900 medications. The
patient has a new medication order for warfarin 5 mg PO
nightly. Which action by the nurse is most appropriate before
giving the first dose?
A. Give the warfarin and monitor the INR in 48 hours.
B. Confirm the patient's most recent INR and review concurrent
medications.
C. Hold the dose until the next day to obtain baseline PT.
D. Request the prescriber change the order to heparin for
immediate effect.
Correct answer: B
Rationale:
• B (correct): Warfarin dosing requires knowledge of
baseline/in-range INR and potential drug interactions
(many drugs, herbal supplements affect warfarin).
Confirming the most recent INR and concurrent meds is
, safe practice before first dose. (Saunders emphasizes verify
labs and meds before anticoagulant administration.) Evolve
• A (incorrect): Giving warfarin without checking INR could
cause bleeding or under-anticoagulation; INR should be
known earlier than 48 hours post-dose for titration.
• C (incorrect): Holding without contacting prescriber is not
appropriate; nurse should verify labs and consult
prescriber as needed.
• D (incorrect): Changing anticoagulant requires prescriber
order and clinical indication; nurse should not unilaterally
request substitution without clinical justification.
2 — Multiple Response (Safe medication practices / high-alert
drugs)
Select all actions that demonstrate safe practice when
administering IV potassium chloride (KCl).
A. Dilute concentrated KCl in IV fluid and administer via infusion
pump.
B. Give an IV push bolus of concentrated KCl to correct severe
hypokalemia quickly.
C. Verify urine output and renal function before administration.
D. Check that the IV site is patent and give through a peripheral
IV at >10 mEq/hr.
E. Recheck serum potassium level per facility protocol.
Correct answers: A, C, E
,Rationale:
• A (correct): KCl must be diluted and given via infusion
pump to avoid rapid infusion which can cause cardiac
arrest.
• C (correct): Renal impairment increases risk of
hyperkalemia; verify urine output and labs.
• E (correct): Rechecking serum potassium per protocol
evaluates response.
• B (incorrect): Concentrated KCl should never be given IV
push except in extreme, controlled central line situations
with prescriber and ICU protocols — in general practice
this is unsafe.
• D (incorrect): Peripheral infusion rates are typically limited
(commonly ≤10 mEq/hr peripherally, depending on
facility); >10 mEq/hr peripherally is unsafe and site
irritation risk increases.
3 — NGN Case (Clinical judgment; cardiovascular)
Scenario: A 68-year-old man with heart failure (EF 30%) is
admitted with worsening dyspnea. He is on lisinopril,
furosemide, and carvedilol. Labs: K⁺ 5.6 mEq/L, BUN 38 mg/dL,
creatinine 2.1 mg/dL, BP 96/58 mm Hg. He reports
lightheadedness. Which nursing action should the nurse
perform first? (Use clinical judgment/priority.)
, A. Hold the ACE inhibitor (lisinopril) and notify the prescriber.
B. Administer furosemide IV as ordered to remove excess
potassium.
C. Place patient on continuous cardiac monitoring and obtain a
12-lead ECG.
D. Give oral sodium polystyrene sulfonate (kayexalate) now.
Correct answer: C
Rationale:
• C (correct): Serum K⁺ 5.6 with symptoms and renal
dysfunction poses immediate cardiac risk; first action is to
assess for cardiac manifestations (monitoring, 12-lead
ECG) to detect peaked T waves/arrhythmias — assessment
precedes interventions. (NCLEX/NCSBN emphasis: assess
first to guide priority interventions.) NCSBN
• A (incorrect): Holding lisinopril may be appropriate, but
assessment (ECG/monitor) and prescriber notification
follow initial assessment.
• B (incorrect): IV loop diuretics can lower K⁺ but require
sufficient urine output and careful evaluation of BP/renal
status; not the first immediate action.
• D (incorrect): Kayexalate is slower acting and may be
contraindicated with bowel issues; not the immediate
priority before monitoring/assessment.
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Multiple Choice (Medication administration principles)
A nurse is preparing to administer 0900 medications. The
patient has a new medication order for warfarin 5 mg PO
nightly. Which action by the nurse is most appropriate before
giving the first dose?
A. Give the warfarin and monitor the INR in 48 hours.
B. Confirm the patient's most recent INR and review concurrent
medications.
C. Hold the dose until the next day to obtain baseline PT.
D. Request the prescriber change the order to heparin for
immediate effect.
Correct answer: B
Rationale:
• B (correct): Warfarin dosing requires knowledge of
baseline/in-range INR and potential drug interactions
(many drugs, herbal supplements affect warfarin).
Confirming the most recent INR and concurrent meds is
, safe practice before first dose. (Saunders emphasizes verify
labs and meds before anticoagulant administration.) Evolve
• A (incorrect): Giving warfarin without checking INR could
cause bleeding or under-anticoagulation; INR should be
known earlier than 48 hours post-dose for titration.
• C (incorrect): Holding without contacting prescriber is not
appropriate; nurse should verify labs and consult
prescriber as needed.
• D (incorrect): Changing anticoagulant requires prescriber
order and clinical indication; nurse should not unilaterally
request substitution without clinical justification.
2 — Multiple Response (Safe medication practices / high-alert
drugs)
Select all actions that demonstrate safe practice when
administering IV potassium chloride (KCl).
A. Dilute concentrated KCl in IV fluid and administer via infusion
pump.
B. Give an IV push bolus of concentrated KCl to correct severe
hypokalemia quickly.
C. Verify urine output and renal function before administration.
D. Check that the IV site is patent and give through a peripheral
IV at >10 mEq/hr.
E. Recheck serum potassium level per facility protocol.
Correct answers: A, C, E
,Rationale:
• A (correct): KCl must be diluted and given via infusion
pump to avoid rapid infusion which can cause cardiac
arrest.
• C (correct): Renal impairment increases risk of
hyperkalemia; verify urine output and labs.
• E (correct): Rechecking serum potassium per protocol
evaluates response.
• B (incorrect): Concentrated KCl should never be given IV
push except in extreme, controlled central line situations
with prescriber and ICU protocols — in general practice
this is unsafe.
• D (incorrect): Peripheral infusion rates are typically limited
(commonly ≤10 mEq/hr peripherally, depending on
facility); >10 mEq/hr peripherally is unsafe and site
irritation risk increases.
3 — NGN Case (Clinical judgment; cardiovascular)
Scenario: A 68-year-old man with heart failure (EF 30%) is
admitted with worsening dyspnea. He is on lisinopril,
furosemide, and carvedilol. Labs: K⁺ 5.6 mEq/L, BUN 38 mg/dL,
creatinine 2.1 mg/dL, BP 96/58 mm Hg. He reports
lightheadedness. Which nursing action should the nurse
perform first? (Use clinical judgment/priority.)
, A. Hold the ACE inhibitor (lisinopril) and notify the prescriber.
B. Administer furosemide IV as ordered to remove excess
potassium.
C. Place patient on continuous cardiac monitoring and obtain a
12-lead ECG.
D. Give oral sodium polystyrene sulfonate (kayexalate) now.
Correct answer: C
Rationale:
• C (correct): Serum K⁺ 5.6 with symptoms and renal
dysfunction poses immediate cardiac risk; first action is to
assess for cardiac manifestations (monitoring, 12-lead
ECG) to detect peaked T waves/arrhythmias — assessment
precedes interventions. (NCLEX/NCSBN emphasis: assess
first to guide priority interventions.) NCSBN
• A (incorrect): Holding lisinopril may be appropriate, but
assessment (ECG/monitor) and prescriber notification
follow initial assessment.
• B (incorrect): IV loop diuretics can lower K⁺ but require
sufficient urine output and careful evaluation of BP/renal
status; not the first immediate action.
• D (incorrect): Kayexalate is slower acting and may be
contraindicated with bowel issues; not the immediate
priority before monitoring/assessment.
