Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — ACE inhibitor (lisinopril): best patient teaching
A 56-year-old patient with newly prescribed lisinopril for
hypertension asks what side effect to report immediately.
Which instruction is most important to emphasize?
A. "If you develop a persistent dry cough, call your prescriber."
B. "If you experience constipation, stop the medicine."
C. "If you have blurred vision, take an extra dose."
D. "If you become pregnant, it is safe to continue."
Answer: A.
Rationale (correct): ACE inhibitors (eg, lisinopril) commonly
cause a persistent dry, nonproductive cough due to increased
bradykinin; patients should report a persistent cough to the
prescriber as an adverse effect that may require switching drug
classes. They are contraindicated in pregnancy because of fetal
risk. NCBI+1
,Why the others are incorrect:
B — Constipation is not the priority adverse effect and stopping
without consulting is unsafe.
C — Blurred vision is not an indication to take extra drug; taking
an extra dose risks hypotension.
D — ACE inhibitors are teratogenic; pregnancy is a
contraindication, not a reason to continue.
Teaching: Avoid pregnancy; report cough, facial swelling
(angioedema), lightheadedness, or muscle weakness (suggests
hyperkalemia). Monitor BP and potassium as ordered. NCBI
2 — Beta-blocker (metoprolol) withholding criteria (NGN-
style)
A patient on metoprolol 50 mg PO twice daily has an AM
assessment: HR 48 bpm, BP 110/62 mm Hg, alert and oriented,
denies chest pain. Which action should the nurse take first?
A. Administer the scheduled dose.
B. Hold the dose and notify the prescriber.
C. Give half the dose and reassess in 30 minutes.
D. Give the dose with orange juice to prevent bradycardia.
Answer: B.
Rationale (correct): Beta-blockers reduce heart rate and
contractility. A resting HR of 48 bpm indicates bradycardia;
standard nursing practice is to hold the beta-blocker and notify
the prescriber for further orders. This aligns with medication-
,administration and safety principles reviewed in Saunders.
Evolve
Why the others are incorrect:
A — Administering could worsen bradycardia and cause
hypotension or syncope.
C — Splitting an oral tablet without an order is not within
nursing scope for safety.
D — No evidence that giving with orange juice prevents
bradycardia; citrus does not counteract beta-blockade.
Teaching: Teach patients to check pulse and report dizziness,
fainting, or HR < 60 unless otherwise instructed.
3 — Digoxin toxicity recognition
A client on chronic digoxin therapy develops nausea, vomiting,
and blurred yellow vision. Which interpretation by the nurse is
most accurate?
A. These are common harmless side effects; continue the drug.
B. These are classic signs of digoxin toxicity; notify the
prescriber.
C. These symptoms indicate hypoglycemia; give juice.
D. These signs indicate early heart failure; double the dose.
Answer: B.
Rationale (correct): Digoxin has a narrow therapeutic index. GI
symptoms (nausea/vomiting), visual changes (yellow/green
, halos), and arrhythmias are classic signs of toxicity—hold dose
and notify provider; measure digoxin level and electrolytes (K+,
Mg2+). NCBI+1
Why the others are incorrect:
A — They are not harmless; they warrant immediate action.
C — Blurred yellow vision is not hypoglycemia; giving juice
would not address toxicity.
D — Doubling dose is dangerous and would worsen toxicity.
Teaching: Take digoxin at same time daily, monitor K+
(hypokalemia increases toxicity risk), and report GI or visual
disturbances immediately.
4 — Dosage calculation: IV insulin bolus (digit-by-digit)
Order: IV regular insulin 0.1 units/kg IV bolus for hyperglycemia.
Patient weight = 70 kg. Calculate dose (units).
A. 5 units
B. 7 units
C. 10 units
D. 14 units
Answer: B — 7 units.
Calculation (digit-by-digit): 0.1 × 70 = 7.0 → 7 units. (0.1 × 70 =
7)
Rationale: Use weight-based dosing; verify syringe and
concentration, double-check with another nurse for IV bolus
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — ACE inhibitor (lisinopril): best patient teaching
A 56-year-old patient with newly prescribed lisinopril for
hypertension asks what side effect to report immediately.
Which instruction is most important to emphasize?
A. "If you develop a persistent dry cough, call your prescriber."
B. "If you experience constipation, stop the medicine."
C. "If you have blurred vision, take an extra dose."
D. "If you become pregnant, it is safe to continue."
Answer: A.
Rationale (correct): ACE inhibitors (eg, lisinopril) commonly
cause a persistent dry, nonproductive cough due to increased
bradykinin; patients should report a persistent cough to the
prescriber as an adverse effect that may require switching drug
classes. They are contraindicated in pregnancy because of fetal
risk. NCBI+1
,Why the others are incorrect:
B — Constipation is not the priority adverse effect and stopping
without consulting is unsafe.
C — Blurred vision is not an indication to take extra drug; taking
an extra dose risks hypotension.
D — ACE inhibitors are teratogenic; pregnancy is a
contraindication, not a reason to continue.
Teaching: Avoid pregnancy; report cough, facial swelling
(angioedema), lightheadedness, or muscle weakness (suggests
hyperkalemia). Monitor BP and potassium as ordered. NCBI
2 — Beta-blocker (metoprolol) withholding criteria (NGN-
style)
A patient on metoprolol 50 mg PO twice daily has an AM
assessment: HR 48 bpm, BP 110/62 mm Hg, alert and oriented,
denies chest pain. Which action should the nurse take first?
A. Administer the scheduled dose.
B. Hold the dose and notify the prescriber.
C. Give half the dose and reassess in 30 minutes.
D. Give the dose with orange juice to prevent bradycardia.
Answer: B.
Rationale (correct): Beta-blockers reduce heart rate and
contractility. A resting HR of 48 bpm indicates bradycardia;
standard nursing practice is to hold the beta-blocker and notify
the prescriber for further orders. This aligns with medication-
,administration and safety principles reviewed in Saunders.
Evolve
Why the others are incorrect:
A — Administering could worsen bradycardia and cause
hypotension or syncope.
C — Splitting an oral tablet without an order is not within
nursing scope for safety.
D — No evidence that giving with orange juice prevents
bradycardia; citrus does not counteract beta-blockade.
Teaching: Teach patients to check pulse and report dizziness,
fainting, or HR < 60 unless otherwise instructed.
3 — Digoxin toxicity recognition
A client on chronic digoxin therapy develops nausea, vomiting,
and blurred yellow vision. Which interpretation by the nurse is
most accurate?
A. These are common harmless side effects; continue the drug.
B. These are classic signs of digoxin toxicity; notify the
prescriber.
C. These symptoms indicate hypoglycemia; give juice.
D. These signs indicate early heart failure; double the dose.
Answer: B.
Rationale (correct): Digoxin has a narrow therapeutic index. GI
symptoms (nausea/vomiting), visual changes (yellow/green
, halos), and arrhythmias are classic signs of toxicity—hold dose
and notify provider; measure digoxin level and electrolytes (K+,
Mg2+). NCBI+1
Why the others are incorrect:
A — They are not harmless; they warrant immediate action.
C — Blurred yellow vision is not hypoglycemia; giving juice
would not address toxicity.
D — Doubling dose is dangerous and would worsen toxicity.
Teaching: Take digoxin at same time daily, monitor K+
(hypokalemia increases toxicity risk), and report GI or visual
disturbances immediately.
4 — Dosage calculation: IV insulin bolus (digit-by-digit)
Order: IV regular insulin 0.1 units/kg IV bolus for hyperglycemia.
Patient weight = 70 kg. Calculate dose (units).
A. 5 units
B. 7 units
C. 10 units
D. 14 units
Answer: B — 7 units.
Calculation (digit-by-digit): 0.1 × 70 = 7.0 → 7 units. (0.1 × 70 =
7)
Rationale: Use weight-based dosing; verify syringe and
concentration, double-check with another nurse for IV bolus
