Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
Section A — Single-best-answer NCLEX-style questions (1–20)
1 — Rights of medication administration
A nurse prepares to give a prescribed oral medication to a
confused, visually impaired patient who says, "I don't think I
should take anything new today." Which action best reflects the
nurse’s responsibility under the right of patient (one of the
rights of medication administration)?
A. Document that the patient refused and place the medication
on the bedside table.
B. Withhold the medication and notify the prescriber
immediately.
C. Ask the patient to sign a refusal form, then give the
medication later when the patient appears calmer.
D. Stop, clarify the patient's understanding of the medication,
,answer questions, and then respect the patient's informed
refusal or consent.
Correct answer: D
Rationales
• A — Incorrect. Placing medication at bedside after a
refusal violates the nurse’s duty to prevent unintended
ingestion and does not respect informed refusal. The nurse
must document refusal and ensure safety, not leave meds
accessible.
• B — Incorrect. Notifying the prescriber may be appropriate
after the patient’s decision is clarified, but immediately
withholding without attempting to ensure informed
decision-making fails to follow the nurse’s duty to educate
and clarify. Also the prescriber may not need immediate
notification if patient simply refuses after explanation.
• C — Incorrect. Forcing or covertly giving later would
violate autonomy and safe administration. Asking for a
signature does not substitute for ensuring informed
understanding prior to administration.
• D — Correct. The nurse must ensure the patient
understands the medication (indication, risks, benefits),
answer questions, and respect patient autonomy. If the
patient still refuses, document and notify the prescriber as
needed. This fulfills the right of patient and supports error
prevention and safety.
,2 — Error prevention (look-alike/sound-alike)
A prescriber writes an order for "hydralazine 50 mg PO q8h
prn." The nurse notes the patient's electronic medication list
also includes "hydroxyzine." What is the best immediate nursing
action?
A. Administer the hydralazine as ordered — the pharmacist will
catch any error.
B. Call the prescriber to clarify the order because hydralazine
and hydroxyzine are easily confused.
C. Substitute hydroxyzine if the prescriber usually prescribes it
for the patient.
D. Hold the order and wait until the next shift.
Correct answer: B
Rationales
• A — Incorrect. Relying solely on the pharmacist is unsafe
— the nurse must confirm ambiguous orders before
administration to prevent harmful medication errors.
• B — Correct. Hydralazine (vasodilator/antihypertensive)
and hydroxyzine (antihistamine/anxiolytic) are look-
alike/sound-alike; clarifying with the prescriber prevents a
potentially dangerous error.
• C — Incorrect. Never substitute medications without
prescriber authorization.
, • D — Incorrect. Holding without clarification delays
treatment and doesn't resolve the ambiguity. The correct
action is to clarify immediately.
3 — Patient teaching / SSRI interactions
A patient is prescribed sertraline for major depression. Which
statement by the patient indicates the need for additional
teaching?
A. "I will avoid taking an MAOI while I’m on sertraline."
B. "If I feel restless and sweaty with a fast heartbeat, I’ll call the
clinic right away."
C. "I can take St. John's wort to help mood as long as I stop
sertraline first."
D. "It may take several weeks before I notice an improvement in
my mood."
Correct answer: C
Rationales
• A — Incorrect (not the best choice to indicate need for
teaching). Avoiding MAOIs is correct; combining SSRIs with
MAOIs risks serotonin syndrome and hypertensive crises.
• B — Incorrect. Restlessness, diaphoresis, and tachycardia
can be early signs of serotonin syndrome — appropriate to
report.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
Section A — Single-best-answer NCLEX-style questions (1–20)
1 — Rights of medication administration
A nurse prepares to give a prescribed oral medication to a
confused, visually impaired patient who says, "I don't think I
should take anything new today." Which action best reflects the
nurse’s responsibility under the right of patient (one of the
rights of medication administration)?
A. Document that the patient refused and place the medication
on the bedside table.
B. Withhold the medication and notify the prescriber
immediately.
C. Ask the patient to sign a refusal form, then give the
medication later when the patient appears calmer.
D. Stop, clarify the patient's understanding of the medication,
,answer questions, and then respect the patient's informed
refusal or consent.
Correct answer: D
Rationales
• A — Incorrect. Placing medication at bedside after a
refusal violates the nurse’s duty to prevent unintended
ingestion and does not respect informed refusal. The nurse
must document refusal and ensure safety, not leave meds
accessible.
• B — Incorrect. Notifying the prescriber may be appropriate
after the patient’s decision is clarified, but immediately
withholding without attempting to ensure informed
decision-making fails to follow the nurse’s duty to educate
and clarify. Also the prescriber may not need immediate
notification if patient simply refuses after explanation.
• C — Incorrect. Forcing or covertly giving later would
violate autonomy and safe administration. Asking for a
signature does not substitute for ensuring informed
understanding prior to administration.
• D — Correct. The nurse must ensure the patient
understands the medication (indication, risks, benefits),
answer questions, and respect patient autonomy. If the
patient still refuses, document and notify the prescriber as
needed. This fulfills the right of patient and supports error
prevention and safety.
,2 — Error prevention (look-alike/sound-alike)
A prescriber writes an order for "hydralazine 50 mg PO q8h
prn." The nurse notes the patient's electronic medication list
also includes "hydroxyzine." What is the best immediate nursing
action?
A. Administer the hydralazine as ordered — the pharmacist will
catch any error.
B. Call the prescriber to clarify the order because hydralazine
and hydroxyzine are easily confused.
C. Substitute hydroxyzine if the prescriber usually prescribes it
for the patient.
D. Hold the order and wait until the next shift.
Correct answer: B
Rationales
• A — Incorrect. Relying solely on the pharmacist is unsafe
— the nurse must confirm ambiguous orders before
administration to prevent harmful medication errors.
• B — Correct. Hydralazine (vasodilator/antihypertensive)
and hydroxyzine (antihistamine/anxiolytic) are look-
alike/sound-alike; clarifying with the prescriber prevents a
potentially dangerous error.
• C — Incorrect. Never substitute medications without
prescriber authorization.
, • D — Incorrect. Holding without clarification delays
treatment and doesn't resolve the ambiguity. The correct
action is to clarify immediately.
3 — Patient teaching / SSRI interactions
A patient is prescribed sertraline for major depression. Which
statement by the patient indicates the need for additional
teaching?
A. "I will avoid taking an MAOI while I’m on sertraline."
B. "If I feel restless and sweaty with a fast heartbeat, I’ll call the
clinic right away."
C. "I can take St. John's wort to help mood as long as I stop
sertraline first."
D. "It may take several weeks before I notice an improvement in
my mood."
Correct answer: C
Rationales
• A — Incorrect (not the best choice to indicate need for
teaching). Avoiding MAOIs is correct; combining SSRIs with
MAOIs risks serotonin syndrome and hypertensive crises.
• B — Incorrect. Restlessness, diaphoresis, and tachycardia
can be early signs of serotonin syndrome — appropriate to
report.
