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
1 — Rights & Error Prevention (Single best answer)
A nurse prepares to give a newly admitted client a scheduled
medication. Which action best satisfies the “right client” and
prevents medication error?
A. Ask the client, “Are you Mr. Jones?” and administer the med.
B. Scan the client’s ID bracelet barcode and compare to the
MAR before administration.
C. Confirm the name verbally with the client’s roommate.
D. Rely on the nurse’s memory because the nurse admitted the
client earlier.
Correct answer: B
Rationale — B (Correct): Scanning the client’s ID bracelet
barcode and comparing to the Medication Administration
,Record (MAR) uses two identifiers and a technology check that
reduces selection errors—aligns with “right client” and standard
safety practice (reduces wrong-patient errors). It’s evidence-
based error prevention.
Rationale — A (Incorrect): Asking “Are you Mr. Jones?” is
insufficient; patient confusion, hearing impairment, or multiple
people with same name can still cause error. Use two identifiers
(name + DOB or barcode).
Rationale — C (Incorrect): A roommate is not a reliable
identifier and could give incorrect information; violates privacy
and right-client verification.
Rationale — D (Incorrect): Memory is unreliable and increases
risk of wrong-patient/omission errors; documentation/scanning
is required.
2 — ACE Inhibitor Contraindication (Single best answer)
A 62-year-old man with hypertension is prescribed lisinopril.
Which finding would make the nurse hold the dose and contact
the provider immediately?
A. Potassium 5.8 mEq/L
B. Blood pressure 150/90 mm Hg
C. Dry cough reported for 3 days
D. Serum creatinine 1.0 mg/dL
Correct answer: A
,Rationale — A (Correct): ACE inhibitors decrease aldosterone
→ potassium retention; a K⁺ of 5.8 mEq/L is hyperkalemia that
can cause dysrhythmias and is a contraindication to giving
lisinopril until evaluated and treated. Immediate action
required.
Rationale — B (Incorrect): BP 150/90 indicates suboptimal
control, but not an acute contraindication—drug may be
appropriate; monitor.
Rationale — C (Incorrect): Dry, persistent cough is a common
adverse effect of ACE inhibitors and may warrant switching, but
it is not an immediate danger requiring withholding the dose
unless severe. It’s important for patient teaching and provider
notification.
Rationale — D (Incorrect): Creatinine 1.0 mg/dL is normal for
many adults and not a reason to hold lisinopril.
3 — IV Infusion Rate (Calculation)
Order: Vancomycin 1,000 mg in 250 mL D5W IV to infuse over 2
hours. Pump tubing delivers mL/hr. What rate (mL/hr) does the
nurse program? Show calculation.
A. 125 mL/hr
B. 100 mL/hr
C. 250 mL/hr
D. 83 mL/hr
, Correct answer: A
Calculation (step-by-step):
Total volume = 250 mL. Time = 2 hours. Rate = volume ÷ time.
250 mL ÷ 2 hr = 125 mL/hr.
Rationale — A (Correct): 125 mL/hr is mathematically correct
and ensures the drug is delivered over the ordered 2 hours.
Rationale — B (Incorrect): 100 mL/hr would infuse 200 mL in 2
hours — too slow; not delivering the full dose in prescribed
time.
Rationale — C (Incorrect): 250 mL/hr would deliver the full
volume in 1 hour — too fast; may increase infusion-related
adverse effects (e.g., "red man" with vancomycin if infused too
rapidly).
Rationale — D (Incorrect): 83 mL/hr approximates 250 ÷ 3 —
incorrect time.
Safety note: Vancomycin must be infused over at least 60–120
minutes depending on dose; faster rates risk infusion reactions.
Monitor for flushing, hypotension.
4 — Pediatric Dosage (mg/kg) (Calculation)
A child weighs 22 lb. The order is amoxicillin 50 mg/kg/day
divided every 8 hours (TID). The suspension concentration is
400 mg/5 mL. What volume (mL) is given per dose? Show work.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1 — Rights & Error Prevention (Single best answer)
A nurse prepares to give a newly admitted client a scheduled
medication. Which action best satisfies the “right client” and
prevents medication error?
A. Ask the client, “Are you Mr. Jones?” and administer the med.
B. Scan the client’s ID bracelet barcode and compare to the
MAR before administration.
C. Confirm the name verbally with the client’s roommate.
D. Rely on the nurse’s memory because the nurse admitted the
client earlier.
Correct answer: B
Rationale — B (Correct): Scanning the client’s ID bracelet
barcode and comparing to the Medication Administration
,Record (MAR) uses two identifiers and a technology check that
reduces selection errors—aligns with “right client” and standard
safety practice (reduces wrong-patient errors). It’s evidence-
based error prevention.
Rationale — A (Incorrect): Asking “Are you Mr. Jones?” is
insufficient; patient confusion, hearing impairment, or multiple
people with same name can still cause error. Use two identifiers
(name + DOB or barcode).
Rationale — C (Incorrect): A roommate is not a reliable
identifier and could give incorrect information; violates privacy
and right-client verification.
Rationale — D (Incorrect): Memory is unreliable and increases
risk of wrong-patient/omission errors; documentation/scanning
is required.
2 — ACE Inhibitor Contraindication (Single best answer)
A 62-year-old man with hypertension is prescribed lisinopril.
Which finding would make the nurse hold the dose and contact
the provider immediately?
A. Potassium 5.8 mEq/L
B. Blood pressure 150/90 mm Hg
C. Dry cough reported for 3 days
D. Serum creatinine 1.0 mg/dL
Correct answer: A
,Rationale — A (Correct): ACE inhibitors decrease aldosterone
→ potassium retention; a K⁺ of 5.8 mEq/L is hyperkalemia that
can cause dysrhythmias and is a contraindication to giving
lisinopril until evaluated and treated. Immediate action
required.
Rationale — B (Incorrect): BP 150/90 indicates suboptimal
control, but not an acute contraindication—drug may be
appropriate; monitor.
Rationale — C (Incorrect): Dry, persistent cough is a common
adverse effect of ACE inhibitors and may warrant switching, but
it is not an immediate danger requiring withholding the dose
unless severe. It’s important for patient teaching and provider
notification.
Rationale — D (Incorrect): Creatinine 1.0 mg/dL is normal for
many adults and not a reason to hold lisinopril.
3 — IV Infusion Rate (Calculation)
Order: Vancomycin 1,000 mg in 250 mL D5W IV to infuse over 2
hours. Pump tubing delivers mL/hr. What rate (mL/hr) does the
nurse program? Show calculation.
A. 125 mL/hr
B. 100 mL/hr
C. 250 mL/hr
D. 83 mL/hr
, Correct answer: A
Calculation (step-by-step):
Total volume = 250 mL. Time = 2 hours. Rate = volume ÷ time.
250 mL ÷ 2 hr = 125 mL/hr.
Rationale — A (Correct): 125 mL/hr is mathematically correct
and ensures the drug is delivered over the ordered 2 hours.
Rationale — B (Incorrect): 100 mL/hr would infuse 200 mL in 2
hours — too slow; not delivering the full dose in prescribed
time.
Rationale — C (Incorrect): 250 mL/hr would deliver the full
volume in 1 hour — too fast; may increase infusion-related
adverse effects (e.g., "red man" with vancomycin if infused too
rapidly).
Rationale — D (Incorrect): 83 mL/hr approximates 250 ÷ 3 —
incorrect time.
Safety note: Vancomycin must be infused over at least 60–120
minutes depending on dose; faster rates risk infusion reactions.
Monitor for flushing, hypotension.
4 — Pediatric Dosage (mg/kg) (Calculation)
A child weighs 22 lb. The order is amoxicillin 50 mg/kg/day
divided every 8 hours (TID). The suspension concentration is
400 mg/5 mL. What volume (mL) is given per dose? Show work.
