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 of medication administration (single answer)
A nurse prepares to give oral metoprolol 25 mg to a new admit.
Which of the following is the most important immediate action
before administering the first dose?
A. Check the patient's BP and HR and confirm they are within
parameters for giving metoprolol.
B. Ask the patient to state their full name.
C. Verify the medication label with the MAR at the medication
cart.
D. Explain the purpose of the drug to the patient.
Correct answer: A
Rationales
• A (Correct): For a beta-blocker (metoprolol), vital signs
(blood pressure and heart rate) determine safety prior to
, administration: bradycardia or hypotension are
contraindications. Checking vitals immediately before the
first dose prevents harm (pharmacodynamic effect: β1
blockade → decreased HR and BP). This is the highest-
priority safety check.
• B (Incorrect): Patient identification is essential (right
patient) but in practice verifying ID can be done
simultaneously; for a drug where immediate physiologic
contraindications exist (β-blocker), assessing vitals before
administering is the priority safety action.
• C (Incorrect): Verifying label with MAR is required, but it
does not address the urgent physiologic risk
(bradycardia/hypotension) that could cause immediate
harm.
• D (Incorrect): Teaching is important (right education), but
is not the immediate safety check when administration
may be contraindicated by vital signs.
2 — Pediatric dosage calculation (single answer; calculation)
Order: Cefazolin 25 mg/kg IV for a child who weighs 12 kg.
Available: Cefazolin 100 mg/mL. How many mL will the nurse
administer?
A. 1.5 mL
B. 2.5 mL
,C. 3.0 mL
D. 4.0 mL
Correct answer: C (3.0 mL)
Rationales (calculation shown):
• Dose required = 25 mg/kg × 12 kg = 300 mg. Available
concentration = 100 mg/mL. Volume = 300 mg ÷ 100
mg/mL = 3.0 mL. So C is correct.
• A (1.5 mL): would deliver 150 mg — subtherapeutic.
• B (2.5 mL): would deliver 250 mg — incorrect dose.
• D (4.0 mL): would deliver 400 mg — overdose risk.
Safety note: Always confirm weight in kg, perform independent
calculation verification (institution policy), and document
time/route and monitor for allergic reaction.
3 — IV infusion rate (single answer; calculation)
A patient is to receive 1,000 mL of 0.9% NaCl to run over 7
hours by infusion pump. What is the infusion rate in mL/hr?
A. 100 mL/hr
B. 125 mL/hr
C. 143 mL/hr
D. 166 mL/hr
Correct answer: C (143 mL/hr)
Rationales (calculation shown):
, • Rate = 1000 mL ÷ 7 hr = 142.857… mL/hr, rounded to 143
mL/hr for pump programming. C correct.
• A (100 mL/hr): would run too slow (10 hours).
• B (125 mL/hr): 8 hours — incorrect.
• D (166 mL/hr): ~6 hours — incorrect and could risk fluid
overload depending on patient status.
Safety note: Round per facility policy and document infusion
start time; monitor for signs of fluid overload.
4 — ACE inhibitor (single answer)
A 58-year-old patient with hypertension is started on lisinopril.
Which of the following must the nurse include in discharge
teaching?
A. “If you develop a dry cough, notify your provider — it may be
related to your new medicine.”
B. “This medication is safe during pregnancy.”
C. “You can stop the medication if your blood pressure feels
fine.”
D. “Avoid potassium-containing foods while on lisinopril.”
Correct answer: A
Rationales
• A (Correct): ACE inhibitors commonly cause an irritating
dry cough due to bradykinin accumulation. Patients should
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1 — Rights of medication administration (single answer)
A nurse prepares to give oral metoprolol 25 mg to a new admit.
Which of the following is the most important immediate action
before administering the first dose?
A. Check the patient's BP and HR and confirm they are within
parameters for giving metoprolol.
B. Ask the patient to state their full name.
C. Verify the medication label with the MAR at the medication
cart.
D. Explain the purpose of the drug to the patient.
Correct answer: A
Rationales
• A (Correct): For a beta-blocker (metoprolol), vital signs
(blood pressure and heart rate) determine safety prior to
, administration: bradycardia or hypotension are
contraindications. Checking vitals immediately before the
first dose prevents harm (pharmacodynamic effect: β1
blockade → decreased HR and BP). This is the highest-
priority safety check.
• B (Incorrect): Patient identification is essential (right
patient) but in practice verifying ID can be done
simultaneously; for a drug where immediate physiologic
contraindications exist (β-blocker), assessing vitals before
administering is the priority safety action.
• C (Incorrect): Verifying label with MAR is required, but it
does not address the urgent physiologic risk
(bradycardia/hypotension) that could cause immediate
harm.
• D (Incorrect): Teaching is important (right education), but
is not the immediate safety check when administration
may be contraindicated by vital signs.
2 — Pediatric dosage calculation (single answer; calculation)
Order: Cefazolin 25 mg/kg IV for a child who weighs 12 kg.
Available: Cefazolin 100 mg/mL. How many mL will the nurse
administer?
A. 1.5 mL
B. 2.5 mL
,C. 3.0 mL
D. 4.0 mL
Correct answer: C (3.0 mL)
Rationales (calculation shown):
• Dose required = 25 mg/kg × 12 kg = 300 mg. Available
concentration = 100 mg/mL. Volume = 300 mg ÷ 100
mg/mL = 3.0 mL. So C is correct.
• A (1.5 mL): would deliver 150 mg — subtherapeutic.
• B (2.5 mL): would deliver 250 mg — incorrect dose.
• D (4.0 mL): would deliver 400 mg — overdose risk.
Safety note: Always confirm weight in kg, perform independent
calculation verification (institution policy), and document
time/route and monitor for allergic reaction.
3 — IV infusion rate (single answer; calculation)
A patient is to receive 1,000 mL of 0.9% NaCl to run over 7
hours by infusion pump. What is the infusion rate in mL/hr?
A. 100 mL/hr
B. 125 mL/hr
C. 143 mL/hr
D. 166 mL/hr
Correct answer: C (143 mL/hr)
Rationales (calculation shown):
, • Rate = 1000 mL ÷ 7 hr = 142.857… mL/hr, rounded to 143
mL/hr for pump programming. C correct.
• A (100 mL/hr): would run too slow (10 hours).
• B (125 mL/hr): 8 hours — incorrect.
• D (166 mL/hr): ~6 hours — incorrect and could risk fluid
overload depending on patient status.
Safety note: Round per facility policy and document infusion
start time; monitor for signs of fluid overload.
4 — ACE inhibitor (single answer)
A 58-year-old patient with hypertension is started on lisinopril.
Which of the following must the nurse include in discharge
teaching?
A. “If you develop a dry cough, notify your provider — it may be
related to your new medicine.”
B. “This medication is safe during pregnancy.”
C. “You can stop the medication if your blood pressure feels
fine.”
D. “Avoid potassium-containing foods while on lisinopril.”
Correct answer: A
Rationales
• A (Correct): ACE inhibitors commonly cause an irritating
dry cough due to bradykinin accumulation. Patients should
