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
Questions
1 (Multiple choice — safe administration)
A nurse prepares to give a new prescription for lisinopril 20 mg
PO daily. Which action is most important before
administration?
A. Ask the patient whether they have a history of angioedema.
B. Check the patient's latest serum potassium and creatinine.
C. Tell the patient to rise slowly from sitting to standing after
the first dose.
D. Instruct the patient to take the medication with food.
Correct answer: B. Check the patient's latest serum potassium
and creatinine.
Rationales:
, • A (incorrect): Asking about angioedema is important (ACE
inhibitors can cause angioedema), but immediate pre-
administration kidney function and potassium are more
critical because ACE inhibitors can cause hyperkalemia and
increase creatinine — baseline labs inform safety of giving
the dose now.
• B (correct): ACE inhibitors reduce aldosterone → can raise
serum K⁺; they also affect renal hemodynamics and may
increase creatinine, especially in bilateral renal artery
stenosis. Checking K⁺ and creatinine before giving a new
ACE inhibitor dose is key for safety.
• C (incorrect): Advising orthostatic precautions is
appropriate teaching (first-dose hypotension), but it's not
the single most important pre-administration safety check
compared with labs that could contraindicate therapy.
• D (incorrect): Lisinopril may be taken with or without food;
telling patient to take with food is unnecessary and not a
priority safety check.
2 (Calculation — IV infusion rate)
Order: Normal saline 1,000 mL IV to infuse over 8 hours via
infusion pump. What rate (mL/hr) should the nurse set? (Show
calculation.)
A. 100 mL/hr
B. 125 mL/hr
,C. 150 mL/hr
D. 200 mL/hr
Correct answer: B. 125 mL/hr
Rationales / Calculation:
• Formula: total volume (mL) ÷ total time (hr) = mL/hr.
• Calculation: 1,000 mL ÷ 8 hr = 125 mL/hr. (Step: 1000 ÷ 8 =
125.)
• A (100 mL/hr): Too slow — would deliver only 800 mL in 8
hr.
• B (125 mL/hr): Correct — delivers 1,000 mL in 8 hr.
• C (150 mL/hr): Too fast — delivers 1,200 mL in 8 hr, risking
fluid overload.
• D (200 mL/hr): Much too fast — 1,600 mL in 8 hr; unsafe
unless ordered.
(Reference: standard pump calculation practices). NCLEX
Practice Tests
3 (Multiple choice — high-alert med safety)
A nurse is preparing to administer IV heparin infusion. Which
practice reduces medication errors most effectively?
A. Use weight-based protocol and an infusion pump with dose
limits preprogrammed.
B. Ask the patient if they prefer the infusion in the left or right
, arm.
C. Draw heparin from the patient's home supply to save
hospital resources.
D. Prepare the heparin infusion on a med-surg floor without
pharmacist verification.
Correct answer: A. Use weight-based protocol and an infusion
pump with dose limits preprogrammed.
Rationales:
• A (correct): Heparin is high-risk. Weight-based protocols,
double checks, and smart pumps with dose-error
reduction software reduce calculation and programming
errors — best practice for safety.
• B (incorrect): Patient preference for site is irrelevant to
preventing medication errors.
• C (incorrect): Using home supplies risks contamination,
incorrect strength, and is unsafe.
• D (incorrect): High-risk infusions should be verified by
pharmacy and follow protocols; preparing without
verification increases error risk.
4 (Pharmacologic classification)
A patient with heart failure is started on furosemide. Which
physiologic effect explains the main therapeutic benefit for
heart failure?
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
Questions
1 (Multiple choice — safe administration)
A nurse prepares to give a new prescription for lisinopril 20 mg
PO daily. Which action is most important before
administration?
A. Ask the patient whether they have a history of angioedema.
B. Check the patient's latest serum potassium and creatinine.
C. Tell the patient to rise slowly from sitting to standing after
the first dose.
D. Instruct the patient to take the medication with food.
Correct answer: B. Check the patient's latest serum potassium
and creatinine.
Rationales:
, • A (incorrect): Asking about angioedema is important (ACE
inhibitors can cause angioedema), but immediate pre-
administration kidney function and potassium are more
critical because ACE inhibitors can cause hyperkalemia and
increase creatinine — baseline labs inform safety of giving
the dose now.
• B (correct): ACE inhibitors reduce aldosterone → can raise
serum K⁺; they also affect renal hemodynamics and may
increase creatinine, especially in bilateral renal artery
stenosis. Checking K⁺ and creatinine before giving a new
ACE inhibitor dose is key for safety.
• C (incorrect): Advising orthostatic precautions is
appropriate teaching (first-dose hypotension), but it's not
the single most important pre-administration safety check
compared with labs that could contraindicate therapy.
• D (incorrect): Lisinopril may be taken with or without food;
telling patient to take with food is unnecessary and not a
priority safety check.
2 (Calculation — IV infusion rate)
Order: Normal saline 1,000 mL IV to infuse over 8 hours via
infusion pump. What rate (mL/hr) should the nurse set? (Show
calculation.)
A. 100 mL/hr
B. 125 mL/hr
,C. 150 mL/hr
D. 200 mL/hr
Correct answer: B. 125 mL/hr
Rationales / Calculation:
• Formula: total volume (mL) ÷ total time (hr) = mL/hr.
• Calculation: 1,000 mL ÷ 8 hr = 125 mL/hr. (Step: 1000 ÷ 8 =
125.)
• A (100 mL/hr): Too slow — would deliver only 800 mL in 8
hr.
• B (125 mL/hr): Correct — delivers 1,000 mL in 8 hr.
• C (150 mL/hr): Too fast — delivers 1,200 mL in 8 hr, risking
fluid overload.
• D (200 mL/hr): Much too fast — 1,600 mL in 8 hr; unsafe
unless ordered.
(Reference: standard pump calculation practices). NCLEX
Practice Tests
3 (Multiple choice — high-alert med safety)
A nurse is preparing to administer IV heparin infusion. Which
practice reduces medication errors most effectively?
A. Use weight-based protocol and an infusion pump with dose
limits preprogrammed.
B. Ask the patient if they prefer the infusion in the left or right
, arm.
C. Draw heparin from the patient's home supply to save
hospital resources.
D. Prepare the heparin infusion on a med-surg floor without
pharmacist verification.
Correct answer: A. Use weight-based protocol and an infusion
pump with dose limits preprogrammed.
Rationales:
• A (correct): Heparin is high-risk. Weight-based protocols,
double checks, and smart pumps with dose-error
reduction software reduce calculation and programming
errors — best practice for safety.
• B (incorrect): Patient preference for site is irrelevant to
preventing medication errors.
• C (incorrect): Using home supplies risks contamination,
incorrect strength, and is unsafe.
• D (incorrect): High-risk infusions should be verified by
pharmacy and follow protocols; preparing without
verification increases error risk.
4 (Pharmacologic classification)
A patient with heart failure is started on furosemide. Which
physiologic effect explains the main therapeutic benefit for
heart failure?
