Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — (Medication principles / Cardiovascular)
A client with hypertension is started on lisinopril. Which
statement by the client indicates the best understanding of the
medication and the nurse’s teaching?
A. “I should stop the medication if I notice a dry cough.”
B. “I can take this drug if I become pregnant.”
C. “I will check my blood pressure and call if I get lightheaded.”
D. “This medicine will lower potassium, so I won’t need to
watch my diet.”
Correct answer: C
Rationale — correct (C):
Lisinopril (an ACE inhibitor) dilates blood vessels by blocking
conversion of angiotensin I → II, lowering blood pressure and
can cause orthostatic hypotension, especially at initiation.
Teaching includes checking blood pressure and reporting
dizziness/lightheadedness — appropriate and safety-focused.
,Rationale — incorrect:
A. Stopping medication without contacting provider is not
recommended; a persistent dry cough is a known adverse effect
of ACE inhibitors and should be reported — provider may
change therapy.
B. ACE inhibitors are contraindicated in pregnancy (teratogenic)
— incorrect and unsafe.
D. ACE inhibitors can cause hyperkalemia in some patients (not
lower potassium); saying “won’t need to watch diet” is
incorrect.
Notes (mechanism/adverse effects/teaching): ACE inhibitors
inhibit ACE → decreased angiotensin II; adverse effects include
cough, hyperkalemia, angioedema, hypotension. Teach
orthostatic precautions and pregnancy avoidance. (Informing
source: standard pharmacology/NCLEX scope.) Elsevier Health
2 — (Cardiovascular / Antianginal)
A 68-year-old client with COPD and chronic stable angina is
prescribed metoprolol (a selective β1 blocker). Which nursing
action is most important before administering the next
scheduled dose?
A. Auscultate lung sounds.
B. Check serum potassium.
C. Obtain apical pulse and blood pressure.
D. Verify respiratory rate only.
,Correct answer: C
Rationale — correct (C):
Beta-1 blockers decrease heart rate and contractility; before
giving, assess apical pulse and blood pressure to detect
bradycardia or hypotension. This is standard safe medication
practice.
Rationale — incorrect:
A. Although nonselective beta blockers may worsen
bronchospasm, metoprolol is β1-selective (cardioselective) at
usual doses; lung auscultation is reasonable but not the most
important pre-administration check.
B. Serum potassium is not an immediate pre-dose check for
metoprolol.
D. Respiratory rate alone is insufficient — bradycardia and
blood pressure are the main immediate safety concerns.
Notes: Use caution in COPD (higher doses may lose beta-1
selectivity) and monitor heart rate; hold if HR is below facility
threshold (commonly <50–60 bpm per protocol).
3 — (Cardiac glycoside / Safety)
A client on digoxin reports nausea, visual halos, and
bradycardia. The nurse recognizes these as signs of digoxin
toxicity. Which lab/condition most increases the risk of digoxin
toxicity?
, A. Hyperkalemia (K+ 6.0 mEq/L)
B. Hypokalemia (K+ 3.0 mEq/L)
C. Hypernatremia (Na+ 150 mEq/L)
D. Elevated magnesium
Correct answer: B
Rationale — correct (B):
Hypokalemia increases sensitivity to digoxin and predisposes to
digoxin toxicity because digoxin and potassium compete at the
Na⁺/K⁺ ATPase pump. Low K+ increases digoxin binding →
toxicity risk.
Rationale — incorrect:
A. Hyperkalemia is often seen with severe digoxin toxicity
(acute overdose) but does not increase risk the same way
chronic hypokalemia does.
C. Hypernatremia is not the primary risk factor for digoxin
toxicity.
D. Elevated magnesium generally does not increase digoxin
toxicity; low magnesium may predispose to arrhythmias.
Notes: Digoxin inhibits Na⁺/K⁺ ATPase → increased intracellular
Ca²⁺ → positive inotropy; adverse effects include arrhythmias,
GI symptoms, visual changes. Monitor levels, electrolytes (K+,
Mg2+), and renal function.
4 — (Anticoagulation / Patient teaching)
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — (Medication principles / Cardiovascular)
A client with hypertension is started on lisinopril. Which
statement by the client indicates the best understanding of the
medication and the nurse’s teaching?
A. “I should stop the medication if I notice a dry cough.”
B. “I can take this drug if I become pregnant.”
C. “I will check my blood pressure and call if I get lightheaded.”
D. “This medicine will lower potassium, so I won’t need to
watch my diet.”
Correct answer: C
Rationale — correct (C):
Lisinopril (an ACE inhibitor) dilates blood vessels by blocking
conversion of angiotensin I → II, lowering blood pressure and
can cause orthostatic hypotension, especially at initiation.
Teaching includes checking blood pressure and reporting
dizziness/lightheadedness — appropriate and safety-focused.
,Rationale — incorrect:
A. Stopping medication without contacting provider is not
recommended; a persistent dry cough is a known adverse effect
of ACE inhibitors and should be reported — provider may
change therapy.
B. ACE inhibitors are contraindicated in pregnancy (teratogenic)
— incorrect and unsafe.
D. ACE inhibitors can cause hyperkalemia in some patients (not
lower potassium); saying “won’t need to watch diet” is
incorrect.
Notes (mechanism/adverse effects/teaching): ACE inhibitors
inhibit ACE → decreased angiotensin II; adverse effects include
cough, hyperkalemia, angioedema, hypotension. Teach
orthostatic precautions and pregnancy avoidance. (Informing
source: standard pharmacology/NCLEX scope.) Elsevier Health
2 — (Cardiovascular / Antianginal)
A 68-year-old client with COPD and chronic stable angina is
prescribed metoprolol (a selective β1 blocker). Which nursing
action is most important before administering the next
scheduled dose?
A. Auscultate lung sounds.
B. Check serum potassium.
C. Obtain apical pulse and blood pressure.
D. Verify respiratory rate only.
,Correct answer: C
Rationale — correct (C):
Beta-1 blockers decrease heart rate and contractility; before
giving, assess apical pulse and blood pressure to detect
bradycardia or hypotension. This is standard safe medication
practice.
Rationale — incorrect:
A. Although nonselective beta blockers may worsen
bronchospasm, metoprolol is β1-selective (cardioselective) at
usual doses; lung auscultation is reasonable but not the most
important pre-administration check.
B. Serum potassium is not an immediate pre-dose check for
metoprolol.
D. Respiratory rate alone is insufficient — bradycardia and
blood pressure are the main immediate safety concerns.
Notes: Use caution in COPD (higher doses may lose beta-1
selectivity) and monitor heart rate; hold if HR is below facility
threshold (commonly <50–60 bpm per protocol).
3 — (Cardiac glycoside / Safety)
A client on digoxin reports nausea, visual halos, and
bradycardia. The nurse recognizes these as signs of digoxin
toxicity. Which lab/condition most increases the risk of digoxin
toxicity?
, A. Hyperkalemia (K+ 6.0 mEq/L)
B. Hypokalemia (K+ 3.0 mEq/L)
C. Hypernatremia (Na+ 150 mEq/L)
D. Elevated magnesium
Correct answer: B
Rationale — correct (B):
Hypokalemia increases sensitivity to digoxin and predisposes to
digoxin toxicity because digoxin and potassium compete at the
Na⁺/K⁺ ATPase pump. Low K+ increases digoxin binding →
toxicity risk.
Rationale — incorrect:
A. Hyperkalemia is often seen with severe digoxin toxicity
(acute overdose) but does not increase risk the same way
chronic hypokalemia does.
C. Hypernatremia is not the primary risk factor for digoxin
toxicity.
D. Elevated magnesium generally does not increase digoxin
toxicity; low magnesium may predispose to arrhythmias.
Notes: Digoxin inhibits Na⁺/K⁺ ATPase → increased intracellular
Ca²⁺ → positive inotropy; adverse effects include arrhythmias,
GI symptoms, visual changes. Monitor levels, electrolytes (K+,
Mg2+), and renal function.
4 — (Anticoagulation / Patient teaching)
