Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Question 1 — Pharmacology: Beta-blocker (multiple choice)
A 68-year-old man with a history of coronary artery disease and
hypertension is started on metoprolol tartrate 50 mg PO twice
daily. Which statement is the best patient teaching point?
A. “Stop taking the medication if you feel dizzy.”
B. “If you miss a dose, take double the next dose to make up for
it.”
C. “Do not suddenly stop this medication; call your provider
before stopping.” (Correct)
D. “You will not need follow-up blood pressure checks after
starting this drug.”
Correct answer: C
Rationale (correct): Metoprolol is a selective β₁-adrenergic
blocker (reduces heart rate and contractility). Abrupt
discontinuation can precipitate rebound tachycardia, angina, or
myocardial ischemia in patients with ischemic heart disease;
patients should consult their prescriber before stopping and the
,dose should be tapered. Patient teaching should include
monitoring pulse and blood pressure, reporting symptomatic
bradycardia or syncope, and avoiding abrupt cessation. Evolve
Why the others are incorrect:
• A — Dizziness may occur; however, the correct action is to
sit/lie down and report persistent syncope/bradycardia to
provider. Simply stopping is not recommended.
• B — Doubling doses increases risk for bradycardia and
hypotension; never double up without provider
instruction.
• D — Follow-up BP and pulse checks are required after
initiation/titration.
Question 2 — Dosage calculation (NGN: calculation +
rationale)
Ordered: Heparin IV infusion 1,000 units/hour. Available:
Heparin 25,000 units in 500 mL D5W. At what rate (mL/hr)
should the infusion pump be set? (Round to whole number.)
A. 10 mL/hr
B. 20 mL/hr (Correct)
C. 25 mL/hr
D. 40 mL/hr
Correct answer: B — 20 mL/hr
,Calculation & rationale (correct): Concentration = 25,000 units
÷ 500 mL = 50 units/mL. To deliver 1,000 units/hr: 1,000 units ÷
50 units/mL = 20 mL/hr. Check units stepwise (units → mL →
hr). This is a standard pump calculation skill emphasized in
Saunders’ dosage calculation content. Studocu+1
Why the others are incorrect:
• A — 10 mL/hr would deliver only 500 units/hr.
• C — 25 mL/hr would deliver 1,250 units/hr (too high).
• D — 40 mL/hr would deliver 2,000 units/hr (dangerous
overdose).
Safety point: Always verify baseline labs (aPTT/anti-Xa per
protocol), double-check infusion parameters with another
clinician, and use infusion pumps and heparin protocols.
Question 3 — Cardiovascular: ACE inhibitor (multiple choice)
A nurse is teaching a patient who is starting lisinopril for
hypertension. Which statement indicates the patient
understands the medication teaching?
A. “If I develop a dry cough, I should tell my doctor.” (Correct)
B. “I can take potassium supplements if I feel weak without
asking anyone.”
C. “This medication is safe during pregnancy.”
D. “I should increase my salt intake while on this drug.”
Correct answer: A
, Rationale (correct): ACE inhibitors (e.g., lisinopril) block
conversion of angiotensin I to angiotensin II → vasodilation and
decreased aldosterone. A persistent dry cough is a common
adverse effect due to increased bradykinin and warrants contact
with the provider (may require switching to an ARB). ACE
inhibitors can cause hyperkalemia and are contraindicated in
pregnancy (fetal renal damage). Patient teaching includes
monitoring for cough, avoiding pregnancy, avoiding potassium
supplements (unless approved), and reporting
dizziness/hypotension. Google Books
Why the others are incorrect:
• B — Potassium supplements without provider approval
risk hyperkalemia.
• C — ACE inhibitors are teratogenic (contraindicated in
pregnancy).
• D — Increasing salt is not advised and may worsen
hypertension.
Question 4 — Endocrine: Insulin administration (NGN:
multiple-response; select all that apply)
A hospitalized client with Type 1 diabetes is prescribed regular
insulin and NPH insulin given at 0800. Which actions should the
nurse perform? (Select all that apply.)
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Question 1 — Pharmacology: Beta-blocker (multiple choice)
A 68-year-old man with a history of coronary artery disease and
hypertension is started on metoprolol tartrate 50 mg PO twice
daily. Which statement is the best patient teaching point?
A. “Stop taking the medication if you feel dizzy.”
B. “If you miss a dose, take double the next dose to make up for
it.”
C. “Do not suddenly stop this medication; call your provider
before stopping.” (Correct)
D. “You will not need follow-up blood pressure checks after
starting this drug.”
Correct answer: C
Rationale (correct): Metoprolol is a selective β₁-adrenergic
blocker (reduces heart rate and contractility). Abrupt
discontinuation can precipitate rebound tachycardia, angina, or
myocardial ischemia in patients with ischemic heart disease;
patients should consult their prescriber before stopping and the
,dose should be tapered. Patient teaching should include
monitoring pulse and blood pressure, reporting symptomatic
bradycardia or syncope, and avoiding abrupt cessation. Evolve
Why the others are incorrect:
• A — Dizziness may occur; however, the correct action is to
sit/lie down and report persistent syncope/bradycardia to
provider. Simply stopping is not recommended.
• B — Doubling doses increases risk for bradycardia and
hypotension; never double up without provider
instruction.
• D — Follow-up BP and pulse checks are required after
initiation/titration.
Question 2 — Dosage calculation (NGN: calculation +
rationale)
Ordered: Heparin IV infusion 1,000 units/hour. Available:
Heparin 25,000 units in 500 mL D5W. At what rate (mL/hr)
should the infusion pump be set? (Round to whole number.)
A. 10 mL/hr
B. 20 mL/hr (Correct)
C. 25 mL/hr
D. 40 mL/hr
Correct answer: B — 20 mL/hr
,Calculation & rationale (correct): Concentration = 25,000 units
÷ 500 mL = 50 units/mL. To deliver 1,000 units/hr: 1,000 units ÷
50 units/mL = 20 mL/hr. Check units stepwise (units → mL →
hr). This is a standard pump calculation skill emphasized in
Saunders’ dosage calculation content. Studocu+1
Why the others are incorrect:
• A — 10 mL/hr would deliver only 500 units/hr.
• C — 25 mL/hr would deliver 1,250 units/hr (too high).
• D — 40 mL/hr would deliver 2,000 units/hr (dangerous
overdose).
Safety point: Always verify baseline labs (aPTT/anti-Xa per
protocol), double-check infusion parameters with another
clinician, and use infusion pumps and heparin protocols.
Question 3 — Cardiovascular: ACE inhibitor (multiple choice)
A nurse is teaching a patient who is starting lisinopril for
hypertension. Which statement indicates the patient
understands the medication teaching?
A. “If I develop a dry cough, I should tell my doctor.” (Correct)
B. “I can take potassium supplements if I feel weak without
asking anyone.”
C. “This medication is safe during pregnancy.”
D. “I should increase my salt intake while on this drug.”
Correct answer: A
, Rationale (correct): ACE inhibitors (e.g., lisinopril) block
conversion of angiotensin I to angiotensin II → vasodilation and
decreased aldosterone. A persistent dry cough is a common
adverse effect due to increased bradykinin and warrants contact
with the provider (may require switching to an ARB). ACE
inhibitors can cause hyperkalemia and are contraindicated in
pregnancy (fetal renal damage). Patient teaching includes
monitoring for cough, avoiding pregnancy, avoiding potassium
supplements (unless approved), and reporting
dizziness/hypotension. Google Books
Why the others are incorrect:
• B — Potassium supplements without provider approval
risk hyperkalemia.
• C — ACE inhibitors are teratogenic (contraindicated in
pregnancy).
• D — Increasing salt is not advised and may worsen
hypertension.
Question 4 — Endocrine: Insulin administration (NGN:
multiple-response; select all that apply)
A hospitalized client with Type 1 diabetes is prescribed regular
insulin and NPH insulin given at 0800. Which actions should the
nurse perform? (Select all that apply.)
