Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Multiple choice (safe med practice / high-alert drugs)
A nurse prepares to give subcutaneous insulin 10 units of
regular insulin at 0730 to a client who is alert and has eaten
breakfast. Which action should the nurse take first?
A. Administer the ordered dose immediately.
B. Verify the blood glucose level before administration.
C. Ask the client if they feel dizzy or shaky.
D. Have another licensed nurse independently verify the dose.
Correct answer: B. Verify the blood glucose level before
administration.
Rationale:
• Why B is correct: For insulin (a high-alert medication),
determine current blood glucose to ensure dose
appropriateness and to prevent hypoglycemia or avoid
giving insulin to a hypoglycemic patient. This follows safe
medication administration principles (assess before giving).
, • Mechanism/adverse effects/teaching: Regular insulin
decreases blood glucose by facilitating cellular glucose
uptake; adverse effects include hypoglycemia (sweating,
dizziness, tachycardia). Patient teaching: carry fast-acting
carbs and recognize hypoglycemia symptoms.
• Why others incorrect: A (immediate administration) skips
assessment. C (ask about symptoms) is useful but not the
first action — objective glucose measurement is required.
D (double check) is recommended for high-dose or
intravenous insulin infusions, but before administering
subcutaneous insulin, verifying blood glucose takes
priority.
2 — Dosage calculation (IV infusion rate)
Order: Heparin continuous infusion at 1,000 units/hour.
Available: Heparin 25,000 units in 250 mL D5W. Calculate the
infusion rate in mL/hour. (Show final mL/hr.)
Correct answer: 10 mL/hr
Rationale & calculation (digit-by-digit):
Concentration = 25,000 units ÷ 250 mL = 100 units/mL.
Needed rate = 1,000 units/hr ÷ 100 units/mL = 10 mL/hr.
• Safety note: Heparin is a high-alert anticoagulant; infusion
pumps and unit labeling required. Monitor aPTT and signs
of bleeding. Contraindicated in active bleeding, severe
thrombocytopenia, or known heparin-induced
, thrombocytopenia (HIT). Teach patient to report bleeding,
bruising.
3 — Multiple choice (cardiovascular — ACE inhibitor)
A client with hypertension begins lisinopril therapy. The nurse
should instruct the client to immediately report which of the
following?
A. Dry cough and sore throat
B. Lightheadedness upon standing
C. A sudden swelling of the face or lips
D. Persistent headache
Correct answer: C. A sudden swelling of the face or lips
Rationale:
• Why C correct: ACE inhibitors can cause angioedema (life-
threatening swelling of face, tongue, lips, airway). This
requires immediate medical attention.
• Mechanism: ACE inhibitors block conversion of angiotensin
I to II, causing vasodilation and decreased aldosterone.
They increase bradykinin levels (linked to cough and rare
angioedema).
• Adverse effects & contraindications: Common adverse
effects: cough (from bradykinin), hyperkalemia,
hypotension, dizziness. Contraindicated in pregnancy
, (teratogenic) and history of angioedema with ACE
inhibitors.
• Why others incorrect: A (dry cough) is common and
should be reported but is not an immediate airway
emergency. B (lightheadedness) is expected initially; teach
to change positions slowly. D (headache) can occur but is
not as urgent as angioedema.
4 — Select-all-that-apply (NGN-style — antibiotic
teaching/safety)
A client starts gentamicin IV for a serious gram-negative
infection. Which instructions/monitoring measures should the
nurse include? (Select all that apply.)
A. Monitor trough levels prior to the next dose.
B. Encourage the client to report tinnitus or hearing loss.
C. Monitor serum creatinine and urine output.
D. Teach the client to take with food to minimize GI upset.
E. Expect an increased risk of bleeding; monitor PT/INR.
Correct answers: A, B, C
Rationale:
• A (Correct): Aminoglycosides are nephrotoxic and ototoxic.
Trough levels are monitored to reduce toxicity and ensure
therapeutic dosing.
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 — Multiple choice (safe med practice / high-alert drugs)
A nurse prepares to give subcutaneous insulin 10 units of
regular insulin at 0730 to a client who is alert and has eaten
breakfast. Which action should the nurse take first?
A. Administer the ordered dose immediately.
B. Verify the blood glucose level before administration.
C. Ask the client if they feel dizzy or shaky.
D. Have another licensed nurse independently verify the dose.
Correct answer: B. Verify the blood glucose level before
administration.
Rationale:
• Why B is correct: For insulin (a high-alert medication),
determine current blood glucose to ensure dose
appropriateness and to prevent hypoglycemia or avoid
giving insulin to a hypoglycemic patient. This follows safe
medication administration principles (assess before giving).
, • Mechanism/adverse effects/teaching: Regular insulin
decreases blood glucose by facilitating cellular glucose
uptake; adverse effects include hypoglycemia (sweating,
dizziness, tachycardia). Patient teaching: carry fast-acting
carbs and recognize hypoglycemia symptoms.
• Why others incorrect: A (immediate administration) skips
assessment. C (ask about symptoms) is useful but not the
first action — objective glucose measurement is required.
D (double check) is recommended for high-dose or
intravenous insulin infusions, but before administering
subcutaneous insulin, verifying blood glucose takes
priority.
2 — Dosage calculation (IV infusion rate)
Order: Heparin continuous infusion at 1,000 units/hour.
Available: Heparin 25,000 units in 250 mL D5W. Calculate the
infusion rate in mL/hour. (Show final mL/hr.)
Correct answer: 10 mL/hr
Rationale & calculation (digit-by-digit):
Concentration = 25,000 units ÷ 250 mL = 100 units/mL.
Needed rate = 1,000 units/hr ÷ 100 units/mL = 10 mL/hr.
• Safety note: Heparin is a high-alert anticoagulant; infusion
pumps and unit labeling required. Monitor aPTT and signs
of bleeding. Contraindicated in active bleeding, severe
thrombocytopenia, or known heparin-induced
, thrombocytopenia (HIT). Teach patient to report bleeding,
bruising.
3 — Multiple choice (cardiovascular — ACE inhibitor)
A client with hypertension begins lisinopril therapy. The nurse
should instruct the client to immediately report which of the
following?
A. Dry cough and sore throat
B. Lightheadedness upon standing
C. A sudden swelling of the face or lips
D. Persistent headache
Correct answer: C. A sudden swelling of the face or lips
Rationale:
• Why C correct: ACE inhibitors can cause angioedema (life-
threatening swelling of face, tongue, lips, airway). This
requires immediate medical attention.
• Mechanism: ACE inhibitors block conversion of angiotensin
I to II, causing vasodilation and decreased aldosterone.
They increase bradykinin levels (linked to cough and rare
angioedema).
• Adverse effects & contraindications: Common adverse
effects: cough (from bradykinin), hyperkalemia,
hypotension, dizziness. Contraindicated in pregnancy
, (teratogenic) and history of angioedema with ACE
inhibitors.
• Why others incorrect: A (dry cough) is common and
should be reported but is not an immediate airway
emergency. B (lightheadedness) is expected initially; teach
to change positions slowly. D (headache) can occur but is
not as urgent as angioedema.
4 — Select-all-that-apply (NGN-style — antibiotic
teaching/safety)
A client starts gentamicin IV for a serious gram-negative
infection. Which instructions/monitoring measures should the
nurse include? (Select all that apply.)
A. Monitor trough levels prior to the next dose.
B. Encourage the client to report tinnitus or hearing loss.
C. Monitor serum creatinine and urine output.
D. Teach the client to take with food to minimize GI upset.
E. Expect an increased risk of bleeding; monitor PT/INR.
Correct answers: A, B, C
Rationale:
• A (Correct): Aminoglycosides are nephrotoxic and ototoxic.
Trough levels are monitored to reduce toxicity and ensure
therapeutic dosing.
