Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) (Cardiovascular — ACE inhibitor)
A 64-year-old man with heart failure is started on lisinopril, 10
mg PO daily. Two weeks later he reports a dry, persistent cough
and the nurse documents a serum potassium of 5.6 mEq/L.
Which nursing action is best?
A. Encourage the patient to increase potassium-rich foods to
replace losses.
B. Hold the lisinopril and notify the prescriber about cough and
hyperkalemia. ✔
C. Advise the patient the cough is harmless and continue
lisinopril.
D. Recommend switching to spironolactone to treat
hyperkalemia.
Correct: B
Rationale — correct: ACE inhibitors (lisinopril) commonly cause
a dry cough (due to increased bradykinin) and can cause
hyperkalemia by decreasing aldosterone-mediated K⁺ excretion.
,With hyperkalemia (K⁺ 5.6 mEq/L) and bothersome cough, the
clinician should hold/stop the ACE inhibitor and notify the
prescriber for evaluation and alternative therapy (e.g., ARB or
other agent) and treat hyperkalemia as indicated.
Why others are wrong:
A — Increasing potassium intake would worsen hyperkalemia.
C — The cough is not harmless in this context and hyperkalemia
is potentially dangerous.
D — Spironolactone is a potassium-sparing diuretic and would
worsen hyperkalemia; it is not used to treat hyperkalemia.
2) (Dosage calculation — IV drip rate)
Order: Ceftriaxone 1,000 mg in 250 mL D5W IV to infuse over
30 minutes. Tubing delivers 15 gtt/mL. What is the flow rate in
drops per minute (gtt/min)? Show calculation.
A. 83 gtt/min
B. 125 gtt/min ✔
C. 150 gtt/min
D. 63 gtt/min
Correct: B
Calculation & Rationale (step by step):
1. Total volume = 250 mL.
2. Time = 30 minutes → mL/min = 250 mL ÷ 30 min = 8.333...
mL/min.
, 3. Tubing = 15 gtt/mL → gtt/min = 8.333... mL/min × 15
gtt/mL = 125 gtt/min.
Round to the nearest whole drop → 125 gtt/min. (All
arithmetic shown digit-by-digit above.)
Why others wrong: Arithmetic does not match the correct
conversion.
3) (Cardiac glycoside — digoxin)
A patient on digoxin therapy calls the clinic reporting nausea,
blurred yellow-green halos, and vomiting. Which serum
condition most increases the risk for digoxin toxicity and should
be checked first?
A. Hypercalcemia
B. Hypokalemia ✔
C. Hyponatremia
D. Hypermagnesemia
Correct: B
Rationale — correct: Hypokalemia increases digoxin binding at
myocardial Na⁺/K⁺-ATPase receptors and predisposes to digoxin
toxicity (nausea, visual disturbances, arrhythmias). Check serum
potassium and digoxin level.
Why others wrong: Hypercalcemia can worsen arrhythmias but
is not the classic primary risk factor for digoxin toxicity;
hyponatremia and hypermagnesemia are less directly
implicated.
, 4) (NGN-style — clinical judgement / respiratory)
Case: A 58-year-old with COPD is prescribed an albuterol
metered-dose inhaler (MDI) and a fluticasone inhaler (inhaled
corticosteroid, ICS). Which instructions should the nurse teach
the patient? (Select all that apply.)
A. Use the albuterol before the fluticasone when both are
prescribed. ✔
B. Rinse mouth after using the fluticasone to reduce thrush risk.
✔
C. Take the fluticasone as needed for wheeze relief.
D. Wait 1 minute between puffs of the same inhaler. ✔
E. Use albuterol daily even when asymptomatic.
Correct: A, B, D
Rationale — correct:
• A: Short-acting bronchodilator (albuterol) should be used
prior to ICS to open airways and improve steroid
deposition.
• B: Rinsing the mouth after ICS reduces risk of
oropharyngeal candidiasis.
• D: Waiting ~1 minute between puffs improves drug
delivery for MDIs.
Why C wrong: ICS are maintenance medications — not for
immediate relief; they should be used regularly, not PRN
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) (Cardiovascular — ACE inhibitor)
A 64-year-old man with heart failure is started on lisinopril, 10
mg PO daily. Two weeks later he reports a dry, persistent cough
and the nurse documents a serum potassium of 5.6 mEq/L.
Which nursing action is best?
A. Encourage the patient to increase potassium-rich foods to
replace losses.
B. Hold the lisinopril and notify the prescriber about cough and
hyperkalemia. ✔
C. Advise the patient the cough is harmless and continue
lisinopril.
D. Recommend switching to spironolactone to treat
hyperkalemia.
Correct: B
Rationale — correct: ACE inhibitors (lisinopril) commonly cause
a dry cough (due to increased bradykinin) and can cause
hyperkalemia by decreasing aldosterone-mediated K⁺ excretion.
,With hyperkalemia (K⁺ 5.6 mEq/L) and bothersome cough, the
clinician should hold/stop the ACE inhibitor and notify the
prescriber for evaluation and alternative therapy (e.g., ARB or
other agent) and treat hyperkalemia as indicated.
Why others are wrong:
A — Increasing potassium intake would worsen hyperkalemia.
C — The cough is not harmless in this context and hyperkalemia
is potentially dangerous.
D — Spironolactone is a potassium-sparing diuretic and would
worsen hyperkalemia; it is not used to treat hyperkalemia.
2) (Dosage calculation — IV drip rate)
Order: Ceftriaxone 1,000 mg in 250 mL D5W IV to infuse over
30 minutes. Tubing delivers 15 gtt/mL. What is the flow rate in
drops per minute (gtt/min)? Show calculation.
A. 83 gtt/min
B. 125 gtt/min ✔
C. 150 gtt/min
D. 63 gtt/min
Correct: B
Calculation & Rationale (step by step):
1. Total volume = 250 mL.
2. Time = 30 minutes → mL/min = 250 mL ÷ 30 min = 8.333...
mL/min.
, 3. Tubing = 15 gtt/mL → gtt/min = 8.333... mL/min × 15
gtt/mL = 125 gtt/min.
Round to the nearest whole drop → 125 gtt/min. (All
arithmetic shown digit-by-digit above.)
Why others wrong: Arithmetic does not match the correct
conversion.
3) (Cardiac glycoside — digoxin)
A patient on digoxin therapy calls the clinic reporting nausea,
blurred yellow-green halos, and vomiting. Which serum
condition most increases the risk for digoxin toxicity and should
be checked first?
A. Hypercalcemia
B. Hypokalemia ✔
C. Hyponatremia
D. Hypermagnesemia
Correct: B
Rationale — correct: Hypokalemia increases digoxin binding at
myocardial Na⁺/K⁺-ATPase receptors and predisposes to digoxin
toxicity (nausea, visual disturbances, arrhythmias). Check serum
potassium and digoxin level.
Why others wrong: Hypercalcemia can worsen arrhythmias but
is not the classic primary risk factor for digoxin toxicity;
hyponatremia and hypermagnesemia are less directly
implicated.
, 4) (NGN-style — clinical judgement / respiratory)
Case: A 58-year-old with COPD is prescribed an albuterol
metered-dose inhaler (MDI) and a fluticasone inhaler (inhaled
corticosteroid, ICS). Which instructions should the nurse teach
the patient? (Select all that apply.)
A. Use the albuterol before the fluticasone when both are
prescribed. ✔
B. Rinse mouth after using the fluticasone to reduce thrush risk.
✔
C. Take the fluticasone as needed for wheeze relief.
D. Wait 1 minute between puffs of the same inhaler. ✔
E. Use albuterol daily even when asymptomatic.
Correct: A, B, D
Rationale — correct:
• A: Short-acting bronchodilator (albuterol) should be used
prior to ICS to open airways and improve steroid
deposition.
• B: Rinsing the mouth after ICS reduces risk of
oropharyngeal candidiasis.
• D: Waiting ~1 minute between puffs improves drug
delivery for MDIs.
Why C wrong: ICS are maintenance medications — not for
immediate relief; they should be used regularly, not PRN
