Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 (Multiple choice — single best answer)
A client with hypertension is started on lisinopril (an ACE
inhibitor). Which finding requires the nurse to hold the next
dose and contact the prescriber immediately?
A. Persistent dry cough for 3 days
B. Lightheadedness when standing from sitting
C. Potassium level 6.0 mEq/L
D. 2+ pitting edema of the ankles
Answer: C. Potassium level 6.0 mEq/L
Rationale — correct (C): ACE inhibitors (like lisinopril) decrease
aldosterone and can cause potassium retention leading to
hyperkalemia; a serum K⁺ of 6.0 mEq/L is potentially life-
threatening and requires immediate action (hold med, notify
prescriber). NCBI
Why others are incorrect:
A — A persistent dry cough is a common adverse effect of ACE
inhibitors and usually prompts evaluation or switching drug, but
,it is not as immediately dangerous as severe hyperkalemia.
B — Orthostatic hypotension can occur; the nurse should
instruct safety measures and report marked hypotension, but it
is not as urgent as hyperkalemia unless syncope occurs.
D — Mild dependent edema is not the typical ACE inhibitor
concern (ACE inhibitors more often reduce afterload); edema
warrants assessment for heart failure but is not the immediate
priority over hyperkalemia.
2 (Calculation — single best answer)
An order reads: Give furosemide 40 mg IV push now. You have a
vial labeled furosemide 20 mg/mL. How many mL will you
administer? (Round to the nearest tenth.)
A. 1.0 mL
B. 1.5 mL
C. 2.0 mL
D. 2.5 mL
Answer: C. 2.0 mL
Rationale — correct (C): Desired dose 40 mg ÷ concentration 20
mg/mL = 2.0 mL. Calculation and verification steps are required
before administration.
Why others are incorrect: A (1.0 mL) would provide only 20 mg;
B (1.5 mL) = 30 mg; D (2.5 mL) = 50 mg — all incorrect dosing.
3 (NGN – case + multiple response)
,A 68-year-old client with chronic heart failure is admitted after
an exacerbation. Current meds: carvedilol, lisinopril,
spironolactone, furosemide. The nurse notes new confusion
and a heart rate of 42/min. Select all actions the nurse should
take immediately (choose 2).
A. Obtain a 12-lead ECG.
B. Check serum potassium level.
C. Administer a PRN dose of metoprolol.
D. Hold the next dose of carvedilol and notify the provider.
E. Give 0.9% NS bolus IV to raise heart rate.
Answer: A and D.
Rationale — correct (A, D): New bradycardia (HR 42) and
confusion in a patient on beta-blocker (carvedilol) and ACE
inhibitor/aldosterone antagonist raises concern for beta-blocker
toxicity or conduction abnormality. Obtain an ECG to evaluate
rhythm (A). Hold the next beta-blocker dose and notify provider
(D) while investigations proceed.
Why others are incorrect:
B — Checking K⁺ is reasonable (especially with spironolactone),
but ECG and immediate med hold are higher priority (cardiac
monitoring first).
C — Administering metoprolol (another beta-blocker) would
worsen bradycardia.
E — Giving IV fluid to raise HR is not indicated without evidence
of hypovolemia; fluids could worsen heart failure.
, 4 (Multiple choice — single best answer)
A client with COPD uses albuterol HFA as a rescue inhaler.
Which patient statement indicates correct understanding of
teaching?
A. “I’ll use my albuterol first, then my inhaled steroid 5 minutes
later.”
B. “I’ll take the steroid inhaler first every time to reduce side
effects.”
C. “I’ll use two puffs of the steroid inhaler if symptoms are
worse.”
D. “I’ll avoid rinsing my mouth after using albuterol.”
Answer: A. “I’ll use my albuterol first, then my inhaled steroid
5 minutes later.”
Rationale — correct (A): Short-acting β₂-agonists (albuterol) are
bronchodilators and should be used before inhaled steroids so
airways open and steroid deposition is optimized. Albuterol acts
on β₂ receptors to relax bronchial smooth muscle. FDA Access
Data+1
Why others incorrect:
B — Steroid first reduces immediate bronchodilation benefit;
rescue bronchodilator should come first.
C — Dose adjustments must follow prescriber’s order; doubling
steroid puffs for acute symptoms is not standard; albuterol is
the rescue.
D — Rinsing mouth is recommended after inhaled
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 (Multiple choice — single best answer)
A client with hypertension is started on lisinopril (an ACE
inhibitor). Which finding requires the nurse to hold the next
dose and contact the prescriber immediately?
A. Persistent dry cough for 3 days
B. Lightheadedness when standing from sitting
C. Potassium level 6.0 mEq/L
D. 2+ pitting edema of the ankles
Answer: C. Potassium level 6.0 mEq/L
Rationale — correct (C): ACE inhibitors (like lisinopril) decrease
aldosterone and can cause potassium retention leading to
hyperkalemia; a serum K⁺ of 6.0 mEq/L is potentially life-
threatening and requires immediate action (hold med, notify
prescriber). NCBI
Why others are incorrect:
A — A persistent dry cough is a common adverse effect of ACE
inhibitors and usually prompts evaluation or switching drug, but
,it is not as immediately dangerous as severe hyperkalemia.
B — Orthostatic hypotension can occur; the nurse should
instruct safety measures and report marked hypotension, but it
is not as urgent as hyperkalemia unless syncope occurs.
D — Mild dependent edema is not the typical ACE inhibitor
concern (ACE inhibitors more often reduce afterload); edema
warrants assessment for heart failure but is not the immediate
priority over hyperkalemia.
2 (Calculation — single best answer)
An order reads: Give furosemide 40 mg IV push now. You have a
vial labeled furosemide 20 mg/mL. How many mL will you
administer? (Round to the nearest tenth.)
A. 1.0 mL
B. 1.5 mL
C. 2.0 mL
D. 2.5 mL
Answer: C. 2.0 mL
Rationale — correct (C): Desired dose 40 mg ÷ concentration 20
mg/mL = 2.0 mL. Calculation and verification steps are required
before administration.
Why others are incorrect: A (1.0 mL) would provide only 20 mg;
B (1.5 mL) = 30 mg; D (2.5 mL) = 50 mg — all incorrect dosing.
3 (NGN – case + multiple response)
,A 68-year-old client with chronic heart failure is admitted after
an exacerbation. Current meds: carvedilol, lisinopril,
spironolactone, furosemide. The nurse notes new confusion
and a heart rate of 42/min. Select all actions the nurse should
take immediately (choose 2).
A. Obtain a 12-lead ECG.
B. Check serum potassium level.
C. Administer a PRN dose of metoprolol.
D. Hold the next dose of carvedilol and notify the provider.
E. Give 0.9% NS bolus IV to raise heart rate.
Answer: A and D.
Rationale — correct (A, D): New bradycardia (HR 42) and
confusion in a patient on beta-blocker (carvedilol) and ACE
inhibitor/aldosterone antagonist raises concern for beta-blocker
toxicity or conduction abnormality. Obtain an ECG to evaluate
rhythm (A). Hold the next beta-blocker dose and notify provider
(D) while investigations proceed.
Why others are incorrect:
B — Checking K⁺ is reasonable (especially with spironolactone),
but ECG and immediate med hold are higher priority (cardiac
monitoring first).
C — Administering metoprolol (another beta-blocker) would
worsen bradycardia.
E — Giving IV fluid to raise HR is not indicated without evidence
of hypovolemia; fluids could worsen heart failure.
, 4 (Multiple choice — single best answer)
A client with COPD uses albuterol HFA as a rescue inhaler.
Which patient statement indicates correct understanding of
teaching?
A. “I’ll use my albuterol first, then my inhaled steroid 5 minutes
later.”
B. “I’ll take the steroid inhaler first every time to reduce side
effects.”
C. “I’ll use two puffs of the steroid inhaler if symptoms are
worse.”
D. “I’ll avoid rinsing my mouth after using albuterol.”
Answer: A. “I’ll use my albuterol first, then my inhaled steroid
5 minutes later.”
Rationale — correct (A): Short-acting β₂-agonists (albuterol) are
bronchodilators and should be used before inhaled steroids so
airways open and steroid deposition is optimized. Albuterol acts
on β₂ receptors to relax bronchial smooth muscle. FDA Access
Data+1
Why others incorrect:
B — Steroid first reduces immediate bronchodilation benefit;
rescue bronchodilator should come first.
C — Dose adjustments must follow prescriber’s order; doubling
steroid puffs for acute symptoms is not standard; albuterol is
the rescue.
D — Rinsing mouth is recommended after inhaled
