Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1. A 68-year-old client with hypertension is started on lisinopril.
Which statement by the client indicates the nurse should
provide additional teaching?
A. “I’ll let my provider know if I develop a dry cough.”
B. “I can take this medication if I get pregnant.”
C. “I should avoid potassium supplements unless my provider
tells me.”
D. “I may feel dizzy when I stand up quickly, so I’ll rise slowly.”
Correct answer: B
Rationales:
A — Incorrect. This is appropriate. ACE inhibitors commonly
cause a nonproductive dry cough; reporting it is correct.
Pharmacology: ACE inhibitors increase bradykinin—contributes
to cough.
B — Correct. ACE inhibitors (e.g., lisinopril) are contraindicated
,in pregnancy (teratogenic, risk of fetal renal
failure/oligohydramnios). Safety: must advise women of
childbearing potential to avoid pregnancy while taking ACE
inhibitors.
C — Incorrect. ACE inhibitors can cause hyperkalemia by
decreasing aldosterone; avoiding potassium supplements
unless instructed is correct.
D — Incorrect. Orthostatic hypotension is a known adverse
effect; slow position changes are appropriate safety teaching.
2. A nurse is preparing to give a new order: metoprolol tartrate
50 mg PO twice daily. Which client statement would be most
concerning and require clarification before administering the
dose?
A. “My blood pressure this morning was 128/74.”
B. “My pulse is 52 beats per minute.”
C. “I take ibuprofen as needed for my arthritis.”
D. “I had a cup of coffee an hour ago.”
Correct answer: B
Rationales:
A — Incorrect. BP is within acceptable range for many adults;
this alone doesn’t require withholding.
B — Correct. Metoprolol is a beta-1 selective blocker that
decreases heart rate and contractility. A pulse of 52 bpm is
bradycardia; administering could worsen bradycardia and cause
hypotension or syncope. Safe med administration requires
,assessing vitals and holding if pulse is below facility threshold
(commonly <60 bpm) and notifying prescriber.
C — Incorrect. NSAIDs may blunt antihypertensive effects but
are not an immediate contraindication to giving metoprolol.
Monitor efficacy.
D — Incorrect. Caffeine may increase HR/BP transiently but is
not a contraindication to metoprolol.
3. (Calculation) Infuse 0.9% sodium chloride 1000 mL IV over 8
hours. The pump only accepts mL/hour. What rate should the
nurse program?
A. 100 mL/hr
B. 125 mL/hr
C. 150 mL/hr
D. 166 mL/hr
Correct answer: B
Rationale (calculation shown):
Required rate = total volume ÷ hours = 1000 mL ÷ 8 hr = 125.0
mL/hr. Choose 125 mL/hr. (Digit check: 8 × 125 = 1000.)
Option explanations:
A — 100 mL/hr × 8 = 800 mL (too little).
B — Correct. Matches calculation.
C — 150 mL/hr × 8 = 1200 mL (too much).
D — 166 mL/hr × 8 ≈ 1328 mL (too much).
, 4. A client with asthma is prescribed propranolol for essential
tremor. Which statement best describes why propranolol may
be problematic for this client?
A. It can cause orthostatic hypotension.
B. It blocks beta-1 receptors only and is safe in asthma.
C. It can precipitate bronchoconstriction by blocking beta-2
receptors.
D. It causes fluid retention that worsens breathing.
Correct answer: C
Rationales:
A — Incorrect. While beta-blockers can cause orthostatic
hypotension, this is not the main asthma concern.
B — Incorrect. Propranolol is a nonselective beta-blocker
(blocks β1 and β2). It is not beta-1 selective.
C — Correct. Nonselective beta-blockers block β2 receptors in
bronchial smooth muscle, risking bronchoconstriction and
asthma exacerbation. Safety: avoid nonselective beta-blockers
in reactive airway disease.
D — Incorrect. Beta-blockers don’t characteristically cause fluid
retention that directly worsens asthma; respiratory risk is due
to bronchospasm.
5. A nurse prepares a high-alert medication: IV potassium
chloride 20 mEq in 100 mL to run over 2 hours. Which action by
the nurse is required before administration?
A. Bolus the potassium over 10 minutes to relieve cramps.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1. A 68-year-old client with hypertension is started on lisinopril.
Which statement by the client indicates the nurse should
provide additional teaching?
A. “I’ll let my provider know if I develop a dry cough.”
B. “I can take this medication if I get pregnant.”
C. “I should avoid potassium supplements unless my provider
tells me.”
D. “I may feel dizzy when I stand up quickly, so I’ll rise slowly.”
Correct answer: B
Rationales:
A — Incorrect. This is appropriate. ACE inhibitors commonly
cause a nonproductive dry cough; reporting it is correct.
Pharmacology: ACE inhibitors increase bradykinin—contributes
to cough.
B — Correct. ACE inhibitors (e.g., lisinopril) are contraindicated
,in pregnancy (teratogenic, risk of fetal renal
failure/oligohydramnios). Safety: must advise women of
childbearing potential to avoid pregnancy while taking ACE
inhibitors.
C — Incorrect. ACE inhibitors can cause hyperkalemia by
decreasing aldosterone; avoiding potassium supplements
unless instructed is correct.
D — Incorrect. Orthostatic hypotension is a known adverse
effect; slow position changes are appropriate safety teaching.
2. A nurse is preparing to give a new order: metoprolol tartrate
50 mg PO twice daily. Which client statement would be most
concerning and require clarification before administering the
dose?
A. “My blood pressure this morning was 128/74.”
B. “My pulse is 52 beats per minute.”
C. “I take ibuprofen as needed for my arthritis.”
D. “I had a cup of coffee an hour ago.”
Correct answer: B
Rationales:
A — Incorrect. BP is within acceptable range for many adults;
this alone doesn’t require withholding.
B — Correct. Metoprolol is a beta-1 selective blocker that
decreases heart rate and contractility. A pulse of 52 bpm is
bradycardia; administering could worsen bradycardia and cause
hypotension or syncope. Safe med administration requires
,assessing vitals and holding if pulse is below facility threshold
(commonly <60 bpm) and notifying prescriber.
C — Incorrect. NSAIDs may blunt antihypertensive effects but
are not an immediate contraindication to giving metoprolol.
Monitor efficacy.
D — Incorrect. Caffeine may increase HR/BP transiently but is
not a contraindication to metoprolol.
3. (Calculation) Infuse 0.9% sodium chloride 1000 mL IV over 8
hours. The pump only accepts mL/hour. What rate should the
nurse program?
A. 100 mL/hr
B. 125 mL/hr
C. 150 mL/hr
D. 166 mL/hr
Correct answer: B
Rationale (calculation shown):
Required rate = total volume ÷ hours = 1000 mL ÷ 8 hr = 125.0
mL/hr. Choose 125 mL/hr. (Digit check: 8 × 125 = 1000.)
Option explanations:
A — 100 mL/hr × 8 = 800 mL (too little).
B — Correct. Matches calculation.
C — 150 mL/hr × 8 = 1200 mL (too much).
D — 166 mL/hr × 8 ≈ 1328 mL (too much).
, 4. A client with asthma is prescribed propranolol for essential
tremor. Which statement best describes why propranolol may
be problematic for this client?
A. It can cause orthostatic hypotension.
B. It blocks beta-1 receptors only and is safe in asthma.
C. It can precipitate bronchoconstriction by blocking beta-2
receptors.
D. It causes fluid retention that worsens breathing.
Correct answer: C
Rationales:
A — Incorrect. While beta-blockers can cause orthostatic
hypotension, this is not the main asthma concern.
B — Incorrect. Propranolol is a nonselective beta-blocker
(blocks β1 and β2). It is not beta-1 selective.
C — Correct. Nonselective beta-blockers block β2 receptors in
bronchial smooth muscle, risking bronchoconstriction and
asthma exacerbation. Safety: avoid nonselective beta-blockers
in reactive airway disease.
D — Incorrect. Beta-blockers don’t characteristically cause fluid
retention that directly worsens asthma; respiratory risk is due
to bronchospasm.
5. A nurse prepares a high-alert medication: IV potassium
chloride 20 mEq in 100 mL to run over 2 hours. Which action by
the nurse is required before administration?
A. Bolus the potassium over 10 minutes to relieve cramps.
