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 nurse is preparing to administer lisinopril (an ACE inhibitor)
10 mg PO daily to a newly admitted patient with hypertension.
Which assessment finding is most important to check before
giving the first dose?
A. Serum potassium level
B. Blood pressure and heart rate
C. Presence of a cough
D. Serum creatinine level
Correct answer: B. Blood pressure and heart rate
Rationales:
A. Serum potassium level — ACE inhibitors can cause
hyperkalemia (by reducing aldosterone), so potassium should
be monitored, but checking potassium is not the most
,immediate pre-dose safety check for the first dose.
B. Blood pressure and heart rate — (Correct) ACE inhibitors can
cause significant first-dose hypotension. It is essential to
measure baseline BP and HR immediately prior to the first dose
to avoid giving the drug to a patient who is already hypotensive
(safety principle: assess current vital signs before
administration).
C. Presence of a cough — ACE inhibitors frequently cause a dry
cough, but this is an adverse effect that develops with use; it is
not a contraindication before the first dose.
D. Serum creatinine level — ACE inhibitors can worsen renal
function in certain patients (e.g., bilateral renal artery stenosis).
Creatinine should be checked, but the most immediate pre-
dose priority to prevent acute harm is current BP and HR.
2
A patient receiving metoprolol (a selective beta-1 blocker) is to
have the morning dose. The nurse documents the patient’s
apical pulse is 52 beats/min and blood pressure 100/58 mm Hg.
Which action is best?
A. Administer the dose as ordered.
B. Hold the dose and notify the prescriber.
C. Give half the dose and recheck the pulse in 30 minutes.
D. Give the dose with a snack to prevent hypotension.
Correct answer: B. Hold the dose and notify the prescriber
,Rationales:
A. Administer the dose as ordered — Not appropriate. Beta-
blockers reduce heart rate and further lower blood pressure;
giving at a low HR (bradycardia) risks symptomatic bradycardia
and hemodynamic compromise.
B. Hold the dose and notify the prescriber — (Correct)
Standard nursing practice: hold beta-blocker if HR is below the
facility threshold (commonly <50–60 bpm depending on
protocol), and contact the prescriber for guidance. Document
rationale and patient assessment.
C. Give half the dose and recheck the pulse in 30 minutes —
Arbitrarily altering dose is unsafe unless a protocol/order
authorizes titration. Not an independent nursing action.
D. Give the dose with a snack to prevent hypotension — Food
may blunt absorption slightly but will not prevent bradycardia
or clinically significant hypotension caused by beta-blockade.
3
A patient with congestive heart failure (CHF) is prescribed
furosemide 40 mg IV push. Which action by the nurse is most
important when administering IV furosemide?
A. Administer the medication rapidly to relieve symptoms.
B. Give the dose slowly and monitor for tinnitus.
C. Push the dose into the IV over 10 seconds.
D. Place the patient in Trendelenburg position before
administration.
, Correct answer: B. Give the dose slowly and monitor for
tinnitus
Rationales:
A. Administer the medication rapidly to relieve symptoms —
Rapid IV push increases risk of ototoxicity and hypotension; this
is unsafe.
B. Give the dose slowly and monitor for tinnitus — (Correct)
Furosemide IV push should be given slowly (over at least 1–2
minutes) to reduce risk of ototoxicity (tinnitus, hearing loss) and
sudden hypotension. Monitoring for tinnitus is appropriate.
C. Push the dose into the IV over 10 seconds — Too rapid;
increases risk of adverse effects (ototoxicity, circulatory
collapse).
D. Place the patient in Trendelenburg position before
administration — Not indicated; position will not prevent
adverse effects and can worsen pulmonary congestion.
4
A patient is newly prescribed sertraline (an SSRI). Which
teaching point is most important to include?
A. "You may stop this medication when you feel better."
B. "Avoid taking MAO inhibitors while on sertraline and for 2
weeks after stopping."
C. "You can take it with grapefruit juice to enhance absorption."
D. "Expect immediate mood improvement within 24–48 hours."
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1
A nurse is preparing to administer lisinopril (an ACE inhibitor)
10 mg PO daily to a newly admitted patient with hypertension.
Which assessment finding is most important to check before
giving the first dose?
A. Serum potassium level
B. Blood pressure and heart rate
C. Presence of a cough
D. Serum creatinine level
Correct answer: B. Blood pressure and heart rate
Rationales:
A. Serum potassium level — ACE inhibitors can cause
hyperkalemia (by reducing aldosterone), so potassium should
be monitored, but checking potassium is not the most
,immediate pre-dose safety check for the first dose.
B. Blood pressure and heart rate — (Correct) ACE inhibitors can
cause significant first-dose hypotension. It is essential to
measure baseline BP and HR immediately prior to the first dose
to avoid giving the drug to a patient who is already hypotensive
(safety principle: assess current vital signs before
administration).
C. Presence of a cough — ACE inhibitors frequently cause a dry
cough, but this is an adverse effect that develops with use; it is
not a contraindication before the first dose.
D. Serum creatinine level — ACE inhibitors can worsen renal
function in certain patients (e.g., bilateral renal artery stenosis).
Creatinine should be checked, but the most immediate pre-
dose priority to prevent acute harm is current BP and HR.
2
A patient receiving metoprolol (a selective beta-1 blocker) is to
have the morning dose. The nurse documents the patient’s
apical pulse is 52 beats/min and blood pressure 100/58 mm Hg.
Which action is best?
A. Administer the dose as ordered.
B. Hold the dose and notify the prescriber.
C. Give half the dose and recheck the pulse in 30 minutes.
D. Give the dose with a snack to prevent hypotension.
Correct answer: B. Hold the dose and notify the prescriber
,Rationales:
A. Administer the dose as ordered — Not appropriate. Beta-
blockers reduce heart rate and further lower blood pressure;
giving at a low HR (bradycardia) risks symptomatic bradycardia
and hemodynamic compromise.
B. Hold the dose and notify the prescriber — (Correct)
Standard nursing practice: hold beta-blocker if HR is below the
facility threshold (commonly <50–60 bpm depending on
protocol), and contact the prescriber for guidance. Document
rationale and patient assessment.
C. Give half the dose and recheck the pulse in 30 minutes —
Arbitrarily altering dose is unsafe unless a protocol/order
authorizes titration. Not an independent nursing action.
D. Give the dose with a snack to prevent hypotension — Food
may blunt absorption slightly but will not prevent bradycardia
or clinically significant hypotension caused by beta-blockade.
3
A patient with congestive heart failure (CHF) is prescribed
furosemide 40 mg IV push. Which action by the nurse is most
important when administering IV furosemide?
A. Administer the medication rapidly to relieve symptoms.
B. Give the dose slowly and monitor for tinnitus.
C. Push the dose into the IV over 10 seconds.
D. Place the patient in Trendelenburg position before
administration.
, Correct answer: B. Give the dose slowly and monitor for
tinnitus
Rationales:
A. Administer the medication rapidly to relieve symptoms —
Rapid IV push increases risk of ototoxicity and hypotension; this
is unsafe.
B. Give the dose slowly and monitor for tinnitus — (Correct)
Furosemide IV push should be given slowly (over at least 1–2
minutes) to reduce risk of ototoxicity (tinnitus, hearing loss) and
sudden hypotension. Monitoring for tinnitus is appropriate.
C. Push the dose into the IV over 10 seconds — Too rapid;
increases risk of adverse effects (ototoxicity, circulatory
collapse).
D. Place the patient in Trendelenburg position before
administration — Not indicated; position will not prevent
adverse effects and can worsen pulmonary congestion.
4
A patient is newly prescribed sertraline (an SSRI). Which
teaching point is most important to include?
A. "You may stop this medication when you feel better."
B. "Avoid taking MAO inhibitors while on sertraline and for 2
weeks after stopping."
C. "You can take it with grapefruit juice to enhance absorption."
D. "Expect immediate mood improvement within 24–48 hours."
