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
Items
1) Right of medication — identification of error
Question: A nurse prepares to give an oral tablet of metoprolol
to Mr. J. The medication label reads metoprolol tartrate 25 mg,
and the MAR lists metoprolol 25 mg PO daily. The nurse notices
the patient’s current blood pressure is 82/48 mm Hg and heart
rate 46 beats/min. What is the best action?
A. Give the dose; bradycardia is expected and is therapeutic.
B. Hold the medication and notify the prescriber. (Correct)
C. Give half the dose to avoid hypotension.
D. Ask the patient if he “usually takes” the medication, then
document and give.
Rationale:
, • B (correct): Safety principle — right patient/right
drug/right time/right dose/right route; assessment
before administration. Metoprolol (a beta-1 selective
blocker) lowers HR and BP through negative chronotropic
and inotropic effects; with HR 46 and BP 82/48,
administering would risk symptomatic bradycardia,
hypotension, syncope. Hold and notify prescriber for
further orders (e.g., hold, ECG, or medication adjustment).
• A (incorrect): Misapplies therapeutic effect; bradycardia
this severe is contraindication to giving additional beta-
blocker without provider direction.
• C (incorrect): Arbitrarily altering dose is a medication
error; only prescriber may change order. Partial dosing
risks under/overdosing and is unsafe.
• D (incorrect): Asking the patient is useful for reconciliation
but does not address acute instability; continuing would be
unsafe.
2) IV infusion rate (mL/hr) — simple calculation
Question: Infuse 1000 mL D5W IV over 8 hours. What rate
(mL/hr) should the nurse set on the pump?
A. 100 mL/hr
B. 125 mL/hr (Correct)
C. 150 mL/hr
D. 80 mL/hr
,Calculation (step-by-step): 1000 mL ÷ 8 hr = 125.0 mL/hr.
Rationale:
• B (correct): Correct division yields 125 mL/hr. Safe pump
programming prevents fluid overload or
underresuscitation.
• Other options (incorrect): Do not match the required total
volume/time.
3) IV infusion with drop factor (gtt/min)
Question: Infuse 500 mL NS over 4 hours using tubing with a
drop factor of 15 gtt/mL. Which drop rate (gtt/min) should the
nurse set?
A. 15 gtt/min
B. 25 gtt/min
C. 31 gtt/min (approx.) (Correct)
D. 45 gtt/min
Calculation (step-by-step):
1. mL/hr = 500 mL ÷ 4 hr = 125 mL/hr.
2. mL/min = 125 ÷ 60 = 2.0833 mL/min.
3. gtt/min = 2.0833 mL/min × 15 gtt/mL = 31.25 gtt/min ≈ 31
gtt/min (round to nearest whole drop).
Rationale:
• C (correct): Correct conversion; rounding to whole drops is
standard. Ensures accurate infusion rate and fluid balance.
, • A, B, D (incorrect): Incorrect computations; would
under/overinfuse.
4) Pediatric single-dose (mg/kg) — acetaminophen
Question: A 18-kg child requires a one-time acetaminophen
dose of 15 mg/kg. What is the appropriate single dose?
A. 180 mg
B. 270 mg (Correct)
C. 45 mg
D. 300 mg
Calculation: 15 mg/kg × 18 kg = 270 mg.
Rationale:
• B (correct): Pediatric dosing often weight-based; ensure
correct mg/kg to avoid toxicity or undertreatment.
• A, C, D (incorrect): Wrong arithmetic or rounding; D (300
mg) is higher than ordered and not indicated.
5) Titration assessment (NGN cue recognition/prioritization) —
IV metoprolol titration
Case: Mr. L. is receiving IV metoprolol for SVT. Current
telemetry: HR 98 bpm (down from 150); BP 92/56 mm Hg (was
110/70); patient complains of dizziness. The prescriber planned
to titrate an additional IV dose to reach HR <90.
Question: Which action should the nurse perform first?
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
Items
1) Right of medication — identification of error
Question: A nurse prepares to give an oral tablet of metoprolol
to Mr. J. The medication label reads metoprolol tartrate 25 mg,
and the MAR lists metoprolol 25 mg PO daily. The nurse notices
the patient’s current blood pressure is 82/48 mm Hg and heart
rate 46 beats/min. What is the best action?
A. Give the dose; bradycardia is expected and is therapeutic.
B. Hold the medication and notify the prescriber. (Correct)
C. Give half the dose to avoid hypotension.
D. Ask the patient if he “usually takes” the medication, then
document and give.
Rationale:
, • B (correct): Safety principle — right patient/right
drug/right time/right dose/right route; assessment
before administration. Metoprolol (a beta-1 selective
blocker) lowers HR and BP through negative chronotropic
and inotropic effects; with HR 46 and BP 82/48,
administering would risk symptomatic bradycardia,
hypotension, syncope. Hold and notify prescriber for
further orders (e.g., hold, ECG, or medication adjustment).
• A (incorrect): Misapplies therapeutic effect; bradycardia
this severe is contraindication to giving additional beta-
blocker without provider direction.
• C (incorrect): Arbitrarily altering dose is a medication
error; only prescriber may change order. Partial dosing
risks under/overdosing and is unsafe.
• D (incorrect): Asking the patient is useful for reconciliation
but does not address acute instability; continuing would be
unsafe.
2) IV infusion rate (mL/hr) — simple calculation
Question: Infuse 1000 mL D5W IV over 8 hours. What rate
(mL/hr) should the nurse set on the pump?
A. 100 mL/hr
B. 125 mL/hr (Correct)
C. 150 mL/hr
D. 80 mL/hr
,Calculation (step-by-step): 1000 mL ÷ 8 hr = 125.0 mL/hr.
Rationale:
• B (correct): Correct division yields 125 mL/hr. Safe pump
programming prevents fluid overload or
underresuscitation.
• Other options (incorrect): Do not match the required total
volume/time.
3) IV infusion with drop factor (gtt/min)
Question: Infuse 500 mL NS over 4 hours using tubing with a
drop factor of 15 gtt/mL. Which drop rate (gtt/min) should the
nurse set?
A. 15 gtt/min
B. 25 gtt/min
C. 31 gtt/min (approx.) (Correct)
D. 45 gtt/min
Calculation (step-by-step):
1. mL/hr = 500 mL ÷ 4 hr = 125 mL/hr.
2. mL/min = 125 ÷ 60 = 2.0833 mL/min.
3. gtt/min = 2.0833 mL/min × 15 gtt/mL = 31.25 gtt/min ≈ 31
gtt/min (round to nearest whole drop).
Rationale:
• C (correct): Correct conversion; rounding to whole drops is
standard. Ensures accurate infusion rate and fluid balance.
, • A, B, D (incorrect): Incorrect computations; would
under/overinfuse.
4) Pediatric single-dose (mg/kg) — acetaminophen
Question: A 18-kg child requires a one-time acetaminophen
dose of 15 mg/kg. What is the appropriate single dose?
A. 180 mg
B. 270 mg (Correct)
C. 45 mg
D. 300 mg
Calculation: 15 mg/kg × 18 kg = 270 mg.
Rationale:
• B (correct): Pediatric dosing often weight-based; ensure
correct mg/kg to avoid toxicity or undertreatment.
• A, C, D (incorrect): Wrong arithmetic or rounding; D (300
mg) is higher than ordered and not indicated.
5) Titration assessment (NGN cue recognition/prioritization) —
IV metoprolol titration
Case: Mr. L. is receiving IV metoprolol for SVT. Current
telemetry: HR 98 bpm (down from 150); BP 92/56 mm Hg (was
110/70); patient complains of dizziness. The prescriber planned
to titrate an additional IV dose to reach HR <90.
Question: Which action should the nurse perform first?
