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 — Rights of medication administration (single-best-answer
MCQ)
A nurse is preparing to give oral lisinopril 20 mg to a patient.
Which of the following is the most important action the nurse
should take immediately before administering the medication?
A. Ask the patient to state their full name and birth date.
B. Verify the patient's potassium level from this morning's lab
results.
C. Compare the medication label with the MAR (medication
administration record).
D. Ensure the patient swallowed all morning medications.
Correct answer: C
Rationales:
,• A. Ask the patient to state their full name and birth date.
— Incorrect (supporting but not the single most important
immediately before administration). Verifying patient
identity is essential (one of the “rights”), but identity check
is most safely done by comparing the MAR and wristband
and asking the patient to state identifiers; identity check
alone is not a substitute for verifying the correct
medication and dose on the label.
• B. Verify the patient's potassium level from this
morning's lab results. — Incorrect. While ACE inhibitors
(like lisinopril) can raise potassium, obtaining labs is
important but not always required immediately before a
single dose if recent values are acceptable; the immediate
pre-administration safety step is verifying the medication
against the MAR. If labs are abnormal, the nurse should
withhold and notify the prescriber.
• C. Compare the medication label with the MAR
(medication administration record). — Correct. The label-
to-MAR check immediately before administration is a
required safety step to ensure right medication and right
dose — it prevents wrong-drug/wrong-dose errors. This
step is central to the “rights of medication administration.”
• D. Ensure the patient swallowed all morning medications.
— Incorrect. Confirming ingestion is relevant for
subsequent/dose verification but does not replace the
, required label-to-MAR check performed immediately
before giving the drug.
2 — Look-alike / sound-alike error prevention (MCQ)
A nurse receives a verbal order for “hydralazine 10 mg IV now”
but the transcribed order reads “hydroxyzine 10 mg IV now.”
Which is the best immediate action?
A. Administer the medication per the transcribed order.
B. Call the prescriber to clarify the order.
C. Give hydralazine orally instead of IV.
D. Ask pharmacy which medication is stocked on the unit.
Correct answer: B
Rationales:
• A. Administer the medication per the transcribed order.
— Incorrect. Administering without clarifying a discrepancy
between verbal and transcribed orders risks a wrong-drug
error; hydralazine and hydroxyzine are LASA (look-alike
sound-alike). Always clarify ambiguous/verbal orders.
• B. Call the prescriber to clarify the order. — Correct.
Clarification from the prescriber is the safest action to
resolve transcription vs. verbal order discrepancy. This
prevents LASA errors.
• C. Give hydralazine orally instead of IV. — Incorrect.
Changing route without prescriber order is unsafe and
, inappropriate. Also the transcribed order is for hydroxyzine
IV (an antihistamine that is rarely given IV in many settings)
— this further indicates the need for clarification.
• D. Ask pharmacy which medication is stocked on the unit.
— Incorrect. Pharmacy may help, but this does not resolve
the prescriber’s intent; only the prescriber can clarify what
was ordered.
3 — Patient teaching: ACE inhibitor (MCQ)
A patient prescribed lisinopril for hypertension asks what side
effects to watch for. Which statement by the nurse is most
important to include?
A. “If you develop a dry cough, call your provider.”
B. “Take lisinopril with a high-potassium snack.”
C. “You can stop the medication if you feel dizzy.”
D. “This medication will make your heart rate slow down.”
Correct answer: A
Rationales:
• A. “If you develop a dry cough, call your provider.” —
Correct. A persistent dry cough is a common adverse effect
of ACE inhibitors due to increased bradykinin. Patients
should report it; providers may change medication to an
ARB if necessary.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1 — Rights of medication administration (single-best-answer
MCQ)
A nurse is preparing to give oral lisinopril 20 mg to a patient.
Which of the following is the most important action the nurse
should take immediately before administering the medication?
A. Ask the patient to state their full name and birth date.
B. Verify the patient's potassium level from this morning's lab
results.
C. Compare the medication label with the MAR (medication
administration record).
D. Ensure the patient swallowed all morning medications.
Correct answer: C
Rationales:
,• A. Ask the patient to state their full name and birth date.
— Incorrect (supporting but not the single most important
immediately before administration). Verifying patient
identity is essential (one of the “rights”), but identity check
is most safely done by comparing the MAR and wristband
and asking the patient to state identifiers; identity check
alone is not a substitute for verifying the correct
medication and dose on the label.
• B. Verify the patient's potassium level from this
morning's lab results. — Incorrect. While ACE inhibitors
(like lisinopril) can raise potassium, obtaining labs is
important but not always required immediately before a
single dose if recent values are acceptable; the immediate
pre-administration safety step is verifying the medication
against the MAR. If labs are abnormal, the nurse should
withhold and notify the prescriber.
• C. Compare the medication label with the MAR
(medication administration record). — Correct. The label-
to-MAR check immediately before administration is a
required safety step to ensure right medication and right
dose — it prevents wrong-drug/wrong-dose errors. This
step is central to the “rights of medication administration.”
• D. Ensure the patient swallowed all morning medications.
— Incorrect. Confirming ingestion is relevant for
subsequent/dose verification but does not replace the
, required label-to-MAR check performed immediately
before giving the drug.
2 — Look-alike / sound-alike error prevention (MCQ)
A nurse receives a verbal order for “hydralazine 10 mg IV now”
but the transcribed order reads “hydroxyzine 10 mg IV now.”
Which is the best immediate action?
A. Administer the medication per the transcribed order.
B. Call the prescriber to clarify the order.
C. Give hydralazine orally instead of IV.
D. Ask pharmacy which medication is stocked on the unit.
Correct answer: B
Rationales:
• A. Administer the medication per the transcribed order.
— Incorrect. Administering without clarifying a discrepancy
between verbal and transcribed orders risks a wrong-drug
error; hydralazine and hydroxyzine are LASA (look-alike
sound-alike). Always clarify ambiguous/verbal orders.
• B. Call the prescriber to clarify the order. — Correct.
Clarification from the prescriber is the safest action to
resolve transcription vs. verbal order discrepancy. This
prevents LASA errors.
• C. Give hydralazine orally instead of IV. — Incorrect.
Changing route without prescriber order is unsafe and
, inappropriate. Also the transcribed order is for hydroxyzine
IV (an antihistamine that is rarely given IV in many settings)
— this further indicates the need for clarification.
• D. Ask pharmacy which medication is stocked on the unit.
— Incorrect. Pharmacy may help, but this does not resolve
the prescriber’s intent; only the prescriber can clarify what
was ordered.
3 — Patient teaching: ACE inhibitor (MCQ)
A patient prescribed lisinopril for hypertension asks what side
effects to watch for. Which statement by the nurse is most
important to include?
A. “If you develop a dry cough, call your provider.”
B. “Take lisinopril with a high-potassium snack.”
C. “You can stop the medication if you feel dizzy.”
D. “This medication will make your heart rate slow down.”
Correct answer: A
Rationales:
• A. “If you develop a dry cough, call your provider.” —
Correct. A persistent dry cough is a common adverse effect
of ACE inhibitors due to increased bradykinin. Patients
should report it; providers may change medication to an
ARB if necessary.
