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)
A nurse is preparing to administer oral metoprolol 50 mg to a
client. Which of the following is the most important pre-
administration action to verify before giving the dose?
A. Ask the client if they have taken any OTC medications today.
B. Check the client’s most recent blood pressure and heart rate.
C. Confirm that the medication label shows the same generic
name as the MAR.
D. Verify the expiration date on the medication bottle.
Answer: B
Rationales
• A. Incorrect. Asking about OTC use is important (drug
interactions), but it is not the most immediate safety check
before administering a beta-blocker.
, • B. Correct. Beta-blockers like metoprolol can cause
bradycardia and hypotension. Checking the client’s current
BP and HR (e.g., hold if HR < 60 or SBP < certain threshold
per facility policy) directly prevents hemodynamic harm
and is the single most important immediate check. This
aligns with “right patient/right drug/right dose/right
route/right time” plus clinical judgment about
physiological appropriateness.
• C. Incorrect. Verifying the generic/brand on the label is
important but secondary to assessing current vital signs
that directly determine safety for a cardiovascular agent.
• D. Incorrect. Expiration checking is required, but it is not
the most critical step for a medication with immediate
hemodynamic effects.
2 — Medication error prevention (single best answer)
A nurse receives an order to give digoxin 0.125 mg PO daily.
Before administering, the nurse notes the client’s serum
potassium is 3.1 mEq/L. The nurse’s best action is to:
A. Give the digoxin and monitor for digoxin toxicity.
B. Hold digoxin and notify the provider of the potassium level.
C. Give half the dose now and the remainder tomorrow.
D. Administer potassium chloride IV push immediately then give
digoxin.
Answer: B
,Rationales
• A. Incorrect. Hypokalemia (K⁺ < 3.5 mEq/L) increases risk of
digoxin toxicity because low potassium enhances digoxin
binding to the Na⁺/K⁺-ATPase. Administering digoxin
without correcting potassium is unsafe.
• B. Correct. Holding digoxin and notifying the prescriber is
appropriate. The nurse uses clinical judgment and
prioritizes patient safety: verify lab abnormalities and
collaborate before giving a narrow therapeutic-index drug.
• C. Incorrect. Splitting doses arbitrarily is unsafe and not an
evidence-based response to lab abnormality.
• D. Incorrect. Potassium chloride should never be given IV
push (dangerous) and IV potassium replacement must
follow safe infusion rates and monitoring; the nurse should
notify the provider and await orders for safe correction.
3 — IV infusion rate calculation (single best answer)
Order: Infuse 900 mL normal saline over 6 hours using an
infusion pump. What rate (mL/hr) should the nurse set?
A. 100 mL/hr
B. 125 mL/hr
C. 150 mL/hr
D. 175 mL/hr
Answer: C
, Rationales / Calculation
• Correct calculation: 900 mL ÷ 6 hr = 150 mL/hr (step-by-
step: 900 ÷ 6 = 150).
• A. Incorrect. 100 mL/hr × 6 hr = 600 mL (too little).
• B. Incorrect. 125 mL/hr × 6 hr = 750 mL (too little).
• C. Correct. 150 mL/hr × 6 hr = 900 mL.
• D. Incorrect. 175 mL/hr × 6 hr = 1050 mL (too much).
4 — IV infusion: titration / vasoactive calculation (single best
answer)
A norepinephrine infusion is prepared as 4 mg in 250 mL D5W
(4,000 mcg/250 mL = 16 mcg/mL). The provider orders
norepinephrine 0.05 mcg/kg/min for a 70-kg client. What
infusion rate (mL/hr) should the nurse set? (Round to one
decimal place.)
A. 6.3 mL/hr
B. 13.1 mL/hr
C. 26.3 mL/hr
D. 31.4 mL/hr
Answer: B
Rationales / Calculation
• Stepwise math:
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)
A nurse is preparing to administer oral metoprolol 50 mg to a
client. Which of the following is the most important pre-
administration action to verify before giving the dose?
A. Ask the client if they have taken any OTC medications today.
B. Check the client’s most recent blood pressure and heart rate.
C. Confirm that the medication label shows the same generic
name as the MAR.
D. Verify the expiration date on the medication bottle.
Answer: B
Rationales
• A. Incorrect. Asking about OTC use is important (drug
interactions), but it is not the most immediate safety check
before administering a beta-blocker.
, • B. Correct. Beta-blockers like metoprolol can cause
bradycardia and hypotension. Checking the client’s current
BP and HR (e.g., hold if HR < 60 or SBP < certain threshold
per facility policy) directly prevents hemodynamic harm
and is the single most important immediate check. This
aligns with “right patient/right drug/right dose/right
route/right time” plus clinical judgment about
physiological appropriateness.
• C. Incorrect. Verifying the generic/brand on the label is
important but secondary to assessing current vital signs
that directly determine safety for a cardiovascular agent.
• D. Incorrect. Expiration checking is required, but it is not
the most critical step for a medication with immediate
hemodynamic effects.
2 — Medication error prevention (single best answer)
A nurse receives an order to give digoxin 0.125 mg PO daily.
Before administering, the nurse notes the client’s serum
potassium is 3.1 mEq/L. The nurse’s best action is to:
A. Give the digoxin and monitor for digoxin toxicity.
B. Hold digoxin and notify the provider of the potassium level.
C. Give half the dose now and the remainder tomorrow.
D. Administer potassium chloride IV push immediately then give
digoxin.
Answer: B
,Rationales
• A. Incorrect. Hypokalemia (K⁺ < 3.5 mEq/L) increases risk of
digoxin toxicity because low potassium enhances digoxin
binding to the Na⁺/K⁺-ATPase. Administering digoxin
without correcting potassium is unsafe.
• B. Correct. Holding digoxin and notifying the prescriber is
appropriate. The nurse uses clinical judgment and
prioritizes patient safety: verify lab abnormalities and
collaborate before giving a narrow therapeutic-index drug.
• C. Incorrect. Splitting doses arbitrarily is unsafe and not an
evidence-based response to lab abnormality.
• D. Incorrect. Potassium chloride should never be given IV
push (dangerous) and IV potassium replacement must
follow safe infusion rates and monitoring; the nurse should
notify the provider and await orders for safe correction.
3 — IV infusion rate calculation (single best answer)
Order: Infuse 900 mL normal saline over 6 hours using an
infusion pump. What rate (mL/hr) should the nurse set?
A. 100 mL/hr
B. 125 mL/hr
C. 150 mL/hr
D. 175 mL/hr
Answer: C
, Rationales / Calculation
• Correct calculation: 900 mL ÷ 6 hr = 150 mL/hr (step-by-
step: 900 ÷ 6 = 150).
• A. Incorrect. 100 mL/hr × 6 hr = 600 mL (too little).
• B. Incorrect. 125 mL/hr × 6 hr = 750 mL (too little).
• C. Correct. 150 mL/hr × 6 hr = 900 mL.
• D. Incorrect. 175 mL/hr × 6 hr = 1050 mL (too much).
4 — IV infusion: titration / vasoactive calculation (single best
answer)
A norepinephrine infusion is prepared as 4 mg in 250 mL D5W
(4,000 mcg/250 mL = 16 mcg/mL). The provider orders
norepinephrine 0.05 mcg/kg/min for a 70-kg client. What
infusion rate (mL/hr) should the nurse set? (Round to one
decimal place.)
A. 6.3 mL/hr
B. 13.1 mL/hr
C. 26.3 mL/hr
D. 31.4 mL/hr
Answer: B
Rationales / Calculation
• Stepwise math:
