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 prepares to give lisinopril 10 mg PO to a newly admitted
client with hypertension and reports of dizziness after standing.
Which action should the nurse perform first before
administering the medication?
A. Administer the dose as ordered; monitor blood pressure
within 1 hour.
B. Check the client's current blood pressure and heart rate. ✔
C. Ask the client whether they take potassium supplements.
D. Notify the prescriber to change the medication to a different
ACE inhibitor.
Correct answer: B
Rationales:
A. Incorrect — administering without checking current vital
,signs risks giving an ACE inhibitor when the client is
hypotensive; ACE inhibitors can further lower blood pressure.
Monitoring after administration is important but not first.
B. Correct — ACE inhibitors (lisinopril) can cause hypotension,
especially first dose effect. Checking pre-administration blood
pressure and heart rate ensures safe administration and
prevents exacerbation of hypotension (patient safety principle:
assess before medication).
C. Incorrect — ACE inhibitors can increase serum potassium, so
asking about potassium supplements is relevant, but checking
current BP is the priority because of dizziness. If potassium
supplements are used, the nurse will also address that before or
after assessing BP.
D. Incorrect — Not the nurse's immediate action. The prescriber
may be notified only after assessment reveals contraindication
(e.g., hypotension, hyperkalemia). Immediate assessment
guides next steps.
2
A client with heart failure is prescribed furosemide 40 mg IV
bolus. The nurse should monitor which lab value most closely
after administration?
A. Serum sodium.
B. Serum potassium. ✔
,C. Serum glucose.
D. Serum phosphorus.
Correct answer: B
Rationales:
A. Incorrect — Loop diuretics affect sodium as well, but
potassium disturbances (hypokalemia) are a more acute and
dangerous effect needing immediate monitoring.
B. Correct — Furosemide (a loop diuretic) causes significant
renal potassium loss and can precipitate hypokalemia, which
increases risk for cardiac dysrhythmias. Monitoring potassium is
essential for patient safety.
C. Incorrect — Furosemide does not directly change glucose;
glucose monitoring is not the primary concern.
D. Incorrect — Phosphorus changes are less commonly
immediately affected and not primary monitoring after a loop
diuretic bolus.
3
A nurse counsels a client newly started on sertraline (SSRI).
Which statement by the client indicates correct understanding
of safe use?
A. "I can stop the medication abruptly if I feel better."
B. "I should avoid St. John's wort while on this medication." ✔
C. "I will take this medication only when I feel anxious."
D. "I will use alcohol to help me sleep while taking this."
, Correct answer: B
Rationales:
A. Incorrect — Abrupt discontinuation of SSRIs can cause
discontinuation syndrome (dizziness, irritability, flu-like
symptoms). Taper per prescriber instructions.
B. Correct — St. John's wort can precipitate serotonin syndrome
when combined with SSRIs due to additive serotonergic effects
— this is a safety teaching point (drug interaction).
C. Incorrect — SSRIs for depression/anxiety are taken daily to
reach steady state and prevent relapse; taking PRN is
ineffective.
D. Incorrect — Alcohol can increase CNS depression and
interact adversely with SSRIs; advising avoidance is appropriate.
4
A patient is prescribed metoprolol tartrate 25 mg PO twice daily
for hypertension. Which of the following findings would be a
contraindication to administering the medication?
A. Blood pressure 150/90 mm Hg, heart rate 58 bpm. ✔
B. Blood pressure 120/76 mm Hg, heart rate 88 bpm.
C. Blood pressure 140/84 mm Hg, heart rate 72 bpm.
D. Blood pressure 160/96 mm Hg, heart rate 92 bpm.
Correct answer: A
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1
A nurse prepares to give lisinopril 10 mg PO to a newly admitted
client with hypertension and reports of dizziness after standing.
Which action should the nurse perform first before
administering the medication?
A. Administer the dose as ordered; monitor blood pressure
within 1 hour.
B. Check the client's current blood pressure and heart rate. ✔
C. Ask the client whether they take potassium supplements.
D. Notify the prescriber to change the medication to a different
ACE inhibitor.
Correct answer: B
Rationales:
A. Incorrect — administering without checking current vital
,signs risks giving an ACE inhibitor when the client is
hypotensive; ACE inhibitors can further lower blood pressure.
Monitoring after administration is important but not first.
B. Correct — ACE inhibitors (lisinopril) can cause hypotension,
especially first dose effect. Checking pre-administration blood
pressure and heart rate ensures safe administration and
prevents exacerbation of hypotension (patient safety principle:
assess before medication).
C. Incorrect — ACE inhibitors can increase serum potassium, so
asking about potassium supplements is relevant, but checking
current BP is the priority because of dizziness. If potassium
supplements are used, the nurse will also address that before or
after assessing BP.
D. Incorrect — Not the nurse's immediate action. The prescriber
may be notified only after assessment reveals contraindication
(e.g., hypotension, hyperkalemia). Immediate assessment
guides next steps.
2
A client with heart failure is prescribed furosemide 40 mg IV
bolus. The nurse should monitor which lab value most closely
after administration?
A. Serum sodium.
B. Serum potassium. ✔
,C. Serum glucose.
D. Serum phosphorus.
Correct answer: B
Rationales:
A. Incorrect — Loop diuretics affect sodium as well, but
potassium disturbances (hypokalemia) are a more acute and
dangerous effect needing immediate monitoring.
B. Correct — Furosemide (a loop diuretic) causes significant
renal potassium loss and can precipitate hypokalemia, which
increases risk for cardiac dysrhythmias. Monitoring potassium is
essential for patient safety.
C. Incorrect — Furosemide does not directly change glucose;
glucose monitoring is not the primary concern.
D. Incorrect — Phosphorus changes are less commonly
immediately affected and not primary monitoring after a loop
diuretic bolus.
3
A nurse counsels a client newly started on sertraline (SSRI).
Which statement by the client indicates correct understanding
of safe use?
A. "I can stop the medication abruptly if I feel better."
B. "I should avoid St. John's wort while on this medication." ✔
C. "I will take this medication only when I feel anxious."
D. "I will use alcohol to help me sleep while taking this."
, Correct answer: B
Rationales:
A. Incorrect — Abrupt discontinuation of SSRIs can cause
discontinuation syndrome (dizziness, irritability, flu-like
symptoms). Taper per prescriber instructions.
B. Correct — St. John's wort can precipitate serotonin syndrome
when combined with SSRIs due to additive serotonergic effects
— this is a safety teaching point (drug interaction).
C. Incorrect — SSRIs for depression/anxiety are taken daily to
reach steady state and prevent relapse; taking PRN is
ineffective.
D. Incorrect — Alcohol can increase CNS depression and
interact adversely with SSRIs; advising avoidance is appropriate.
4
A patient is prescribed metoprolol tartrate 25 mg PO twice daily
for hypertension. Which of the following findings would be a
contraindication to administering the medication?
A. Blood pressure 150/90 mm Hg, heart rate 58 bpm. ✔
B. Blood pressure 120/76 mm Hg, heart rate 88 bpm.
C. Blood pressure 140/84 mm Hg, heart rate 72 bpm.
D. Blood pressure 160/96 mm Hg, heart rate 92 bpm.
Correct answer: A
