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
Traditional NCLEX-style multiple choice (1–19)
1 — Rights of medication administration
A nurse prepares to administer a newly ordered oral ACE
inhibitor to an adult hospitalized patient. Which of the following
is the most important action to complete just before giving the
medication?
A. Ask the patient to state two identifiers (name and date of
birth).
B. Check the patient's current blood pressure and pulse.
C. Confirm the dose against the MAR.
D. Document patient teaching after administration.
Correct answer: B. Check the patient's current blood pressure
and pulse.
Rationales
,• A. Ask the patient to state two identifiers. — Incorrect as
the single most important action just before giving the
drug. Using two patient identifiers is required (right
patient) and prevents ID errors, but for an ACE inhibitor
(which can cause hypotension), verifying current vital signs
immediately before administration is the highest priority
for patient safety.
• B. Check the patient's current blood pressure and pulse.
— Correct. ACE inhibitors cause vasodilation and can
produce symptomatic hypotension—especially with the
first doses, after dose increases, or in hypovolemic
patients. Checking BP and pulse immediately before
administration detects contraindications (SBP low) and
prevents harm.
• C. Confirm the dose against the MAR. — Incorrect as the
most important immediate pre-administration action for
this scenario. Dose confirmation is essential (right dose)
but the question asks the most important action just
before giving an ACE inhibitor; vital signs are the key safety
check.
• D. Document patient teaching after administration. —
Incorrect. Documentation/teaching are important but not
the highest immediate safety measure prior to ACE
inhibitor administration.
,2 — Medication error prevention
A nurse receives a phone order for morphine 2 mg IV PRN for
severe pain. Which action best reduces the risk of
transcription/administration error?
A. Administer morphine immediately and document at the end
of shift.
B. Ask the prescriber to sign the order later.
C. Repeat the order back to the prescriber and clarify
frequency/route.
D. Have another nurse witness the morphine waste.
Correct answer: C. Repeat the order back to the prescriber and
clarify frequency/route.
Rationales
• A. Administer morphine immediately and document at
the end of shift. — Incorrect. This risks administering
without a verified, clear order and violates safe
documentation practice; never delay verification.
• B. Ask the prescriber to sign the order later. — Incorrect.
Prescriber signature later does not prevent immediate
transcription errors; critical to clarify content now.
• C. Repeat the order back to the prescriber and clarify
frequency/route. — Correct. Read-back verification is a
proven safety strategy for telephone/verbal orders; it
reduces miscommunication and transcription errors.
, • D. Have another nurse witness the morphine waste. —
Incorrect. Witnessing waste applies to controlled
substance disposal, not to preventing the initial
transcription/interpretation error of a phone order.
3 — ACE inhibitor patient teaching
A patient started on lisinopril asks what side effects to expect.
Which teaching point is most important to include?
A. “You may notice a persistent dry cough; tell me if this
occurs.”
B. “Increase your potassium intake to counterbalance effects.”
C. “You can continue this medication if you become pregnant.”
D. “Check your blood glucose hourly.”
Correct answer: A. “You may notice a persistent dry cough; tell
me if this occurs.”
Rationales
• A. “You may notice a persistent dry cough; tell me if this
occurs.” — Correct. A persistent dry, nonproductive cough
is a common adverse effect of ACE inhibitors due to
increased bradykinin; patient should report it because
switching to an ARB may be needed.
• B. “Increase your potassium intake to counterbalance
effects.” — Incorrect. ACE inhibitors can cause
hyperkalemia, not hypokalemia; patients should avoid
excess potassium and be monitored.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
Traditional NCLEX-style multiple choice (1–19)
1 — Rights of medication administration
A nurse prepares to administer a newly ordered oral ACE
inhibitor to an adult hospitalized patient. Which of the following
is the most important action to complete just before giving the
medication?
A. Ask the patient to state two identifiers (name and date of
birth).
B. Check the patient's current blood pressure and pulse.
C. Confirm the dose against the MAR.
D. Document patient teaching after administration.
Correct answer: B. Check the patient's current blood pressure
and pulse.
Rationales
,• A. Ask the patient to state two identifiers. — Incorrect as
the single most important action just before giving the
drug. Using two patient identifiers is required (right
patient) and prevents ID errors, but for an ACE inhibitor
(which can cause hypotension), verifying current vital signs
immediately before administration is the highest priority
for patient safety.
• B. Check the patient's current blood pressure and pulse.
— Correct. ACE inhibitors cause vasodilation and can
produce symptomatic hypotension—especially with the
first doses, after dose increases, or in hypovolemic
patients. Checking BP and pulse immediately before
administration detects contraindications (SBP low) and
prevents harm.
• C. Confirm the dose against the MAR. — Incorrect as the
most important immediate pre-administration action for
this scenario. Dose confirmation is essential (right dose)
but the question asks the most important action just
before giving an ACE inhibitor; vital signs are the key safety
check.
• D. Document patient teaching after administration. —
Incorrect. Documentation/teaching are important but not
the highest immediate safety measure prior to ACE
inhibitor administration.
,2 — Medication error prevention
A nurse receives a phone order for morphine 2 mg IV PRN for
severe pain. Which action best reduces the risk of
transcription/administration error?
A. Administer morphine immediately and document at the end
of shift.
B. Ask the prescriber to sign the order later.
C. Repeat the order back to the prescriber and clarify
frequency/route.
D. Have another nurse witness the morphine waste.
Correct answer: C. Repeat the order back to the prescriber and
clarify frequency/route.
Rationales
• A. Administer morphine immediately and document at
the end of shift. — Incorrect. This risks administering
without a verified, clear order and violates safe
documentation practice; never delay verification.
• B. Ask the prescriber to sign the order later. — Incorrect.
Prescriber signature later does not prevent immediate
transcription errors; critical to clarify content now.
• C. Repeat the order back to the prescriber and clarify
frequency/route. — Correct. Read-back verification is a
proven safety strategy for telephone/verbal orders; it
reduces miscommunication and transcription errors.
, • D. Have another nurse witness the morphine waste. —
Incorrect. Witnessing waste applies to controlled
substance disposal, not to preventing the initial
transcription/interpretation error of a phone order.
3 — ACE inhibitor patient teaching
A patient started on lisinopril asks what side effects to expect.
Which teaching point is most important to include?
A. “You may notice a persistent dry cough; tell me if this
occurs.”
B. “Increase your potassium intake to counterbalance effects.”
C. “You can continue this medication if you become pregnant.”
D. “Check your blood glucose hourly.”
Correct answer: A. “You may notice a persistent dry cough; tell
me if this occurs.”
Rationales
• A. “You may notice a persistent dry cough; tell me if this
occurs.” — Correct. A persistent dry, nonproductive cough
is a common adverse effect of ACE inhibitors due to
increased bradykinin; patient should report it because
switching to an ARB may be needed.
• B. “Increase your potassium intake to counterbalance
effects.” — Incorrect. ACE inhibitors can cause
hyperkalemia, not hypokalemia; patients should avoid
excess potassium and be monitored.
