Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
1) Pediatric dose — oral suspension (dosage calculation)
A 18-kg child is prescribed amoxicillin 50 mg/kg/day divided
every 12 hours for an acute otitis media. The pharmacy
dispenses amoxicillin suspension 250 mg/5 mL. How many mL
should the nurse give per dose?
A. 4.5 mL
B. 6.0 mL
C. 9.0 mL
D. 18.0 mL
Answer: C. 9.0 mL
Rationale — calculation (digit-by-digit):
• Total daily dose = 50 mg/kg/day × 18 kg = 50 × 18 = 900
mg/day.
• Divided q12h → dose per administration = 900 mg ÷ 2 =
450 mg per dose.
• Suspension concentration: 250 mg per 5 mL → 250 ÷ 5 =
50 mg/mL.
• Volume = dose ÷ concentration = 450 mg ÷ 50 mg/mL = 9
mL.
,Why others are wrong:
• A (4.5 mL) = half of needed volume.
• B (6.0 mL) = would give 300 mg (insufficient).
• D (18.0 mL) = 900 mg (entire daily dose at once) — not
prescribed.
2) IV infusion rate (mL/hr and drops/min)
An IV bag contains 1,000 mL normal saline to be infused over 8
hours using a microdrip set that delivers 60 gtt/mL. Which is the
correct infusion rate (round to nearest whole number) in drops
per minute?
A. 21 gtt/min
B. 31 gtt/min
C. 125 gtt/min
D. 500 gtt/min
Answer: B. 31 gtt/min
Rationale — calculation (digit-by-digit):
• mL/hr = 1,000 mL ÷ 8 hr = 125 mL/hr.
• Drops/min = (mL/hr × gtt/mL) ÷ 60 = (125 × 60) ÷ 60 = 125
gtt/min — BUT note: the set is microdrip 60 gtt/mL. Wait
— re-calculate carefully: microdrip 60 gtt/mL means each
mL = 60 drops. So: drops/min = (125 mL/hr × 60 gtt/mL) ÷
60 min/hr = 125 gtt/min. (Answer C) However because the
, exam item used 15 gtt/mL commonly — if the set had
been 15 gtt/mL the result would be 31 gtt/min. We must
use the microdrip 60 gtt/mL given in the stem, so correct
is C (125 gtt/min).
Correction (final): Given the stem uses 60 gtt/mL, the correct
choice is C. 125 gtt/min. (If your clinical setting uses 15 gtt/mL
macrodrip, result would be ~31 gtt/min; always use the set
specified.)
Why other choices are wrong:
• A & B are values from using a 15 gtt/mL set — not
applicable here.
• D (500 gtt/min) is far too high.
Teaching point: always verify drip factor (gtt/mL) on the
administration set before calculating. (Saunders emphasizes
practicing medication and IV calculations.) Google Books
3) High-alert medication & safety check
Which action by a nurse best follows safe-medication practices
for administering subcutaneous insulin (a high-alert
medication)?
A. Document the insulin dose immediately after giving and have
no independent verification.
B. Have a second nurse independently verify the insulin type,
dose, and client identity before administration.
, C. Ask the nursing assistant to sign that the insulin was given.
D. Only verify with pharmacy if the dose seems unusually high.
Answer: B. Have a second nurse independently verify the
insulin type, dose, and client identity before administration.
Rationale:
• Correct: Insulin is a high-alert medication; independent
double-checks (two RNs verifying right patient, drug, dose,
time, route) reduce serious errors. Saunders highlights
medication safety and the need to double-check high-risk
meds and calculations. Google Books
• A is unsafe: documentation alone is not a safety barrier.
• C is inappropriate: nursing assistants should not verify
high-alert drug administration.
• D is inadequate: waiting for pharmacist only if dose seems
high misses routine double-check requirement.
4) Digoxin — signs of toxicity & actions
A patient on digoxin and furosemide reports nausea, vision
changes (yellow halos), and heart rate 48/min. What should the
nurse do first?
A. Administer the next scheduled dose of digoxin.
B. Hold digoxin and notify the provider immediately.
C. Increase furosemide dose to reduce fluid overload.
Examination
9th Edition
1) Pediatric dose — oral suspension (dosage calculation)
A 18-kg child is prescribed amoxicillin 50 mg/kg/day divided
every 12 hours for an acute otitis media. The pharmacy
dispenses amoxicillin suspension 250 mg/5 mL. How many mL
should the nurse give per dose?
A. 4.5 mL
B. 6.0 mL
C. 9.0 mL
D. 18.0 mL
Answer: C. 9.0 mL
Rationale — calculation (digit-by-digit):
• Total daily dose = 50 mg/kg/day × 18 kg = 50 × 18 = 900
mg/day.
• Divided q12h → dose per administration = 900 mg ÷ 2 =
450 mg per dose.
• Suspension concentration: 250 mg per 5 mL → 250 ÷ 5 =
50 mg/mL.
• Volume = dose ÷ concentration = 450 mg ÷ 50 mg/mL = 9
mL.
,Why others are wrong:
• A (4.5 mL) = half of needed volume.
• B (6.0 mL) = would give 300 mg (insufficient).
• D (18.0 mL) = 900 mg (entire daily dose at once) — not
prescribed.
2) IV infusion rate (mL/hr and drops/min)
An IV bag contains 1,000 mL normal saline to be infused over 8
hours using a microdrip set that delivers 60 gtt/mL. Which is the
correct infusion rate (round to nearest whole number) in drops
per minute?
A. 21 gtt/min
B. 31 gtt/min
C. 125 gtt/min
D. 500 gtt/min
Answer: B. 31 gtt/min
Rationale — calculation (digit-by-digit):
• mL/hr = 1,000 mL ÷ 8 hr = 125 mL/hr.
• Drops/min = (mL/hr × gtt/mL) ÷ 60 = (125 × 60) ÷ 60 = 125
gtt/min — BUT note: the set is microdrip 60 gtt/mL. Wait
— re-calculate carefully: microdrip 60 gtt/mL means each
mL = 60 drops. So: drops/min = (125 mL/hr × 60 gtt/mL) ÷
60 min/hr = 125 gtt/min. (Answer C) However because the
, exam item used 15 gtt/mL commonly — if the set had
been 15 gtt/mL the result would be 31 gtt/min. We must
use the microdrip 60 gtt/mL given in the stem, so correct
is C (125 gtt/min).
Correction (final): Given the stem uses 60 gtt/mL, the correct
choice is C. 125 gtt/min. (If your clinical setting uses 15 gtt/mL
macrodrip, result would be ~31 gtt/min; always use the set
specified.)
Why other choices are wrong:
• A & B are values from using a 15 gtt/mL set — not
applicable here.
• D (500 gtt/min) is far too high.
Teaching point: always verify drip factor (gtt/mL) on the
administration set before calculating. (Saunders emphasizes
practicing medication and IV calculations.) Google Books
3) High-alert medication & safety check
Which action by a nurse best follows safe-medication practices
for administering subcutaneous insulin (a high-alert
medication)?
A. Document the insulin dose immediately after giving and have
no independent verification.
B. Have a second nurse independently verify the insulin type,
dose, and client identity before administration.
, C. Ask the nursing assistant to sign that the insulin was given.
D. Only verify with pharmacy if the dose seems unusually high.
Answer: B. Have a second nurse independently verify the
insulin type, dose, and client identity before administration.
Rationale:
• Correct: Insulin is a high-alert medication; independent
double-checks (two RNs verifying right patient, drug, dose,
time, route) reduce serious errors. Saunders highlights
medication safety and the need to double-check high-risk
meds and calculations. Google Books
• A is unsafe: documentation alone is not a safety barrier.
• C is inappropriate: nursing assistants should not verify
high-alert drug administration.
• D is inadequate: waiting for pharmacist only if dose seems
high misses routine double-check requirement.
4) Digoxin — signs of toxicity & actions
A patient on digoxin and furosemide reports nausea, vision
changes (yellow halos), and heart rate 48/min. What should the
nurse do first?
A. Administer the next scheduled dose of digoxin.
B. Hold digoxin and notify the provider immediately.
C. Increase furosemide dose to reduce fluid overload.
