Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Question 1 — Medication-administration safety (NGN-style
case)
A 68-year-old patient with atrial fibrillation is admitted. The
provider orders warfarin 5 mg PO nightly. Baseline INR = 1.0.
The patient’s current home medication list includes
amiodarone. Which action by the nurse is BEST before
administering the first dose of warfarin?
A. Give warfarin and obtain INR in 72 hours.
B. Hold warfarin and clarify because amiodarone increases
warfarin effect.
C. Give warfarin and teach the patient to avoid leafy greens.
D. Give warfarin and schedule daily INR monitoring starting
tomorrow.
E. Substitute low-molecular-weight heparin (LMWH) instead of
warfarin.
Correct answer: B.
Rationale (correct): Amiodarone inhibits warfarin metabolism
,and increases INR — starting warfarin at a routine dose without
clarification risks over-anticoagulation and bleeding; the nurse
should clarify the order with the prescriber (hold/clarify).
Mechanism: CYP-mediated inhibition increases warfarin plasma
levels. Key adverse effect to avoid: major bleeding.
Contraindication/precaution: drug interactions that potentiate
warfarin. Patient teaching (if started): explain bleeding risk,
report unusual bleeding, and discuss diet consistency.
Why other options are incorrect:
A & D risk giving warfarin without addressing the interacting
med. INR monitoring alone doesn’t remove immediate
interaction risk. C is incomplete and unsafe as initial action. E is
a prescriber decision; nurse should clarify the order rather than
change therapy.
Question 2 — Dosage calculation (oral pediatric)
A child weighs 18 kg. The prescribed acetaminophen
suspension is 15 mg/kg per dose PO every 4–6 hours PRN (max
5 doses/day). The pharmacy provides a 160 mg/5 mL
suspension. What volume (mL) should the nurse give for one
dose? (Round to nearest 0.1 mL.)
A. 6.8 mL
B. 8.4 mL
C. 10.6 mL
D. 12.5 mL
E. 5.3 mL
,Correct answer: B. 8.4 mL
Rationale (correct): Dose = 15 mg/kg × 18 kg = 270 mg per
dose. Suspension concentration = 160 mg / 5 mL → 32 mg/mL.
Volume = 270 mg ÷ 32 mg/mL = 8.4375 mL → 8.4 mL (rounded
to 0.1 mL). Mechanism: calculation by weight-based dosing;
teaching: use proper measuring device, confirm interval and
maximum daily doses.
Why other options are incorrect: A (6.8 mL) would underdose;
C and D overdose; E is too low.
Question 3 — Cardiovascular drug (ACE inhibitor)
A 56-year-old patient is started on lisinopril for hypertension.
Which instruction should the nurse include in discharge
teaching?
A. “If you develop a dry cough, call your provider.”
B. “Take lisinopril with a high-potassium salt substitute for
balance.”
C. “Stop taking this drug if dizziness occurs.”
D. “It may increase blood glucose — monitor for
hyperglycemia.”
E. “Avoid dairy products 1 hour before and after dose.”
Correct answer: A.
Rationale (correct): ACE inhibitors commonly cause a
nonproductive cough due to increased bradykinin; persistent
cough warrants provider evaluation and possible drug
substitution (e.g., ARB). Mechanism: ACE inhibition increases
, bradykinin. Adverse effects: cough, hyperkalemia, angioedema,
hypotension. Contraindicated in pregnancy. Patient teaching:
report cough, swelling of face/lips, lightheadedness on first
dose.
Why other options are incorrect: B is unsafe — ACE inhibitors +
high potassium increases hyperkalemia risk. C is incomplete —
mild dizziness should be reported but stopping abruptly is not
recommended without provider direction. D is false (not known
to increase glucose). E is irrelevant.
Question 4 — Respiratory drug (short-acting beta2 agonist)
A patient with acute asthma exacerbation receives inhaled
albuterol via nebulizer. Which adverse effect should the nurse
expect and monitor for after administration?
A. Bradycardia and hypothermia.
B. Tremor and tachycardia.
C. Hypoglycemia and weight gain.
D. Constipation and urinary retention.
E. Hallucinations and insomnia.
Correct answer: B.
Rationale (correct): Albuterol (β2-agonist) can cause
tachycardia and tremor due to β2 stimulation in skeletal muscle
and some β1 cross-stimulation. Mechanism: bronchodilation via
increased cAMP; adverse effects include palpitations,
tachycardia, tremor, hypokalemia. Teach: use as rescue med,
report palpitations not typical for patient.
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Question 1 — Medication-administration safety (NGN-style
case)
A 68-year-old patient with atrial fibrillation is admitted. The
provider orders warfarin 5 mg PO nightly. Baseline INR = 1.0.
The patient’s current home medication list includes
amiodarone. Which action by the nurse is BEST before
administering the first dose of warfarin?
A. Give warfarin and obtain INR in 72 hours.
B. Hold warfarin and clarify because amiodarone increases
warfarin effect.
C. Give warfarin and teach the patient to avoid leafy greens.
D. Give warfarin and schedule daily INR monitoring starting
tomorrow.
E. Substitute low-molecular-weight heparin (LMWH) instead of
warfarin.
Correct answer: B.
Rationale (correct): Amiodarone inhibits warfarin metabolism
,and increases INR — starting warfarin at a routine dose without
clarification risks over-anticoagulation and bleeding; the nurse
should clarify the order with the prescriber (hold/clarify).
Mechanism: CYP-mediated inhibition increases warfarin plasma
levels. Key adverse effect to avoid: major bleeding.
Contraindication/precaution: drug interactions that potentiate
warfarin. Patient teaching (if started): explain bleeding risk,
report unusual bleeding, and discuss diet consistency.
Why other options are incorrect:
A & D risk giving warfarin without addressing the interacting
med. INR monitoring alone doesn’t remove immediate
interaction risk. C is incomplete and unsafe as initial action. E is
a prescriber decision; nurse should clarify the order rather than
change therapy.
Question 2 — Dosage calculation (oral pediatric)
A child weighs 18 kg. The prescribed acetaminophen
suspension is 15 mg/kg per dose PO every 4–6 hours PRN (max
5 doses/day). The pharmacy provides a 160 mg/5 mL
suspension. What volume (mL) should the nurse give for one
dose? (Round to nearest 0.1 mL.)
A. 6.8 mL
B. 8.4 mL
C. 10.6 mL
D. 12.5 mL
E. 5.3 mL
,Correct answer: B. 8.4 mL
Rationale (correct): Dose = 15 mg/kg × 18 kg = 270 mg per
dose. Suspension concentration = 160 mg / 5 mL → 32 mg/mL.
Volume = 270 mg ÷ 32 mg/mL = 8.4375 mL → 8.4 mL (rounded
to 0.1 mL). Mechanism: calculation by weight-based dosing;
teaching: use proper measuring device, confirm interval and
maximum daily doses.
Why other options are incorrect: A (6.8 mL) would underdose;
C and D overdose; E is too low.
Question 3 — Cardiovascular drug (ACE inhibitor)
A 56-year-old patient is started on lisinopril for hypertension.
Which instruction should the nurse include in discharge
teaching?
A. “If you develop a dry cough, call your provider.”
B. “Take lisinopril with a high-potassium salt substitute for
balance.”
C. “Stop taking this drug if dizziness occurs.”
D. “It may increase blood glucose — monitor for
hyperglycemia.”
E. “Avoid dairy products 1 hour before and after dose.”
Correct answer: A.
Rationale (correct): ACE inhibitors commonly cause a
nonproductive cough due to increased bradykinin; persistent
cough warrants provider evaluation and possible drug
substitution (e.g., ARB). Mechanism: ACE inhibition increases
, bradykinin. Adverse effects: cough, hyperkalemia, angioedema,
hypotension. Contraindicated in pregnancy. Patient teaching:
report cough, swelling of face/lips, lightheadedness on first
dose.
Why other options are incorrect: B is unsafe — ACE inhibitors +
high potassium increases hyperkalemia risk. C is incomplete —
mild dizziness should be reported but stopping abruptly is not
recommended without provider direction. D is false (not known
to increase glucose). E is irrelevant.
Question 4 — Respiratory drug (short-acting beta2 agonist)
A patient with acute asthma exacerbation receives inhaled
albuterol via nebulizer. Which adverse effect should the nurse
expect and monitor for after administration?
A. Bradycardia and hypothermia.
B. Tremor and tachycardia.
C. Hypoglycemia and weight gain.
D. Constipation and urinary retention.
E. Hallucinations and insomnia.
Correct answer: B.
Rationale (correct): Albuterol (β2-agonist) can cause
tachycardia and tremor due to β2 stimulation in skeletal muscle
and some β1 cross-stimulation. Mechanism: bronchodilation via
increased cAMP; adverse effects include palpitations,
tachycardia, tremor, hypokalemia. Teach: use as rescue med,
report palpitations not typical for patient.
