Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 (Multiple choice — single best answer)
A 68-year-old client with hypertension is prescribed lisinopril.
Which statement by the client indicates understanding of
important adverse effects and necessary precautions?
A. “I’ll take an extra diuretic if I feel dizzy in the mornings.”
B. “If I develop a dry cough, I’ll tell my provider.”
C. “I’ll avoid drinking grapefruit juice while taking this
medication.”
D. “I’ll stop the medication immediately if I get a headache.”
Correct answer: B
Rationale:
• Why B is correct: ACE inhibitors such as lisinopril
commonly cause a persistent dry cough due to
accumulation of bradykinin; the client should report it
because the provider may switch to an ARB. Teach to
, report cough, signs of angioedema (facial swelling) or
hypotension.
• Why A is incorrect: The client should not self-adjust
diuretics; dizziness may indicate orthostatic hypotension —
report to provider rather than adding medication.
• Why C is incorrect: Grapefruit juice interacts primarily with
certain statins and calcium channel blockers (e.g.,
felodipine), not ACE inhibitors.
• Why D is incorrect: Headache alone is not an indication to
abruptly stop ACE inhibitor therapy; abrupt cessation may
destabilize BP. Report significant adverse effects to the
prescriber.
Teaching points: Monitor BP and renal function
(BUN/creatinine, potassium). Contraindicated in pregnancy
(teratogenic) and caution with hyperkalemia.
2 (NGN-style — case + multiple response priority)
A 57-year-old admitted with heart failure is receiving
furosemide 40 mg IV twice daily. The nurse notes the client’s
most recent serum potassium is 2.9 mEq/L (low). Rank the
nurse’s actions from most to least appropriate.
Actions:
1. Administer 40 mEq oral potassium chloride now per
standing order.
, 2. Hold the next dose of IV furosemide and notify the
provider.
3. Place the client on a cardiac monitor and obtain an ECG.
4. Encourage the client to eat potassium-rich foods during
meals.
Correct ranking (most → least): 3 → 2 → 1 → 4
Rationale:
• 3 (most appropriate): Hypokalemia <3.0 mEq/L can cause
cardiac dysrhythmias; immediate cardiac monitoring and
ECG assessment to detect changes (e.g., U waves, flattened
T waves) is priority.
• 2: Holding further loop diuretic doses and notifying the
prescriber is appropriate to prevent further potassium loss.
• 1: Administering a large oral potassium bolus (40 mEq)
may be appropriate if ordered, but giving without
confirming orders or assessing ECG/IV access risks is less
immediate than monitoring and notifying. Also, IV
replacement may be required for severe hypokalemia—
must follow provider orders and facility protocol.
• 4 (least): Encouraging potassium-rich foods is appropriate
for prevention/maintenance but not an immediate
corrective action for severe hypokalemia.
, Teaching points: Furosemide causes renal potassium loss. Be
aware of interactions (e.g., digoxin toxicity risk with
hypokalemia).
3 (Multiple choice — single best answer)
A client with COPD uses albuterol inhaler PRN. Which statement
indicates correct teaching?
A. “I’ll space my inhaler puffs 10 seconds apart.”
B. “I’ll rinse my mouth after using the inhaler.”
C. “I’ll use the inhaler just before exercise when I have cough.”
D. “I’ll expect sedation after each inhalation.”
Correct answer: C
Rationale:
• Why C is correct: Albuterol is a short-acting beta2-agonist
used as a pre-exercise prophylactic to prevent
bronchospasm; using it before activity is appropriate.
• Why A is incorrect: Spacing puffs is typically 20–30
seconds for inhalers (or one minute) depending on device;
10 seconds is too short for optimal lung deposition.
(Teaching: wait ~20–30 seconds between puffs if no
specific device instructions.)
• Why B is incorrect: Rinsing the mouth is primarily required
after inhaled corticosteroids (to prevent thrush), not short-
acting beta2-agonists.
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1 (Multiple choice — single best answer)
A 68-year-old client with hypertension is prescribed lisinopril.
Which statement by the client indicates understanding of
important adverse effects and necessary precautions?
A. “I’ll take an extra diuretic if I feel dizzy in the mornings.”
B. “If I develop a dry cough, I’ll tell my provider.”
C. “I’ll avoid drinking grapefruit juice while taking this
medication.”
D. “I’ll stop the medication immediately if I get a headache.”
Correct answer: B
Rationale:
• Why B is correct: ACE inhibitors such as lisinopril
commonly cause a persistent dry cough due to
accumulation of bradykinin; the client should report it
because the provider may switch to an ARB. Teach to
, report cough, signs of angioedema (facial swelling) or
hypotension.
• Why A is incorrect: The client should not self-adjust
diuretics; dizziness may indicate orthostatic hypotension —
report to provider rather than adding medication.
• Why C is incorrect: Grapefruit juice interacts primarily with
certain statins and calcium channel blockers (e.g.,
felodipine), not ACE inhibitors.
• Why D is incorrect: Headache alone is not an indication to
abruptly stop ACE inhibitor therapy; abrupt cessation may
destabilize BP. Report significant adverse effects to the
prescriber.
Teaching points: Monitor BP and renal function
(BUN/creatinine, potassium). Contraindicated in pregnancy
(teratogenic) and caution with hyperkalemia.
2 (NGN-style — case + multiple response priority)
A 57-year-old admitted with heart failure is receiving
furosemide 40 mg IV twice daily. The nurse notes the client’s
most recent serum potassium is 2.9 mEq/L (low). Rank the
nurse’s actions from most to least appropriate.
Actions:
1. Administer 40 mEq oral potassium chloride now per
standing order.
, 2. Hold the next dose of IV furosemide and notify the
provider.
3. Place the client on a cardiac monitor and obtain an ECG.
4. Encourage the client to eat potassium-rich foods during
meals.
Correct ranking (most → least): 3 → 2 → 1 → 4
Rationale:
• 3 (most appropriate): Hypokalemia <3.0 mEq/L can cause
cardiac dysrhythmias; immediate cardiac monitoring and
ECG assessment to detect changes (e.g., U waves, flattened
T waves) is priority.
• 2: Holding further loop diuretic doses and notifying the
prescriber is appropriate to prevent further potassium loss.
• 1: Administering a large oral potassium bolus (40 mEq)
may be appropriate if ordered, but giving without
confirming orders or assessing ECG/IV access risks is less
immediate than monitoring and notifying. Also, IV
replacement may be required for severe hypokalemia—
must follow provider orders and facility protocol.
• 4 (least): Encouraging potassium-rich foods is appropriate
for prevention/maintenance but not an immediate
corrective action for severe hypokalemia.
, Teaching points: Furosemide causes renal potassium loss. Be
aware of interactions (e.g., digoxin toxicity risk with
hypokalemia).
3 (Multiple choice — single best answer)
A client with COPD uses albuterol inhaler PRN. Which statement
indicates correct teaching?
A. “I’ll space my inhaler puffs 10 seconds apart.”
B. “I’ll rinse my mouth after using the inhaler.”
C. “I’ll use the inhaler just before exercise when I have cough.”
D. “I’ll expect sedation after each inhalation.”
Correct answer: C
Rationale:
• Why C is correct: Albuterol is a short-acting beta2-agonist
used as a pre-exercise prophylactic to prevent
bronchospasm; using it before activity is appropriate.
• Why A is incorrect: Spacing puffs is typically 20–30
seconds for inhalers (or one minute) depending on device;
10 seconds is too short for optimal lung deposition.
(Teaching: wait ~20–30 seconds between puffs if no
specific device instructions.)
• Why B is incorrect: Rinsing the mouth is primarily required
after inhaled corticosteroids (to prevent thrush), not short-
acting beta2-agonists.
