Saunders Comprehensive Review for the NCLEX-
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) (Multiple choice — medication administration principles)
A nurse is preparing to administer scheduled morning
medications. According to the “five rights” and safe medication
administration, which action by the nurse is most important
immediately before giving an oral medication to a confused
older adult?
A. Crush the tablet and mix with applesauce to ensure
swallowing.
B. Ask the patient to state his name and date of birth; if unable,
check the wrist band and medical record.
C. Offer a full glass of juice to aid absorption.
D. Document administration after leaving the room so the
patient is not disturbed.
Correct answer: B
,Rationale:
B is correct — verifying identity (name and date of birth) is
central to the “right patient” and must be done immediately
before administration; if the patient cannot reliably state
identity, confirm using the wristband and chart. This prevents
wrong-patient errors and is a core safe-medication practice. A
(crushing without verifying that the drug is crushable) risks
altering drug release and absorption and may be
contraindicated for some formulations (e.g., enteric-coated or
extended-release). C is incorrect because routine administration
with juice is not universally indicated and may interact with
specific drugs (e.g., certain statins and grapefruit juice). D is
unsafe — documentation should be done immediately after
administration (or per agency policy), not deferred, because
delayed documentation can mask omissions or errors. (Aligns
with medication safety teaching and Saunders’ emphasis on
rights and safe practices.) Evolve
2) (Dosage calculation — NGN-style numeric entry)
An order: Furosemide (Lasix) 40 mg IV push STAT. On hand:
furosemide 20 mg/mL. How many milliliters should the nurse
prepare and administer?
Show calculation and final mL.
Correct answer: 2 mL
,Rationale / calculation (digit-by-digit):
Ordered dose = 40 mg. Concentration = 20 mg per 1 mL.
Divide ordered dose by concentration: 40 ÷ 20 = 2.
Thus prepare 2 mL.
Rationale: convert ordered dose to volume using the supplied
concentration. Administer IV push slowly per facility protocol to
avoid ototoxicity and hypotension (monitor BP and hearing in
high doses). Incorrect volumes (e.g., 1 mL or 4 mL) would result
in underdose or overdose. (Dosage calculation practice mirrors
Saunders examples emphasizing correct setup and unit
consistency.)
3) (Select-all-that-apply — anticoagulation nursing actions)
A patient is receiving continuous heparin infusion for DVT.
Which nursing actions are appropriate? (Select all that apply.)
A. Monitor aPTT (or institutional protocol monitoring test) at
prescribed intervals.
B. Hold heparin and notify the provider if platelet count drops
by >50% from baseline.
C. Expect to reverse bleeding with vitamin K if major bleeding
occurs.
D. Use a small-gauge needle and apply firm pressure after
injections to minimize bruising.
E. Use a preservative-containing heparin vial in neonates.
Correct answers: A, B, D
, Rationale:
A — correct: monitoring aPTT or institution-specific coagulation
tests guides heparin dosing. B — correct: a >50% drop in
platelets suggests heparin-induced thrombocytopenia (HIT) and
requires stopping heparin and notifying provider. C — incorrect:
vitamin K reverses warfarin, not heparin; protamine sulfate is
the antidote for heparin. D — correct: applying pressure after
injections (and using appropriate technique) helps reduce
hematoma/bruising. E — incorrect: use preservative-free
formulations in neonates/infants to avoid benzyl alcohol
toxicity; preservative-containing vials are avoided. (Consistent
with heparin prescribing information and nursing safety
practice.) FDA Access Data
4) (Multiple choice — cardiovascular pharmacology)
A patient with chronic stable angina is prescribed metoprolol
succinate. Which statement by the patient indicates
appropriate understanding of medication teaching?
A. “If I get dizzy when I stand up, I’ll stop taking the
medication.”
B. “I’ll check my heart rate each morning; I’ll call my provider if
it is under 60 beats/min.”
C. “I can stop taking this drug when my chest pain goes away.”
D. “This medication will immediately dissolve my chest pain
right away.”
PN® Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
1) (Multiple choice — medication administration principles)
A nurse is preparing to administer scheduled morning
medications. According to the “five rights” and safe medication
administration, which action by the nurse is most important
immediately before giving an oral medication to a confused
older adult?
A. Crush the tablet and mix with applesauce to ensure
swallowing.
B. Ask the patient to state his name and date of birth; if unable,
check the wrist band and medical record.
C. Offer a full glass of juice to aid absorption.
D. Document administration after leaving the room so the
patient is not disturbed.
Correct answer: B
,Rationale:
B is correct — verifying identity (name and date of birth) is
central to the “right patient” and must be done immediately
before administration; if the patient cannot reliably state
identity, confirm using the wristband and chart. This prevents
wrong-patient errors and is a core safe-medication practice. A
(crushing without verifying that the drug is crushable) risks
altering drug release and absorption and may be
contraindicated for some formulations (e.g., enteric-coated or
extended-release). C is incorrect because routine administration
with juice is not universally indicated and may interact with
specific drugs (e.g., certain statins and grapefruit juice). D is
unsafe — documentation should be done immediately after
administration (or per agency policy), not deferred, because
delayed documentation can mask omissions or errors. (Aligns
with medication safety teaching and Saunders’ emphasis on
rights and safe practices.) Evolve
2) (Dosage calculation — NGN-style numeric entry)
An order: Furosemide (Lasix) 40 mg IV push STAT. On hand:
furosemide 20 mg/mL. How many milliliters should the nurse
prepare and administer?
Show calculation and final mL.
Correct answer: 2 mL
,Rationale / calculation (digit-by-digit):
Ordered dose = 40 mg. Concentration = 20 mg per 1 mL.
Divide ordered dose by concentration: 40 ÷ 20 = 2.
Thus prepare 2 mL.
Rationale: convert ordered dose to volume using the supplied
concentration. Administer IV push slowly per facility protocol to
avoid ototoxicity and hypotension (monitor BP and hearing in
high doses). Incorrect volumes (e.g., 1 mL or 4 mL) would result
in underdose or overdose. (Dosage calculation practice mirrors
Saunders examples emphasizing correct setup and unit
consistency.)
3) (Select-all-that-apply — anticoagulation nursing actions)
A patient is receiving continuous heparin infusion for DVT.
Which nursing actions are appropriate? (Select all that apply.)
A. Monitor aPTT (or institutional protocol monitoring test) at
prescribed intervals.
B. Hold heparin and notify the provider if platelet count drops
by >50% from baseline.
C. Expect to reverse bleeding with vitamin K if major bleeding
occurs.
D. Use a small-gauge needle and apply firm pressure after
injections to minimize bruising.
E. Use a preservative-containing heparin vial in neonates.
Correct answers: A, B, D
, Rationale:
A — correct: monitoring aPTT or institution-specific coagulation
tests guides heparin dosing. B — correct: a >50% drop in
platelets suggests heparin-induced thrombocytopenia (HIT) and
requires stopping heparin and notifying provider. C — incorrect:
vitamin K reverses warfarin, not heparin; protamine sulfate is
the antidote for heparin. D — correct: applying pressure after
injections (and using appropriate technique) helps reduce
hematoma/bruising. E — incorrect: use preservative-free
formulations in neonates/infants to avoid benzyl alcohol
toxicity; preservative-containing vials are avoided. (Consistent
with heparin prescribing information and nursing safety
practice.) FDA Access Data
4) (Multiple choice — cardiovascular pharmacology)
A patient with chronic stable angina is prescribed metoprolol
succinate. Which statement by the patient indicates
appropriate understanding of medication teaching?
A. “If I get dizzy when I stand up, I’ll stop taking the
medication.”
B. “I’ll check my heart rate each morning; I’ll call my provider if
it is under 60 beats/min.”
C. “I can stop taking this drug when my chest pain goes away.”
D. “This medication will immediately dissolve my chest pain
right away.”
