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
Items
1 — Rights of medication (safety)
A patient is prescribed amoxicillin 500 mg PO. Before giving the
first dose the nurse notes in the chart “penicillin allergy —
hives.” Which is the nurse’s best action?
A. Give the amoxicillin; most penicillin allergies are mild.
B. Ask the patient to describe the allergic reaction and hold the
drug until clarified.
C. Call the pharmacy to check if amoxicillin is a penicillin
derivative and then give it.
D. Give a test dose of 50 mg and observe for reaction.
Correct: B
Rationales
, • A (incorrect): Unsafe. Hives indicates an IgE-mediated
reaction — giving amoxicillin could provoke urticaria or
anaphylaxis. Patient safety requires verification and
alternative therapy if allergy confirmed.
• B (correct): Best practice: verify allergy details (type,
timing, reaction). If reaction suggests true penicillin allergy,
hold and notify prescriber for alternative agent — this
follows med-administration rights (right patient, drug,
dose, route, time, and documentation; and allergy check).
• C (incorrect): Pharmacy check is helpful, but the nurse
must first clarify the allergy with the patient; reliance on
pharmacy alone delays immediate safety action.
• D (incorrect): Test dosing for penicillin allergies is not a
routine nursing action and can be dangerous without
prescriber and allergy-testing protocols.
2 — Look-alike/sound-alike error prevention
Which strategy best reduces medication errors related to look-
alike drug names?
A. Store all high-risk meds together to simplify access.
B. Use Tall Man lettering and separate storage.
C. Allow verbal orders for these drugs to save time.
D. Substitute the drug with a similar sounding generic name.
Correct: B
,Rationales
• A (incorrect): Storing similar-appearing drugs together
increases risk of selection errors.
• B (correct): Tall Man lettering (e.g., predniSONE vs
predniSOLONE) and separate storage of look-alike/sound-
alike drugs are evidence-based risk-reduction strategies.
They reduce visual confusion and selection errors.
• C (incorrect): Verbal orders increase risk of
miscommunication, especially for sound-alike names.
Avoid unless necessary and always read back.
• D (incorrect): Substituting names unsafely is not
acceptable; correct use of generic names can help but
substitution without prescriber approval is unsafe.
3 — ACE inhibitor (pharmacodynamics & contraindication)
Which statement correctly describes why lisinopril (an ACE
inhibitor) is contraindicated during pregnancy?
A. It causes uterine contractions that precipitate preterm labor.
B. It decreases placental perfusion by vasoconstriction.
C. It is teratogenic and can cause fetal renal failure and
oligohydramnios.
D. It causes maternal hyperglycemia that affects the fetus.
Correct: C
Rationales
, • A (incorrect): ACE inhibitors do not cause uterine
contractions.
• B (incorrect): ACE inhibitors cause vasodilation, not
vasoconstriction; the fetal harm mechanism is different.
• C (correct): ACE inhibitors cross the placenta and are
associated with fetal renal dysgenesis, oligohydramnios,
and fetal/neonatal renal failure — thus contraindicated in
pregnancy. This is a well-established safety principle.
• D (incorrect): ACE inhibitors are not associated with
maternal hyperglycemia as the mechanism of fetal harm.
(Teaching point: women of childbearing age should be
counseled and switched to pregnancy-safe antihypertensives.)
4 — IV infusion rate (basic calculation)
Order: Normal saline 1,000 mL IV to infuse over 8 hours. What
rate (mL/hr) should the nurse set on the infusion pump?
A. 100 mL/hr
B. 125 mL/hr
C. 150 mL/hr
D. 200 mL/hr
Correct: B — 125 mL/hr
Rationale (calculation shown)
• 1,000 mL ÷ 8 hr = 125.0 mL/hr.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
Items
1 — Rights of medication (safety)
A patient is prescribed amoxicillin 500 mg PO. Before giving the
first dose the nurse notes in the chart “penicillin allergy —
hives.” Which is the nurse’s best action?
A. Give the amoxicillin; most penicillin allergies are mild.
B. Ask the patient to describe the allergic reaction and hold the
drug until clarified.
C. Call the pharmacy to check if amoxicillin is a penicillin
derivative and then give it.
D. Give a test dose of 50 mg and observe for reaction.
Correct: B
Rationales
, • A (incorrect): Unsafe. Hives indicates an IgE-mediated
reaction — giving amoxicillin could provoke urticaria or
anaphylaxis. Patient safety requires verification and
alternative therapy if allergy confirmed.
• B (correct): Best practice: verify allergy details (type,
timing, reaction). If reaction suggests true penicillin allergy,
hold and notify prescriber for alternative agent — this
follows med-administration rights (right patient, drug,
dose, route, time, and documentation; and allergy check).
• C (incorrect): Pharmacy check is helpful, but the nurse
must first clarify the allergy with the patient; reliance on
pharmacy alone delays immediate safety action.
• D (incorrect): Test dosing for penicillin allergies is not a
routine nursing action and can be dangerous without
prescriber and allergy-testing protocols.
2 — Look-alike/sound-alike error prevention
Which strategy best reduces medication errors related to look-
alike drug names?
A. Store all high-risk meds together to simplify access.
B. Use Tall Man lettering and separate storage.
C. Allow verbal orders for these drugs to save time.
D. Substitute the drug with a similar sounding generic name.
Correct: B
,Rationales
• A (incorrect): Storing similar-appearing drugs together
increases risk of selection errors.
• B (correct): Tall Man lettering (e.g., predniSONE vs
predniSOLONE) and separate storage of look-alike/sound-
alike drugs are evidence-based risk-reduction strategies.
They reduce visual confusion and selection errors.
• C (incorrect): Verbal orders increase risk of
miscommunication, especially for sound-alike names.
Avoid unless necessary and always read back.
• D (incorrect): Substituting names unsafely is not
acceptable; correct use of generic names can help but
substitution without prescriber approval is unsafe.
3 — ACE inhibitor (pharmacodynamics & contraindication)
Which statement correctly describes why lisinopril (an ACE
inhibitor) is contraindicated during pregnancy?
A. It causes uterine contractions that precipitate preterm labor.
B. It decreases placental perfusion by vasoconstriction.
C. It is teratogenic and can cause fetal renal failure and
oligohydramnios.
D. It causes maternal hyperglycemia that affects the fetus.
Correct: C
Rationales
, • A (incorrect): ACE inhibitors do not cause uterine
contractions.
• B (incorrect): ACE inhibitors cause vasodilation, not
vasoconstriction; the fetal harm mechanism is different.
• C (correct): ACE inhibitors cross the placenta and are
associated with fetal renal dysgenesis, oligohydramnios,
and fetal/neonatal renal failure — thus contraindicated in
pregnancy. This is a well-established safety principle.
• D (incorrect): ACE inhibitors are not associated with
maternal hyperglycemia as the mechanism of fetal harm.
(Teaching point: women of childbearing age should be
counseled and switched to pregnancy-safe antihypertensives.)
4 — IV infusion rate (basic calculation)
Order: Normal saline 1,000 mL IV to infuse over 8 hours. What
rate (mL/hr) should the nurse set on the infusion pump?
A. 100 mL/hr
B. 125 mL/hr
C. 150 mL/hr
D. 200 mL/hr
Correct: B — 125 mL/hr
Rationale (calculation shown)
• 1,000 mL ÷ 8 hr = 125.0 mL/hr.
