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
1 (Medication Rights — single-best-answer)
A nurse prepares to give a new oral medication to a confused
older adult who is unable to swallow. The medication is
available only as an immediate-release tablet. The nurse’s best
action is to:
A. Crush the tablet and administer it with applesauce.
B. Ask the charge nurse to have the medication converted to an
alternative form (e.g., liquid) or hold and notify prescriber.
C. Hold the medication indefinitely without documentation.
D. Administer the tablet via enteral tube without checking tube
placement because the patient is NPO.
Correct answer: B
Rationales
, • A (Incorrect). Crushing a medication may be inappropriate
(enteric/coated, extended-release) and can alter
absorption and safety. Crushing without checking
compatibility with swallowing/absorption and without
prescriber/pharmacy approval violates the right action and
may cause harm.
• B (Correct). The nurse should request an alternative form
(liquid), consult pharmacy, or contact the prescriber to
change formulation or route. This follows the rights of
medication administration (right drug, right route, right
form) and prevents an unsafe practice.
• C (Incorrect). Holding without documentation and without
notifying prescriber or pharmacist is unsafe and violates
accountability. Holding must be documented and
communicated with prescriber and pharmacy.
• D (Incorrect). Administering without verifying tube
placement risks aspiration or pneumothorax; also, crushing
tablets and giving via tube may be contraindicated for
some formulations. Always verify route compatibility and
tube placement.
2 (Medication Error Prevention — single-best-answer)
Which strategy most effectively reduces medication errors
when administering high-alert medications (e.g., heparin,
insulin)?
,A. Allowing verbal orders from any licensed staff during busy
times.
B. Using standardized order sets, independent double-checks,
and barcode medication administration (BCMA).
C. Relying on memory and handwritten notes for calculations.
D. Rotating staff frequently so everyone gains exposure to all
high-alert meds.
Correct answer: B
Rationales
• A (Incorrect). Verbal orders increase risk for transcription
errors; high-alert meds should have written/electronic
orders and read-back when verbalization is unavoidable.
• B (Correct). Standardized order sets, independent double-
checks for high-risk drugs, and barcode scanning decrease
human error and improve safety — evidence-based best
practices.
• C (Incorrect). Memory and handwritten notes are error-
prone. Use calculators, EMR dosing aids, and double-
checks instead.
• D (Incorrect). Rotating staff doesn't address system
safeguards and may increase risk if staff are less familiar
with specific protocols. Competency and safeguards matter
more.
, 3 (Patient Teaching — ACE inhibitor)
A patient is prescribed lisinopril. Which statement by the
patient indicates the need for further teaching?
A. “If I get a dry cough, I should tell my provider.”
B. “I’ll avoid taking potassium supplements unless my provider
says it’s okay.”
C. “If I become pregnant, I should keep taking lisinopril because
it’s safe.”
D. “I will monitor for facial swelling and seek immediate help if
it occurs.”
Correct answer: C
Rationales
• A (Incorrect). A persistent dry cough is a common adverse
effect due to increased bradykinin; patient should report it
as an indication to evaluate therapy.
• B (Incorrect). ACE inhibitors can cause hyperkalemia; the
patient should avoid potassium supplements or potassium-
sparing diuretics unless approved by the provider.
• C (Correct). ACE inhibitors are teratogenic (can cause fetal
renal damage and other malformations). Pregnancy is a
contraindication — patient must stop and notify provider
immediately. The statement indicates misunderstanding.
• D (Incorrect). Angioedema (facial/lip/tongue swelling) is a
rare but serious adverse effect; immediate medical
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
1 (Medication Rights — single-best-answer)
A nurse prepares to give a new oral medication to a confused
older adult who is unable to swallow. The medication is
available only as an immediate-release tablet. The nurse’s best
action is to:
A. Crush the tablet and administer it with applesauce.
B. Ask the charge nurse to have the medication converted to an
alternative form (e.g., liquid) or hold and notify prescriber.
C. Hold the medication indefinitely without documentation.
D. Administer the tablet via enteral tube without checking tube
placement because the patient is NPO.
Correct answer: B
Rationales
, • A (Incorrect). Crushing a medication may be inappropriate
(enteric/coated, extended-release) and can alter
absorption and safety. Crushing without checking
compatibility with swallowing/absorption and without
prescriber/pharmacy approval violates the right action and
may cause harm.
• B (Correct). The nurse should request an alternative form
(liquid), consult pharmacy, or contact the prescriber to
change formulation or route. This follows the rights of
medication administration (right drug, right route, right
form) and prevents an unsafe practice.
• C (Incorrect). Holding without documentation and without
notifying prescriber or pharmacist is unsafe and violates
accountability. Holding must be documented and
communicated with prescriber and pharmacy.
• D (Incorrect). Administering without verifying tube
placement risks aspiration or pneumothorax; also, crushing
tablets and giving via tube may be contraindicated for
some formulations. Always verify route compatibility and
tube placement.
2 (Medication Error Prevention — single-best-answer)
Which strategy most effectively reduces medication errors
when administering high-alert medications (e.g., heparin,
insulin)?
,A. Allowing verbal orders from any licensed staff during busy
times.
B. Using standardized order sets, independent double-checks,
and barcode medication administration (BCMA).
C. Relying on memory and handwritten notes for calculations.
D. Rotating staff frequently so everyone gains exposure to all
high-alert meds.
Correct answer: B
Rationales
• A (Incorrect). Verbal orders increase risk for transcription
errors; high-alert meds should have written/electronic
orders and read-back when verbalization is unavoidable.
• B (Correct). Standardized order sets, independent double-
checks for high-risk drugs, and barcode scanning decrease
human error and improve safety — evidence-based best
practices.
• C (Incorrect). Memory and handwritten notes are error-
prone. Use calculators, EMR dosing aids, and double-
checks instead.
• D (Incorrect). Rotating staff doesn't address system
safeguards and may increase risk if staff are less familiar
with specific protocols. Competency and safeguards matter
more.
, 3 (Patient Teaching — ACE inhibitor)
A patient is prescribed lisinopril. Which statement by the
patient indicates the need for further teaching?
A. “If I get a dry cough, I should tell my provider.”
B. “I’ll avoid taking potassium supplements unless my provider
says it’s okay.”
C. “If I become pregnant, I should keep taking lisinopril because
it’s safe.”
D. “I will monitor for facial swelling and seek immediate help if
it occurs.”
Correct answer: C
Rationales
• A (Incorrect). A persistent dry cough is a common adverse
effect due to increased bradykinin; patient should report it
as an indication to evaluate therapy.
• B (Incorrect). ACE inhibitors can cause hyperkalemia; the
patient should avoid potassium supplements or potassium-
sparing diuretics unless approved by the provider.
• C (Correct). ACE inhibitors are teratogenic (can cause fetal
renal damage and other malformations). Pregnancy is a
contraindication — patient must stop and notify provider
immediately. The statement indicates misunderstanding.
• D (Incorrect). Angioedema (facial/lip/tongue swelling) is a
rare but serious adverse effect; immediate medical
