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
Questions
1 (Medication safety — Rights of med administration)
A nurse prepares to give oral atenolol (beta-blocker) to a 68-
year-old patient with hypertension. Before administration the
nurse notes the patient’s heart rate is 48 bpm (baseline 72
earlier). Which action is best?
A. Administer the atenolol and recheck the heart rate in 30
minutes.
B. Hold the atenolol and notify the prescriber. (Correct)
C. Give half the dose now and half in 4 hours.
D. Ask the patient if they “feel fine” and then administer as
ordered.
,Correct answer: B. Hold the atenolol and notify the prescriber.
Rationales:
A. Administer & recheck in 30 min — Incorrect. Beta-blockers
reduce heart rate via β₁ blockade; giving when HR <50 bpm risks
symptomatic bradycardia, hypotension, syncope. Immediate
action is to hold and notify prescriber. Patient safety principle:
withhold when vital sign contraindicates med.
B. Hold & notify — Correct. Holds dose because HR is below the
usual safety threshold (commonly <50–60 bpm depending on
policy) and reports to prescriber for further orders.
Pharmacodynamics: β₁ blockade decreases HR and AV
conduction.
C. Split dose — Incorrect. Splitting an immediate-release oral
beta-blocker dose is not a safe titration strategy and may still
produce bradycardia; no prescriber order supports it.
D. Ask if “feel fine” then administer — Incorrect. Subjective
patient report cannot replace objective vitals; patient may be
asymptomatic yet at risk. This violates rights of medication and
safe practice.
2 (Drug classification / contraindication)
A patient with a history of bilateral renal artery stenosis is
prescribed lisinopril. The nurse recognizes that lisinopril (an ACE
inhibitor) is contraindicated because it may cause:
A. Hyperkalemia and further decrease in renal perfusion.
(Correct)
,B. Bradycardia due to direct nodal blockade.
C. Neutropenia via bone marrow suppression.
D. Increased platelet aggregation and clotting.
Correct answer: A. Hyperkalemia and further decrease in renal
perfusion.
Rationales:
A. Hyperkalemia & decreased renal perfusion — Correct. ACE
inhibitors reduce angiotensin II → decreased efferent arteriolar
constriction → can precipitate acute renal failure in bilateral
renal artery stenosis; they also decrease aldosterone → risk of
hyperkalemia. Contraindication/precaution principle.
B. Bradycardia via nodal blockade — Incorrect. ACE inhibitors
do not cause direct AV nodal blockade; bradycardia is more
typical of beta-blockers, calcium channel blockers, digoxin.
C. Neutropenia via marrow suppression — Incorrect. ACE
inhibitors rarely cause neutropenia; severe
neutropenia/agranulocytosis is more associated with agents like
clozapine.
D. Increased platelet aggregation — Incorrect. ACE inhibitors
are not prothrombotic.
3 (Dosage calculation — IV infusion rate)
Ordered: D5W 1000 mL IV to infuse over 8 hours.
What is the infusion rate in mL/hr? (Round to whole number.)
A. 100 mL/hr
, B. 125 mL/hr (Correct)
C. 200 mL/hr
D. 150 mL/hr
Correct answer: B. 125 mL/hr.
Rationales & calculation:
Total volume ÷ total hours = 1000 mL ÷ 8 hr = 125 mL/hr.
A. 100 mL/hr = 800 mL in 8 hr (too slow).
B. 125 mL/hr = correct.
C. 200 mL/hr = 1600 mL in 8 hr (too fast). Risk: fluid overload.
D. 150 mL/hr = 1200 mL in 8 hr (too fast).
4 (Psychiatric drug — SSRI patient teaching)
A 24-year-old woman starts sertraline (an SSRI). Which teaching
point is most important for the nurse to reinforce at the first
follow-up?
A. “You can discontinue the medication abruptly if sexual side
effects occur.”
B. “It may take 4–6 weeks to notice full benefit; report
worsening mood or suicidal thoughts immediately.” (Correct)
C. “Always take with a high-fat meal to increase absorption.”
D. “Sertraline will cause immediate severe drowsiness—do not
drive for 2 weeks.”
Correct answer: B. It may take 4–6 weeks... report worsening
mood or suicidal thoughts immediately.
PN® Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
NURSING PHARMACOLOGY (ADVANCED — DRUG
ADMINISTRATION, DOSAGE & CATEGORIES). TEST BANK
Questions
1 (Medication safety — Rights of med administration)
A nurse prepares to give oral atenolol (beta-blocker) to a 68-
year-old patient with hypertension. Before administration the
nurse notes the patient’s heart rate is 48 bpm (baseline 72
earlier). Which action is best?
A. Administer the atenolol and recheck the heart rate in 30
minutes.
B. Hold the atenolol and notify the prescriber. (Correct)
C. Give half the dose now and half in 4 hours.
D. Ask the patient if they “feel fine” and then administer as
ordered.
,Correct answer: B. Hold the atenolol and notify the prescriber.
Rationales:
A. Administer & recheck in 30 min — Incorrect. Beta-blockers
reduce heart rate via β₁ blockade; giving when HR <50 bpm risks
symptomatic bradycardia, hypotension, syncope. Immediate
action is to hold and notify prescriber. Patient safety principle:
withhold when vital sign contraindicates med.
B. Hold & notify — Correct. Holds dose because HR is below the
usual safety threshold (commonly <50–60 bpm depending on
policy) and reports to prescriber for further orders.
Pharmacodynamics: β₁ blockade decreases HR and AV
conduction.
C. Split dose — Incorrect. Splitting an immediate-release oral
beta-blocker dose is not a safe titration strategy and may still
produce bradycardia; no prescriber order supports it.
D. Ask if “feel fine” then administer — Incorrect. Subjective
patient report cannot replace objective vitals; patient may be
asymptomatic yet at risk. This violates rights of medication and
safe practice.
2 (Drug classification / contraindication)
A patient with a history of bilateral renal artery stenosis is
prescribed lisinopril. The nurse recognizes that lisinopril (an ACE
inhibitor) is contraindicated because it may cause:
A. Hyperkalemia and further decrease in renal perfusion.
(Correct)
,B. Bradycardia due to direct nodal blockade.
C. Neutropenia via bone marrow suppression.
D. Increased platelet aggregation and clotting.
Correct answer: A. Hyperkalemia and further decrease in renal
perfusion.
Rationales:
A. Hyperkalemia & decreased renal perfusion — Correct. ACE
inhibitors reduce angiotensin II → decreased efferent arteriolar
constriction → can precipitate acute renal failure in bilateral
renal artery stenosis; they also decrease aldosterone → risk of
hyperkalemia. Contraindication/precaution principle.
B. Bradycardia via nodal blockade — Incorrect. ACE inhibitors
do not cause direct AV nodal blockade; bradycardia is more
typical of beta-blockers, calcium channel blockers, digoxin.
C. Neutropenia via marrow suppression — Incorrect. ACE
inhibitors rarely cause neutropenia; severe
neutropenia/agranulocytosis is more associated with agents like
clozapine.
D. Increased platelet aggregation — Incorrect. ACE inhibitors
are not prothrombotic.
3 (Dosage calculation — IV infusion rate)
Ordered: D5W 1000 mL IV to infuse over 8 hours.
What is the infusion rate in mL/hr? (Round to whole number.)
A. 100 mL/hr
, B. 125 mL/hr (Correct)
C. 200 mL/hr
D. 150 mL/hr
Correct answer: B. 125 mL/hr.
Rationales & calculation:
Total volume ÷ total hours = 1000 mL ÷ 8 hr = 125 mL/hr.
A. 100 mL/hr = 800 mL in 8 hr (too slow).
B. 125 mL/hr = correct.
C. 200 mL/hr = 1600 mL in 8 hr (too fast). Risk: fluid overload.
D. 150 mL/hr = 1200 mL in 8 hr (too fast).
4 (Psychiatric drug — SSRI patient teaching)
A 24-year-old woman starts sertraline (an SSRI). Which teaching
point is most important for the nurse to reinforce at the first
follow-up?
A. “You can discontinue the medication abruptly if sexual side
effects occur.”
B. “It may take 4–6 weeks to notice full benefit; report
worsening mood or suicidal thoughts immediately.” (Correct)
C. “Always take with a high-fat meal to increase absorption.”
D. “Sertraline will cause immediate severe drowsiness—do not
drive for 2 weeks.”
Correct answer: B. It may take 4–6 weeks... report worsening
mood or suicidal thoughts immediately.
