ATI RN PHARMACOLOGY| 9TH EDITION (Author:Alissa Althoff)|
MEDICATION SAFETY |EXAMINATION GUIDE| DUE JULY 2026
(QUESTIONS and CORRECT ANSWERS)
,1. A 72-year-old patient with chronic kidney disease (eGFR 25
mL/min/1.73m²) is prescribed apixaban 5 mg twice daily for stroke
prevention in atrial fibrillation. Which medication safety action is most
critical?
A. Administer the medication as prescribed, as no dose adjustment is
needed.
B. Reduce the dose to 2.5 mg twice daily based on renal function.
C. Hold the dose and monitor for signs of bleeding.
D. Switch to warfarin due to the risk of accumulation.
Correct Answer: B
Explanation: Apixaban requires dose reduction to 2.5 mg twice daily in
patients with at least two of the following: age ≥80 years, body weight
≤60 kg, or serum creatinine ≥1.5 mg/dL. In this case, age and renal
impairment indicate a need for dose adjustment. A is incorrect because
it ignores the dose adjustment criteria. C is inappropriate as a proactive
dose adjustment is indicated before bleeding occurs. D is incorrect
because apixaban is preferred in renal impairment over warfarin, which
can be more difficult to manage in such patients.
2. A patient on a continuous morphine infusion via a PCA pump is
exhibiting a respiratory rate of 6 breaths/min, pinpoint pupils, and a
sedation score of 4 (on a 0-4 scale). Which is the immediate priority
intervention?
A. Administer naloxone 0.4 mg IV rapidly and observe.
B. Titrate the naloxone dose to effect and prepare for repeated doses.
C. Stop the infusion and wait for the patient to wake up.
,D. Administer flumazenil to reverse any benzodiazepine effects.
Correct Answer: B
Explanation: The patient is showing signs of severe opioid-induced
respiratory depression. Naloxone should be titrated to effect (e.g., 0.04–
0.4 mg IV) to reverse respiratory depression without precipitating acute
withdrawal, especially in chronic opioid users. A is incorrect because a
rapid bolus may cause acute withdrawal and pulmonary edema. C is
unsafe and could lead to fatal apnea. D is incorrect because flumazenil
reverses benzodiazepines, not opioids.
3. A pharmacist receives a prescription for amiodarone loading dose.
Which baseline assessment is essential to prevent a serious adverse
effect associated with this therapy?
A. Serum potassium and magnesium levels.
B. Baseline liver function tests (ALT/AST).
C. Baseline pulmonary function tests (PFTs).
D. Serum creatinine and BUN.
Correct Answer: C
Explanation: Amiodarone can cause pulmonary toxicity, including
interstitial pneumonitis and fibrosis. Baseline PFTs and a chest X-ray are
recommended to establish a baseline for monitoring. A is important for
preventing torsades de pointes but is more crucial for drugs like
quinidine. B is monitored but is not the most essential baseline safety
assessment. D is relevant for renal clearance but not the primary safety
concern.
, 4. Which of the following best describes a "high-alert" medication
according to the Institute for Safe Medication Practices (ISMP)?
A. A medication with a narrow therapeutic index that requires
therapeutic drug monitoring.
B. A medication that has a heightened risk of causing significant patient
harm when used in error.
C. A medication that is classified as a controlled substance by the DEA.
D. A medication that is available only through a Risk Evaluation and
Mitigation Strategy (REMS).
Correct Answer: B
Explanation: ISMP defines high-alert medications as those that bear a
heightened risk of causing significant patient harm when used in error. A
refers to narrow therapeutic index drugs, which are a subset. C
describes controlled substances but not all are high-alert. D describes
REMS drugs, which have specific safety protocols but are not the
definition of high-alert.
5. A 45-year-old patient with a history of depression is started on
linezolid for a MRSA infection. Which food or medication interaction is
most concerning for this patient?
A. Concurrent use of acetaminophen.
B. Consumption of aged cheese or red wine.
C. Concurrent use of metoprolol.
D. Consumption of grapefruit juice.
Correct Answer: B
Explanation: Linezolid is a weak, reversible MAOI. Concurrent use with
tyramine-rich foods (aged cheese, cured meats, red wine) can
precipitate a hypertensive crisis. C is a concern because serotonergic
MEDICATION SAFETY |EXAMINATION GUIDE| DUE JULY 2026
(QUESTIONS and CORRECT ANSWERS)
,1. A 72-year-old patient with chronic kidney disease (eGFR 25
mL/min/1.73m²) is prescribed apixaban 5 mg twice daily for stroke
prevention in atrial fibrillation. Which medication safety action is most
critical?
A. Administer the medication as prescribed, as no dose adjustment is
needed.
B. Reduce the dose to 2.5 mg twice daily based on renal function.
C. Hold the dose and monitor for signs of bleeding.
D. Switch to warfarin due to the risk of accumulation.
Correct Answer: B
Explanation: Apixaban requires dose reduction to 2.5 mg twice daily in
patients with at least two of the following: age ≥80 years, body weight
≤60 kg, or serum creatinine ≥1.5 mg/dL. In this case, age and renal
impairment indicate a need for dose adjustment. A is incorrect because
it ignores the dose adjustment criteria. C is inappropriate as a proactive
dose adjustment is indicated before bleeding occurs. D is incorrect
because apixaban is preferred in renal impairment over warfarin, which
can be more difficult to manage in such patients.
2. A patient on a continuous morphine infusion via a PCA pump is
exhibiting a respiratory rate of 6 breaths/min, pinpoint pupils, and a
sedation score of 4 (on a 0-4 scale). Which is the immediate priority
intervention?
A. Administer naloxone 0.4 mg IV rapidly and observe.
B. Titrate the naloxone dose to effect and prepare for repeated doses.
C. Stop the infusion and wait for the patient to wake up.
,D. Administer flumazenil to reverse any benzodiazepine effects.
Correct Answer: B
Explanation: The patient is showing signs of severe opioid-induced
respiratory depression. Naloxone should be titrated to effect (e.g., 0.04–
0.4 mg IV) to reverse respiratory depression without precipitating acute
withdrawal, especially in chronic opioid users. A is incorrect because a
rapid bolus may cause acute withdrawal and pulmonary edema. C is
unsafe and could lead to fatal apnea. D is incorrect because flumazenil
reverses benzodiazepines, not opioids.
3. A pharmacist receives a prescription for amiodarone loading dose.
Which baseline assessment is essential to prevent a serious adverse
effect associated with this therapy?
A. Serum potassium and magnesium levels.
B. Baseline liver function tests (ALT/AST).
C. Baseline pulmonary function tests (PFTs).
D. Serum creatinine and BUN.
Correct Answer: C
Explanation: Amiodarone can cause pulmonary toxicity, including
interstitial pneumonitis and fibrosis. Baseline PFTs and a chest X-ray are
recommended to establish a baseline for monitoring. A is important for
preventing torsades de pointes but is more crucial for drugs like
quinidine. B is monitored but is not the most essential baseline safety
assessment. D is relevant for renal clearance but not the primary safety
concern.
, 4. Which of the following best describes a "high-alert" medication
according to the Institute for Safe Medication Practices (ISMP)?
A. A medication with a narrow therapeutic index that requires
therapeutic drug monitoring.
B. A medication that has a heightened risk of causing significant patient
harm when used in error.
C. A medication that is classified as a controlled substance by the DEA.
D. A medication that is available only through a Risk Evaluation and
Mitigation Strategy (REMS).
Correct Answer: B
Explanation: ISMP defines high-alert medications as those that bear a
heightened risk of causing significant patient harm when used in error. A
refers to narrow therapeutic index drugs, which are a subset. C
describes controlled substances but not all are high-alert. D describes
REMS drugs, which have specific safety protocols but are not the
definition of high-alert.
5. A 45-year-old patient with a history of depression is started on
linezolid for a MRSA infection. Which food or medication interaction is
most concerning for this patient?
A. Concurrent use of acetaminophen.
B. Consumption of aged cheese or red wine.
C. Concurrent use of metoprolol.
D. Consumption of grapefruit juice.
Correct Answer: B
Explanation: Linezolid is a weak, reversible MAOI. Concurrent use with
tyramine-rich foods (aged cheese, cured meats, red wine) can
precipitate a hypertensive crisis. C is a concern because serotonergic
