NCLEX-RN Pharmacology Practice Questions
PDF |
Introduction to Pharmacology |
20 ATI & NGN-Style NCLEX Questions with
Detailed
Rationales |
Medication Safety, Drug
Interactions, Clinical Judgment, Nursing Exam
Study Guide
Question 1
Clinical Scenario
A 78-year-old male client with a history of hypertension, type 2
diabetes, and chronic kidney disease (Stage 3) is admitted to
the medical-surgical unit with pneumonia. The nurse is
reviewing the client's home medication list during medication
reconciliation. The client reports taking lisinopril 20 mg daily,
,metformin 1000 mg twice daily, and atorvastatin 40 mg daily.
The admitting physician orders intravenous ceftriaxone and oral
azithromycin for the pneumonia.
Question Stem
Which action should the nurse prioritize during medication
reconciliation?
A. Hold the atorvastatin due to potential drug interaction with
ceftriaxone
B. Request an order to hold the lisinopril due to acute kidney
injury risk
C. Verify the metformin dose with the provider given renal
impairment
D. Administer all home medications as scheduled without
changes
Correct Answer: C. Verify the metformin dose with the
provider given renal impairment
Detailed Rationale
Metformin is contraindicated or requires dose adjustment in
clients with renal impairment due to the risk of lactic acidosis, a
rare but potentially fatal adverse effect. The client's chronic
,kidney disease (Stage 3) with an estimated glomerular filtration
rate (eGFR) between 30-59 mL/min/1.73m² requires careful
evaluation of metformin therapy. The FDA recommends that
metformin be avoided or used with dose reduction when eGFR
is below 45 mL/min/1.73m². The nurse should verify the dose
with the provider and monitor renal function closely.
Option A is incorrect because atorvastatin does not have a
significant interaction with ceftriaxone requiring medication
holding. Option B, while lisinopril may affect renal function,
holding it without provider order is not the priority, especially
since the client has been stable on this medication. Option D is
dangerous because administering medications without
verification in the context of changing clinical status could lead
to adverse outcomes. This scenario illustrates the critical
nursing responsibility of medication reconciliation, particularly
when clients have comorbidities affecting drug metabolism and
excretion. The nurse should also monitor the client's renal
function, blood glucose levels, and signs of lactic acidosis such
as muscle pain, difficulty breathing, and gastrointestinal
distress.
Learning Objective
• Identify risk factors for metformin-associated lactic acidosis
, • Apply medication reconciliation principles for clients with
renal impairment
• Recognize when medication doses require verification
based on organ function
• Prioritize medication safety actions during care transitions
Medication Safety Focus
Medication reconciliation
Question 2
Clinical Scenario
A 65-year-old female client is receiving intravenous vancomycin
for a methicillin-resistant Staphylococcus aureus (MRSA)
infection. The nurse notes that the client reports feeling dizzy
and complains of ringing in her ears (tinnitus). The most recent
vancomycin trough level drawn 30 minutes before the fourth
dose is reported as 22 mcg/mL (therapeutic range: 10-20
mcg/mL). The client's serum creatinine has increased from 0.9
mg/dL to 1.6 mg/dL over the past 48 hours.
Question Stem
PDF |
Introduction to Pharmacology |
20 ATI & NGN-Style NCLEX Questions with
Detailed
Rationales |
Medication Safety, Drug
Interactions, Clinical Judgment, Nursing Exam
Study Guide
Question 1
Clinical Scenario
A 78-year-old male client with a history of hypertension, type 2
diabetes, and chronic kidney disease (Stage 3) is admitted to
the medical-surgical unit with pneumonia. The nurse is
reviewing the client's home medication list during medication
reconciliation. The client reports taking lisinopril 20 mg daily,
,metformin 1000 mg twice daily, and atorvastatin 40 mg daily.
The admitting physician orders intravenous ceftriaxone and oral
azithromycin for the pneumonia.
Question Stem
Which action should the nurse prioritize during medication
reconciliation?
A. Hold the atorvastatin due to potential drug interaction with
ceftriaxone
B. Request an order to hold the lisinopril due to acute kidney
injury risk
C. Verify the metformin dose with the provider given renal
impairment
D. Administer all home medications as scheduled without
changes
Correct Answer: C. Verify the metformin dose with the
provider given renal impairment
Detailed Rationale
Metformin is contraindicated or requires dose adjustment in
clients with renal impairment due to the risk of lactic acidosis, a
rare but potentially fatal adverse effect. The client's chronic
,kidney disease (Stage 3) with an estimated glomerular filtration
rate (eGFR) between 30-59 mL/min/1.73m² requires careful
evaluation of metformin therapy. The FDA recommends that
metformin be avoided or used with dose reduction when eGFR
is below 45 mL/min/1.73m². The nurse should verify the dose
with the provider and monitor renal function closely.
Option A is incorrect because atorvastatin does not have a
significant interaction with ceftriaxone requiring medication
holding. Option B, while lisinopril may affect renal function,
holding it without provider order is not the priority, especially
since the client has been stable on this medication. Option D is
dangerous because administering medications without
verification in the context of changing clinical status could lead
to adverse outcomes. This scenario illustrates the critical
nursing responsibility of medication reconciliation, particularly
when clients have comorbidities affecting drug metabolism and
excretion. The nurse should also monitor the client's renal
function, blood glucose levels, and signs of lactic acidosis such
as muscle pain, difficulty breathing, and gastrointestinal
distress.
Learning Objective
• Identify risk factors for metformin-associated lactic acidosis
, • Apply medication reconciliation principles for clients with
renal impairment
• Recognize when medication doses require verification
based on organ function
• Prioritize medication safety actions during care transitions
Medication Safety Focus
Medication reconciliation
Question 2
Clinical Scenario
A 65-year-old female client is receiving intravenous vancomycin
for a methicillin-resistant Staphylococcus aureus (MRSA)
infection. The nurse notes that the client reports feeling dizzy
and complains of ringing in her ears (tinnitus). The most recent
vancomycin trough level drawn 30 minutes before the fourth
dose is reported as 22 mcg/mL (therapeutic range: 10-20
mcg/mL). The client's serum creatinine has increased from 0.9
mg/dL to 1.6 mg/dL over the past 48 hours.
Question Stem
