NCLEX-RN Introduction to Pharmacology
Practice Questions |
20 NGN Clinical Scenarios with Detailed Rationales | ATI
Pharmacology Made Easy | Nursing Exam Prep PDF
Introduction to Pharmacology - NCLEX-RN Practice Questions
Question 1
Clinical Scenario
A 72-year-old male client with a history of hypertension, type 2
diabetes, and stage 3 chronic kidney disease is admitted to the
medical-surgical unit with pneumonia. The healthcare provider
prescribes ceftriaxone 1 gram IV every 24 hours. The client's
laboratory results show: serum creatinine 2.1 mg/dL, BUN 32
mg/dL, eGFR 42 mL/min/1.73m², and serum potassium 5.1
mEq/L. The client reports taking lisinopril 20 mg daily and
metformin 1000 mg twice daily at home. The nurse reviews the
medication orders and notes the ceftriaxone prescription.
Question Stem
,Which action should the nurse take first?
A. Administer the ceftriaxone as prescribed
B. Request a dose adjustment for ceftriaxone
C. Hold the ceftriaxone and notify the healthcare provider
D. Administer the ceftriaxone and monitor renal function
Correct Answer
B. Request a dose adjustment for ceftriaxone
Detailed Rationale
Correct Answer Explanation: Ceftriaxone is primarily eliminated
renally, and in clients with renal impairment (eGFR < 60
mL/min/1.73m²), dose adjustment is necessary to prevent drug
accumulation and toxicity. The client's eGFR of 42
mL/min/1.73m² indicates moderate renal impairment, requiring
a dose reduction. The nurse should request a dose adjustment
based on renal function before administering the medication.
This is a priority action because administering a standard dose
could lead to neurotoxicity, seizures, or other adverse effects.
Incorrect Options:
• A. Administer the ceftriaxone as prescribed: This is unsafe
because the client has significant renal impairment
, requiring dose adjustment. Administering the full dose
without adjustment could lead to drug accumulation and
toxicity.
• C. Hold the ceftriaxone and notify the healthcare
provider: While notifying the provider is appropriate,
holding the medication completely may delay necessary
antibiotic therapy for pneumonia. Dose adjustment, not
complete discontinuation, is typically the preferred
approach.
• D. Administer the ceftriaxone and monitor renal
function: This is unsafe because it places the client at risk
for toxicity before monitoring is completed. The nurse
should address the dose adjustment before administration.
Pharmacology Principles: Ceftriaxone is a third-generation
cephalosporin that exhibits time-dependent bacterial killing. In
renal impairment, the elimination half-life increases from
approximately 6-9 hours to up to 20 hours, requiring dose
reduction to maintain safe serum concentrations. The drug is
normally 33-67% excreted unchanged in the urine.
Nursing Considerations: The nurse should calculate creatinine
clearance or assess eGFR before administering renally
eliminated medications. For ceftriaxone, the recommended
dose adjustment for clients with eGFR < 60 mL/min/1.73m² is
typically a reduced dose or extended dosing interval. The nurse
, should also monitor for signs of cephalosporin toxicity including
confusion, seizures, and altered mental status. Additionally, the
client's elevated potassium (5.1 mEq/L) may be related to the
lisinopril, an ACE inhibitor, which can cause hyperkalemia,
particularly in clients with renal impairment.
Medication Safety Implications: This scenario highlights the
importance of renal dosing in older adult clients with chronic
conditions. Polypharmacy in this population increases the risk
for drug-drug interactions and adverse effects. The nurse should
perform a thorough medication reconciliation and assess renal
function before administering new medications.
Patient Teaching Points: The nurse should educate the client
about the importance of renal function monitoring and the
signs of drug toxicity, including confusion, changes in mental
status, and seizure activity. The client should also be instructed
to report any unusual symptoms promptly.
Learning Objective
After completing this question, the learner should be able to:
• Identify clients at risk for medication toxicity due to renal
impairment
• Apply renal function parameters to determine the need for
dose adjustment
Practice Questions |
20 NGN Clinical Scenarios with Detailed Rationales | ATI
Pharmacology Made Easy | Nursing Exam Prep PDF
Introduction to Pharmacology - NCLEX-RN Practice Questions
Question 1
Clinical Scenario
A 72-year-old male client with a history of hypertension, type 2
diabetes, and stage 3 chronic kidney disease is admitted to the
medical-surgical unit with pneumonia. The healthcare provider
prescribes ceftriaxone 1 gram IV every 24 hours. The client's
laboratory results show: serum creatinine 2.1 mg/dL, BUN 32
mg/dL, eGFR 42 mL/min/1.73m², and serum potassium 5.1
mEq/L. The client reports taking lisinopril 20 mg daily and
metformin 1000 mg twice daily at home. The nurse reviews the
medication orders and notes the ceftriaxone prescription.
Question Stem
,Which action should the nurse take first?
A. Administer the ceftriaxone as prescribed
B. Request a dose adjustment for ceftriaxone
C. Hold the ceftriaxone and notify the healthcare provider
D. Administer the ceftriaxone and monitor renal function
Correct Answer
B. Request a dose adjustment for ceftriaxone
Detailed Rationale
Correct Answer Explanation: Ceftriaxone is primarily eliminated
renally, and in clients with renal impairment (eGFR < 60
mL/min/1.73m²), dose adjustment is necessary to prevent drug
accumulation and toxicity. The client's eGFR of 42
mL/min/1.73m² indicates moderate renal impairment, requiring
a dose reduction. The nurse should request a dose adjustment
based on renal function before administering the medication.
This is a priority action because administering a standard dose
could lead to neurotoxicity, seizures, or other adverse effects.
Incorrect Options:
• A. Administer the ceftriaxone as prescribed: This is unsafe
because the client has significant renal impairment
, requiring dose adjustment. Administering the full dose
without adjustment could lead to drug accumulation and
toxicity.
• C. Hold the ceftriaxone and notify the healthcare
provider: While notifying the provider is appropriate,
holding the medication completely may delay necessary
antibiotic therapy for pneumonia. Dose adjustment, not
complete discontinuation, is typically the preferred
approach.
• D. Administer the ceftriaxone and monitor renal
function: This is unsafe because it places the client at risk
for toxicity before monitoring is completed. The nurse
should address the dose adjustment before administration.
Pharmacology Principles: Ceftriaxone is a third-generation
cephalosporin that exhibits time-dependent bacterial killing. In
renal impairment, the elimination half-life increases from
approximately 6-9 hours to up to 20 hours, requiring dose
reduction to maintain safe serum concentrations. The drug is
normally 33-67% excreted unchanged in the urine.
Nursing Considerations: The nurse should calculate creatinine
clearance or assess eGFR before administering renally
eliminated medications. For ceftriaxone, the recommended
dose adjustment for clients with eGFR < 60 mL/min/1.73m² is
typically a reduced dose or extended dosing interval. The nurse
, should also monitor for signs of cephalosporin toxicity including
confusion, seizures, and altered mental status. Additionally, the
client's elevated potassium (5.1 mEq/L) may be related to the
lisinopril, an ACE inhibitor, which can cause hyperkalemia,
particularly in clients with renal impairment.
Medication Safety Implications: This scenario highlights the
importance of renal dosing in older adult clients with chronic
conditions. Polypharmacy in this population increases the risk
for drug-drug interactions and adverse effects. The nurse should
perform a thorough medication reconciliation and assess renal
function before administering new medications.
Patient Teaching Points: The nurse should educate the client
about the importance of renal function monitoring and the
signs of drug toxicity, including confusion, changes in mental
status, and seizure activity. The client should also be instructed
to report any unusual symptoms promptly.
Learning Objective
After completing this question, the learner should be able to:
• Identify clients at risk for medication toxicity due to renal
impairment
• Apply renal function parameters to determine the need for
dose adjustment
