• ATI Pharmacology Made Easy:
• 20 Original NCLEX-RN Style Questions with
Clinical Scenarios & Rationales
Question 1
Clinical Scenario
A 68-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 community-acquired pneumonia.
The healthcare provider prescribes ceftriaxone 1 gram IV every
24 hours. The nurse reviews the client's medication
administration record and notes that the client received
vancomycin 1 gram IV 6 hours ago for a prior infection. The
client's current vital signs are: temperature 38.2°C (100.8°F),
heart rate 92 bpm, blood pressure 142/88 mmHg, respiratory
rate 22/min, and oxygen saturation 94% on room air. Laboratory
results show serum creatinine 2.1 mg/dL (baseline 1.2 mg/dL),
BUN 42 mg/dL, and potassium 5.1 mEq/L.
,Question Stem
Which action should the nurse take first?
A. Administer the ceftriaxone as prescribed
B. Hold the ceftriaxone and contact the healthcare provider
C. Obtain a blood culture before administering the ceftriaxone
D. Administer normal saline 500 mL IV bolus before the
ceftriaxone
Correct Answer: B. Hold the ceftriaxone and contact the
healthcare provider
Detailed Rationale
The correct answer is to hold the ceftriaxone and contact the
healthcare provider. This client has multiple risk factors for
medication-related complications that require immediate
attention. First, the client has worsening renal function (serum
creatinine elevated from 1.2 to 2.1 mg/dL, BUN 42 mg/dL),
which impacts medication clearance and increases the risk of
adverse effects. Second, the client received vancomycin 6 hours
ago, which combined with ceftriaxone can potentiate
nephrotoxicity. Third, ceftriaxone carries significant risks
including potential precipitation with calcium-containing
,solutions and can exacerbate hyperkalemia in clients with renal
impairment.
Option A is incorrect because administering the medication
without addressing the renal impairment and potential drug
interaction would be unsafe. The nurse must verify the
appropriateness of the dose and timing given the client's acute
kidney injury. Option C, while obtaining blood cultures before
antibiotics is generally appropriate, is not the priority action
here because the medication safety concern must be addressed
first. Option D is incorrect because administering a fluid bolus
could worsen the client's fluid status and does not address the
primary concern of medication safety with impaired renal
function. The nurse should first hold the medication, assess the
client's fluid status, review the medication reconciliation, and
contact the healthcare provider for clarification regarding the
dose, timing, and need for alternative antibiotic therapy given
the client's renal impairment and recent vancomycin
administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify risk factors for medication-related nephrotoxicity
• Prioritize medication safety concerns over routine
interventions
, • Recognize the importance of medication reconciliation in
preventing adverse drug events
• Demonstrate appropriate nursing action when medication
safety is compromised
Medication Safety Focus
High-alert medication with renal toxicity potential
Question 2
Clinical Scenario
A 45-year-old female client is prescribed warfarin 5 mg orally
daily for atrial fibrillation. The client is being discharged home
and the nurse is providing medication education. The client
states, "I don't understand why I need to take this medication. I
feel fine and haven't had any problems with my heart." The
client's international normalized ratio (INR) from this morning is
2.3 (therapeutic range 2.0-3.0 for atrial fibrillation). The client's
medication list includes amiodarone 200 mg daily, lisinopril 10
mg daily, and levothyroxine 75 mcg daily.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
• 20 Original NCLEX-RN Style Questions with
Clinical Scenarios & Rationales
Question 1
Clinical Scenario
A 68-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 community-acquired pneumonia.
The healthcare provider prescribes ceftriaxone 1 gram IV every
24 hours. The nurse reviews the client's medication
administration record and notes that the client received
vancomycin 1 gram IV 6 hours ago for a prior infection. The
client's current vital signs are: temperature 38.2°C (100.8°F),
heart rate 92 bpm, blood pressure 142/88 mmHg, respiratory
rate 22/min, and oxygen saturation 94% on room air. Laboratory
results show serum creatinine 2.1 mg/dL (baseline 1.2 mg/dL),
BUN 42 mg/dL, and potassium 5.1 mEq/L.
,Question Stem
Which action should the nurse take first?
A. Administer the ceftriaxone as prescribed
B. Hold the ceftriaxone and contact the healthcare provider
C. Obtain a blood culture before administering the ceftriaxone
D. Administer normal saline 500 mL IV bolus before the
ceftriaxone
Correct Answer: B. Hold the ceftriaxone and contact the
healthcare provider
Detailed Rationale
The correct answer is to hold the ceftriaxone and contact the
healthcare provider. This client has multiple risk factors for
medication-related complications that require immediate
attention. First, the client has worsening renal function (serum
creatinine elevated from 1.2 to 2.1 mg/dL, BUN 42 mg/dL),
which impacts medication clearance and increases the risk of
adverse effects. Second, the client received vancomycin 6 hours
ago, which combined with ceftriaxone can potentiate
nephrotoxicity. Third, ceftriaxone carries significant risks
including potential precipitation with calcium-containing
,solutions and can exacerbate hyperkalemia in clients with renal
impairment.
Option A is incorrect because administering the medication
without addressing the renal impairment and potential drug
interaction would be unsafe. The nurse must verify the
appropriateness of the dose and timing given the client's acute
kidney injury. Option C, while obtaining blood cultures before
antibiotics is generally appropriate, is not the priority action
here because the medication safety concern must be addressed
first. Option D is incorrect because administering a fluid bolus
could worsen the client's fluid status and does not address the
primary concern of medication safety with impaired renal
function. The nurse should first hold the medication, assess the
client's fluid status, review the medication reconciliation, and
contact the healthcare provider for clarification regarding the
dose, timing, and need for alternative antibiotic therapy given
the client's renal impairment and recent vancomycin
administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify risk factors for medication-related nephrotoxicity
• Prioritize medication safety concerns over routine
interventions
, • Recognize the importance of medication reconciliation in
preventing adverse drug events
• Demonstrate appropriate nursing action when medication
safety is compromised
Medication Safety Focus
High-alert medication with renal toxicity potential
Question 2
Clinical Scenario
A 45-year-old female client is prescribed warfarin 5 mg orally
daily for atrial fibrillation. The client is being discharged home
and the nurse is providing medication education. The client
states, "I don't understand why I need to take this medication. I
feel fine and haven't had any problems with my heart." The
client's international normalized ratio (INR) from this morning is
2.3 (therapeutic range 2.0-3.0 for atrial fibrillation). The client's
medication list includes amiodarone 200 mg daily, lisinopril 10
mg daily, and levothyroxine 75 mcg daily.
Question Stem
Which statement by the client indicates understanding of the
medication teaching?
