• Comprehensive NCLEX Pharmacology Prep:
• 20 Medication Safety Questions with Next-
Gen Style Scenarios
Question 1
Clinical Scenario
A 72-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 admission. The client
reports taking lisinopril 20 mg daily, metformin 1000 mg twice
daily, and aspirin 81 mg daily. The client's admission serum
creatinine is 2.1 mg/dL (baseline 1.4 mg/dL) and potassium is
5.2 mEq/L. The healthcare provider orders continuation of
home medications.
Question Stem
Which medication order should the nurse question and discuss
with the healthcare provider?
Options
,A. Lisinopril 20 mg daily
B. Metformin 1000 mg twice daily
C. Aspirin 81 mg daily
D. Continue all home medications as ordered
Correct Answer
B. Metformin 1000 mg twice daily
Detailed Rationale
The correct answer is B. Metformin should be questioned due
to the client's acute kidney injury (serum creatinine elevated to
2.1 mg/dL from baseline 1.4 mg/dL) and the associated risk of
lactic acidosis. Metformin is contraindicated in clients with renal
impairment, particularly when serum creatinine exceeds 1.5
mg/dL in males or when the estimated glomerular filtration rate
(eGFR) falls below 30 mL/min/1.73m². The contrast dye used
during diagnostic studies or acute kidney injury further
increases the risk of metformin accumulation and lactic
acidosis, a rare but potentially fatal adverse effect. The nurse
should hold the metformin and notify the healthcare provider
for dose adjustment or alternative antidiabetic therapy.
,Option A is incorrect because although lisinopril is an ACE
inhibitor that can further increase potassium levels, the current
potassium of 5.2 mEq/L requires monitoring but is not an
absolute contraindication. However, with acute kidney injury,
the risk of hyperkalemia increases, and the nurse should
monitor closely. Option C is incorrect because low-dose aspirin
is appropriate for cardiovascular protection unless
contraindicated by active bleeding or allergy. Option D is
incorrect because it fails to recognize the need for medication
adjustment based on the client's changing clinical status. The
nurse's priority is medication safety and preventing adverse
drug events through careful medication reconciliation and
clinical judgment.
Learning Objectives
• Identify contraindications for metformin use in clients with
renal impairment.
• Recognize laboratory values that indicate acute kidney
injury.
• Apply clinical judgment to medication reconciliation during
hospitalization.
• Prioritize medication safety through questioning
inappropriate medication orders.
Medication Safety Focus
, Contraindication - Renal impairment and metformin-associated
lactic acidosis risk
Question 2
Clinical Scenario
A 45-year-old female client is admitted to the emergency
department with severe headache, nausea, and blurred vision.
The client reports taking ibuprofen 800 mg three times daily for
chronic back pain for the past three months. The client's blood
pressure is 158/94 mmHg, heart rate is 92 bpm, and
temperature is 98.6°F. The client has no known drug allergies.
The healthcare provider orders ketorolac 30 mg IV for pain
management.
Question Stem
Which nursing action is most appropriate before administering
ketorolac?
Options
A. Administer the medication as ordered without additional
assessment
B. Assess the client's pain level using a numeric rating scale
C. Review the client's most recent complete blood count and
renal function tests
• 20 Medication Safety Questions with Next-
Gen Style Scenarios
Question 1
Clinical Scenario
A 72-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 admission. The client
reports taking lisinopril 20 mg daily, metformin 1000 mg twice
daily, and aspirin 81 mg daily. The client's admission serum
creatinine is 2.1 mg/dL (baseline 1.4 mg/dL) and potassium is
5.2 mEq/L. The healthcare provider orders continuation of
home medications.
Question Stem
Which medication order should the nurse question and discuss
with the healthcare provider?
Options
,A. Lisinopril 20 mg daily
B. Metformin 1000 mg twice daily
C. Aspirin 81 mg daily
D. Continue all home medications as ordered
Correct Answer
B. Metformin 1000 mg twice daily
Detailed Rationale
The correct answer is B. Metformin should be questioned due
to the client's acute kidney injury (serum creatinine elevated to
2.1 mg/dL from baseline 1.4 mg/dL) and the associated risk of
lactic acidosis. Metformin is contraindicated in clients with renal
impairment, particularly when serum creatinine exceeds 1.5
mg/dL in males or when the estimated glomerular filtration rate
(eGFR) falls below 30 mL/min/1.73m². The contrast dye used
during diagnostic studies or acute kidney injury further
increases the risk of metformin accumulation and lactic
acidosis, a rare but potentially fatal adverse effect. The nurse
should hold the metformin and notify the healthcare provider
for dose adjustment or alternative antidiabetic therapy.
,Option A is incorrect because although lisinopril is an ACE
inhibitor that can further increase potassium levels, the current
potassium of 5.2 mEq/L requires monitoring but is not an
absolute contraindication. However, with acute kidney injury,
the risk of hyperkalemia increases, and the nurse should
monitor closely. Option C is incorrect because low-dose aspirin
is appropriate for cardiovascular protection unless
contraindicated by active bleeding or allergy. Option D is
incorrect because it fails to recognize the need for medication
adjustment based on the client's changing clinical status. The
nurse's priority is medication safety and preventing adverse
drug events through careful medication reconciliation and
clinical judgment.
Learning Objectives
• Identify contraindications for metformin use in clients with
renal impairment.
• Recognize laboratory values that indicate acute kidney
injury.
• Apply clinical judgment to medication reconciliation during
hospitalization.
• Prioritize medication safety through questioning
inappropriate medication orders.
Medication Safety Focus
, Contraindication - Renal impairment and metformin-associated
lactic acidosis risk
Question 2
Clinical Scenario
A 45-year-old female client is admitted to the emergency
department with severe headache, nausea, and blurred vision.
The client reports taking ibuprofen 800 mg three times daily for
chronic back pain for the past three months. The client's blood
pressure is 158/94 mmHg, heart rate is 92 bpm, and
temperature is 98.6°F. The client has no known drug allergies.
The healthcare provider orders ketorolac 30 mg IV for pain
management.
Question Stem
Which nursing action is most appropriate before administering
ketorolac?
Options
A. Administer the medication as ordered without additional
assessment
B. Assess the client's pain level using a numeric rating scale
C. Review the client's most recent complete blood count and
renal function tests
