NCLEX-RN Pharmacology Exam Prep:
Introduction to Pharmacology | 20 High-Yield MCQs &
Explanations
Question 1
Clinical Scenario
A nurse is preparing to administer a newly prescribed oral
medication to a 68-year-old client admitted with community-
acquired pneumonia. The client has a history of chronic kidney
disease, hypertension, and osteoarthritis. During medication
reconciliation, the client states, "I also take several herbal
supplements and an over-the-counter pain medicine every
day."
Question Stem
Which nursing action is the priority before administering the
prescribed medication?
A. Ask the client to take the herbal supplements at least 2 hours
after the prescription medication.
B. Complete a comprehensive medication reconciliation,
including prescription, over-the-counter, and herbal products.
,C. Advise the client to stop taking all over-the-counter
medications immediately.
D. Administer the medication as prescribed because herbal
supplements are considered natural products.
Correct Answer
Correct Answer: B. Complete a comprehensive medication
reconciliation, including prescription, over-the-counter, and
herbal products.
Detailed Rationale
Medication reconciliation is a critical safety process performed
whenever a client is admitted, transferred, or discharged. The
purpose is to identify all prescription medications, over-the-
counter (OTC) products, vitamins, and herbal supplements to
prevent drug interactions, duplicate therapy, contraindications,
and medication omissions. Many herbal products significantly
alter drug metabolism. For example, St. John's wort induces
hepatic CYP450 enzymes, reducing the effectiveness of many
medications, while ginkgo biloba and garlic may increase
bleeding risk when combined with anticoagulants. OTC NSAIDs
can worsen kidney function and increase blood pressure,
particularly in older adults with chronic kidney disease.
Option A is incorrect because spacing medications does not
eliminate clinically significant interactions. Option C is
,inappropriate because the nurse should first assess all
medications and collaborate with the provider before
recommending discontinuation. Option D is unsafe because
"natural" products may have potent pharmacologic effects and
clinically important interactions.
The nurse should verify allergies, assess renal and hepatic
function, compare the medication list with current
prescriptions, and notify the provider of any discrepancies
before medication administration. Thorough medication
reconciliation is one of the most effective strategies for
preventing medication errors and adverse drug events.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the purpose of medication reconciliation.
• Identify why herbal supplements should be included in
medication assessment.
• Prioritize nursing actions that reduce medication errors.
• Recognize potential drug-herbal interactions.
Medication Safety Focus: Medication Reconciliation
Question 2
Clinical Scenario
, A 74-year-old client with heart failure is prescribed an oral
medication eliminated primarily by the kidneys. Laboratory
results include:
• Serum creatinine: 2.3 mg/dL
• eGFR: 28 mL/min/1.73 m²
The nurse reviews the medication profile before administration.
Question Stem
Which pharmacokinetic principle should guide the nurse's
clinical judgment?
A. Renal impairment may decrease drug elimination, increasing
the risk for toxicity.
B. Renal impairment increases first-pass metabolism of
medications.
C. Renal impairment increases protein binding, reducing
adverse effects.
D. Renal impairment accelerates drug absorption from the
gastrointestinal tract.
Correct Answer
Correct Answer: A. Renal impairment may decrease drug
elimination, increasing the risk for toxicity.
Detailed Rationale
Introduction to Pharmacology | 20 High-Yield MCQs &
Explanations
Question 1
Clinical Scenario
A nurse is preparing to administer a newly prescribed oral
medication to a 68-year-old client admitted with community-
acquired pneumonia. The client has a history of chronic kidney
disease, hypertension, and osteoarthritis. During medication
reconciliation, the client states, "I also take several herbal
supplements and an over-the-counter pain medicine every
day."
Question Stem
Which nursing action is the priority before administering the
prescribed medication?
A. Ask the client to take the herbal supplements at least 2 hours
after the prescription medication.
B. Complete a comprehensive medication reconciliation,
including prescription, over-the-counter, and herbal products.
,C. Advise the client to stop taking all over-the-counter
medications immediately.
D. Administer the medication as prescribed because herbal
supplements are considered natural products.
Correct Answer
Correct Answer: B. Complete a comprehensive medication
reconciliation, including prescription, over-the-counter, and
herbal products.
Detailed Rationale
Medication reconciliation is a critical safety process performed
whenever a client is admitted, transferred, or discharged. The
purpose is to identify all prescription medications, over-the-
counter (OTC) products, vitamins, and herbal supplements to
prevent drug interactions, duplicate therapy, contraindications,
and medication omissions. Many herbal products significantly
alter drug metabolism. For example, St. John's wort induces
hepatic CYP450 enzymes, reducing the effectiveness of many
medications, while ginkgo biloba and garlic may increase
bleeding risk when combined with anticoagulants. OTC NSAIDs
can worsen kidney function and increase blood pressure,
particularly in older adults with chronic kidney disease.
Option A is incorrect because spacing medications does not
eliminate clinically significant interactions. Option C is
,inappropriate because the nurse should first assess all
medications and collaborate with the provider before
recommending discontinuation. Option D is unsafe because
"natural" products may have potent pharmacologic effects and
clinically important interactions.
The nurse should verify allergies, assess renal and hepatic
function, compare the medication list with current
prescriptions, and notify the provider of any discrepancies
before medication administration. Thorough medication
reconciliation is one of the most effective strategies for
preventing medication errors and adverse drug events.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the purpose of medication reconciliation.
• Identify why herbal supplements should be included in
medication assessment.
• Prioritize nursing actions that reduce medication errors.
• Recognize potential drug-herbal interactions.
Medication Safety Focus: Medication Reconciliation
Question 2
Clinical Scenario
, A 74-year-old client with heart failure is prescribed an oral
medication eliminated primarily by the kidneys. Laboratory
results include:
• Serum creatinine: 2.3 mg/dL
• eGFR: 28 mL/min/1.73 m²
The nurse reviews the medication profile before administration.
Question Stem
Which pharmacokinetic principle should guide the nurse's
clinical judgment?
A. Renal impairment may decrease drug elimination, increasing
the risk for toxicity.
B. Renal impairment increases first-pass metabolism of
medications.
C. Renal impairment increases protein binding, reducing
adverse effects.
D. Renal impairment accelerates drug absorption from the
gastrointestinal tract.
Correct Answer
Correct Answer: A. Renal impairment may decrease drug
elimination, increasing the risk for toxicity.
Detailed Rationale
