ATI Pharmacology & NGN NCLEX Prep:
20 Medication Safety Scenarios with
Rationales |
High-Alert Drugs, Clinical Judgment & Test
Bank
Question 1
Clinical Scenario
A 72-year-old male client with a history of heart failure,
hypertension, and chronic kidney disease (Stage 3) is admitted
to the medical-surgical unit. The nurse is performing medication
reconciliation and notes the client takes lisinopril 20 mg daily,
furosemide 40 mg daily, and potassium chloride 20 mEq daily.
The client's morning laboratory results show: serum potassium
5.8 mEq/L, BUN 32 mg/dL, creatinine 2.1 mg/dL, and eGFR 42
mL/min/1.73m². The client reports generalized weakness and
nausea.
Question Stem
Which action should the nurse take FIRST?
,A. Administer the scheduled lisinopril as ordered.
B. Hold the potassium chloride supplement and notify the
healthcare provider.
C. Administer furosemide to promote potassium excretion.
D. Encourage the client to increase oral fluid intake.
Correct Answer: B. Hold the potassium chloride supplement
and notify the healthcare provider.
Detailed Rationale
The correct answer is to hold the potassium chloride
supplement and notify the healthcare provider. The client has
hyperkalemia with a serum potassium of 5.8 mEq/L, which
exceeds the normal range of 3.5-5.0 mEq/L. Hyperkalemia is a
medical emergency that can lead to fatal cardiac arrhythmias,
including ventricular fibrillation and asystole. The client's
symptoms of weakness and nausea are consistent with
hyperkalemia. ACE inhibitors like lisinopril can cause
hyperkalemia by reducing aldosterone secretion, which
decreases potassium excretion. Additionally, the client's renal
impairment (Stage 3 CKD with eGFR 42 mL/min/1.73m²) impairs
potassium excretion. Potassium chloride supplementation is
contraindicated in the presence of hyperkalemia and must be
held immediately.
,Option A is incorrect because administering lisinopril would
further increase potassium levels and is not the priority action.
Option C is incorrect because while furosemide does promote
potassium excretion, administering it without addressing the
potassium supplement and without provider notification is
inappropriate. Option D is incorrect because increasing fluid
intake does not address hyperkalemia and could worsen fluid
overload in a heart failure patient.
Nursing considerations include: monitoring ECG for peaked T
waves, widened QRS, and prolonged PR interval; assessing for
muscle weakness and paresthesia; and preparing for potential
interventions such as calcium gluconate, insulin with dextrose,
or sodium polystyrene sulfonate as ordered.
Learning Objective
After completing this question, the learner should be able to:
• Identify hyperkalemia as an adverse effect of ACE
inhibitors and potassium supplements.
• Recognize signs and symptoms of electrolyte imbalances in
clients with renal impairment.
• Prioritize nursing actions for abnormal laboratory values.
• Implement medication safety principles when managing
clients on potassium supplements.
, Medication Safety Focus: High-alert medication (potassium
supplements), adverse effect (hyperkalemia), and laboratory
monitoring.
Question 2
Clinical Scenario
A 45-year-old female client with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. She is newly
diagnosed and asks the nurse about the medication. The client
expresses concern because she has read about "serious side
effects" online.
Question Stem
Which statement by the client indicates correct understanding
of methotrexate therapy?
A. "I should take this medication with my morning coffee on an
empty stomach."
B. "I can stop taking this medication if I start feeling better."
C. "I need to take folic acid supplements daily as prescribed to
help prevent side effects."
D. "I should take this medication every day to control my
symptoms."
20 Medication Safety Scenarios with
Rationales |
High-Alert Drugs, Clinical Judgment & Test
Bank
Question 1
Clinical Scenario
A 72-year-old male client with a history of heart failure,
hypertension, and chronic kidney disease (Stage 3) is admitted
to the medical-surgical unit. The nurse is performing medication
reconciliation and notes the client takes lisinopril 20 mg daily,
furosemide 40 mg daily, and potassium chloride 20 mEq daily.
The client's morning laboratory results show: serum potassium
5.8 mEq/L, BUN 32 mg/dL, creatinine 2.1 mg/dL, and eGFR 42
mL/min/1.73m². The client reports generalized weakness and
nausea.
Question Stem
Which action should the nurse take FIRST?
,A. Administer the scheduled lisinopril as ordered.
B. Hold the potassium chloride supplement and notify the
healthcare provider.
C. Administer furosemide to promote potassium excretion.
D. Encourage the client to increase oral fluid intake.
Correct Answer: B. Hold the potassium chloride supplement
and notify the healthcare provider.
Detailed Rationale
The correct answer is to hold the potassium chloride
supplement and notify the healthcare provider. The client has
hyperkalemia with a serum potassium of 5.8 mEq/L, which
exceeds the normal range of 3.5-5.0 mEq/L. Hyperkalemia is a
medical emergency that can lead to fatal cardiac arrhythmias,
including ventricular fibrillation and asystole. The client's
symptoms of weakness and nausea are consistent with
hyperkalemia. ACE inhibitors like lisinopril can cause
hyperkalemia by reducing aldosterone secretion, which
decreases potassium excretion. Additionally, the client's renal
impairment (Stage 3 CKD with eGFR 42 mL/min/1.73m²) impairs
potassium excretion. Potassium chloride supplementation is
contraindicated in the presence of hyperkalemia and must be
held immediately.
,Option A is incorrect because administering lisinopril would
further increase potassium levels and is not the priority action.
Option C is incorrect because while furosemide does promote
potassium excretion, administering it without addressing the
potassium supplement and without provider notification is
inappropriate. Option D is incorrect because increasing fluid
intake does not address hyperkalemia and could worsen fluid
overload in a heart failure patient.
Nursing considerations include: monitoring ECG for peaked T
waves, widened QRS, and prolonged PR interval; assessing for
muscle weakness and paresthesia; and preparing for potential
interventions such as calcium gluconate, insulin with dextrose,
or sodium polystyrene sulfonate as ordered.
Learning Objective
After completing this question, the learner should be able to:
• Identify hyperkalemia as an adverse effect of ACE
inhibitors and potassium supplements.
• Recognize signs and symptoms of electrolyte imbalances in
clients with renal impairment.
• Prioritize nursing actions for abnormal laboratory values.
• Implement medication safety principles when managing
clients on potassium supplements.
, Medication Safety Focus: High-alert medication (potassium
supplements), adverse effect (hyperkalemia), and laboratory
monitoring.
Question 2
Clinical Scenario
A 45-year-old female client with rheumatoid arthritis has been
prescribed methotrexate 15 mg orally once weekly. She is newly
diagnosed and asks the nurse about the medication. The client
expresses concern because she has read about "serious side
effects" online.
Question Stem
Which statement by the client indicates correct understanding
of methotrexate therapy?
A. "I should take this medication with my morning coffee on an
empty stomach."
B. "I can stop taking this medication if I start feeling better."
C. "I need to take folic acid supplements daily as prescribed to
help prevent side effects."
D. "I should take this medication every day to control my
symptoms."
