Pharmacology Made Incredibly Easy
5th Edition
• Author(s)Cherie R. Rebar; Nicole M.
Heimgartner; Carolyn Gersch
NCLEX-RN Pharmacology Practice
Questions
Introduction to Pharmacology
,Test Bank
Question 1
Clinical Scenario
A nurse is preparing morning medications for a 78-year-old client who
has hypertension, type 2 diabetes mellitus, and osteoarthritis. The
medication administration record lists metformin, lisinopril, and
ibuprofen as prescribed medications. During medication reconciliation,
the client reports taking an over-the-counter cold remedy containing
pseudoephedrine several times during the week. The nurse notes a
blood pressure of 166/88 mm Hg.
Question Stem
Which action should the nurse take first?
A. Administer all prescribed medications and reassess the blood
pressure in 1 hour.
,B. Hold metformin because the client is older than 65 years.
C. Notify the provider about the client's use of pseudoephedrine and
elevated blood pressure.
D. Instruct the client to discontinue lisinopril until the blood pressure
decreases.
Correct Answer
Correct Answer: C. Notify the provider about the client's use of
pseudoephedrine and elevated blood pressure.
Detailed Rationale
Pseudoephedrine is a sympathomimetic decongestant that can increase
vascular tone and may raise blood pressure. The client's medication
history and elevated blood pressure require clinical review before
simply proceeding with routine administration. Medication
reconciliation is designed to identify prescription, OTC, and
complementary medications that can affect treatment safety. The nurse
should communicate the relevant finding to the prescribing provider
and reinforce the importance of reporting OTC products.
Option A is incorrect because administering all medications without
addressing a potentially contributing medication interaction could delay
treatment of the elevated blood pressure. Option B is incorrect because
age alone is not a reason to withhold metformin; renal function and the
client's overall clinical status are more relevant. Option D is incorrect
because the nurse should not independently discontinue an
antihypertensive medication.
This scenario illustrates pharmacodynamic interaction: two agents can
produce opposing or additive physiologic effects even though one is a
, prescription drug and the other is OTC. Older adults are particularly
vulnerable to adverse medication effects because multiple medications
and age-related physiologic changes can increase medication-related
risk.
Learning Objective
After completing this question, the learner should be able to:
• Identify clinically significant OTC medication interactions.
• Apply medication reconciliation principles.
• Recognize when additional medication review is required before
administration.
Medication Safety Focus: Medication reconciliation
Question 2
Clinical Scenario
A nurse is preparing to administer insulin lispro to a 10-year-old child
with type 1 diabetes mellitus. The child's blood glucose is 248 mg/dL.
The child has an order for rapid-acting insulin before meals. The
breakfast tray has not yet arrived, and the child tells the nurse, "I'm not
hungry."
Question Stem
Which action should the nurse take?
A. Administer the insulin now because the blood glucose is elevated.
B. Administer half of the prescribed dose and give the remaining dose
later.
5th Edition
• Author(s)Cherie R. Rebar; Nicole M.
Heimgartner; Carolyn Gersch
NCLEX-RN Pharmacology Practice
Questions
Introduction to Pharmacology
,Test Bank
Question 1
Clinical Scenario
A nurse is preparing morning medications for a 78-year-old client who
has hypertension, type 2 diabetes mellitus, and osteoarthritis. The
medication administration record lists metformin, lisinopril, and
ibuprofen as prescribed medications. During medication reconciliation,
the client reports taking an over-the-counter cold remedy containing
pseudoephedrine several times during the week. The nurse notes a
blood pressure of 166/88 mm Hg.
Question Stem
Which action should the nurse take first?
A. Administer all prescribed medications and reassess the blood
pressure in 1 hour.
,B. Hold metformin because the client is older than 65 years.
C. Notify the provider about the client's use of pseudoephedrine and
elevated blood pressure.
D. Instruct the client to discontinue lisinopril until the blood pressure
decreases.
Correct Answer
Correct Answer: C. Notify the provider about the client's use of
pseudoephedrine and elevated blood pressure.
Detailed Rationale
Pseudoephedrine is a sympathomimetic decongestant that can increase
vascular tone and may raise blood pressure. The client's medication
history and elevated blood pressure require clinical review before
simply proceeding with routine administration. Medication
reconciliation is designed to identify prescription, OTC, and
complementary medications that can affect treatment safety. The nurse
should communicate the relevant finding to the prescribing provider
and reinforce the importance of reporting OTC products.
Option A is incorrect because administering all medications without
addressing a potentially contributing medication interaction could delay
treatment of the elevated blood pressure. Option B is incorrect because
age alone is not a reason to withhold metformin; renal function and the
client's overall clinical status are more relevant. Option D is incorrect
because the nurse should not independently discontinue an
antihypertensive medication.
This scenario illustrates pharmacodynamic interaction: two agents can
produce opposing or additive physiologic effects even though one is a
, prescription drug and the other is OTC. Older adults are particularly
vulnerable to adverse medication effects because multiple medications
and age-related physiologic changes can increase medication-related
risk.
Learning Objective
After completing this question, the learner should be able to:
• Identify clinically significant OTC medication interactions.
• Apply medication reconciliation principles.
• Recognize when additional medication review is required before
administration.
Medication Safety Focus: Medication reconciliation
Question 2
Clinical Scenario
A nurse is preparing to administer insulin lispro to a 10-year-old child
with type 1 diabetes mellitus. The child's blood glucose is 248 mg/dL.
The child has an order for rapid-acting insulin before meals. The
breakfast tray has not yet arrived, and the child tells the nurse, "I'm not
hungry."
Question Stem
Which action should the nurse take?
A. Administer the insulin now because the blood glucose is elevated.
B. Administer half of the prescribed dose and give the remaining dose
later.
