ATI Pharmacology Made Easy Study Guide |
15 NCLEX-RN NGN Practice Questions &
Detailed Rationales
Question 1
Clinical Scenario
An 82-year-old female client is admitted to the medical-surgical
unit with an acute exacerbation of chronic heart failure. During
the admission process, the nurse reviews her home medication
list, which she brought on a piece of paper, and compares it
with the provider's admission orders and the physical bottles
brought by her family. The nurse notes that the client has been
taking "frusemide 40 mg daily" at home, but the provider has
prescribed "furosemide 40 mg PO daily."
,Question Stem
Which action should the nurse take first to ensure medication
safety during this transition of care?
A. Administer the furosemide as prescribed by the admitting
provider since it is the same active drug.
B. Document the discrepancy in the electronic health record
and notify the pharmacy to update the database.
C. Contact the prescribing provider to clarify the prescription
and verify the correct medication name, dose, and frequency.
D. Clarify with the client and family if "frusemide" and
"furosemide" are the same medication before entering the
reconciled list.
Correct Answer: C. Contact the prescribing provider to clarify
the prescription and verify the correct medication name, dose,
and frequency.
Detailed Rationale
Medication reconciliation is a critical process designed to
prevent medication errors at transition points of care.
Furosemide (commonly known as Lasix) was historically
referred to as "frusemide" in some international compendia
(such as the British Pharmacopoeia). While they are indeed the
same drug, any discrepancy or unfamiliar naming convention on
a home medication list must be formally clarified and reconciled
,by the healthcare provider to prevent transcription or
interpretation errors.
The nurse's priority action is to contact the prescribing provider
to formally reconcile and verify the home medication, ensuring
that the correct drug name, dose, and frequency are officially
ordered. Administering the medication (Option A) without
resolving the naming discrepancy violates safe administration
practices. Documenting the discrepancy and notifying the
pharmacy (Option B) is a secondary administrative step that
does not resolve the immediate clinical need for a clear, verified
order. While asking the family (Option D) provides context, the
patient and family cannot legally authorize or formally reconcile
a medical prescription; the licensed prescriber must perform
this action.
Learning Objectives
After completing this question, the learner should be able to:
• Define the purpose and process of medication
reconciliation during admission.
• Identify international naming variations of common
medications (e.g., furosemide/frusemide).
• Prioritize immediate nursing actions when a medication
discrepancy is identified.
Medication Safety Focus: Medication reconciliation
, Question 2
Clinical Scenario
A nurse is preparing to administer a newly prescribed dose of
liquid oral cyclosporine to a 45-year-old male client who
underwent a renal transplant 3 months ago. The nurse is
reviewing the administration protocol and the client's dietary
tray, which was just delivered to the bedside.
Question Stem
Which beverage on the client's breakfast tray requires the nurse
to intervene and modify the administration plan?
A. Apple juice
B. Grapefruit juice
C. Whole milk
D. Orange juice
Correct Answer: B. Grapefruit juice
Detailed Rationale
Cyclosporine is an immunosuppressant with a narrow
therapeutic index used to prevent organ rejection. Grapefruit
juice contains compounds (furanocoumarins) that inhibit the
cytochrome P450 3A4 (CYP3A4) enzyme system in the small
intestine. This enzyme is responsible for metabolizing
cyclosporine.
15 NCLEX-RN NGN Practice Questions &
Detailed Rationales
Question 1
Clinical Scenario
An 82-year-old female client is admitted to the medical-surgical
unit with an acute exacerbation of chronic heart failure. During
the admission process, the nurse reviews her home medication
list, which she brought on a piece of paper, and compares it
with the provider's admission orders and the physical bottles
brought by her family. The nurse notes that the client has been
taking "frusemide 40 mg daily" at home, but the provider has
prescribed "furosemide 40 mg PO daily."
,Question Stem
Which action should the nurse take first to ensure medication
safety during this transition of care?
A. Administer the furosemide as prescribed by the admitting
provider since it is the same active drug.
B. Document the discrepancy in the electronic health record
and notify the pharmacy to update the database.
C. Contact the prescribing provider to clarify the prescription
and verify the correct medication name, dose, and frequency.
D. Clarify with the client and family if "frusemide" and
"furosemide" are the same medication before entering the
reconciled list.
Correct Answer: C. Contact the prescribing provider to clarify
the prescription and verify the correct medication name, dose,
and frequency.
Detailed Rationale
Medication reconciliation is a critical process designed to
prevent medication errors at transition points of care.
Furosemide (commonly known as Lasix) was historically
referred to as "frusemide" in some international compendia
(such as the British Pharmacopoeia). While they are indeed the
same drug, any discrepancy or unfamiliar naming convention on
a home medication list must be formally clarified and reconciled
,by the healthcare provider to prevent transcription or
interpretation errors.
The nurse's priority action is to contact the prescribing provider
to formally reconcile and verify the home medication, ensuring
that the correct drug name, dose, and frequency are officially
ordered. Administering the medication (Option A) without
resolving the naming discrepancy violates safe administration
practices. Documenting the discrepancy and notifying the
pharmacy (Option B) is a secondary administrative step that
does not resolve the immediate clinical need for a clear, verified
order. While asking the family (Option D) provides context, the
patient and family cannot legally authorize or formally reconcile
a medical prescription; the licensed prescriber must perform
this action.
Learning Objectives
After completing this question, the learner should be able to:
• Define the purpose and process of medication
reconciliation during admission.
• Identify international naming variations of common
medications (e.g., furosemide/frusemide).
• Prioritize immediate nursing actions when a medication
discrepancy is identified.
Medication Safety Focus: Medication reconciliation
, Question 2
Clinical Scenario
A nurse is preparing to administer a newly prescribed dose of
liquid oral cyclosporine to a 45-year-old male client who
underwent a renal transplant 3 months ago. The nurse is
reviewing the administration protocol and the client's dietary
tray, which was just delivered to the bedside.
Question Stem
Which beverage on the client's breakfast tray requires the nurse
to intervene and modify the administration plan?
A. Apple juice
B. Grapefruit juice
C. Whole milk
D. Orange juice
Correct Answer: B. Grapefruit juice
Detailed Rationale
Cyclosporine is an immunosuppressant with a narrow
therapeutic index used to prevent organ rejection. Grapefruit
juice contains compounds (furanocoumarins) that inhibit the
cytochrome P450 3A4 (CYP3A4) enzyme system in the small
intestine. This enzyme is responsible for metabolizing
cyclosporine.
