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 78-year-old woman with hypertension, heart failure with preserved
ejection fraction, and chronic kidney disease is admitted for dizziness.
Her home medications include lisinopril, furosemide, spironolactone,
and an over-the-counter medication she reports taking daily for knee
pain. Laboratory results are: potassium 5.7 mEq/L, BUN 39 mg/dL, and
creatinine 1.9 mg/dL, increased from a baseline of 1.3 mg/dL. During
medication reconciliation, the nurse identifies the over-the-counter
medication as ibuprofen.
Question Stem
Which medication should the nurse identify as the priority safety
concern during medication reconciliation?
,A. Furosemide
B. Ibuprofen
C. Lisinopril
D. Spironolactone
Options
A. Furosemide
B. Ibuprofen
C. Lisinopril
D. Spironolactone
Correct Answer
Correct Answer: B. Ibuprofen
Detailed Rationale
Ibuprofen is the priority safety concern because this patient has chronic
kidney disease, rising creatinine, hyperkalemia, and concurrent therapy
with an ACE inhibitor and a diuretic. NSAIDs can reduce renal blood
flow and increase the risk of acute kidney injury, particularly in older
adults and patients with existing renal impairment. The combination of
an NSAID with an ACE inhibitor and diuretic is a recognized high-risk
combination for AKI.
A. Furosemide is not the priority concern. Loop diuretics can promote
potassium loss and are often used to manage fluid overload. Although
renal function and volume status should be monitored, furosemide
does not explain the potentially preventable interaction as strongly as
ibuprofen does.
, C. Lisinopril requires monitoring of renal function and potassium, but it
may have a clear therapeutic indication for this patient. ACE inhibitors
can contribute to hyperkalemia, particularly with renal impairment and
potassium-sparing drugs.
D. Spironolactone can increase potassium and therefore warrants
evaluation given the potassium of 5.7 mEq/L, but the immediate
medication-reconciliation opportunity is identifying the avoidable OTC
NSAID.
The nurse should document the OTC medication, notify the appropriate
prescriber/pharmacist, and teach the patient not to self-medicate with
NSAIDs without professional guidance.
Learning Objective
After completing this question, the learner should be able to:
• Identify medication combinations that increase AKI risk.
• Recognize the importance of complete medication reconciliation,
including OTC products.
• Interpret abnormal renal and electrolyte findings in relation to
medications.
• Identify older adults and patients with CKD as higher-risk
populations for medication-related renal injury.
Medication Safety Focus
Medication reconciliation / Drug interaction
Question 2
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 78-year-old woman with hypertension, heart failure with preserved
ejection fraction, and chronic kidney disease is admitted for dizziness.
Her home medications include lisinopril, furosemide, spironolactone,
and an over-the-counter medication she reports taking daily for knee
pain. Laboratory results are: potassium 5.7 mEq/L, BUN 39 mg/dL, and
creatinine 1.9 mg/dL, increased from a baseline of 1.3 mg/dL. During
medication reconciliation, the nurse identifies the over-the-counter
medication as ibuprofen.
Question Stem
Which medication should the nurse identify as the priority safety
concern during medication reconciliation?
,A. Furosemide
B. Ibuprofen
C. Lisinopril
D. Spironolactone
Options
A. Furosemide
B. Ibuprofen
C. Lisinopril
D. Spironolactone
Correct Answer
Correct Answer: B. Ibuprofen
Detailed Rationale
Ibuprofen is the priority safety concern because this patient has chronic
kidney disease, rising creatinine, hyperkalemia, and concurrent therapy
with an ACE inhibitor and a diuretic. NSAIDs can reduce renal blood
flow and increase the risk of acute kidney injury, particularly in older
adults and patients with existing renal impairment. The combination of
an NSAID with an ACE inhibitor and diuretic is a recognized high-risk
combination for AKI.
A. Furosemide is not the priority concern. Loop diuretics can promote
potassium loss and are often used to manage fluid overload. Although
renal function and volume status should be monitored, furosemide
does not explain the potentially preventable interaction as strongly as
ibuprofen does.
, C. Lisinopril requires monitoring of renal function and potassium, but it
may have a clear therapeutic indication for this patient. ACE inhibitors
can contribute to hyperkalemia, particularly with renal impairment and
potassium-sparing drugs.
D. Spironolactone can increase potassium and therefore warrants
evaluation given the potassium of 5.7 mEq/L, but the immediate
medication-reconciliation opportunity is identifying the avoidable OTC
NSAID.
The nurse should document the OTC medication, notify the appropriate
prescriber/pharmacist, and teach the patient not to self-medicate with
NSAIDs without professional guidance.
Learning Objective
After completing this question, the learner should be able to:
• Identify medication combinations that increase AKI risk.
• Recognize the importance of complete medication reconciliation,
including OTC products.
• Interpret abnormal renal and electrolyte findings in relation to
medications.
• Identify older adults and patients with CKD as higher-risk
populations for medication-related renal injury.
Medication Safety Focus
Medication reconciliation / Drug interaction
Question 2
