This question tests medication reconciliation and safety in a client with type 2 diabetes after a prescription change. The priority concern is ensuring accurate and safe medication administration to prevent hypoglycemia from outdated dosing. Holding the dose and verifying the current insulin order with the prescriber/pharmacy before administration is the best choice for ensuring client safety as the MAR shows the old 30 units, risking overdose. Administering 30 units ignores the change; documenting verbal without verification is insufficient; and delegating to UAP is inappropriate. The decision-making principle in medication safety is to confirm updates in the MAR before giving. Nurses must hold until clarified. A transferable strategy for medication reconciliation is to cross-verify recent changes against administration records.

This question tests medication reconciliation and safety in a client with rheumatoid arthritis being discharged. The priority concern is ensuring accurate and safe medication administration to prevent methotrexate toxicity. Clarifying with the prescriber because TMP-SMX can increase methotrexate toxicity risk is the best choice for ensuring client safety as it inhibits folate metabolism, amplifying effects. Teaching to take with water is general; documenting without clarification risks harm; and delegating to pharmacist is secondary. The decision-making principle in medication safety is to flag folate antagonists with methotrexate during discharge. Nurses must seek adjustments. A transferable strategy for medication reconciliation is to screen antibiotics for interactions with immunosuppressants.

This question tests medication reconciliation and safety in a client with constipation and glaucoma reporting new symptoms. The priority concern is ensuring accurate and safe medication administration to avoid anticholinergic effects in glaucoma. Questioning amitriptyline is appropriate because its anticholinergic properties can worsen glaucoma and cause urinary retention. Docusate is for constipation; latanoprost treats glaucoma; and fluids are supportive. The decision-making principle in medication safety is to contraindicate anticholinergics in glaucoma during review. Nurses should correlate symptoms with new meds. A transferable strategy for medication reconciliation is to screen for drug-class contraindications in comorbid conditions.

This question tests medication reconciliation and safety during shift handover for a client with atrial fibrillation. The priority concern is ensuring accurate and safe medication administration to prevent beta-blocker overdose from duplicates. Holding the next dose and contacting the prescriber/pharmacy to clarify and discontinue the duplicate order is the best choice for ensuring client safety as both metoprolol formulations active could cause bradycardia. Administering now risks error; documenting without hold is unsafe; and delegating to next shift delays. The decision-making principle in medication safety is to suspend administration until duplicates are resolved. Nurses must verify order changes in the MAR. A transferable strategy for medication reconciliation is to reconcile during handovers and inactivate outdated orders immediately.

This question tests medication reconciliation and safety in a client with seizure disorder and a recent anticoagulant change. The priority concern is ensuring accurate and safe medication administration to prevent errors from duplicate orders. Contacting the prescriber/pharmacy to verify anticoagulant therapy and inactivate the duplicate order is the best choice for ensuring client safety as concurrent warfarin and rivaroxaban increase bleeding risk. Administering rivaroxaban and discontinuing warfarin unilaterally is inappropriate; documenting without action risks error; and delegating to the charge nurse delays intervention. The decision-making principle in medication safety is to resolve order duplications promptly during reconciliation. Nurses must verify changes and update records to avoid administration errors. A transferable strategy for medication reconciliation is to flag active overlapping orders in the pharmacy profile and seek immediate clarification.

This question tests medication reconciliation and safety in a client admitted for GI bleed with chronic NSAID use. The priority concern is ensuring accurate and safe medication administration to prevent further gastrointestinal injury. Holding ketorolac and notifying the provider about NSAID use in a client with GI bleed is the best choice for ensuring client safety as ketorolac, an NSAID, can exacerbate bleeding. Administering ketorolac ignores the risk; documenting without action fails to intervene; and asking family to bring bottles delays resolution. The decision-making principle in medication safety is to assess for contraindications based on client history during reconciliation. Nurses must withhold potentially harmful drugs and seek clarification immediately. A transferable strategy for medication reconciliation is to correlate home medications with admission diagnoses for potential exacerbations and act preemptively.

This question tests medication reconciliation and safety in a client with bipolar disorder discharged after dehydration. The priority concern is ensuring accurate and safe medication administration to prevent lithium toxicity. Questioning hydrochlorothiazide is correct because it can increase lithium levels, especially post-dehydration, risking toxicity. Levothyroxine is unrelated; lithium itself is the home med; and naproxen may interact but is PRN and less immediate. The decision-making principle in medication safety involves monitoring for diuretic-induced drug level changes during discharge. Nurses must evaluate electrolyte balance and drug interactions. A transferable strategy for medication reconciliation is to anticipate how new medications affect steady-state levels of chronic therapies.

This question tests medication reconciliation and safety in a client with depression and chronic pain reporting new symptoms. The priority concern is ensuring accurate and safe medication administration to avoid serotonin syndrome. Tramadol use with sertraline in a symptomatic client requires immediate intervention because this combination can cause serotonin excess, manifesting as restlessness, sweating, and tremor. Acetaminophen PRN is safe; morning sertraline is standard; and pain level 4/10 is not urgent. The decision-making principle in medication safety is to identify serotonergic interactions during review. Nurses should monitor for syndrome symptoms and intervene. A transferable strategy for medication reconciliation is to screen for additive neurotransmitter effects in polypharmacy.

This question tests medication reconciliation and safety in a client with osteoarthritis admitted for acute kidney injury. The priority concern is ensuring accurate and safe medication administration to avoid further renal damage from NSAIDs. Notifying the provider about NSAID use and requesting alternative pain management due to kidney injury is the best choice for ensuring client safety as ketorolac and ibuprofen can worsen AKI. Requesting a stool softener addresses constipation but not the core issue; documenting without action risks harm; and delegating to UAP is inappropriate for reconciliation. The decision-making principle in medication safety is to contraindicate nephrotoxic drugs in AKI during admission. Nurses must advocate for safer alternatives. A transferable strategy for medication reconciliation is to align medications with current organ function and adjust accordingly.

This question tests medication reconciliation and safety in a client admitted for COPD exacerbation and pneumonia. The priority concern is ensuring accurate and safe medication administration to avoid drug interactions that could lead to toxicity. Identifying that azithromycin is ordered while the client takes theophylline ER requires immediate intervention because this combination can increase theophylline levels, risking seizures or arrhythmias. The client using albuterol more than twice daily suggests poor control but is not an immediate interaction; tiotropium once daily is appropriate; and continuing prednisone at home dose is standard without contraindication. The decision-making principle in medication safety is to review for pharmacokinetic interactions during admission reconciliation. Nurses should flag combinations that elevate drug levels and notify providers promptly. A transferable strategy for medication reconciliation is to use drug interaction checkers and prioritize urgent notifications for high-risk pairings.