Nclexpn Quiz: Medication Reconciliation And Safety

What this quiz covers

This quiz focuses on Medication Reconciliation And Safety, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexpn.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Administer 30 units as listed on the MAR and recheck glucose at 0200
2. Hold the dose and verify the current insulin order with the prescriber/pharmacy before administration (correct answer)
3. Document the provider's earlier verbal change in the nursing notes and give 20 units
4. Ask the UAP to reprint the MAR and bring it to the bedside

Explanation: 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 The priority concern is ensuring accurate and safe medication administration to prevent hypoglycemia from outdated dosing.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.

Question 2

1. Clarify with the prescriber because TMP-SMX can increase methotrexate toxicity risk (correct answer)
2. Teach the client to take TMP-SMX with a full glass of water
3. Document all discharge medications and provide a printed list to the client
4. Delegate to the pharmacist to counsel the client about methotrexate weekly dosing

Explanation: 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.

Question 3

1. Docusate 100 mg PO BID
2. Latanoprost eye drops nightly
3. Amitriptyline 25 mg PO at bedtime (correct answer)
4. Encouraging oral fluids as tolerated

Explanation: 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.

Question 4

1. Administer metoprolol tartrate now and start succinate tomorrow
2. Ask the oncoming nurse to verify the correct formulation at the next shift
3. Document the change in the nursing notes and continue with scheduled doses
4. Hold the next beta-blocker dose and contact the prescriber/pharmacy to clarify and discontinue the duplicate order (correct answer)

Explanation: 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.

Question 5

1. Administer rivaroxaban now and discontinue warfarin in the MAR
2. Contact the prescriber/pharmacy to verify anticoagulant therapy and inactivate the duplicate order (correct answer)
3. Document the discrepancy and continue to monitor for bleeding
4. Ask the charge nurse to update the medication history when time allows

Explanation: 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.

Question 6

1. Hold ketorolac and notify the provider about NSAID use in a client with GI bleed (correct answer)
2. Administer ketorolac as ordered and reassess pain in 30 minutes
3. Document that the client uses ibuprofen at home and continue the MAR as written
4. Ask the client's family to bring in the home medication bottles for verification tomorrow

Explanation: 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.

Question 7

1. Levothyroxine 75 mcg PO daily
2. Lithium 300 mg PO TID
3. Hydrochlorothiazide 25 mg PO daily (correct answer)
4. Naproxen 220 mg PO PRN pain

Explanation: 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.

Question 8

1. Tramadol use with sertraline in a symptomatic client (correct answer)
2. Acetaminophen PRN for mild pain
3. Sertraline taken once daily in the morning
4. Client reports pain is 4/10 before PRN medication

Explanation: 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.

Question 9

1. Request an order for a stool softener due to opioid-sparing pain plan
2. Notify the provider about NSAID use and request alternative pain management due to kidney injury (correct answer)
3. Document the client's home ibuprofen use and continue the admission orders
4. Delegate to the UAP to obtain the client's preferred pain rating scale

Explanation: 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.

Question 10

1. The client reports using albuterol more than twice daily at home
2. Azithromycin is ordered while the client takes theophylline ER (correct answer)
3. Tiotropium is listed as once daily on the home medication list
4. Prednisone is continued at the client's home dose

Explanation: 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.

Question 11

1. Simvastatin dose increase from 20 mg to 40 mg
2. Concurrent simvastatin and fluconazole use with symptoms suggestive of rhabdomyolysis (correct answer)
3. Client reports taking simvastatin at bedtime
4. Fluconazole therapy planned for 7 days

Explanation: This question tests medication reconciliation and safety in a client reporting muscle pain and dark urine after medication changes. The priority concern is ensuring accurate and safe medication administration to prevent severe adverse effects like rhabdomyolysis. Concurrent simvastatin and fluconazole use with symptoms suggestive of rhabdomyolysis requires immediate intervention because fluconazole inhibits simvastatin metabolism, increasing myopathy risk. Dose increase alone is not urgent without symptoms; bedtime dosing is optimal; and 7-day therapy is standard but secondary. The decision-making principle in medication safety is to recognize interaction-induced toxicities during review. Nurses should correlate symptoms with recent changes for prompt action. A transferable strategy for medication reconciliation is to link client symptoms to potential drug interactions and escalate urgently.

Question 12

1. Administer the bedtime zolpidem as ordered to promote sleep
2. Notify the provider about multiple CNS depressants and fall risk and request medication review (correct answer)
3. Document the home medication list in the chart and continue monitoring
4. Ask the physical therapist to evaluate the client's gait before changing medications

Explanation: This question tests medication reconciliation and safety in an elderly client admitted for dizziness and falls. The priority concern is ensuring accurate and safe medication administration to minimize fall risk from CNS depressants. Notifying the provider about multiple CNS depressants and fall risk and requesting medication review is the best choice for ensuring client safety as clonazepam, zolpidem, and hydrocodone increase sedation synergistically. Administering zolpidem ignores the risk; documenting without action fails to protect; and consulting PT is secondary. The decision-making principle in medication safety is to deprescribe in polypharmacy for geriatrics during admission. Nurses must highlight cumulative depressant effects. A transferable strategy for medication reconciliation is to tally sedating medications and prioritize de-escalation in vulnerable populations.

Question 13

1. Scheduled acetaminophen plus PRN acetaminophen exceeding recommended daily limits (correct answer)
2. Oxycodone is ordered PRN for breakthrough pain
3. Client reports pain level 6/10 on admission
4. Acetaminophen is available in both tablet and liquid forms

Explanation: This question tests medication reconciliation and safety in a client with chronic hepatitis C admitted for abdominal pain. The priority concern is ensuring accurate and safe medication administration to prevent hepatotoxicity from overdose. Scheduled acetaminophen plus PRN exceeding daily limits requires immediate intervention because total dose over 4g/day risks liver damage in hepatitis. Oxycodone PRN is standard; pain level 6/10 needs assessment; and forms availability is irrelevant. The decision-making principle in medication safety is to calculate cumulative doses during admission. Nurses must prevent exceeding limits. A transferable strategy for medication reconciliation is to sum all sources of a drug and adjust orders accordingly.

Question 14

1. Carbidopa-levodopa is scheduled three times daily
2. The client reports occasional dizziness when standing
3. Tamsulosin is taken at night at home
4. Diphenhydramine is ordered in a client already taking oxybutynin (correct answer)

Explanation: This question tests medication reconciliation and safety in a client with Parkinson disease and BPH admitted for confusion. The priority concern is ensuring accurate and safe medication administration to prevent anticholinergic overload. Identifying diphenhydramine ordered in a client taking oxybutynin requires immediate intervention because both have anticholinergic effects, worsening confusion in the elderly. Carbidopa-levodopa three times daily is standard; tamsulosin at night is appropriate; and occasional dizziness is common but not urgent. The decision-making principle in medication safety is to assess for cumulative side effects in polypharmacy during admission. Nurses should intervene on additive drug classes like anticholinergics. A transferable strategy for medication reconciliation is to categorize medications by mechanism and check for redundancies that amplify risks.

Question 15

1. Client requests antiemetic medication for nausea
2. Client reports last bowel movement was 4 days ago
3. Oxycodone IR is available PRN for breakthrough pain
4. Two long-acting opioids are ordered concurrently (correct answer)

Explanation: This question tests medication reconciliation and safety in a client with chronic pain admitted for constipation and nausea. The priority concern is ensuring accurate and safe medication administration to avoid opioid overdose. Two long-acting opioids ordered concurrently requires immediate intervention because morphine ER and oxycodone ER duplication increases respiratory depression risk. Last BM 4 days ago suggests constipation but is expected; oxycodone IR PRN is for breakthrough; and antiemetic request addresses symptom. The decision-making principle in medication safety is to eliminate opioid duplications during admission. Nurses should notify for single therapy. A transferable strategy for medication reconciliation is to identify class overlaps and streamline regimens.

Question 16

1. Client requests a refill for sildenafil at discharge
2. Atorvastatin scheduled at bedtime
3. Aspirin 81 mg daily continued
4. Sildenafil use with a new nitroglycerin prescription (correct answer)

Explanation: This question tests medication reconciliation and safety in a client with CAD and ED discharged after angina evaluation. The priority concern is ensuring accurate and safe medication administration to prevent severe hypotension. Sildenafil use with a new nitroglycerin prescription requires immediate intervention because the combination can cause life-threatening hypotension. Atorvastatin at bedtime is optimal; aspirin continuation is standard; and refill request is secondary. The decision-making principle in medication safety is to avoid PDE5 inhibitors with nitrates during discharge. Nurses should educate on interactions. A transferable strategy for medication reconciliation is to highlight PRN and home med contraindications.