NCLEX Pharmacology Questions with
Rationales |
ATI Pharmacology Made Easy & NGN
Nursing Exam Prep
Question 1
Clinical Scenario
A nurse is caring for a 72-year-old client who was admitted with
community-acquired pneumonia and dehydration. The provider
prescribes gentamicin IV for a severe gram-negative infection.
The client has a history of chronic kidney disease stage 3 and
takes lisinopril daily for hypertension. Morning laboratory
results show: serum creatinine 2.1 mg/dL, BUN 38 mg/dL,
potassium 4.6 mEq/L, and urine output 28 mL/hr for the last 4
hours. The client reports mild dizziness but denies pain.
Question Stem
Which action should the nurse take before administering the
first dose of gentamicin?
,A. Administer the medication and monitor for diarrhea after the
infusion
B. Request a trough gentamicin level immediately after the dose
is given
C. Clarify the prescription with the provider because the client
has impaired renal function
D. Hold the lisinopril and give the gentamicin as prescribed
Correct Answer
Correct Answer: C. Clarify the prescription with the provider
because the client has impaired renal function
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic with a significant
risk for nephrotoxicity and ototoxicity, especially in older
adults and clients with preexisting renal impairment. This
client already shows evidence of reduced kidney function,
including an elevated serum creatinine, elevated BUN, and low
urine output. Because aminoglycosides are primarily excreted
by the kidneys, impaired renal clearance increases serum drug
levels and raises the risk of toxicity. The safest nursing action is
to clarify the prescription before the first dose so the provider
can determine whether the dose should be reduced, the
interval extended, or an alternative antibiotic selected.
Option A is unsafe because administering the medication
without addressing renal impairment may worsen kidney injury.
,Diarrhea can occur with antibiotics, but it is not the priority
concern here.
Option B is incorrect because trough levels are typically
obtained before a scheduled dose after therapy has begun, not
immediately after the first dose. Peak and trough monitoring
helps guide dosing, but it does not replace appropriate pre-
administration assessment.
Option D is incorrect because holding lisinopril does not resolve
the primary issue. Although lisinopril can affect renal perfusion,
the greater concern is that gentamicin dosing itself may be
inappropriate for the client’s renal status.
Key nursing responsibilities include reviewing renal labs,
monitoring intake and output, assessing for tinnitus or hearing
changes, and verifying that high-risk medications are safe for
the client’s condition before administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify why aminoglycosides require caution in clients
with renal impairment.
• Recognize laboratory findings that increase the risk of
medication toxicity.
• Prioritize prescription clarification before administering a
potentially nephrotoxic medication.
, • Describe key nursing assessments associated with
aminoglycoside therapy.
Medication Safety Focus
Monitoring / Renal impairment / High-risk medication
administration
Question 2
Clinical Scenario
A nurse is teaching a 24-year-old client who has a new
prescription for an oral contraceptive containing ethinyl
estradiol and norethindrone. The client also started taking
rifampin 1 week ago for latent tuberculosis. During the teaching
session, the client says, “I’m glad I won’t need to use condoms
anymore now that I’m on the pill.” The client has no other
health problems and does not smoke.
Question Stem
Which response by the nurse is most appropriate?
A. “That is correct because rifampin does not affect hormonal
contraceptives.”
B. “You should use a backup nonhormonal contraceptive
method while taking rifampin.”
C. “Take the oral contraceptive with food to prevent the
Rationales |
ATI Pharmacology Made Easy & NGN
Nursing Exam Prep
Question 1
Clinical Scenario
A nurse is caring for a 72-year-old client who was admitted with
community-acquired pneumonia and dehydration. The provider
prescribes gentamicin IV for a severe gram-negative infection.
The client has a history of chronic kidney disease stage 3 and
takes lisinopril daily for hypertension. Morning laboratory
results show: serum creatinine 2.1 mg/dL, BUN 38 mg/dL,
potassium 4.6 mEq/L, and urine output 28 mL/hr for the last 4
hours. The client reports mild dizziness but denies pain.
Question Stem
Which action should the nurse take before administering the
first dose of gentamicin?
,A. Administer the medication and monitor for diarrhea after the
infusion
B. Request a trough gentamicin level immediately after the dose
is given
C. Clarify the prescription with the provider because the client
has impaired renal function
D. Hold the lisinopril and give the gentamicin as prescribed
Correct Answer
Correct Answer: C. Clarify the prescription with the provider
because the client has impaired renal function
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic with a significant
risk for nephrotoxicity and ototoxicity, especially in older
adults and clients with preexisting renal impairment. This
client already shows evidence of reduced kidney function,
including an elevated serum creatinine, elevated BUN, and low
urine output. Because aminoglycosides are primarily excreted
by the kidneys, impaired renal clearance increases serum drug
levels and raises the risk of toxicity. The safest nursing action is
to clarify the prescription before the first dose so the provider
can determine whether the dose should be reduced, the
interval extended, or an alternative antibiotic selected.
Option A is unsafe because administering the medication
without addressing renal impairment may worsen kidney injury.
,Diarrhea can occur with antibiotics, but it is not the priority
concern here.
Option B is incorrect because trough levels are typically
obtained before a scheduled dose after therapy has begun, not
immediately after the first dose. Peak and trough monitoring
helps guide dosing, but it does not replace appropriate pre-
administration assessment.
Option D is incorrect because holding lisinopril does not resolve
the primary issue. Although lisinopril can affect renal perfusion,
the greater concern is that gentamicin dosing itself may be
inappropriate for the client’s renal status.
Key nursing responsibilities include reviewing renal labs,
monitoring intake and output, assessing for tinnitus or hearing
changes, and verifying that high-risk medications are safe for
the client’s condition before administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify why aminoglycosides require caution in clients
with renal impairment.
• Recognize laboratory findings that increase the risk of
medication toxicity.
• Prioritize prescription clarification before administering a
potentially nephrotoxic medication.
, • Describe key nursing assessments associated with
aminoglycoside therapy.
Medication Safety Focus
Monitoring / Renal impairment / High-risk medication
administration
Question 2
Clinical Scenario
A nurse is teaching a 24-year-old client who has a new
prescription for an oral contraceptive containing ethinyl
estradiol and norethindrone. The client also started taking
rifampin 1 week ago for latent tuberculosis. During the teaching
session, the client says, “I’m glad I won’t need to use condoms
anymore now that I’m on the pill.” The client has no other
health problems and does not smoke.
Question Stem
Which response by the nurse is most appropriate?
A. “That is correct because rifampin does not affect hormonal
contraceptives.”
B. “You should use a backup nonhormonal contraceptive
method while taking rifampin.”
C. “Take the oral contraceptive with food to prevent the
