NCLEX-RN Pharmacology Exam |
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His history includes chronic kidney disease stage 3,
hypertension, and type 2 diabetes mellitus. He has been
prescribed gentamicin IV in combination with another
antibiotic. Baseline laboratory results include:
• Serum creatinine: 2.0 mg/dL
• BUN: 38 mg/dL
• WBC: 16,500/mm³
• Temperature: 38.8°C (101.8°F)
,The nurse reviews the medication administration record before
giving the next dose.
Question Stem
Which nursing action is the priority before administering the
scheduled dose of gentamicin?
A. Assess the client's hearing and review the most recent peak
and trough drug levels.
B. Encourage the client to increase dietary potassium intake.
C. Administer the medication immediately to prevent treatment
delay.
D. Hold the medication until the client's temperature returns to
normal.
Correct Answer
Correct Answer: A. Assess the client's hearing and review the
most recent peak and trough drug levels.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that exhibits
concentration-dependent bacterial killing but is associated with
significant risks of nephrotoxicity and ototoxicity. Older adults
and patients with impaired renal function are especially
vulnerable because aminoglycosides are eliminated almost
,entirely by the kidneys. Before administering each dose, the
nurse should review renal function, assess for hearing changes
(such as tinnitus or dizziness), and evaluate peak and trough
levels to ensure therapeutic concentrations without toxic
accumulation.
Option B is incorrect because potassium intake is not routinely
altered for gentamicin therapy. Electrolyte monitoring may be
indicated in critically ill patients, but increasing potassium is not
the priority intervention.
Option C is unsafe because administering gentamicin without
reviewing renal function and drug levels increases the risk of
toxicity. Medication safety always takes precedence over
avoiding minor delays.
Option D is incorrect because persistent fever is expected
during early treatment of bacterial infections and is not an
indication to withhold antibiotics.
Patient teaching should include reporting tinnitus, hearing loss,
dizziness, or decreased urine output immediately. Monitoring
serum creatinine, urine output, and therapeutic drug levels is
essential throughout therapy to reduce preventable adverse
events.
Learning Objectives
After completing this question, the learner should be able to:
, • Identify priority assessments before administering
aminoglycosides.
• Recognize patients at increased risk for aminoglycoside
toxicity.
• Interpret the importance of peak and trough monitoring.
• Prioritize medication safety over administration timing.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for treatment of
acne vulgaris. During discharge teaching, she asks how to take
the medication safely. She has no significant medical history and
takes a daily multivitamin containing calcium.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I'll use sunscreen and protective clothing when outdoors."
B. "I'll take the medication with a full glass of water."
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His history includes chronic kidney disease stage 3,
hypertension, and type 2 diabetes mellitus. He has been
prescribed gentamicin IV in combination with another
antibiotic. Baseline laboratory results include:
• Serum creatinine: 2.0 mg/dL
• BUN: 38 mg/dL
• WBC: 16,500/mm³
• Temperature: 38.8°C (101.8°F)
,The nurse reviews the medication administration record before
giving the next dose.
Question Stem
Which nursing action is the priority before administering the
scheduled dose of gentamicin?
A. Assess the client's hearing and review the most recent peak
and trough drug levels.
B. Encourage the client to increase dietary potassium intake.
C. Administer the medication immediately to prevent treatment
delay.
D. Hold the medication until the client's temperature returns to
normal.
Correct Answer
Correct Answer: A. Assess the client's hearing and review the
most recent peak and trough drug levels.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that exhibits
concentration-dependent bacterial killing but is associated with
significant risks of nephrotoxicity and ototoxicity. Older adults
and patients with impaired renal function are especially
vulnerable because aminoglycosides are eliminated almost
,entirely by the kidneys. Before administering each dose, the
nurse should review renal function, assess for hearing changes
(such as tinnitus or dizziness), and evaluate peak and trough
levels to ensure therapeutic concentrations without toxic
accumulation.
Option B is incorrect because potassium intake is not routinely
altered for gentamicin therapy. Electrolyte monitoring may be
indicated in critically ill patients, but increasing potassium is not
the priority intervention.
Option C is unsafe because administering gentamicin without
reviewing renal function and drug levels increases the risk of
toxicity. Medication safety always takes precedence over
avoiding minor delays.
Option D is incorrect because persistent fever is expected
during early treatment of bacterial infections and is not an
indication to withhold antibiotics.
Patient teaching should include reporting tinnitus, hearing loss,
dizziness, or decreased urine output immediately. Monitoring
serum creatinine, urine output, and therapeutic drug levels is
essential throughout therapy to reduce preventable adverse
events.
Learning Objectives
After completing this question, the learner should be able to:
, • Identify priority assessments before administering
aminoglycosides.
• Recognize patients at increased risk for aminoglycoside
toxicity.
• Interpret the importance of peak and trough monitoring.
• Prioritize medication safety over administration timing.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for treatment of
acne vulgaris. During discharge teaching, she asks how to take
the medication safely. She has no significant medical history and
takes a daily multivitamin containing calcium.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I'll use sunscreen and protective clothing when outdoors."
B. "I'll take the medication with a full glass of water."
