NCLEX-RN Pharmacology Practice Exam:
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original ATI & Next Gen NCLEX-Style
Questions with Rationales
Question 1
Clinical Scenario
A 68-year-old woman is admitted with fever, productive cough,
and shortness of breath. She is diagnosed with community-
acquired pneumonia. Her medical history includes chronic
kidney disease (stage 3), hypertension, and type 2 diabetes
mellitus. Current medications include lisinopril, metformin, and
hydrochlorothiazide. The provider prescribes levofloxacin 750
mg IV once daily. Laboratory results show a serum creatinine of
2.0 mg/dL (177 µmol/L), WBC count of 15,400/mm³, and
potassium of 4.2 mEq/L.
Question Stem
,Which nursing action is the priority before administering the
first dose of levofloxacin?
A. Assess the patient's renal function and verify whether the
prescribed dose requires adjustment.
B. Administer the medication immediately to avoid delaying
antibiotic therapy.
C. Encourage the patient to drink grapefruit juice with the
medication.
D. Hold metformin for 24 hours after the antibiotic is started.
Correct Answer
A. Assess the patient's renal function and verify whether the
prescribed dose requires adjustment.
Detailed Rationale
Levofloxacin is primarily eliminated by the kidneys. Patients
with reduced renal function have decreased drug clearance,
increasing the risk of adverse effects such as QT interval
prolongation, central nervous system toxicity, tendinopathy,
tendon rupture, and dysglycemia. Before administering the
medication, the nurse should evaluate renal function and
determine whether dosage adjustment is necessary based on
the patient's estimated creatinine clearance. This promotes
medication safety while ensuring effective antimicrobial
therapy.
,Option B is incorrect because although early antibiotic
administration improves outcomes in pneumonia, medication
safety requires verifying that the prescribed dose is appropriate
for renal impairment before administration.
Option C is incorrect because grapefruit juice is not clinically
significant with levofloxacin. More important teaching includes
avoiding concurrent administration with calcium, magnesium,
iron, zinc, or antacids because they reduce absorption of oral
fluoroquinolones.
Option D is incorrect because levofloxacin alone is not an
indication to routinely discontinue metformin. Metformin is
generally withheld when iodinated contrast is administered or
when severe acute kidney injury develops.
Medication Safety Considerations: Fluoroquinolones carry an
FDA Boxed Warning regarding tendinitis, tendon rupture,
peripheral neuropathy, and central nervous system effects.
Older adults and patients with renal impairment require close
monitoring and possible dose reduction.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize when renal dose adjustment is necessary for
fluoroquinolones.
, • Prioritize medication safety before antibiotic
administration.
• Identify major boxed warnings associated with
levofloxacin.
Medication Safety Focus
Monitoring—Renal Function and Dose Adjustment
Question 2
Clinical Scenario
A 25-year-old woman presents to an urgent care clinic with
dysuria, urinary frequency, and urgency. She is diagnosed with
an uncomplicated urinary tract infection and is prescribed
trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days. During
discharge teaching, the nurse reviews home medications and
lifestyle habits.
Question Stem
Which statement by the patient indicates a need for additional
teaching?
A. "I'll drink plenty of fluids while taking this medication."
B. "I'll use sunscreen and protective clothing if I'm outdoors."
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original ATI & Next Gen NCLEX-Style
Questions with Rationales
Question 1
Clinical Scenario
A 68-year-old woman is admitted with fever, productive cough,
and shortness of breath. She is diagnosed with community-
acquired pneumonia. Her medical history includes chronic
kidney disease (stage 3), hypertension, and type 2 diabetes
mellitus. Current medications include lisinopril, metformin, and
hydrochlorothiazide. The provider prescribes levofloxacin 750
mg IV once daily. Laboratory results show a serum creatinine of
2.0 mg/dL (177 µmol/L), WBC count of 15,400/mm³, and
potassium of 4.2 mEq/L.
Question Stem
,Which nursing action is the priority before administering the
first dose of levofloxacin?
A. Assess the patient's renal function and verify whether the
prescribed dose requires adjustment.
B. Administer the medication immediately to avoid delaying
antibiotic therapy.
C. Encourage the patient to drink grapefruit juice with the
medication.
D. Hold metformin for 24 hours after the antibiotic is started.
Correct Answer
A. Assess the patient's renal function and verify whether the
prescribed dose requires adjustment.
Detailed Rationale
Levofloxacin is primarily eliminated by the kidneys. Patients
with reduced renal function have decreased drug clearance,
increasing the risk of adverse effects such as QT interval
prolongation, central nervous system toxicity, tendinopathy,
tendon rupture, and dysglycemia. Before administering the
medication, the nurse should evaluate renal function and
determine whether dosage adjustment is necessary based on
the patient's estimated creatinine clearance. This promotes
medication safety while ensuring effective antimicrobial
therapy.
,Option B is incorrect because although early antibiotic
administration improves outcomes in pneumonia, medication
safety requires verifying that the prescribed dose is appropriate
for renal impairment before administration.
Option C is incorrect because grapefruit juice is not clinically
significant with levofloxacin. More important teaching includes
avoiding concurrent administration with calcium, magnesium,
iron, zinc, or antacids because they reduce absorption of oral
fluoroquinolones.
Option D is incorrect because levofloxacin alone is not an
indication to routinely discontinue metformin. Metformin is
generally withheld when iodinated contrast is administered or
when severe acute kidney injury develops.
Medication Safety Considerations: Fluoroquinolones carry an
FDA Boxed Warning regarding tendinitis, tendon rupture,
peripheral neuropathy, and central nervous system effects.
Older adults and patients with renal impairment require close
monitoring and possible dose reduction.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize when renal dose adjustment is necessary for
fluoroquinolones.
, • Prioritize medication safety before antibiotic
administration.
• Identify major boxed warnings associated with
levofloxacin.
Medication Safety Focus
Monitoring—Renal Function and Dose Adjustment
Question 2
Clinical Scenario
A 25-year-old woman presents to an urgent care clinic with
dysuria, urinary frequency, and urgency. She is diagnosed with
an uncomplicated urinary tract infection and is prescribed
trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days. During
discharge teaching, the nurse reviews home medications and
lifestyle habits.
Question Stem
Which statement by the patient indicates a need for additional
teaching?
A. "I'll drink plenty of fluids while taking this medication."
B. "I'll use sunscreen and protective clothing if I'm outdoors."
