NCLEX-RN Pharmacology Infection Practice
Questions |
Antibiotics, Antifungals & Antivirals |
20 Original MCQs with Rationales
Question 1
Clinical Scenario
A 68-year-old male is receiving intravenous gentamicin therapy
for a severe Pseudomonas aeruginosa urinary tract infection.
The patient’s medical history includes chronic kidney disease
(Stage 3). During the morning assessment, the nurse notes the
patient’s urine output has decreased from 50 mL/hr to 15
mL/hr over the last 4 hours, and his serum creatinine has risen
from 1.2 mg/dL to 2.1 mg/dL.
Question Stem
Which action should the nurse take first?
A. Hold the next scheduled dose of gentamicin and notify the
healthcare provider.
,B. Obtain a prescribed peak gentamicin serum level 30 minutes
after the next dose.
C. Administer a 500 mL bolus of normal saline as prescribed to
flush the kidneys.
D. Document the findings and continue to monitor urine output
hourly.
Correct Answer
A. Hold the next scheduled dose of gentamicin and notify the
healthcare provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic known for its narrow
therapeutic index and significant risk of nephrotoxicity and
ototoxicity. The patient’s clinical presentation—a sudden,
dramatic decrease in urine output (oliguria) combined with a
significant rise in serum creatinine—strongly indicates acute
kidney injury (AKI) secondary to gentamicin toxicity.
In clinical nursing practice, the priority action when suspecting
drug-induced nephrotoxicity is to limit further damage. The
nurse must hold the next dose of the offending medication
immediately and contact the provider. Continuing to administer
the medication (Option D) would exacerbate the renal injury.
Obtaining a peak level (Option B) is inappropriate at this point
because the next dose should not be given, and peak levels
,monitor therapeutic efficacy, whereas a trough level would be
more useful to evaluate drug accumulation and clearance.
While IV hydration (Option C) may be indicated to support renal
perfusion, the immediate nursing safety action is to stop drug
administration to prevent further toxicity.
Learning Objectives
• Recognize the clinical signs of aminoglycoside-induced
nephrotoxicity.
• Prioritize safety interventions when acute kidney injury is
suspected during antibiotic therapy.
• Interpret renal laboratory values (serum creatinine and
urine output) to guide medication safety.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 24-year-old female presents to the urgent care clinic with a
high fever, severe sore throat, and difficulty swallowing. She is
diagnosed with acute streptococcal pharyngitis. The patient’s
medical record indicates a documented allergy to penicillin,
described as "throat swelling, hives, and difficulty breathing
, requiring epinephrine" three years ago. The healthcare provider
prescribes oral cefadroxil.
Question Stem
Which action should the nurse take next?
A. Administer the cefadroxil as prescribed and monitor the
patient closely for 30 minutes.
B. Instruct the patient to take the medication with food to
prevent gastrointestinal upset.
C. Question the prescription and contact the healthcare
provider to suggest an alternative class of antibiotic.
D. Educate the patient on the signs of a mild allergic rash and
when to seek emergency care.
Correct Answer
C. Question the prescription and contact the healthcare
provider to suggest an alternative class of antibiotic.
Detailed Rationale
Cefadroxil is a first-generation cephalosporin. Patients who have
a history of a severe, IgE-mediated anaphylactic reaction to
penicillins (characterized by bronchospasm, urticaria,
angioedema, or cardiovascular collapse) have a 3% to 10% risk
of cross-sensitivity to cephalosporins, particularly first-
generation agents.
Questions |
Antibiotics, Antifungals & Antivirals |
20 Original MCQs with Rationales
Question 1
Clinical Scenario
A 68-year-old male is receiving intravenous gentamicin therapy
for a severe Pseudomonas aeruginosa urinary tract infection.
The patient’s medical history includes chronic kidney disease
(Stage 3). During the morning assessment, the nurse notes the
patient’s urine output has decreased from 50 mL/hr to 15
mL/hr over the last 4 hours, and his serum creatinine has risen
from 1.2 mg/dL to 2.1 mg/dL.
Question Stem
Which action should the nurse take first?
A. Hold the next scheduled dose of gentamicin and notify the
healthcare provider.
,B. Obtain a prescribed peak gentamicin serum level 30 minutes
after the next dose.
C. Administer a 500 mL bolus of normal saline as prescribed to
flush the kidneys.
D. Document the findings and continue to monitor urine output
hourly.
Correct Answer
A. Hold the next scheduled dose of gentamicin and notify the
healthcare provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic known for its narrow
therapeutic index and significant risk of nephrotoxicity and
ototoxicity. The patient’s clinical presentation—a sudden,
dramatic decrease in urine output (oliguria) combined with a
significant rise in serum creatinine—strongly indicates acute
kidney injury (AKI) secondary to gentamicin toxicity.
In clinical nursing practice, the priority action when suspecting
drug-induced nephrotoxicity is to limit further damage. The
nurse must hold the next dose of the offending medication
immediately and contact the provider. Continuing to administer
the medication (Option D) would exacerbate the renal injury.
Obtaining a peak level (Option B) is inappropriate at this point
because the next dose should not be given, and peak levels
,monitor therapeutic efficacy, whereas a trough level would be
more useful to evaluate drug accumulation and clearance.
While IV hydration (Option C) may be indicated to support renal
perfusion, the immediate nursing safety action is to stop drug
administration to prevent further toxicity.
Learning Objectives
• Recognize the clinical signs of aminoglycoside-induced
nephrotoxicity.
• Prioritize safety interventions when acute kidney injury is
suspected during antibiotic therapy.
• Interpret renal laboratory values (serum creatinine and
urine output) to guide medication safety.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 24-year-old female presents to the urgent care clinic with a
high fever, severe sore throat, and difficulty swallowing. She is
diagnosed with acute streptococcal pharyngitis. The patient’s
medical record indicates a documented allergy to penicillin,
described as "throat swelling, hives, and difficulty breathing
, requiring epinephrine" three years ago. The healthcare provider
prescribes oral cefadroxil.
Question Stem
Which action should the nurse take next?
A. Administer the cefadroxil as prescribed and monitor the
patient closely for 30 minutes.
B. Instruct the patient to take the medication with food to
prevent gastrointestinal upset.
C. Question the prescription and contact the healthcare
provider to suggest an alternative class of antibiotic.
D. Educate the patient on the signs of a mild allergic rash and
when to seek emergency care.
Correct Answer
C. Question the prescription and contact the healthcare
provider to suggest an alternative class of antibiotic.
Detailed Rationale
Cefadroxil is a first-generation cephalosporin. Patients who have
a history of a severe, IgE-mediated anaphylactic reaction to
penicillins (characterized by bronchospasm, urticaria,
angioedema, or cardiovascular collapse) have a 3% to 10% risk
of cross-sensitivity to cephalosporins, particularly first-
generation agents.
