NCLEX-RN Pharmacology Practice Questions |
Infection Antibiotics Antifungals Antivirals |
20 Original NGN-Style MCQs with Detailed
Rationales & Clinical Judgment
Question 1
Clinical Scenario
A 28-year-old female patient is admitted with a severe urinary
tract infection that has progressed to pyelonephritis. She has no
significant past medical history except for mild asthma. The
healthcare provider prescribes IV gentamicin $5\text{ mg/kg}$
daily. Before administering the first dose, the nurse reviews her
baseline laboratory results: Serum creatinine is $0.8\text{
mg/dL}$, BUN is $12\text{ mg/dL}$, and a urine pregnancy test
is positive.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed dose of IV gentamicin as
scheduled.
,B. Withhold the medication and contact the healthcare
provider.
C. Inform the patient that she will need serial peak and trough
blood levels drawn.
D. Request a prescription for an inhaled bronchodilator to have
at the bedside.
Correct Answer
Correct Answer: B. Withhold the medication and contact the
healthcare provider.
Detailed Rationale
Aminoglycosides, such as gentamicin, carry a high risk of fetal
harm and are classified as category D or highly contraindicated
during pregnancy due to their ability to cross the placenta.
Specifically, gentamicin can cause irreversible bilateral
congenital deafness (ototoxicity) in the fetus, as well as
neonatal nephrotoxicity. Because the patient’s pregnancy test is
positive, the nurse's priority action must be to protect both the
mother and the fetus by withholding the medication and
notifying the prescribing provider to obtain an alternative, safer
antibiotic class (such as cephalosporins or penicillins, which are
generally considered safe in pregnancy).
Administering the medication (Option A) is incorrect and
constitutes a major medication safety violation due to the
,severe teratogenic risks. Explaining peak and trough protocols
(Option C) is premature and inappropriate because the drug
should not be administered to this pregnant patient. While
gentamicin can occasionally trigger bronchospasms in rare
instances, and the patient has a history of asthma, requesting a
bronchodilator (Option D) is not the priority compared to
addressing the positive pregnancy test.
Learning Objective
After completing this question, the learner should be able to:
• Identify pregnancy as a critical contraindication for
aminoglycoside therapy.
• Prioritize patient safety by withholding teratogenic
medications.
• Recommend safe alternative antimicrobial classes for
pregnant patients.
Medication Safety Focus
Contraindication (Pregnancy / Teratogenicity)
Question 2
Clinical Scenario
A 64-year-old male is receiving intravenous vancomycin
$1.25\text{ g}$ every 12 hours for a confirmed methicillin-
resistant Staphylococcus aureus (MRSA) osteomyelitis infection.
, Exactly 15 minutes after the nurse initiates the third dose of the
infusion, the patient presses the call light. The nurse assesses
the patient and notes intense flushing, redness, and a pruritic
maculopapular rash across his face, neck, and upper torso. His
vital signs are: blood pressure $118/72\text{ mmHg}$, heart
rate $88\text{ bpm}$, respiratory rate $16\text{ breaths/min}$,
and $O_2$ saturation $98\%$ on room air.
Question Stem
Which action should the nurse take first?
A. Stop the infusion and prepare to administer intramuscular
epinephrine.
B. Slow the infusion rate of the vancomycin and document the
reaction.
C. Temporarily stop the infusion and administer prescribed
diphenhydramine.
D. Obtain a stat blood specimen to measure the vancomycin
trough level.
Correct Answer
Correct Answer: C. Temporarily stop the infusion and administer
prescribed diphenhydramine.
Detailed Rationale
Infection Antibiotics Antifungals Antivirals |
20 Original NGN-Style MCQs with Detailed
Rationales & Clinical Judgment
Question 1
Clinical Scenario
A 28-year-old female patient is admitted with a severe urinary
tract infection that has progressed to pyelonephritis. She has no
significant past medical history except for mild asthma. The
healthcare provider prescribes IV gentamicin $5\text{ mg/kg}$
daily. Before administering the first dose, the nurse reviews her
baseline laboratory results: Serum creatinine is $0.8\text{
mg/dL}$, BUN is $12\text{ mg/dL}$, and a urine pregnancy test
is positive.
Question Stem
Which action should the nurse take first?
A. Administer the prescribed dose of IV gentamicin as
scheduled.
,B. Withhold the medication and contact the healthcare
provider.
C. Inform the patient that she will need serial peak and trough
blood levels drawn.
D. Request a prescription for an inhaled bronchodilator to have
at the bedside.
Correct Answer
Correct Answer: B. Withhold the medication and contact the
healthcare provider.
Detailed Rationale
Aminoglycosides, such as gentamicin, carry a high risk of fetal
harm and are classified as category D or highly contraindicated
during pregnancy due to their ability to cross the placenta.
Specifically, gentamicin can cause irreversible bilateral
congenital deafness (ototoxicity) in the fetus, as well as
neonatal nephrotoxicity. Because the patient’s pregnancy test is
positive, the nurse's priority action must be to protect both the
mother and the fetus by withholding the medication and
notifying the prescribing provider to obtain an alternative, safer
antibiotic class (such as cephalosporins or penicillins, which are
generally considered safe in pregnancy).
Administering the medication (Option A) is incorrect and
constitutes a major medication safety violation due to the
,severe teratogenic risks. Explaining peak and trough protocols
(Option C) is premature and inappropriate because the drug
should not be administered to this pregnant patient. While
gentamicin can occasionally trigger bronchospasms in rare
instances, and the patient has a history of asthma, requesting a
bronchodilator (Option D) is not the priority compared to
addressing the positive pregnancy test.
Learning Objective
After completing this question, the learner should be able to:
• Identify pregnancy as a critical contraindication for
aminoglycoside therapy.
• Prioritize patient safety by withholding teratogenic
medications.
• Recommend safe alternative antimicrobial classes for
pregnant patients.
Medication Safety Focus
Contraindication (Pregnancy / Teratogenicity)
Question 2
Clinical Scenario
A 64-year-old male is receiving intravenous vancomycin
$1.25\text{ g}$ every 12 hours for a confirmed methicillin-
resistant Staphylococcus aureus (MRSA) osteomyelitis infection.
, Exactly 15 minutes after the nurse initiates the third dose of the
infusion, the patient presses the call light. The nurse assesses
the patient and notes intense flushing, redness, and a pruritic
maculopapular rash across his face, neck, and upper torso. His
vital signs are: blood pressure $118/72\text{ mmHg}$, heart
rate $88\text{ bpm}$, respiratory rate $16\text{ breaths/min}$,
and $O_2$ saturation $98\%$ on room air.
Question Stem
Which action should the nurse take first?
A. Stop the infusion and prepare to administer intramuscular
epinephrine.
B. Slow the infusion rate of the vancomycin and document the
reaction.
C. Temporarily stop the infusion and administer prescribed
diphenhydramine.
D. Obtain a stat blood specimen to measure the vancomycin
trough level.
Correct Answer
Correct Answer: C. Temporarily stop the infusion and administer
prescribed diphenhydramine.
Detailed Rationale
