NCLEX-RN Pharmacology Practice Questions |
20 NGN-Style MCQs with Rationales |
Antibiotics, Antifungals & Antivirals |
Infection Pharmacology Exam Prep |
Nursing Study Guide
Question 1
Clinical Scenario
A 76-year-old male client is admitted to the medical-surgical
unit with community-acquired pneumonia. The healthcare
provider prescribes intravenous ceftriaxone 1 gram daily. The
client's admission laboratory results show a serum creatinine of
1.8 mg/dL and BUN of 32 mg/dL. The client reports a history of
a "rash" when given amoxicillin 10 years ago. The nurse reviews
the medication order and prepares to administer the first dose.
Question Stem
Which action should the nurse take first?
A. Administer the ceftriaxone as prescribed and monitor for
allergic reaction.
,B. Hold the ceftriaxone and request an order for a
cephalosporin skin test.
C. Contact the healthcare provider to clarify the order due to
renal function.
D. Administer the ceftriaxone with a slower infusion rate to
prevent nephrotoxicity.
Correct Answer: C. Contact the healthcare provider to clarify
the order due to renal function.
Detailed Rationale
The correct answer is C. Ceftriaxone is a third-generation
cephalosporin that is primarily excreted by the kidneys. In an
older adult client with elevated serum creatinine (1.8 mg/dL)
and BUN (32 mg/dL), renal function is significantly impaired,
indicating that dosage adjustment may be necessary to prevent
drug accumulation and potential toxicity . Ceftriaxone is
typically dosed based on renal function, and the nurse must
contact the provider to request an appropriate dose
adjustment.
Option A is incorrect because administering the drug without
addressing the renal impairment could lead to toxic
accumulation and adverse effects. While monitoring for allergic
,reactions is important, it is not the priority given the renal
function findings. Option B is incorrect because cephalosporin
skin testing is not standard practice and has limited predictive
value; cross-reactivity between penicillins and cephalosporins is
low (approximately 1-3%) and does not require skin testing.
Option D is incorrect because infusion rate adjustments do not
prevent nephrotoxicity with ceftriaxone; dose adjustment based
on creatinine clearance is the appropriate intervention.
Relevant Pharmacology Principles: Cephalosporins share a
beta-lactam ring with penicillins, and cross-reactivity can occur,
but the priority here is the renal impairment. Many antibiotics
require dose reduction when creatinine clearance falls below 50
mL/min.
Nursing Considerations: The nurse should assess the client's
baseline renal function, monitor for signs of cephalosporin
adverse effects (diarrhea, rash, superinfection), and ensure the
provider is notified of significant laboratory abnormalities.
Learning Objective
After completing this question, the learner should be able to:
• Identify laboratory values indicating renal impairment
requiring antibiotic dose adjustment.
, • Prioritize nursing actions when medication orders conflict
with client assessment data.
• Explain the importance of renal function monitoring in
older adults receiving cephalosporin therapy.
Medication Safety Focus
Renal function monitoring and dose adjustment
Question 2
Clinical Scenario
A 28-year-old female client is diagnosed with a urinary tract
infection (UTI) and prescribed ciprofloxacin 250 mg orally twice
daily for 7 days. During the medication history, the client
reports she takes an oral contraceptive pill daily. She also
mentions she started taking a multivitamin with iron and
calcium last week.
Question Stem
Which information is most important for the nurse to include in
client teaching?
A. "Ciprofloxacin may decrease the effectiveness of your birth
control pill; use a backup contraceptive method."
20 NGN-Style MCQs with Rationales |
Antibiotics, Antifungals & Antivirals |
Infection Pharmacology Exam Prep |
Nursing Study Guide
Question 1
Clinical Scenario
A 76-year-old male client is admitted to the medical-surgical
unit with community-acquired pneumonia. The healthcare
provider prescribes intravenous ceftriaxone 1 gram daily. The
client's admission laboratory results show a serum creatinine of
1.8 mg/dL and BUN of 32 mg/dL. The client reports a history of
a "rash" when given amoxicillin 10 years ago. The nurse reviews
the medication order and prepares to administer the first dose.
Question Stem
Which action should the nurse take first?
A. Administer the ceftriaxone as prescribed and monitor for
allergic reaction.
,B. Hold the ceftriaxone and request an order for a
cephalosporin skin test.
C. Contact the healthcare provider to clarify the order due to
renal function.
D. Administer the ceftriaxone with a slower infusion rate to
prevent nephrotoxicity.
Correct Answer: C. Contact the healthcare provider to clarify
the order due to renal function.
Detailed Rationale
The correct answer is C. Ceftriaxone is a third-generation
cephalosporin that is primarily excreted by the kidneys. In an
older adult client with elevated serum creatinine (1.8 mg/dL)
and BUN (32 mg/dL), renal function is significantly impaired,
indicating that dosage adjustment may be necessary to prevent
drug accumulation and potential toxicity . Ceftriaxone is
typically dosed based on renal function, and the nurse must
contact the provider to request an appropriate dose
adjustment.
Option A is incorrect because administering the drug without
addressing the renal impairment could lead to toxic
accumulation and adverse effects. While monitoring for allergic
,reactions is important, it is not the priority given the renal
function findings. Option B is incorrect because cephalosporin
skin testing is not standard practice and has limited predictive
value; cross-reactivity between penicillins and cephalosporins is
low (approximately 1-3%) and does not require skin testing.
Option D is incorrect because infusion rate adjustments do not
prevent nephrotoxicity with ceftriaxone; dose adjustment based
on creatinine clearance is the appropriate intervention.
Relevant Pharmacology Principles: Cephalosporins share a
beta-lactam ring with penicillins, and cross-reactivity can occur,
but the priority here is the renal impairment. Many antibiotics
require dose reduction when creatinine clearance falls below 50
mL/min.
Nursing Considerations: The nurse should assess the client's
baseline renal function, monitor for signs of cephalosporin
adverse effects (diarrhea, rash, superinfection), and ensure the
provider is notified of significant laboratory abnormalities.
Learning Objective
After completing this question, the learner should be able to:
• Identify laboratory values indicating renal impairment
requiring antibiotic dose adjustment.
, • Prioritize nursing actions when medication orders conflict
with client assessment data.
• Explain the importance of renal function monitoring in
older adults receiving cephalosporin therapy.
Medication Safety Focus
Renal function monitoring and dose adjustment
Question 2
Clinical Scenario
A 28-year-old female client is diagnosed with a urinary tract
infection (UTI) and prescribed ciprofloxacin 250 mg orally twice
daily for 7 days. During the medication history, the client
reports she takes an oral contraceptive pill daily. She also
mentions she started taking a multivitamin with iron and
calcium last week.
Question Stem
Which information is most important for the nurse to include in
client teaching?
A. "Ciprofloxacin may decrease the effectiveness of your birth
control pill; use a backup contraceptive method."
