ATI Pharmacology Made Easy Infection
Practice Questions |
20 NCLEX-RN NGN Pharmacology Antibiotics,
Antifungals & Antivirals MCQs with Detailed
Rationales | Nursing Exam Study Guide
Question 1
Clinical Scenario
A 76-year-old male client with a history of chronic kidney
disease (Stage 3) is admitted with sepsis secondary to a urinary
tract infection. The healthcare provider prescribes intravenous
gentamicin. The nurse reviews the client's admission laboratory
results: serum creatinine 1.9 mg/dL (baseline 1.2 mg/dL), BUN
42 mg/dL, and weight 82 kg. The nurse calculates the client's
creatinine clearance at 38 mL/min.
Question Stem
,Which action should the nurse take first before administering
the prescribed gentamicin?
A. Administer the gentamicin as ordered and monitor urine
output hourly.
B. Hold the gentamicin and request a consult for hemodialysis.
C. Notify the healthcare provider to discuss dose adjustment or
alternative therapy.
D. Administer a 500 mL normal saline bolus before the
gentamicin infusion.
Options
A. Administer the gentamicin as ordered and monitor urine
output hourly.
B. Hold the gentamicin and request a consult for hemodialysis.
C. Notify the healthcare provider to discuss dose adjustment or
alternative therapy.
D. Administer a 500 mL normal saline bolus before the
gentamicin infusion.
Correct Answer
Correct Answer: C. Notify the healthcare provider to discuss
dose adjustment or alternative therapy.
,Detailed Rationale
Correct Answer Rationale: Aminoglycosides, such as
gentamicin, are predominantly excreted unchanged by the
kidneys and are well-documented for their nephrotoxic
potential. The risk of acute kidney injury (AKI) is significantly
elevated when these drugs are administered to clients with pre-
existing renal impairment, as evidenced by this client's elevated
serum creatinine and reduced creatinine clearance of 38
mL/min. The nurse's priority is to act as a client advocate and
safeguard against medication-related harm. The appropriate
action is to contact the healthcare provider to discuss the need
for a dose reduction based on the client's renal function,
extended dosing intervals, or selection of an alternative, less
nephrotoxic antibiotic . Administering a standard dose without
adjustment could lead to drug accumulation and further renal
damage .
Incorrect Option Rationale:
• Option A is incorrect because administering a nephrotoxic
medication at a standard dose to a client with significant
renal impairment without any provider discussion
constitutes unsafe practice and increases the risk of
toxicity.
• Option B is incorrect and premature. While a significant
decline in renal function warrants attention, the first step
, is to address the medication order; hemodialysis may not
be immediately indicated, and the provider should first be
consulted regarding the medication plan.
• Option D is incorrect. While fluid boluses may be a part of
sepsis management, the priority action is to address the
specific nephrotoxic medication. Administering a bolus
does not correct the underlying issue of impaired drug
excretion and could be contraindicated in some clients.
Pharmacology Principles & Nursing
Considerations: Aminoglycosides have a narrow therapeutic
index, and therapeutic drug monitoring is essential. Trough
levels should be drawn immediately before the next dose to
ensure they are not accumulating, which is a primary predictor
of nephrotoxicity. This scenario emphasizes the critical nursing
role of evaluating laboratory data (creatinine, BUN, creatinine
clearance) and understanding their implications for safe
medication administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify the risk factors and laboratory indicators of
nephrotoxicity associated with aminoglycoside therapy.
Practice Questions |
20 NCLEX-RN NGN Pharmacology Antibiotics,
Antifungals & Antivirals MCQs with Detailed
Rationales | Nursing Exam Study Guide
Question 1
Clinical Scenario
A 76-year-old male client with a history of chronic kidney
disease (Stage 3) is admitted with sepsis secondary to a urinary
tract infection. The healthcare provider prescribes intravenous
gentamicin. The nurse reviews the client's admission laboratory
results: serum creatinine 1.9 mg/dL (baseline 1.2 mg/dL), BUN
42 mg/dL, and weight 82 kg. The nurse calculates the client's
creatinine clearance at 38 mL/min.
Question Stem
,Which action should the nurse take first before administering
the prescribed gentamicin?
A. Administer the gentamicin as ordered and monitor urine
output hourly.
B. Hold the gentamicin and request a consult for hemodialysis.
C. Notify the healthcare provider to discuss dose adjustment or
alternative therapy.
D. Administer a 500 mL normal saline bolus before the
gentamicin infusion.
Options
A. Administer the gentamicin as ordered and monitor urine
output hourly.
B. Hold the gentamicin and request a consult for hemodialysis.
C. Notify the healthcare provider to discuss dose adjustment or
alternative therapy.
D. Administer a 500 mL normal saline bolus before the
gentamicin infusion.
Correct Answer
Correct Answer: C. Notify the healthcare provider to discuss
dose adjustment or alternative therapy.
,Detailed Rationale
Correct Answer Rationale: Aminoglycosides, such as
gentamicin, are predominantly excreted unchanged by the
kidneys and are well-documented for their nephrotoxic
potential. The risk of acute kidney injury (AKI) is significantly
elevated when these drugs are administered to clients with pre-
existing renal impairment, as evidenced by this client's elevated
serum creatinine and reduced creatinine clearance of 38
mL/min. The nurse's priority is to act as a client advocate and
safeguard against medication-related harm. The appropriate
action is to contact the healthcare provider to discuss the need
for a dose reduction based on the client's renal function,
extended dosing intervals, or selection of an alternative, less
nephrotoxic antibiotic . Administering a standard dose without
adjustment could lead to drug accumulation and further renal
damage .
Incorrect Option Rationale:
• Option A is incorrect because administering a nephrotoxic
medication at a standard dose to a client with significant
renal impairment without any provider discussion
constitutes unsafe practice and increases the risk of
toxicity.
• Option B is incorrect and premature. While a significant
decline in renal function warrants attention, the first step
, is to address the medication order; hemodialysis may not
be immediately indicated, and the provider should first be
consulted regarding the medication plan.
• Option D is incorrect. While fluid boluses may be a part of
sepsis management, the priority action is to address the
specific nephrotoxic medication. Administering a bolus
does not correct the underlying issue of impaired drug
excretion and could be contraindicated in some clients.
Pharmacology Principles & Nursing
Considerations: Aminoglycosides have a narrow therapeutic
index, and therapeutic drug monitoring is essential. Trough
levels should be drawn immediately before the next dose to
ensure they are not accumulating, which is a primary predictor
of nephrotoxicity. This scenario emphasizes the critical nursing
role of evaluating laboratory data (creatinine, BUN, creatinine
clearance) and understanding their implications for safe
medication administration.
Learning Objective
After completing this question, the learner should be able to:
• Identify the risk factors and laboratory indicators of
nephrotoxicity associated with aminoglycoside therapy.
