NCLEX-RN Pharmacology Infection
Practice Questions |
20 ATI & NGN-Style Antibiotics,
Antifungals & Antivirals MCQs with
Rationales
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His medical history includes chronic kidney
disease (stage 3), hypertension, and type 2 diabetes
mellitus. He is prescribed gentamicin IV in addition to
ceftriaxone. Baseline laboratory results include: serum
creatinine 1.9 mg/dL, BUN 34 mg/dL, potassium 4.3 mEq/L,
and WBC 16,500/mm³. On the third day of therapy, the client
reports ringing in both ears and feeling "off balance."
Question Stem
Which nursing action is the priority?
A. Administer the next scheduled dose and reassess in 2
hours.
,B. Notify the provider and hold the next dose of gentamicin
pending further evaluation.
C. Encourage increased oral fluid intake and continue
therapy.
D. Reassure the client that these symptoms are expected
and temporary.
Correct Answer
B. Notify the provider and hold the next dose of
gentamicin pending further evaluation.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that inhibits
bacterial protein synthesis and is reserved for serious gram-
negative infections because of its potential toxicity. The
client's complaints of tinnitus and balance disturbances are
classic early manifestations of ototoxicity, one of the most
significant adverse effects associated with aminoglycosides.
Because this client also has chronic kidney disease,
impaired renal clearance increases drug accumulation and
further elevates the risk of both ototoxicity and
nephrotoxicity. The priority nursing intervention is to
withhold additional doses and promptly notify the provider
so serum drug levels and renal function can be evaluated.
,Continued administration may result in permanent hearing
loss.
Option A is unsafe because administering another dose
could worsen toxicity. Option C does not address the
underlying adverse reaction; hydration alone cannot reverse
drug accumulation. Option D is incorrect because tinnitus
and vestibular symptoms are not expected therapeutic
effects and should never be minimized. Nursing
responsibilities include monitoring peak and trough drug
levels, assessing renal function, documenting hearing or
balance changes, and educating patients to report auditory
symptoms immediately.
Learning Objectives
After completing this question, the learner should be able
to:
• Recognize early manifestations of aminoglycoside
ototoxicity.
• Prioritize nursing interventions when serious adverse
effects occur.
• Identify factors that increase aminoglycoside toxicity
risk.
• Describe appropriate monitoring for gentamicin
therapy.
, Medication Safety Focus
Monitoring for nephrotoxicity and ototoxicity
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for the
treatment of acne vulgaris. During discharge teaching, she
asks how to take the medication to ensure it works well and
avoids complications.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I'll use sunscreen and protective clothing while taking
this medication."
B. "I'll take the medication with a full glass of water and
remain upright afterward."
C. "I'll take my dose with a glass of milk every morning to
reduce stomach upset."
D. "I'll complete the entire course even if my skin improves
before it's finished."
Correct Answer
Practice Questions |
20 ATI & NGN-Style Antibiotics,
Antifungals & Antivirals MCQs with
Rationales
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His medical history includes chronic kidney
disease (stage 3), hypertension, and type 2 diabetes
mellitus. He is prescribed gentamicin IV in addition to
ceftriaxone. Baseline laboratory results include: serum
creatinine 1.9 mg/dL, BUN 34 mg/dL, potassium 4.3 mEq/L,
and WBC 16,500/mm³. On the third day of therapy, the client
reports ringing in both ears and feeling "off balance."
Question Stem
Which nursing action is the priority?
A. Administer the next scheduled dose and reassess in 2
hours.
,B. Notify the provider and hold the next dose of gentamicin
pending further evaluation.
C. Encourage increased oral fluid intake and continue
therapy.
D. Reassure the client that these symptoms are expected
and temporary.
Correct Answer
B. Notify the provider and hold the next dose of
gentamicin pending further evaluation.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that inhibits
bacterial protein synthesis and is reserved for serious gram-
negative infections because of its potential toxicity. The
client's complaints of tinnitus and balance disturbances are
classic early manifestations of ototoxicity, one of the most
significant adverse effects associated with aminoglycosides.
Because this client also has chronic kidney disease,
impaired renal clearance increases drug accumulation and
further elevates the risk of both ototoxicity and
nephrotoxicity. The priority nursing intervention is to
withhold additional doses and promptly notify the provider
so serum drug levels and renal function can be evaluated.
,Continued administration may result in permanent hearing
loss.
Option A is unsafe because administering another dose
could worsen toxicity. Option C does not address the
underlying adverse reaction; hydration alone cannot reverse
drug accumulation. Option D is incorrect because tinnitus
and vestibular symptoms are not expected therapeutic
effects and should never be minimized. Nursing
responsibilities include monitoring peak and trough drug
levels, assessing renal function, documenting hearing or
balance changes, and educating patients to report auditory
symptoms immediately.
Learning Objectives
After completing this question, the learner should be able
to:
• Recognize early manifestations of aminoglycoside
ototoxicity.
• Prioritize nursing interventions when serious adverse
effects occur.
• Identify factors that increase aminoglycoside toxicity
risk.
• Describe appropriate monitoring for gentamicin
therapy.
, Medication Safety Focus
Monitoring for nephrotoxicity and ototoxicity
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for the
treatment of acne vulgaris. During discharge teaching, she
asks how to take the medication to ensure it works well and
avoids complications.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I'll use sunscreen and protective clothing while taking
this medication."
B. "I'll take the medication with a full glass of water and
remain upright afterward."
C. "I'll take my dose with a glass of milk every morning to
reduce stomach upset."
D. "I'll complete the entire course even if my skin improves
before it's finished."
Correct Answer
