NCLEX-RN Pharmacology Practice
Questions |
20 ATI & NGN-Style MCQs on Antibiotics,
Antifungals & Antivirals with Detailed
Rationales
Question 1
Clinical Scenario
A 72-year-old man is admitted with fever, productive cough,
and shortness of breath. He is diagnosed with community-
acquired pneumonia. His medical history includes chronic
kidney disease (stage 4), hypertension, and type 2 diabetes
mellitus. The provider prescribes gentamicin IV. Baseline
laboratory results include:
• Serum creatinine: 2.8 mg/dL
• BUN: 42 mg/dL
• Potassium: 4.4 mEq/L
• WBC: 16,500/mm³
,The nurse reviews the prescription before administering the
first dose.
Question Stem
Which nursing action is the priority before administering the
medication?
A. Verify the patient's baseline renal function and anticipate
dosage adjustment.
B. Encourage the patient to increase dietary potassium
intake.
C. Administer the medication rapidly to achieve therapeutic
levels.
D. Delay administration until the patient is afebrile.
Correct Answer
Correct Answer: A. Verify the patient's baseline renal
function and anticipate dosage adjustment.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that inhibits
bacterial protein synthesis by binding to the 30S ribosomal
subunit, making it bactericidal against many aerobic gram-
,negative organisms. Aminoglycosides carry significant risks
of nephrotoxicity and ototoxicity, particularly in older
adults and patients with preexisting kidney disease. Because
gentamicin is eliminated primarily by the kidneys, impaired
renal function prolongs drug clearance and increases the
risk of toxic serum concentrations. The nurse should verify
baseline renal function, ensure the prescribed dose is
appropriate for the patient's estimated glomerular filtration
rate (eGFR), and anticipate therapeutic drug monitoring
(peak and trough levels) as indicated.
Option B is incorrect because potassium intake is unrelated
to preventing gentamicin toxicity. Option C is unsafe
because aminoglycosides should be infused according to
institutional guidelines; rapid administration does not
improve efficacy and may increase adverse effects. Option D
is incorrect because antibiotic therapy should begin
promptly once prescribed; delaying treatment until the fever
resolves would worsen infection.
Nursing care includes monitoring urine output, daily serum
creatinine, hearing changes, tinnitus, and vestibular
symptoms. Patients should be instructed to report
decreased hearing, ringing in the ears, dizziness, or reduced
urine output immediately.
, Learning Objectives
After completing this question, the learner should be able
to:
• Identify patients at increased risk for aminoglycoside
toxicity.
• Prioritize assessment of renal function before
administering nephrotoxic antibiotics.
• Recognize the need for dosage adjustment in renal
impairment.
• Describe nursing monitoring for gentamicin therapy.
Medication Safety Focus
Monitoring (Renal Function and Drug Levels)
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for
treatment of acne vulgaris. During discharge teaching, she
states she plans to begin taking a prenatal vitamin and
enjoys drinking milk with every meal. She also reports
spending several hours outdoors each weekend.
Questions |
20 ATI & NGN-Style MCQs on Antibiotics,
Antifungals & Antivirals with Detailed
Rationales
Question 1
Clinical Scenario
A 72-year-old man is admitted with fever, productive cough,
and shortness of breath. He is diagnosed with community-
acquired pneumonia. His medical history includes chronic
kidney disease (stage 4), hypertension, and type 2 diabetes
mellitus. The provider prescribes gentamicin IV. Baseline
laboratory results include:
• Serum creatinine: 2.8 mg/dL
• BUN: 42 mg/dL
• Potassium: 4.4 mEq/L
• WBC: 16,500/mm³
,The nurse reviews the prescription before administering the
first dose.
Question Stem
Which nursing action is the priority before administering the
medication?
A. Verify the patient's baseline renal function and anticipate
dosage adjustment.
B. Encourage the patient to increase dietary potassium
intake.
C. Administer the medication rapidly to achieve therapeutic
levels.
D. Delay administration until the patient is afebrile.
Correct Answer
Correct Answer: A. Verify the patient's baseline renal
function and anticipate dosage adjustment.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that inhibits
bacterial protein synthesis by binding to the 30S ribosomal
subunit, making it bactericidal against many aerobic gram-
,negative organisms. Aminoglycosides carry significant risks
of nephrotoxicity and ototoxicity, particularly in older
adults and patients with preexisting kidney disease. Because
gentamicin is eliminated primarily by the kidneys, impaired
renal function prolongs drug clearance and increases the
risk of toxic serum concentrations. The nurse should verify
baseline renal function, ensure the prescribed dose is
appropriate for the patient's estimated glomerular filtration
rate (eGFR), and anticipate therapeutic drug monitoring
(peak and trough levels) as indicated.
Option B is incorrect because potassium intake is unrelated
to preventing gentamicin toxicity. Option C is unsafe
because aminoglycosides should be infused according to
institutional guidelines; rapid administration does not
improve efficacy and may increase adverse effects. Option D
is incorrect because antibiotic therapy should begin
promptly once prescribed; delaying treatment until the fever
resolves would worsen infection.
Nursing care includes monitoring urine output, daily serum
creatinine, hearing changes, tinnitus, and vestibular
symptoms. Patients should be instructed to report
decreased hearing, ringing in the ears, dizziness, or reduced
urine output immediately.
, Learning Objectives
After completing this question, the learner should be able
to:
• Identify patients at increased risk for aminoglycoside
toxicity.
• Prioritize assessment of renal function before
administering nephrotoxic antibiotics.
• Recognize the need for dosage adjustment in renal
impairment.
• Describe nursing monitoring for gentamicin therapy.
Medication Safety Focus
Monitoring (Renal Function and Drug Levels)
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for
treatment of acne vulgaris. During discharge teaching, she
states she plans to begin taking a prenatal vitamin and
enjoys drinking milk with every meal. She also reports
spending several hours outdoors each weekend.
