NCLEX-RN Pharmacology Exam Questions
& Rationales |
Infection Medications (Antibiotics,
Antifungals & Antivirals) |
20 Original ATI & NGN-Style Practice
Questions
Question 1
Clinical Scenario
A 68-year-old woman is admitted with fever, productive
cough, and shortness of breath. She is diagnosed with
community-acquired pneumonia and is prescribed
ceftriaxone IV. Her history includes a documented
anaphylactic reaction to penicillin 10 years ago. Current
vital signs are: temperature 38.8°C (101.8°F), heart rate
108/min, blood pressure 132/78 mm Hg, respiratory rate
24/min, and oxygen saturation 91% on room air.
Question Stem
,Which action should the nurse take before administering
the first dose of ceftriaxone?
A. Administer the medication and monitor the client closely
for 30 minutes.
B. Verify the allergy history and notify the provider about the
reported anaphylactic reaction.
C. Premedicate the client with diphenhydramine before
administering ceftriaxone.
D. Dilute the medication in additional IV fluid to reduce the
risk of an allergic reaction.
Correct Answer
Correct Answer: B. Verify the allergy history and notify
the provider about the reported anaphylactic reaction.
Detailed Rationale
The priority nursing action is to verify the reported allergy
and communicate the history of anaphylaxis to the provider
before administering ceftriaxone. Although many patients
with penicillin allergies can safely receive cephalosporins, a
history of severe IgE-mediated reactions such as
anaphylaxis requires careful evaluation because cross-
reactivity, while uncommon, remains clinically significant.
Administering the medication before clarification could
,place the client at risk for a life-threatening hypersensitivity
reaction.
Option A is incorrect because observation after
administration does not eliminate the risk of preventable
anaphylaxis. Safety requires assessment before
administration. Option C is incorrect because
antihistamines do not prevent anaphylaxis and should not
be used to justify giving a potentially contraindicated
medication. Option D is incorrect because dilution has no
effect on allergic reactions; hypersensitivity is immune-
mediated rather than concentration-dependent.
Nurses play a key role in medication safety by distinguishing
between mild medication intolerance and true allergic
reactions, documenting allergies accurately, and
collaborating with prescribers before administering
antibiotics. Emergency equipment and medications such as
epinephrine should always be readily available whenever
there is concern for severe hypersensitivity.
Learning Objectives
After completing this question, the learner should be able
to:
• Differentiate a true medication allergy from medication
intolerance.
, • Identify when a reported antibiotic allergy requires
provider clarification.
• Prioritize nursing interventions before administering
beta-lactam antibiotics.
• Promote medication safety through accurate allergy
assessment.
Medication Safety Focus: Contraindication and allergy
assessment
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for
treatment of acne vulgaris. During discharge teaching, she
tells the nurse that she takes a daily calcium supplement
and often drinks a large glass of milk with breakfast. She
plans to take the medication each morning with breakfast.
Question Stem
Which teaching should the nurse provide?
A. Take doxycycline with milk to decrease stomach irritation.
B. Take doxycycline at bedtime immediately before lying
down.
& Rationales |
Infection Medications (Antibiotics,
Antifungals & Antivirals) |
20 Original ATI & NGN-Style Practice
Questions
Question 1
Clinical Scenario
A 68-year-old woman is admitted with fever, productive
cough, and shortness of breath. She is diagnosed with
community-acquired pneumonia and is prescribed
ceftriaxone IV. Her history includes a documented
anaphylactic reaction to penicillin 10 years ago. Current
vital signs are: temperature 38.8°C (101.8°F), heart rate
108/min, blood pressure 132/78 mm Hg, respiratory rate
24/min, and oxygen saturation 91% on room air.
Question Stem
,Which action should the nurse take before administering
the first dose of ceftriaxone?
A. Administer the medication and monitor the client closely
for 30 minutes.
B. Verify the allergy history and notify the provider about the
reported anaphylactic reaction.
C. Premedicate the client with diphenhydramine before
administering ceftriaxone.
D. Dilute the medication in additional IV fluid to reduce the
risk of an allergic reaction.
Correct Answer
Correct Answer: B. Verify the allergy history and notify
the provider about the reported anaphylactic reaction.
Detailed Rationale
The priority nursing action is to verify the reported allergy
and communicate the history of anaphylaxis to the provider
before administering ceftriaxone. Although many patients
with penicillin allergies can safely receive cephalosporins, a
history of severe IgE-mediated reactions such as
anaphylaxis requires careful evaluation because cross-
reactivity, while uncommon, remains clinically significant.
Administering the medication before clarification could
,place the client at risk for a life-threatening hypersensitivity
reaction.
Option A is incorrect because observation after
administration does not eliminate the risk of preventable
anaphylaxis. Safety requires assessment before
administration. Option C is incorrect because
antihistamines do not prevent anaphylaxis and should not
be used to justify giving a potentially contraindicated
medication. Option D is incorrect because dilution has no
effect on allergic reactions; hypersensitivity is immune-
mediated rather than concentration-dependent.
Nurses play a key role in medication safety by distinguishing
between mild medication intolerance and true allergic
reactions, documenting allergies accurately, and
collaborating with prescribers before administering
antibiotics. Emergency equipment and medications such as
epinephrine should always be readily available whenever
there is concern for severe hypersensitivity.
Learning Objectives
After completing this question, the learner should be able
to:
• Differentiate a true medication allergy from medication
intolerance.
, • Identify when a reported antibiotic allergy requires
provider clarification.
• Prioritize nursing interventions before administering
beta-lactam antibiotics.
• Promote medication safety through accurate allergy
assessment.
Medication Safety Focus: Contraindication and allergy
assessment
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for
treatment of acne vulgaris. During discharge teaching, she
tells the nurse that she takes a daily calcium supplement
and often drinks a large glass of milk with breakfast. She
plans to take the medication each morning with breakfast.
Question Stem
Which teaching should the nurse provide?
A. Take doxycycline with milk to decrease stomach irritation.
B. Take doxycycline at bedtime immediately before lying
down.
