NCLEX-RN Pharmacology Infection Exam |
20 ATI NGN-Style Antibiotics, Antifungals &
Antivirals Practice Questions with
Rationales
Question 1
Clinical Scenario
A 72-year-old male is admitted to the medical-surgical unit
with sepsis secondary to a urinary tract infection. The
healthcare provider prescribes intravenous gentamicin. The
client's baseline serum creatinine is 1.1 mg/dL. On day three
of therapy, the nurse reviews morning laboratory results and
notes the serum creatinine has risen to 2.0 mg/dL. The
client's urine output has decreased to 20 mL/hr over the past
two hours.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled gentamicin dose and monitor
creatinine levels closely.
B. Hold the gentamicin dose and notify the healthcare
provider immediately.
,C. Increase the client's intravenous fluid rate to promote
urine output.
D. Obtain a gentamicin trough level before administering the
next dose.
Correct Answer: B. Hold the gentamicin dose and notify
the healthcare provider immediately.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic with a narrow
therapeutic index and significant potential for nephrotoxicity
and ototoxicity. The drug is eliminated primarily by the
kidneys, and accumulation in patients with impaired renal
function can lead to acute kidney injury (AKI) and permanent
damage. A rising serum creatinine from 1.1 mg/dL to 2.0
mg/dL and decreased urine output (<30 mL/hr) indicate
acute kidney injury, a serious adverse effect of
aminoglycoside therapy.
Option A is incorrect because administering the scheduled
dose would further accumulate the drug in renal tubules,
worsening nephrotoxicity. Option C, increasing fluids, is not
a priority action before holding the nephrotoxic medication;
while fluid resuscitation may be indicated for sepsis, it does
not address the drug-induced kidney injury. Option D,
,obtaining a trough level, is an appropriate monitoring
parameter but is not the priority action; the nurse must first
hold the medication and notify the provider for dose
adjustment based on renal function and serum drug levels.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify signs of nephrotoxicity associated with
aminoglycoside therapy.
• Prioritize nursing actions when laboratory values
indicate drug toxicity.
• Explain the importance of renal function monitoring
during gentamicin therapy.
Medication Safety Focus: Monitoring for nephrotoxicity
Question 2
Clinical Scenario
A 45-year-old female client is prescribed oral fluconazole for
a recurrent vaginal yeast infection. During the medication
history, the nurse learns the client takes warfarin daily for a
history of deep vein thrombosis. The client's current INR is
2.8 (therapeutic range 2.0–3.0).
, Question Stem
The nurse should prioritize monitoring for which potential
complication?
A. Decreased antifungal effectiveness requiring a higher
fluconazole dose.
B. Elevated INR and increased risk of bleeding.
C. Reduced warfarin effectiveness leading to thrombus
formation.
D. Acute tendon rupture in the lower extremities.
Correct Answer: B. Elevated INR and increased risk of
bleeding.
Detailed Rationale
Fluconazole is a systemic azole antifungal that inhibits the
cytochrome P450 (CYP450) enzyme system, particularly
CYP2C9, CYP2C19, and CYP3A4. Warfarin is primarily
metabolized by CYP2C9. When fluconazole and warfarin are
administered concurrently, fluconazole inhibits warfarin
metabolism, leading to increased circulating warfarin levels,
a prolonged prothrombin time, elevated INR, and an
increased risk of serious bleeding.
20 ATI NGN-Style Antibiotics, Antifungals &
Antivirals Practice Questions with
Rationales
Question 1
Clinical Scenario
A 72-year-old male is admitted to the medical-surgical unit
with sepsis secondary to a urinary tract infection. The
healthcare provider prescribes intravenous gentamicin. The
client's baseline serum creatinine is 1.1 mg/dL. On day three
of therapy, the nurse reviews morning laboratory results and
notes the serum creatinine has risen to 2.0 mg/dL. The
client's urine output has decreased to 20 mL/hr over the past
two hours.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled gentamicin dose and monitor
creatinine levels closely.
B. Hold the gentamicin dose and notify the healthcare
provider immediately.
,C. Increase the client's intravenous fluid rate to promote
urine output.
D. Obtain a gentamicin trough level before administering the
next dose.
Correct Answer: B. Hold the gentamicin dose and notify
the healthcare provider immediately.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic with a narrow
therapeutic index and significant potential for nephrotoxicity
and ototoxicity. The drug is eliminated primarily by the
kidneys, and accumulation in patients with impaired renal
function can lead to acute kidney injury (AKI) and permanent
damage. A rising serum creatinine from 1.1 mg/dL to 2.0
mg/dL and decreased urine output (<30 mL/hr) indicate
acute kidney injury, a serious adverse effect of
aminoglycoside therapy.
Option A is incorrect because administering the scheduled
dose would further accumulate the drug in renal tubules,
worsening nephrotoxicity. Option C, increasing fluids, is not
a priority action before holding the nephrotoxic medication;
while fluid resuscitation may be indicated for sepsis, it does
not address the drug-induced kidney injury. Option D,
,obtaining a trough level, is an appropriate monitoring
parameter but is not the priority action; the nurse must first
hold the medication and notify the provider for dose
adjustment based on renal function and serum drug levels.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify signs of nephrotoxicity associated with
aminoglycoside therapy.
• Prioritize nursing actions when laboratory values
indicate drug toxicity.
• Explain the importance of renal function monitoring
during gentamicin therapy.
Medication Safety Focus: Monitoring for nephrotoxicity
Question 2
Clinical Scenario
A 45-year-old female client is prescribed oral fluconazole for
a recurrent vaginal yeast infection. During the medication
history, the nurse learns the client takes warfarin daily for a
history of deep vein thrombosis. The client's current INR is
2.8 (therapeutic range 2.0–3.0).
, Question Stem
The nurse should prioritize monitoring for which potential
complication?
A. Decreased antifungal effectiveness requiring a higher
fluconazole dose.
B. Elevated INR and increased risk of bleeding.
C. Reduced warfarin effectiveness leading to thrombus
formation.
D. Acute tendon rupture in the lower extremities.
Correct Answer: B. Elevated INR and increased risk of
bleeding.
Detailed Rationale
Fluconazole is a systemic azole antifungal that inhibits the
cytochrome P450 (CYP450) enzyme system, particularly
CYP2C9, CYP2C19, and CYP3A4. Warfarin is primarily
metabolized by CYP2C9. When fluconazole and warfarin are
administered concurrently, fluconazole inhibits warfarin
metabolism, leading to increased circulating warfarin levels,
a prolonged prothrombin time, elevated INR, and an
increased risk of serious bleeding.
