ATI Pharmacology Made Easy NCLEX-RN
Infection Practice Questions |
Antibiotics, Antifungals & Antivirals |
20 Original NGN-Style MCQs with Rationales
Question 1
Clinical Scenario
A 68-year-old male is admitted with a severe complicated
urinary tract infection (UTI) and is prescribed intravenous
gentamicin. The client has a history of stage 3 chronic kidney
disease (CKD). The nurse is preparing to administer the third
dose of gentamicin. The client’s baseline creatinine was
$1.2\text{ mg/dL}$, and the current morning lab result shows a
creatinine of $1.9\text{ mg/dL}$.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled dose of gentamicin on time to
maintain therapeutic serum levels.
,B. Obtain a gentamicin peak level exactly 30 minutes after the
infusion completes.
C. Hold the scheduled dose of gentamicin and notify the
healthcare provider.
D. Encourage the client to increase oral fluid intake to $2\text{
to }3\text{ Liters}$ per day.
Correct Answer
Correct Answer: C. Hold the scheduled dose of gentamicin and
notify the healthcare provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic known for its narrow
therapeutic index and significant potential for nephrotoxicity
and ototoxicity. Nephrotoxicity is typically reversible if caught
early, but continuing the medication in the face of rapidly
declining renal function can lead to acute kidney injury (AKI) or
permanent damage. The client's serum creatinine has risen
significantly from a baseline of $1.2\text{ mg/dL}$ to $1.9\text{
mg/dL}$, indicating a severe decline in renal clearance.
Administering the scheduled dose (Option A) would further
accumulate the drug in the renal tubules, exacerbating toxicity.
While obtaining peak and trough levels (Option B) is standard
for monitoring aminoglycoside therapy, a trough level is drawn
immediately before the next dose, and a peak level is drawn
,after administration; however, before giving another dose, the
provider must be notified of the acute renal impairment to
adjust or discontinue the medication. Encouraging fluids
(Option D) is a supportive measure to help flush the kidneys,
but it does not address the immediate safety risk of
administering a nephrotoxic drug to a patient with acute renal
decline. Holding the dose is the priority action to ensure safety.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize laboratory indicators of acute nephrotoxicity
secondary to aminoglycoside therapy.
• Prioritize patient safety by holding high-alert nephrotoxic
medications when renal function declines.
• Understand the clinical purpose and timing of therapeutic
drug monitoring (trough and peak levels) for gentamicin.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
A 28-year-old female client with a history of deep vein
thrombosis (DVT) treated with warfarin is diagnosed with a
severe vulvovaginal candidiasis infection. The healthcare
provider prescribes a multi-day oral course of fluconazole.
, Question Stem
Which finding or potential complication should the nurse
prioritize during the medication reconciliation and teaching
session?
A. Decreased therapeutic effect of fluconazole resulting in
persistent vaginal discharge.
B. An increased risk of bleeding and an elevated International
Normalized Ratio (INR).
C. A sudden decrease in the INR, predisposing the client to
recurrent thromboembolism.
D. Development of acute tendonitis or tendon rupture,
especially in the Achilles tendon.
Correct Answer
Correct Answer: B. An increased risk of bleeding and an
elevated International Normalized Ratio (INR).
Detailed Rationale
Fluconazole is a systemic azole antifungal that is a potent
inhibitor of the cytochrome P450 (CYP450) enzyme system,
specifically CYP2C9. Warfarin is primarily metabolized by
CYP2C9. When fluconazole and warfarin are administered
concurrently, fluconazole inhibits the metabolism of warfarin,
leading to increased circulating levels of warfarin, a prolonged
Infection Practice Questions |
Antibiotics, Antifungals & Antivirals |
20 Original NGN-Style MCQs with Rationales
Question 1
Clinical Scenario
A 68-year-old male is admitted with a severe complicated
urinary tract infection (UTI) and is prescribed intravenous
gentamicin. The client has a history of stage 3 chronic kidney
disease (CKD). The nurse is preparing to administer the third
dose of gentamicin. The client’s baseline creatinine was
$1.2\text{ mg/dL}$, and the current morning lab result shows a
creatinine of $1.9\text{ mg/dL}$.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled dose of gentamicin on time to
maintain therapeutic serum levels.
,B. Obtain a gentamicin peak level exactly 30 minutes after the
infusion completes.
C. Hold the scheduled dose of gentamicin and notify the
healthcare provider.
D. Encourage the client to increase oral fluid intake to $2\text{
to }3\text{ Liters}$ per day.
Correct Answer
Correct Answer: C. Hold the scheduled dose of gentamicin and
notify the healthcare provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic known for its narrow
therapeutic index and significant potential for nephrotoxicity
and ototoxicity. Nephrotoxicity is typically reversible if caught
early, but continuing the medication in the face of rapidly
declining renal function can lead to acute kidney injury (AKI) or
permanent damage. The client's serum creatinine has risen
significantly from a baseline of $1.2\text{ mg/dL}$ to $1.9\text{
mg/dL}$, indicating a severe decline in renal clearance.
Administering the scheduled dose (Option A) would further
accumulate the drug in the renal tubules, exacerbating toxicity.
While obtaining peak and trough levels (Option B) is standard
for monitoring aminoglycoside therapy, a trough level is drawn
immediately before the next dose, and a peak level is drawn
,after administration; however, before giving another dose, the
provider must be notified of the acute renal impairment to
adjust or discontinue the medication. Encouraging fluids
(Option D) is a supportive measure to help flush the kidneys,
but it does not address the immediate safety risk of
administering a nephrotoxic drug to a patient with acute renal
decline. Holding the dose is the priority action to ensure safety.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize laboratory indicators of acute nephrotoxicity
secondary to aminoglycoside therapy.
• Prioritize patient safety by holding high-alert nephrotoxic
medications when renal function declines.
• Understand the clinical purpose and timing of therapeutic
drug monitoring (trough and peak levels) for gentamicin.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
A 28-year-old female client with a history of deep vein
thrombosis (DVT) treated with warfarin is diagnosed with a
severe vulvovaginal candidiasis infection. The healthcare
provider prescribes a multi-day oral course of fluconazole.
, Question Stem
Which finding or potential complication should the nurse
prioritize during the medication reconciliation and teaching
session?
A. Decreased therapeutic effect of fluconazole resulting in
persistent vaginal discharge.
B. An increased risk of bleeding and an elevated International
Normalized Ratio (INR).
C. A sudden decrease in the INR, predisposing the client to
recurrent thromboembolism.
D. Development of acute tendonitis or tendon rupture,
especially in the Achilles tendon.
Correct Answer
Correct Answer: B. An increased risk of bleeding and an
elevated International Normalized Ratio (INR).
Detailed Rationale
Fluconazole is a systemic azole antifungal that is a potent
inhibitor of the cytochrome P450 (CYP450) enzyme system,
specifically CYP2C9. Warfarin is primarily metabolized by
CYP2C9. When fluconazole and warfarin are administered
concurrently, fluconazole inhibits the metabolism of warfarin,
leading to increased circulating levels of warfarin, a prolonged
