NCLEX-RN Pharmacology Practice Exam:
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 ATI & NGN-Style Questions with Detailed
Rationales
Question 1
Clinical Scenario
A 28-year-old female client at 32 weeks gestation is admitted to
the obstetric unit with a confirmed urinary tract infection (UTI).
She reports dysuria, urinary frequency, and low-grade fever. Her
medical record reveals a history of a severe, anaphylactic
reaction to penicillin (hives, airway swelling). The healthcare
provider is considering antibiotic therapy.
Question Stem
Which of the following prescribed antibiotics is contraindicated
for this client?
A. Nitrofurantoin
B. Erythromycin
C. Aztreonam
,D. Ciprofloxacin
Correct Answer
Correct Answer: D. Ciprofloxacin
Detailed Rationale
Fluoroquinolones, such as ciprofloxacin, are generally
contraindicated during pregnancy. They carry a risk of cartilage
malformation and arthropathy in the developing fetus, as
demonstrated in animal studies. While they may be used in
rare, life-threatening situations where no alternative exists,
safer options are available for standard UTIs in pregnant
individuals.
Furthermore, ciprofloxacin is not a first-line choice for pregnant
clients when other agents can be used. Let's analyze the other
choices:
• Nitrofurantoin (Option A) is commonly used to treat UTIs
in pregnant women. However, it must be avoided during
the term of pregnancy (38–42 weeks gestation) due to the
risk of neonatal hemolytic anemia. At 32 weeks gestation,
it is not strictly contraindicated, though quinolones remain
a class-wide hazard throughout all trimesters.
• Erythromycin (Option B) is a macrolide and is generally
considered safe during pregnancy, although it is not
typically the first choice for a Gram-negative UTI.
, • Aztreonam (Option C) is a monobactam antibiotic.
Because its monocyclic beta-lactam ring structure differs
significantly from penicillins, it does not cross-react with
penicillin allergies, making it safe for a client with a history
of penicillin anaphylaxis. It is also considered safe to use
during pregnancy (Pregnancy Category B).
Learning Objectives
After completing this question, the learner should be able to:
• Identify antibiotics that are contraindicated during
pregnancy due to fetal risk.
• Select safe alternative antibiotics for clients with a severe
penicillin allergy.
• Apply clinical judgment when assessing medication safety
profiles for obstetric clients.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 64-year-old male client with a history of chronic kidney
disease (CKD, Stage 3) is hospitalized with a severe wound
infection. The healthcare provider prescribes IV gentamicin
$2\text{ mg/kg}$ every 12 hours. The nurse is preparing to
, administer the third dose. The client's most recent serum
creatinine has risen from $1.2\text{ mg/dL}$ to $2.1\text{
mg/dL}$ over the last 48 hours.
Question Stem
Which action should the nurse take first?
A. Administer the dose as scheduled and request a peak drug
level in 30 minutes.
B. Hold the scheduled dose and notify the healthcare provider
of the rising creatinine.
C. Infuse the gentamicin slowly over 2 hours instead of the
standard 30 minutes.
D. Increase the client's oral fluid intake to flush the kidneys
before starting the infusion.
Correct Answer
Correct Answer: B. Hold the scheduled dose and notify the
healthcare provider of the rising creatinine.
Detailed Rationale
Aminoglycosides, such as gentamicin, are highly nephrotoxic
and ototoxic. They are excreted unchanged by the kidneys,
meaning renal impairment directly decreases drug clearance,
leading to accumulation and toxicity. A significant rise in serum
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 ATI & NGN-Style Questions with Detailed
Rationales
Question 1
Clinical Scenario
A 28-year-old female client at 32 weeks gestation is admitted to
the obstetric unit with a confirmed urinary tract infection (UTI).
She reports dysuria, urinary frequency, and low-grade fever. Her
medical record reveals a history of a severe, anaphylactic
reaction to penicillin (hives, airway swelling). The healthcare
provider is considering antibiotic therapy.
Question Stem
Which of the following prescribed antibiotics is contraindicated
for this client?
A. Nitrofurantoin
B. Erythromycin
C. Aztreonam
,D. Ciprofloxacin
Correct Answer
Correct Answer: D. Ciprofloxacin
Detailed Rationale
Fluoroquinolones, such as ciprofloxacin, are generally
contraindicated during pregnancy. They carry a risk of cartilage
malformation and arthropathy in the developing fetus, as
demonstrated in animal studies. While they may be used in
rare, life-threatening situations where no alternative exists,
safer options are available for standard UTIs in pregnant
individuals.
Furthermore, ciprofloxacin is not a first-line choice for pregnant
clients when other agents can be used. Let's analyze the other
choices:
• Nitrofurantoin (Option A) is commonly used to treat UTIs
in pregnant women. However, it must be avoided during
the term of pregnancy (38–42 weeks gestation) due to the
risk of neonatal hemolytic anemia. At 32 weeks gestation,
it is not strictly contraindicated, though quinolones remain
a class-wide hazard throughout all trimesters.
• Erythromycin (Option B) is a macrolide and is generally
considered safe during pregnancy, although it is not
typically the first choice for a Gram-negative UTI.
, • Aztreonam (Option C) is a monobactam antibiotic.
Because its monocyclic beta-lactam ring structure differs
significantly from penicillins, it does not cross-react with
penicillin allergies, making it safe for a client with a history
of penicillin anaphylaxis. It is also considered safe to use
during pregnancy (Pregnancy Category B).
Learning Objectives
After completing this question, the learner should be able to:
• Identify antibiotics that are contraindicated during
pregnancy due to fetal risk.
• Select safe alternative antibiotics for clients with a severe
penicillin allergy.
• Apply clinical judgment when assessing medication safety
profiles for obstetric clients.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
A 64-year-old male client with a history of chronic kidney
disease (CKD, Stage 3) is hospitalized with a severe wound
infection. The healthcare provider prescribes IV gentamicin
$2\text{ mg/kg}$ every 12 hours. The nurse is preparing to
, administer the third dose. The client's most recent serum
creatinine has risen from $1.2\text{ mg/dL}$ to $2.1\text{
mg/dL}$ over the last 48 hours.
Question Stem
Which action should the nurse take first?
A. Administer the dose as scheduled and request a peak drug
level in 30 minutes.
B. Hold the scheduled dose and notify the healthcare provider
of the rising creatinine.
C. Infuse the gentamicin slowly over 2 hours instead of the
standard 30 minutes.
D. Increase the client's oral fluid intake to flush the kidneys
before starting the infusion.
Correct Answer
Correct Answer: B. Hold the scheduled dose and notify the
healthcare provider of the rising creatinine.
Detailed Rationale
Aminoglycosides, such as gentamicin, are highly nephrotoxic
and ototoxic. They are excreted unchanged by the kidneys,
meaning renal impairment directly decreases drug clearance,
leading to accumulation and toxicity. A significant rise in serum
