NCLEX-RN Pharmacology Practice Exam |
Infection Antibiotics Antifungals Antivirals |
20 Original NGN-Style Questions with Detailed
Rationales |
Nursing Medication Safety Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His history includes chronic kidney disease (stage
3), hypertension, and atrial fibrillation treated with warfarin.
The provider prescribes levofloxacin 750 mg IV once daily.
Current assessment findings include a temperature of 38.6°C
(101.5°F), heart rate of 94/min, blood pressure of 132/78 mm
Hg, respiratory rate of 22/min, and oxygen saturation of 92% on
room air. Laboratory results reveal an INR of 2.8 and serum
creatinine of 2.0 mg/dL.
Question Stem
,Which nursing action is the priority before administering the
first dose of levofloxacin?
A. Administer the medication as prescribed because the INR is
therapeutic.
B. Contact the provider to discuss renal dose adjustment before
administration.
C. Hold the medication until the patient's INR decreases below
2.0.
D. Administer vitamin K before giving the antibiotic.
Correct Answer
Correct Answer: B. Contact the provider to discuss renal dose
adjustment before administration.
Detailed Rationale
Levofloxacin, a fluoroquinolone antibiotic, is primarily
eliminated by the kidneys. In patients with impaired renal
function, reduced drug clearance increases the risk of adverse
effects such as QT prolongation, central nervous system toxicity,
tendinopathy, and dysglycemia. Because this patient has stage 3
chronic kidney disease and an elevated serum creatinine, the
nurse should verify that the prescribed dose is appropriate
before administration. This action promotes safe medication
administration while avoiding unnecessary delays in treating
pneumonia.
,Option A is incorrect because administering the medication
without assessing renal dosing may expose the patient to
toxicity. A therapeutic INR does not eliminate the need for dose
adjustment.
Option C is incorrect because an INR of 2.8 is expected for many
patients receiving warfarin for atrial fibrillation. The antibiotic
should not be withheld solely because of a therapeutic INR,
although increased INR monitoring is warranted because
fluoroquinolones may potentiate warfarin.
Option D is incorrect because prophylactic vitamin K
administration is inappropriate and may reverse necessary
anticoagulation.
The nurse should also monitor renal function, assess for tendon
pain, observe for cardiac rhythm changes in at-risk patients,
educate the patient to report neurologic symptoms, and
monitor the INR more frequently during therapy due to the
interaction between levofloxacin and warfarin.
Learning Objectives
After completing this question, the learner should be able to:
• Identify when renal dose adjustment is necessary for
fluoroquinolone therapy.
• Recognize clinically significant drug interactions involving
warfarin.
, • Prioritize nursing assessment before administering renally
eliminated antibiotics.
Medication Safety Focus
Monitoring and renal dose adjustment
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for Lyme
disease. During discharge teaching, she states she plans to take
the medication with breakfast, a calcium supplement, and a
large glass of milk because it "helps prevent stomach upset."
She also spends several hours outdoors each day for work.
Question Stem
Which statement by the patient indicates a need for additional
teaching?
A. "I'll wear sunscreen and protective clothing while taking this
medication."
B. "I'll finish the entire prescription even if I feel better."
C. "I'll take the medication with my calcium supplement and
milk each morning."
Infection Antibiotics Antifungals Antivirals |
20 Original NGN-Style Questions with Detailed
Rationales |
Nursing Medication Safety Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His history includes chronic kidney disease (stage
3), hypertension, and atrial fibrillation treated with warfarin.
The provider prescribes levofloxacin 750 mg IV once daily.
Current assessment findings include a temperature of 38.6°C
(101.5°F), heart rate of 94/min, blood pressure of 132/78 mm
Hg, respiratory rate of 22/min, and oxygen saturation of 92% on
room air. Laboratory results reveal an INR of 2.8 and serum
creatinine of 2.0 mg/dL.
Question Stem
,Which nursing action is the priority before administering the
first dose of levofloxacin?
A. Administer the medication as prescribed because the INR is
therapeutic.
B. Contact the provider to discuss renal dose adjustment before
administration.
C. Hold the medication until the patient's INR decreases below
2.0.
D. Administer vitamin K before giving the antibiotic.
Correct Answer
Correct Answer: B. Contact the provider to discuss renal dose
adjustment before administration.
Detailed Rationale
Levofloxacin, a fluoroquinolone antibiotic, is primarily
eliminated by the kidneys. In patients with impaired renal
function, reduced drug clearance increases the risk of adverse
effects such as QT prolongation, central nervous system toxicity,
tendinopathy, and dysglycemia. Because this patient has stage 3
chronic kidney disease and an elevated serum creatinine, the
nurse should verify that the prescribed dose is appropriate
before administration. This action promotes safe medication
administration while avoiding unnecessary delays in treating
pneumonia.
,Option A is incorrect because administering the medication
without assessing renal dosing may expose the patient to
toxicity. A therapeutic INR does not eliminate the need for dose
adjustment.
Option C is incorrect because an INR of 2.8 is expected for many
patients receiving warfarin for atrial fibrillation. The antibiotic
should not be withheld solely because of a therapeutic INR,
although increased INR monitoring is warranted because
fluoroquinolones may potentiate warfarin.
Option D is incorrect because prophylactic vitamin K
administration is inappropriate and may reverse necessary
anticoagulation.
The nurse should also monitor renal function, assess for tendon
pain, observe for cardiac rhythm changes in at-risk patients,
educate the patient to report neurologic symptoms, and
monitor the INR more frequently during therapy due to the
interaction between levofloxacin and warfarin.
Learning Objectives
After completing this question, the learner should be able to:
• Identify when renal dose adjustment is necessary for
fluoroquinolone therapy.
• Recognize clinically significant drug interactions involving
warfarin.
, • Prioritize nursing assessment before administering renally
eliminated antibiotics.
Medication Safety Focus
Monitoring and renal dose adjustment
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for Lyme
disease. During discharge teaching, she states she plans to take
the medication with breakfast, a calcium supplement, and a
large glass of milk because it "helps prevent stomach upset."
She also spends several hours outdoors each day for work.
Question Stem
Which statement by the patient indicates a need for additional
teaching?
A. "I'll wear sunscreen and protective clothing while taking this
medication."
B. "I'll finish the entire prescription even if I feel better."
C. "I'll take the medication with my calcium supplement and
milk each morning."
