NCLEX-RN Pharmacology Infection Exam |
20 Original ATI & NGN-Style Practice
Questions with Detailed Rationales |
Antibiotics, Antifungals & Antivirals
Question 1
Clinical Scenario
A 67-year-old man is admitted with community-acquired
pneumonia. His medical history includes chronic kidney
disease (stage 3), hypertension, and atrial fibrillation
managed with warfarin. The provider prescribes levofloxacin
750 mg orally once daily. The nurse reviews the patient's
medication profile before administering the first dose.
Question Stem
Which nursing action is the priority before administering the
prescribed medication?
A. Review the patient's most recent INR and monitor for
signs of bleeding.
,B. Administer the medication with milk to reduce gastric
irritation.
C. Encourage the patient to restrict fluid intake during
therapy.
D. Hold the medication if the patient's temperature is below
38°C (100.4°F).
Correct Answer
Correct Answer: A. Review the patient's most recent INR
and monitor for signs of bleeding.
Detailed Rationale
Levofloxacin is a fluoroquinolone antibiotic that can
potentiate the anticoagulant effects of warfarin by altering
intestinal vitamin K-producing flora and interfering with
warfarin metabolism. This interaction may increase the
patient's INR and significantly raise the risk of bleeding.
Because this patient already receives chronic warfarin
therapy, verifying the most recent INR and monitoring for
bleeding (epistaxis, bruising, hematuria, melena, or bleeding
gums) are priority nursing responsibilities. The nurse should
also notify the provider if excessive anticoagulation is
suspected.
Option B is incorrect because dairy products decrease
absorption of fluoroquinolones due to chelation with
,calcium. Levofloxacin should not be administered
simultaneously with milk or calcium-containing products.
Option C is incorrect because adequate hydration is
encouraged to help reduce crystalluria and support renal
elimination. Option D is incorrect because antibiotic therapy
should not be withheld solely because a patient's fever has
improved or is absent; treatment is based on the diagnosed
infection and prescribed course.
Medication safety includes recognizing clinically significant
drug interactions, especially in older adults with multiple
comorbidities. The nurse should also monitor renal function
because impaired kidney function may require dosage
adjustment.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify a clinically significant interaction between
fluoroquinolones and warfarin.
• Prioritize nursing assessment before antibiotic
administration.
• Recognize monitoring parameters for patients receiving
levofloxacin.
, • Apply medication safety principles in older adults with
polypharmacy.
Medication Safety Focus
Drug interaction
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for moderate
acne vulgaris. During discharge teaching, she tells the nurse
she takes a daily multivitamin containing iron, drinks a
protein shake made with milk every morning, and spends
several hours outdoors working as a lifeguard.
Question Stem
Which patient statement indicates the need for further
teaching?
A. "I'll use sunscreen and wear protective clothing while
taking this medication."
B. "I'll finish all of my medication even if my skin improves."
C. "I'll take the doxycycline with my iron supplement and
breakfast milk."
20 Original ATI & NGN-Style Practice
Questions with Detailed Rationales |
Antibiotics, Antifungals & Antivirals
Question 1
Clinical Scenario
A 67-year-old man is admitted with community-acquired
pneumonia. His medical history includes chronic kidney
disease (stage 3), hypertension, and atrial fibrillation
managed with warfarin. The provider prescribes levofloxacin
750 mg orally once daily. The nurse reviews the patient's
medication profile before administering the first dose.
Question Stem
Which nursing action is the priority before administering the
prescribed medication?
A. Review the patient's most recent INR and monitor for
signs of bleeding.
,B. Administer the medication with milk to reduce gastric
irritation.
C. Encourage the patient to restrict fluid intake during
therapy.
D. Hold the medication if the patient's temperature is below
38°C (100.4°F).
Correct Answer
Correct Answer: A. Review the patient's most recent INR
and monitor for signs of bleeding.
Detailed Rationale
Levofloxacin is a fluoroquinolone antibiotic that can
potentiate the anticoagulant effects of warfarin by altering
intestinal vitamin K-producing flora and interfering with
warfarin metabolism. This interaction may increase the
patient's INR and significantly raise the risk of bleeding.
Because this patient already receives chronic warfarin
therapy, verifying the most recent INR and monitoring for
bleeding (epistaxis, bruising, hematuria, melena, or bleeding
gums) are priority nursing responsibilities. The nurse should
also notify the provider if excessive anticoagulation is
suspected.
Option B is incorrect because dairy products decrease
absorption of fluoroquinolones due to chelation with
,calcium. Levofloxacin should not be administered
simultaneously with milk or calcium-containing products.
Option C is incorrect because adequate hydration is
encouraged to help reduce crystalluria and support renal
elimination. Option D is incorrect because antibiotic therapy
should not be withheld solely because a patient's fever has
improved or is absent; treatment is based on the diagnosed
infection and prescribed course.
Medication safety includes recognizing clinically significant
drug interactions, especially in older adults with multiple
comorbidities. The nurse should also monitor renal function
because impaired kidney function may require dosage
adjustment.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify a clinically significant interaction between
fluoroquinolones and warfarin.
• Prioritize nursing assessment before antibiotic
administration.
• Recognize monitoring parameters for patients receiving
levofloxacin.
, • Apply medication safety principles in older adults with
polypharmacy.
Medication Safety Focus
Drug interaction
Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for moderate
acne vulgaris. During discharge teaching, she tells the nurse
she takes a daily multivitamin containing iron, drinks a
protein shake made with milk every morning, and spends
several hours outdoors working as a lifeguard.
Question Stem
Which patient statement indicates the need for further
teaching?
A. "I'll use sunscreen and wear protective clothing while
taking this medication."
B. "I'll finish all of my medication even if my skin improves."
C. "I'll take the doxycycline with my iron supplement and
breakfast milk."
