NCLEX-RN Pharmacology Infection
Practice Questions |
20 Original Antibiotics, Antifungals &
Antivirals MCQs with Detailed Rationales |
ATI & NGN Style Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His medical history includes chronic kidney
disease (stage 3), hypertension, and type 2 diabetes
mellitus. He is prescribed gentamicin IV after sputum
cultures identify a susceptible gram-negative organism.
Baseline laboratory results include serum creatinine 2.1
mg/dL (186 µmol/L), BUN 34 mg/dL (12.1 mmol/L), and
potassium 4.3 mEq/L (4.3 mmol/L). The nurse reviews the
medication administration record before administering the
second dose.
Question Stem
Which nursing action is the highest priority before
administering the next dose of gentamicin?
,A. Administer the medication with food to decrease
gastrointestinal upset.
B. Review the most recent serum gentamicin trough level
and renal function results.
C. Encourage the client to increase dietary potassium intake.
D. Obtain a repeat sputum culture immediately before
administering the dose.
Correct Answer
Correct Answer: B. Review the most recent serum
gentamicin trough level and renal function results.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that exhibits
concentration-dependent bacterial killing but is associated
with significant nephrotoxicity and ototoxicity. Because this
patient already has chronic kidney disease, impaired drug
clearance increases the risk for toxic accumulation. Before
administering subsequent doses, the nurse should review
renal function (serum creatinine, BUN, urine output) and
serum trough levels, which should remain below the
therapeutic toxicity threshold according to institutional
protocols. Elevated trough levels indicate inadequate
clearance and may require delaying the dose or adjusting
the regimen. Careful monitoring helps prevent irreversible
,kidney injury and hearing loss while maintaining therapeutic
efficacy.
Option A is incorrect because gentamicin is commonly
administered intravenously, and food does not significantly
affect IV administration. Option C is inappropriate because
potassium supplementation is unrelated to preventing
aminoglycoside toxicity and may be harmful if not clinically
indicated. Option D is unnecessary before every scheduled
dose; sputum cultures are generally obtained before
initiating antibiotics or when treatment failure is suspected,
not before routine administration.
Nurses should also monitor hearing changes, tinnitus,
dizziness, urine output, and concurrent use of other
nephrotoxic medications such as vancomycin, NSAIDs, or
loop diuretics. Early recognition of toxicity significantly
reduces the risk of permanent complications.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify essential monitoring parameters for
aminoglycoside therapy.
• Recognize patients at increased risk for nephrotoxicity.
, • Prioritize nursing assessments before administering
gentamicin.
• Explain the purpose of therapeutic drug monitoring.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 25-year-old woman is prescribed doxycycline for
treatment of Lyme disease. During discharge teaching, she
tells the nurse she routinely drinks a large glass of milk with
breakfast and takes an over-the-counter calcium
supplement each morning. She also enjoys spending
weekends at the beach.
Question Stem
Which statement by the patient indicates a need for further
teaching?
A. "I'll wear sunscreen and protective clothing when
outdoors."
B. "I'll finish the medication even if I feel better after several
days."
Practice Questions |
20 Original Antibiotics, Antifungals &
Antivirals MCQs with Detailed Rationales |
ATI & NGN Style Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old man is admitted with community-acquired
pneumonia. His medical history includes chronic kidney
disease (stage 3), hypertension, and type 2 diabetes
mellitus. He is prescribed gentamicin IV after sputum
cultures identify a susceptible gram-negative organism.
Baseline laboratory results include serum creatinine 2.1
mg/dL (186 µmol/L), BUN 34 mg/dL (12.1 mmol/L), and
potassium 4.3 mEq/L (4.3 mmol/L). The nurse reviews the
medication administration record before administering the
second dose.
Question Stem
Which nursing action is the highest priority before
administering the next dose of gentamicin?
,A. Administer the medication with food to decrease
gastrointestinal upset.
B. Review the most recent serum gentamicin trough level
and renal function results.
C. Encourage the client to increase dietary potassium intake.
D. Obtain a repeat sputum culture immediately before
administering the dose.
Correct Answer
Correct Answer: B. Review the most recent serum
gentamicin trough level and renal function results.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that exhibits
concentration-dependent bacterial killing but is associated
with significant nephrotoxicity and ototoxicity. Because this
patient already has chronic kidney disease, impaired drug
clearance increases the risk for toxic accumulation. Before
administering subsequent doses, the nurse should review
renal function (serum creatinine, BUN, urine output) and
serum trough levels, which should remain below the
therapeutic toxicity threshold according to institutional
protocols. Elevated trough levels indicate inadequate
clearance and may require delaying the dose or adjusting
the regimen. Careful monitoring helps prevent irreversible
,kidney injury and hearing loss while maintaining therapeutic
efficacy.
Option A is incorrect because gentamicin is commonly
administered intravenously, and food does not significantly
affect IV administration. Option C is inappropriate because
potassium supplementation is unrelated to preventing
aminoglycoside toxicity and may be harmful if not clinically
indicated. Option D is unnecessary before every scheduled
dose; sputum cultures are generally obtained before
initiating antibiotics or when treatment failure is suspected,
not before routine administration.
Nurses should also monitor hearing changes, tinnitus,
dizziness, urine output, and concurrent use of other
nephrotoxic medications such as vancomycin, NSAIDs, or
loop diuretics. Early recognition of toxicity significantly
reduces the risk of permanent complications.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify essential monitoring parameters for
aminoglycoside therapy.
• Recognize patients at increased risk for nephrotoxicity.
, • Prioritize nursing assessments before administering
gentamicin.
• Explain the purpose of therapeutic drug monitoring.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 25-year-old woman is prescribed doxycycline for
treatment of Lyme disease. During discharge teaching, she
tells the nurse she routinely drinks a large glass of milk with
breakfast and takes an over-the-counter calcium
supplement each morning. She also enjoys spending
weekends at the beach.
Question Stem
Which statement by the patient indicates a need for further
teaching?
A. "I'll wear sunscreen and protective clothing when
outdoors."
B. "I'll finish the medication even if I feel better after several
days."
