NCLEX-RN Pharmacology Practice
Questions |
Infection Medications (Antibiotics,
Antifungals & Antivirals) |
20 ATI & NGN-Style MCQs with Detailed
Rationales
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 type 2 diabetes mellitus. The
provider prescribes gentamicin IV in combination with
another antibiotic while awaiting culture results. Current
laboratory values include: serum creatinine 2.1 mg/dL
(baseline 1.8 mg/dL), BUN 42 mg/dL, potassium 4.3 mEq/L,
and WBC 16,500/mm³. The nurse reviews the medication
administration record before administering the first dose.
Question Stem
,Which assessment finding should the nurse report to the
provider before administering gentamicin?
A. White blood cell count of 16,500/mm³
B. Serum creatinine of 2.1 mg/dL
C. Temperature of 38.4°C (101.1°F)
D. Productive cough with yellow sputum
Correct Answer
Correct Answer: B. Serum creatinine of 2.1 mg/dL
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that inhibits
bacterial protein synthesis by binding to the 30S ribosomal
subunit. It is highly effective against many serious gram-
negative infections but carries significant risks of
nephrotoxicity and ototoxicity, particularly in older adults
and patients with impaired renal function. Because
gentamicin is almost entirely eliminated by the kidneys,
reduced renal function increases serum drug concentrations
and the likelihood of toxicity. A rising serum creatinine
warrants provider notification because dosing may require
adjustment, additional laboratory monitoring, or selection of
an alternative antibiotic. Monitoring peak and trough drug
levels is also essential to balance efficacy with safety.
,Option A is expected in bacterial pneumonia and supports
the need for antibiotic therapy rather than delaying it. Option
C reflects an active infection and is not a contraindication to
treatment. Option D is a common manifestation of bacterial
pneumonia and likewise does not require withholding the
medication. The nurse's priority is recognizing the patient's
increased susceptibility to medication-related harm and
advocating for dose adjustment before administration.
Ongoing monitoring should include urine output, renal
laboratory values, hearing changes, tinnitus, and vestibular
symptoms throughout therapy.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify patients at increased risk for aminoglycoside
toxicity.
• Recognize laboratory values requiring intervention
before antibiotic administration.
• Describe essential nursing monitoring for gentamicin
therapy.
• Prioritize medication safety in patients with renal
impairment.
Medication Safety Focus: Monitoring
, Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for
moderate acne. During discharge teaching, she states she
wants to make sure she takes the medication correctly
because she recently started college and has a busy
schedule.
Question Stem
Which statement by the client indicates correct
understanding of doxycycline therapy?
A. "I will take the medication with an antacid if it upsets my
stomach."
B. "I should stop taking the medication once my skin starts
improving."
C. "I will use sunscreen because this medication can make
my skin more sensitive."
D. "I can safely take this medication during pregnancy if
prescribed."
Correct Answer
Correct Answer: C. "I will use sunscreen because this
medication can make my skin more sensitive."
Questions |
Infection Medications (Antibiotics,
Antifungals & Antivirals) |
20 ATI & NGN-Style MCQs with Detailed
Rationales
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 type 2 diabetes mellitus. The
provider prescribes gentamicin IV in combination with
another antibiotic while awaiting culture results. Current
laboratory values include: serum creatinine 2.1 mg/dL
(baseline 1.8 mg/dL), BUN 42 mg/dL, potassium 4.3 mEq/L,
and WBC 16,500/mm³. The nurse reviews the medication
administration record before administering the first dose.
Question Stem
,Which assessment finding should the nurse report to the
provider before administering gentamicin?
A. White blood cell count of 16,500/mm³
B. Serum creatinine of 2.1 mg/dL
C. Temperature of 38.4°C (101.1°F)
D. Productive cough with yellow sputum
Correct Answer
Correct Answer: B. Serum creatinine of 2.1 mg/dL
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic that inhibits
bacterial protein synthesis by binding to the 30S ribosomal
subunit. It is highly effective against many serious gram-
negative infections but carries significant risks of
nephrotoxicity and ototoxicity, particularly in older adults
and patients with impaired renal function. Because
gentamicin is almost entirely eliminated by the kidneys,
reduced renal function increases serum drug concentrations
and the likelihood of toxicity. A rising serum creatinine
warrants provider notification because dosing may require
adjustment, additional laboratory monitoring, or selection of
an alternative antibiotic. Monitoring peak and trough drug
levels is also essential to balance efficacy with safety.
,Option A is expected in bacterial pneumonia and supports
the need for antibiotic therapy rather than delaying it. Option
C reflects an active infection and is not a contraindication to
treatment. Option D is a common manifestation of bacterial
pneumonia and likewise does not require withholding the
medication. The nurse's priority is recognizing the patient's
increased susceptibility to medication-related harm and
advocating for dose adjustment before administration.
Ongoing monitoring should include urine output, renal
laboratory values, hearing changes, tinnitus, and vestibular
symptoms throughout therapy.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify patients at increased risk for aminoglycoside
toxicity.
• Recognize laboratory values requiring intervention
before antibiotic administration.
• Describe essential nursing monitoring for gentamicin
therapy.
• Prioritize medication safety in patients with renal
impairment.
Medication Safety Focus: Monitoring
, Question 2
Clinical Scenario
A 24-year-old woman is prescribed doxycycline for
moderate acne. During discharge teaching, she states she
wants to make sure she takes the medication correctly
because she recently started college and has a busy
schedule.
Question Stem
Which statement by the client indicates correct
understanding of doxycycline therapy?
A. "I will take the medication with an antacid if it upsets my
stomach."
B. "I should stop taking the medication once my skin starts
improving."
C. "I will use sunscreen because this medication can make
my skin more sensitive."
D. "I can safely take this medication during pregnancy if
prescribed."
Correct Answer
Correct Answer: C. "I will use sunscreen because this
medication can make my skin more sensitive."
