NCLEX-RN Pharmacology Exam Questions
with Rationales |
20 Original Nursing Pharmacology MCQs |
Medication Safety & Clinical Judgment
Review Guide
Question 1
Clinical Scenario
A 78-year-old female is admitted to the medical-surgical unit
with a severe urinary tract infection and urosepsis. The
provider prescribes intravenous gentamicin. The client's
medical history includes type 2 diabetes mellitus and stage
3 chronic kidney disease (baseline serum creatinine 1.3
mg/dL). The nurse reviews the morning laboratory results
before administering the scheduled dose: serum creatinine
has increased to 2.1 mg/dL, BUN is 42 mg/dL, and urine
output over the past 8 hours is 120 mL.
Question Stem
,Which nursing action should the nurse take first?
A. Administer the gentamicin as scheduled to maintain
therapeutic drug levels.
B. Obtain a gentamicin trough level immediately before the
next dose.
C. Hold the gentamicin and notify the healthcare provider.
D. Encourage the client to increase oral fluid intake to 2 L per
day.
Correct Answer: C. Hold the gentamicin and notify the
healthcare provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic with a narrow
therapeutic index and significant potential for nephrotoxicity
and ototoxicity. It is eliminated almost entirely by the
kidneys, and accumulation in patients with renal impairment
can lead to acute kidney injury, irreversible hearing loss, and
vestibular damage . The client's serum creatinine has risen
from a baseline of 1.3 mg/dL to 2.1 mg/dL, representing a
clinically significant decline in renal function. The decreased
urine output (120 mL over 8 hours, or 15 mL/hour) further
supports impaired renal clearance. Administering the
scheduled dose (Option A) would cause further drug
,accumulation and worsen nephrotoxicity. While obtaining a
trough level (Option B) is an important monitoring
parameter, the priority action is to hold the medication and
notify the provider so the dose can be adjusted or an
alternative antibiotic selected. Increasing oral fluid intake
(Option D) is generally encouraged for patients receiving
aminoglycosides, but it does not address the immediate
concern of declining renal function and could be harmful if
the client has fluid overload. The nurse should anticipate
that the provider may order a reduced dose, extended dosing
interval, or change to a different antibiotic class based on
the culture results.
Learning Objective
After completing this question, the learner should be able
to:
• Identify laboratory findings that indicate nephrotoxicity
in patients receiving aminoglycosides.
• Prioritize nursing actions when monitoring parameters
suggest drug toxicity.
• Explain the importance of therapeutic drug monitoring
for renally eliminated antibiotics.
Medication Safety Focus
Monitoring – Aminoglycoside nephrotoxicity
, Question 2
Clinical Scenario
A 64-year-old male with a history of atrial fibrillation is
receiving warfarin therapy (INR maintained at 2.5). He
develops a productive cough, fever, and chest pain and is
diagnosed with community-acquired pneumonia. The
healthcare provider prescribes oral levofloxacin. The nurse
reviews the medication reconciliation and prepares to
provide patient education.
Question Stem
Which instruction is most important for the nurse to include
in the teaching plan?
A. "Take an antacid with the levofloxacin to prevent stomach
upset."
B. "Report any tendon pain or swelling immediately."
C. "Avoid foods high in vitamin K while taking this antibiotic."
D. "This medication may cause your urine to turn orange."
Correct Answer: B. "Report any tendon pain or swelling
immediately."
with Rationales |
20 Original Nursing Pharmacology MCQs |
Medication Safety & Clinical Judgment
Review Guide
Question 1
Clinical Scenario
A 78-year-old female is admitted to the medical-surgical unit
with a severe urinary tract infection and urosepsis. The
provider prescribes intravenous gentamicin. The client's
medical history includes type 2 diabetes mellitus and stage
3 chronic kidney disease (baseline serum creatinine 1.3
mg/dL). The nurse reviews the morning laboratory results
before administering the scheduled dose: serum creatinine
has increased to 2.1 mg/dL, BUN is 42 mg/dL, and urine
output over the past 8 hours is 120 mL.
Question Stem
,Which nursing action should the nurse take first?
A. Administer the gentamicin as scheduled to maintain
therapeutic drug levels.
B. Obtain a gentamicin trough level immediately before the
next dose.
C. Hold the gentamicin and notify the healthcare provider.
D. Encourage the client to increase oral fluid intake to 2 L per
day.
Correct Answer: C. Hold the gentamicin and notify the
healthcare provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic with a narrow
therapeutic index and significant potential for nephrotoxicity
and ototoxicity. It is eliminated almost entirely by the
kidneys, and accumulation in patients with renal impairment
can lead to acute kidney injury, irreversible hearing loss, and
vestibular damage . The client's serum creatinine has risen
from a baseline of 1.3 mg/dL to 2.1 mg/dL, representing a
clinically significant decline in renal function. The decreased
urine output (120 mL over 8 hours, or 15 mL/hour) further
supports impaired renal clearance. Administering the
scheduled dose (Option A) would cause further drug
,accumulation and worsen nephrotoxicity. While obtaining a
trough level (Option B) is an important monitoring
parameter, the priority action is to hold the medication and
notify the provider so the dose can be adjusted or an
alternative antibiotic selected. Increasing oral fluid intake
(Option D) is generally encouraged for patients receiving
aminoglycosides, but it does not address the immediate
concern of declining renal function and could be harmful if
the client has fluid overload. The nurse should anticipate
that the provider may order a reduced dose, extended dosing
interval, or change to a different antibiotic class based on
the culture results.
Learning Objective
After completing this question, the learner should be able
to:
• Identify laboratory findings that indicate nephrotoxicity
in patients receiving aminoglycosides.
• Prioritize nursing actions when monitoring parameters
suggest drug toxicity.
• Explain the importance of therapeutic drug monitoring
for renally eliminated antibiotics.
Medication Safety Focus
Monitoring – Aminoglycoside nephrotoxicity
, Question 2
Clinical Scenario
A 64-year-old male with a history of atrial fibrillation is
receiving warfarin therapy (INR maintained at 2.5). He
develops a productive cough, fever, and chest pain and is
diagnosed with community-acquired pneumonia. The
healthcare provider prescribes oral levofloxacin. The nurse
reviews the medication reconciliation and prepares to
provide patient education.
Question Stem
Which instruction is most important for the nurse to include
in the teaching plan?
A. "Take an antacid with the levofloxacin to prevent stomach
upset."
B. "Report any tendon pain or swelling immediately."
C. "Avoid foods high in vitamin K while taking this antibiotic."
D. "This medication may cause your urine to turn orange."
Correct Answer: B. "Report any tendon pain or swelling
immediately."
