ATI Pharmacology Made Easy Infection
Practice Questions |
20 Original NCLEX-RN NGN Pharmacology
MCQs |
Antibiotics, Antifungals & Antivirals |
Nursing Exam Prep with Rationales
Question 1
Clinical Scenario
A 68-year-old male with a history of chronic kidney disease
(CKD) Stage 3 is admitted to the medical-surgical unit with a
severe complicated urinary tract infection. The provider
prescribes IV gentamicin 2 mg/kg every 12 hours. The client’s
baseline serum creatinine is 1.8 mg/dL. Before administering
the third dose, the nurse reviews the client’s morning
laboratory results and notes that the serum creatinine has
risen to 2.4 mg/dL.
Question Stem
,Which action should the nurse take first?
A. Administer the scheduled gentamicin dose on time and
request a repeat creatinine level.
B. Hold the scheduled gentamicin dose and notify the
primary care provider.
C. Increase the IV fluid infusion rate to flush the kidneys
before administering the medication.
D. Administer the medication and request a peak and trough
gentamicin level.
Correct Answer
Correct Answer: B. Hold the scheduled gentamicin dose and
notify the primary care provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic known for its
narrow therapeutic index and significant potential for
nephrotoxicity and ototoxicity. Nephrotoxicity is primarily
caused by accumulation of the drug within the renal
proximal tubular cells, which can lead to acute tubular
necrosis (ATN).
In this scenario, the client's serum creatinine increased from
a baseline of 1.8 mg/dL to 2.4 mg/dL, indicating acute kidney
injury (AKI) superimposed on chronic kidney disease.
,Administering further doses of gentamicin in the presence of
rapidly declining renal function will drastically increase
serum drug levels, worsening renal damage and increasing
the risk of irreversible vestibular and cochlear ototoxicity.
Therefore, the priority nursing action is to hold the
medication to prevent further toxicity and immediately notify
the provider to discuss dosage adjustment, therapeutic drug
monitoring (trough levels), or transitioning to a less
nephrotoxic therapeutic alternative.
• Option A is incorrect because administering the drug in
the face of an acute rise in creatinine is unsafe and
exposes the client to a high risk of worsening kidney
injury.
• Option C is incorrect because, while hydration is
important in managing aminoglycoside therapy,
initiating or increasing IV fluids without holding the
offending nephrotoxin is insufficient and does not
address the immediate safety risk.
• Option D is incorrect because administering the dose
before getting clarification or adjusting for the renal
impairment is dangerous. Trough levels should be
drawn immediately before a dose, and peak levels are
drawn shortly after infusion, but the drug must be held
first when acute renal decline is detected.
, Learning Objective
After completing this question, the learner should be able
to:
• Identify the clinical indicators of aminoglycoside-
induced nephrotoxicity.
• Prioritize patient safety by holding nephrotoxic
medications when acute kidney injury is suspected.
• Incorporate renal laboratory values (serum creatinine)
into clinical decision-making during antimicrobial
therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 26-year-old female client is being discharged home with a
10-day course of oral doxycycline for the treatment of
moderate pelvic inflammatory disease. The nurse is
conducting discharge teaching regarding safe administration
of this medication.
Question Stem
Which instruction should the nurse include in the teaching
plan?
Practice Questions |
20 Original NCLEX-RN NGN Pharmacology
MCQs |
Antibiotics, Antifungals & Antivirals |
Nursing Exam Prep with Rationales
Question 1
Clinical Scenario
A 68-year-old male with a history of chronic kidney disease
(CKD) Stage 3 is admitted to the medical-surgical unit with a
severe complicated urinary tract infection. The provider
prescribes IV gentamicin 2 mg/kg every 12 hours. The client’s
baseline serum creatinine is 1.8 mg/dL. Before administering
the third dose, the nurse reviews the client’s morning
laboratory results and notes that the serum creatinine has
risen to 2.4 mg/dL.
Question Stem
,Which action should the nurse take first?
A. Administer the scheduled gentamicin dose on time and
request a repeat creatinine level.
B. Hold the scheduled gentamicin dose and notify the
primary care provider.
C. Increase the IV fluid infusion rate to flush the kidneys
before administering the medication.
D. Administer the medication and request a peak and trough
gentamicin level.
Correct Answer
Correct Answer: B. Hold the scheduled gentamicin dose and
notify the primary care provider.
Detailed Rationale
Gentamicin is an aminoglycoside antibiotic known for its
narrow therapeutic index and significant potential for
nephrotoxicity and ototoxicity. Nephrotoxicity is primarily
caused by accumulation of the drug within the renal
proximal tubular cells, which can lead to acute tubular
necrosis (ATN).
In this scenario, the client's serum creatinine increased from
a baseline of 1.8 mg/dL to 2.4 mg/dL, indicating acute kidney
injury (AKI) superimposed on chronic kidney disease.
,Administering further doses of gentamicin in the presence of
rapidly declining renal function will drastically increase
serum drug levels, worsening renal damage and increasing
the risk of irreversible vestibular and cochlear ototoxicity.
Therefore, the priority nursing action is to hold the
medication to prevent further toxicity and immediately notify
the provider to discuss dosage adjustment, therapeutic drug
monitoring (trough levels), or transitioning to a less
nephrotoxic therapeutic alternative.
• Option A is incorrect because administering the drug in
the face of an acute rise in creatinine is unsafe and
exposes the client to a high risk of worsening kidney
injury.
• Option C is incorrect because, while hydration is
important in managing aminoglycoside therapy,
initiating or increasing IV fluids without holding the
offending nephrotoxin is insufficient and does not
address the immediate safety risk.
• Option D is incorrect because administering the dose
before getting clarification or adjusting for the renal
impairment is dangerous. Trough levels should be
drawn immediately before a dose, and peak levels are
drawn shortly after infusion, but the drug must be held
first when acute renal decline is detected.
, Learning Objective
After completing this question, the learner should be able
to:
• Identify the clinical indicators of aminoglycoside-
induced nephrotoxicity.
• Prioritize patient safety by holding nephrotoxic
medications when acute kidney injury is suspected.
• Incorporate renal laboratory values (serum creatinine)
into clinical decision-making during antimicrobial
therapy.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 26-year-old female client is being discharged home with a
10-day course of oral doxycycline for the treatment of
moderate pelvic inflammatory disease. The nurse is
conducting discharge teaching regarding safe administration
of this medication.
Question Stem
Which instruction should the nurse include in the teaching
plan?
