NCLEX-RN Pharmacology Practice
Questions: 20 Infection Medication MCQs
with Detailed Rationales |
Antibiotics, Antifungals & Antivirals |
ATI & NGN Style Study Guide
Question 1
Difficulty: Easy
Clinical Scenario
A 45-year-old male is diagnosed with a bacterial skin
infection and is prescribed oral cephalexin 500 mg every 6
hours. During medication reconciliation, the nurse notes the
patient has a documented history of anaphylaxis to
amoxicillin.
Question Stem
Which action should the nurse take first?
Options
A. Administer the cephalexin with food to prevent
gastrointestinal upset.
,B. Hold the medication and notify the healthcare provider.
C. Assess the patient for a history of seasonal environmental
allergies.
D. Instruct the patient to report any mild rash after the first
dose.
Correct Answer
Correct Answer: B. Hold the medication and notify the
healthcare provider.
Detailed Rationale
Cross-sensitivity between penicillins and cephalosporins is
a major clinical concern, especially when the patient has a
history of anaphylaxis, which is a severe, life-threatening IgE-
mediated reaction. While the overall cross-reactivity rate is
relatively low (approximately 1-10%), a history of anaphylaxis
to a penicillin is a strict contraindication to administering
cephalosporins due to the risk of a similar severe, potentially
fatal reaction. The nurse's priority is patient safety, which
requires holding the medication and contacting the provider
to request an alternative antibiotic class (e.g., clindamycin
or a macrolide). Administering the medication (Option A)
puts the patient at immediate risk for anaphylaxis. Assessing
for seasonal allergies (Option C) is irrelevant to this severe,
specific drug allergy. Instructing the patient to report a mild
rash (Option D) is inappropriate and unsafe because the
,medication should not be administered at all given the
anaphylaxis history.
Learning Objective
• Identify contraindications for cephalosporin antibiotics.
• Prioritize nursing actions for patients with severe
penicillin allergies.
• Recognize the risk of cross-sensitivity between beta-
lactam antibiotics.
Medication Safety Focus
Contraindication
Question 2
Difficulty: Easy
Clinical Scenario
A 68-year-old female is admitted to the medical unit with
herpes simplex encephalitis. The healthcare provider
prescribes intravenous (IV) acyclovir.
Question Stem
Which nursing intervention is the priority to prevent a
common adverse effect of this medication?
Options
A. Administer the medication via rapid IV push over 1 to 2
, minutes.
B. Ensure the patient receives adequate IV hydration before
and during the infusion.
C. Monitor the patient’s blood glucose levels every 4 hours.
D. Apply a warm compress to the IV site prior to
administration.
Correct Answer
Correct Answer: B. Ensure the patient receives adequate IV
hydration before and during the infusion.
Detailed Rationale
IV acyclovir can crystallize in the renal tubules, leading to
acute kidney injury (nephrotoxicity). The priority nursing
intervention to prevent this complication is to ensure
adequate hydration, typically by administering IV fluids
before and during the infusion, and encouraging oral fluid
intake if the patient is able to tolerate it. The medication
must be infused slowly over at least 1 hour, not via rapid IV
push (Option A), as rapid infusion significantly increases the
risk of renal toxicity. Acyclovir does not typically cause
significant hypoglycemia or hyperglycemia, making routine
blood glucose monitoring (Option C) unnecessary unless the
patient has a pre-existing diagnosis of diabetes. A warm
compress (Option D) does not prevent the primary systemic
Questions: 20 Infection Medication MCQs
with Detailed Rationales |
Antibiotics, Antifungals & Antivirals |
ATI & NGN Style Study Guide
Question 1
Difficulty: Easy
Clinical Scenario
A 45-year-old male is diagnosed with a bacterial skin
infection and is prescribed oral cephalexin 500 mg every 6
hours. During medication reconciliation, the nurse notes the
patient has a documented history of anaphylaxis to
amoxicillin.
Question Stem
Which action should the nurse take first?
Options
A. Administer the cephalexin with food to prevent
gastrointestinal upset.
,B. Hold the medication and notify the healthcare provider.
C. Assess the patient for a history of seasonal environmental
allergies.
D. Instruct the patient to report any mild rash after the first
dose.
Correct Answer
Correct Answer: B. Hold the medication and notify the
healthcare provider.
Detailed Rationale
Cross-sensitivity between penicillins and cephalosporins is
a major clinical concern, especially when the patient has a
history of anaphylaxis, which is a severe, life-threatening IgE-
mediated reaction. While the overall cross-reactivity rate is
relatively low (approximately 1-10%), a history of anaphylaxis
to a penicillin is a strict contraindication to administering
cephalosporins due to the risk of a similar severe, potentially
fatal reaction. The nurse's priority is patient safety, which
requires holding the medication and contacting the provider
to request an alternative antibiotic class (e.g., clindamycin
or a macrolide). Administering the medication (Option A)
puts the patient at immediate risk for anaphylaxis. Assessing
for seasonal allergies (Option C) is irrelevant to this severe,
specific drug allergy. Instructing the patient to report a mild
rash (Option D) is inappropriate and unsafe because the
,medication should not be administered at all given the
anaphylaxis history.
Learning Objective
• Identify contraindications for cephalosporin antibiotics.
• Prioritize nursing actions for patients with severe
penicillin allergies.
• Recognize the risk of cross-sensitivity between beta-
lactam antibiotics.
Medication Safety Focus
Contraindication
Question 2
Difficulty: Easy
Clinical Scenario
A 68-year-old female is admitted to the medical unit with
herpes simplex encephalitis. The healthcare provider
prescribes intravenous (IV) acyclovir.
Question Stem
Which nursing intervention is the priority to prevent a
common adverse effect of this medication?
Options
A. Administer the medication via rapid IV push over 1 to 2
, minutes.
B. Ensure the patient receives adequate IV hydration before
and during the infusion.
C. Monitor the patient’s blood glucose levels every 4 hours.
D. Apply a warm compress to the IV site prior to
administration.
Correct Answer
Correct Answer: B. Ensure the patient receives adequate IV
hydration before and during the infusion.
Detailed Rationale
IV acyclovir can crystallize in the renal tubules, leading to
acute kidney injury (nephrotoxicity). The priority nursing
intervention to prevent this complication is to ensure
adequate hydration, typically by administering IV fluids
before and during the infusion, and encouraging oral fluid
intake if the patient is able to tolerate it. The medication
must be infused slowly over at least 1 hour, not via rapid IV
push (Option A), as rapid infusion significantly increases the
risk of renal toxicity. Acyclovir does not typically cause
significant hypoglycemia or hyperglycemia, making routine
blood glucose monitoring (Option C) unnecessary unless the
patient has a pre-existing diagnosis of diabetes. A warm
compress (Option D) does not prevent the primary systemic
