Bring a large pot of lightly salted water to a rolling boil.

Add fettuccine pasta and cook until tender yet firm, about 8 minutes.

While pasta cooks, melt 1 tablespoon of butter in a deep skillet over medium heat.

Add shrimp and minced garlic to the skillet.

Cook and stir until shrimp turn pink, 2 to 3 minutes.

Add remaining butter to the skillet and let melt.

Stir in cream cheese and garlic powder until smooth, about 2 minutes.

Stir in milk and Parmesan cheese until cheese is melted and sauce is smooth, about 2 minutes more.

Season with ground black pepper.

Fold prepared basil pesto into the cream sauce.

Drain the cooked fettuccine.

Toss the fettuccine with the prepared sauce and serve.