NCLEX-RN Pharmacology Infection Drugs Exam
Prep
20 Original Antibiotics, Antifungals &
Antivirals Practice Questions with Rationales |
Nursing Test Bank Study Guide
Question 1
Clinical Scenario
A 72-year-old male client with a history of chronic kidney
disease (Stage 3) and hypertension is admitted to the medical-
surgical unit with community-acquired pneumonia. The
healthcare provider orders intravenous vancomycin 1 gram
every 12 hours. The client's admission laboratory results show
serum creatinine 2.1 mg/dL and BUN 32 mg/dL. The nurse
reviews the medication order and the client's chart.
Question Stem
Which action should the nurse take first?
A. Administer the vancomycin as ordered
B. Request a trough level be drawn immediately
,C. Hold the vancomycin and contact the healthcare provider
D. Increase the client's IV fluid rate to prevent nephrotoxicity
Correct Answer
C. Hold the vancomycin and contact the healthcare provider
Detailed Rationale
Why C is correct: The client has Stage 3 chronic kidney disease
with a serum creatinine of 2.1 mg/dL, indicating significant
renal impairment. Vancomycin is primarily eliminated by the
kidneys and requires dosage adjustment based on renal
function to prevent accumulation and toxicity. The standard
dose of 1 gram every 12 hours is typically appropriate for clients
with normal renal function; however, this dose is too high for a
client with impaired renal function and could lead to
nephrotoxicity. The nurse should hold the medication and
contact the healthcare provider to request a dosage adjustment
based on the client's creatinine clearance. This demonstrates
safe medication administration and prevention of adverse drug
events.
Why A is incorrect: Administering the vancomycin as ordered
without addressing the renal impairment could result in toxic
vancomycin levels, leading to nephrotoxicity, ototoxicity, and
,other serious adverse effects. The nurse has a responsibility to
question orders that may be unsafe based on client-specific
factors.
Why B is incorrect: While vancomycin trough levels are
important for monitoring therapeutic efficacy and safety,
drawing a trough level immediately would not be appropriate.
Trough levels should be drawn just before the next dose after
steady state has been achieved (typically after the third or
fourth dose). Drawing a trough immediately would provide no
useful clinical information and would delay appropriate
intervention.
Why D is incorrect: Increasing IV fluid rates would not
adequately address the underlying issue of inappropriate
vancomycin dosing for renal function. While adequate hydration
is important for renal protection, it does not replace the need
for proper dose adjustment. Additionally, increasing fluids
without a provider order and without assessing the client's fluid
status could lead to fluid overload, especially in an older adult
with hypertension.
Nursing Considerations: Vancomycin is a high-alert medication
requiring careful monitoring of renal function, serum trough
levels, and signs of toxicity. The recommended vancomycin
trough level for pneumonia is typically 10-15 mcg/mL.
Nephrotoxicity is manifested by rising serum creatinine and
, decreased urine output. The nurse should monitor for signs of
ototoxicity (tinnitus, hearing loss) and red man syndrome
(flushing, rash). Patient teaching should include reporting any
changes in hearing, ringing in ears, or decreased urine output.
Learning Objective
After completing this question, the learner should be able to:
• Identify risk factors for vancomycin-induced nephrotoxicity
• Recognize the need for dosage adjustment in clients with
renal impairment
• Prioritize nursing actions when medication orders may be
unsafe
• Understand appropriate timing for therapeutic drug
monitoring
Medication Safety Focus
High-alert medication, Renal dosing, Medication safety
Question 2
Clinical Scenario
Prep
20 Original Antibiotics, Antifungals &
Antivirals Practice Questions with Rationales |
Nursing Test Bank Study Guide
Question 1
Clinical Scenario
A 72-year-old male client with a history of chronic kidney
disease (Stage 3) and hypertension is admitted to the medical-
surgical unit with community-acquired pneumonia. The
healthcare provider orders intravenous vancomycin 1 gram
every 12 hours. The client's admission laboratory results show
serum creatinine 2.1 mg/dL and BUN 32 mg/dL. The nurse
reviews the medication order and the client's chart.
Question Stem
Which action should the nurse take first?
A. Administer the vancomycin as ordered
B. Request a trough level be drawn immediately
,C. Hold the vancomycin and contact the healthcare provider
D. Increase the client's IV fluid rate to prevent nephrotoxicity
Correct Answer
C. Hold the vancomycin and contact the healthcare provider
Detailed Rationale
Why C is correct: The client has Stage 3 chronic kidney disease
with a serum creatinine of 2.1 mg/dL, indicating significant
renal impairment. Vancomycin is primarily eliminated by the
kidneys and requires dosage adjustment based on renal
function to prevent accumulation and toxicity. The standard
dose of 1 gram every 12 hours is typically appropriate for clients
with normal renal function; however, this dose is too high for a
client with impaired renal function and could lead to
nephrotoxicity. The nurse should hold the medication and
contact the healthcare provider to request a dosage adjustment
based on the client's creatinine clearance. This demonstrates
safe medication administration and prevention of adverse drug
events.
Why A is incorrect: Administering the vancomycin as ordered
without addressing the renal impairment could result in toxic
vancomycin levels, leading to nephrotoxicity, ototoxicity, and
,other serious adverse effects. The nurse has a responsibility to
question orders that may be unsafe based on client-specific
factors.
Why B is incorrect: While vancomycin trough levels are
important for monitoring therapeutic efficacy and safety,
drawing a trough level immediately would not be appropriate.
Trough levels should be drawn just before the next dose after
steady state has been achieved (typically after the third or
fourth dose). Drawing a trough immediately would provide no
useful clinical information and would delay appropriate
intervention.
Why D is incorrect: Increasing IV fluid rates would not
adequately address the underlying issue of inappropriate
vancomycin dosing for renal function. While adequate hydration
is important for renal protection, it does not replace the need
for proper dose adjustment. Additionally, increasing fluids
without a provider order and without assessing the client's fluid
status could lead to fluid overload, especially in an older adult
with hypertension.
Nursing Considerations: Vancomycin is a high-alert medication
requiring careful monitoring of renal function, serum trough
levels, and signs of toxicity. The recommended vancomycin
trough level for pneumonia is typically 10-15 mcg/mL.
Nephrotoxicity is manifested by rising serum creatinine and
, decreased urine output. The nurse should monitor for signs of
ototoxicity (tinnitus, hearing loss) and red man syndrome
(flushing, rash). Patient teaching should include reporting any
changes in hearing, ringing in ears, or decreased urine output.
Learning Objective
After completing this question, the learner should be able to:
• Identify risk factors for vancomycin-induced nephrotoxicity
• Recognize the need for dosage adjustment in clients with
renal impairment
• Prioritize nursing actions when medication orders may be
unsafe
• Understand appropriate timing for therapeutic drug
monitoring
Medication Safety Focus
High-alert medication, Renal dosing, Medication safety
Question 2
Clinical Scenario
