NCLEX-RN Pharmacology Infection
Practice Questions |
20 Original Antibiotics, Antifungals &
Antivirals NCLEX-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 72-year-old male with a history of chronic kidney disease
stage 3 (baseline serum creatinine 1.8 mg/dL) is admitted
with sepsis secondary to a healthcare-associated
pneumonia. The provider orders intravenous vancomycin 1
gram every 12 hours. The nurse reviews the morning
laboratory results: serum creatinine 2.6 mg/dL, BUN 42
mg/dL, and WBC 14,200/mm³. The most recent vancomycin
trough level drawn 30 minutes before the previous dose was
22 mcg/mL.
Question Stem
Which nursing action should the nurse take first?
,A. Administer the vancomycin as ordered and monitor for
signs of ototoxicity.
B. Notify the provider and hold the next dose of vancomycin.
C. Draw a vancomycin peak level 1 hour after the infusion
begins.
D. Increase the vancomycin infusion rate to complete
administration within 30 minutes.
Correct Answer: B. Notify the provider and hold the next
dose of vancomycin.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic with a narrow
therapeutic index and significant nephrotoxic potential. It is
primarily eliminated by the kidneys, making patients with
renal impairment particularly vulnerable to drug
accumulation and toxicity. The therapeutic vancomycin
trough level for most serious infections is 10-20 mcg/mL;
levels above this range increase the risk of nephrotoxicity
and ototoxicity . This patient's trough level of 22 mcg/mL is
above the therapeutic threshold, and his serum creatinine
has risen from 1.8 to 2.6 mg/dL—indicating worsening renal
function likely from drug accumulation. Administering
,another dose would further increase drug levels and
potentially cause irreversible kidney damage.
Option A is incorrect because administering a nephrotoxic
medication when renal function is declining and trough
levels are elevated is unsafe and violates the principle of "do
no harm." Option C is incorrect because vancomycin
monitoring primarily relies on trough levels (drawn
immediately before the next dose) to guide dosing and
prevent toxicity, not peak levels . Option D is incorrect
because vancomycin should be infused over at least 60
minutes to prevent Vancomycin Flushing Syndrome (Red
Man Syndrome); rapid infusion increases histamine release
and reaction risk.
Nurses must monitor renal function, trough levels, and signs
of ototoxicity (tinnitus, hearing loss) throughout vancomycin
therapy. In this case, the provider should be notified for dose
adjustment, extended dosing intervals, or alternative
antibiotic selection.
Learning Objectives
After completing this question, the learner should be able
to:
, • Identify patients at increased risk for vancomycin-
induced nephrotoxicity.
• Interpret vancomycin trough levels and determine
appropriate nursing actions.
• Prioritize medication safety interventions for
nephrotoxic high-alert medications.
Medication Safety Focus: Monitoring Parameters
Question 2
Clinical Scenario
A 26-year-old female is prescribed doxycycline 100 mg twice
daily for 14 days to treat a confirmed Mycoplasma
pneumoniae respiratory infection. She reports taking a daily
calcium supplement with vitamin D and frequently drinks
milk with meals. She also takes combined oral
contraceptives. The nurse is providing discharge medication
education.
Question Stem
Which statement by the patient indicates a need for
additional teaching?
A. "I'll wear sunscreen and protective clothing when I'm
outdoors."
Practice Questions |
20 Original Antibiotics, Antifungals &
Antivirals NCLEX-Style MCQs with Detailed
Rationales
Question 1
Clinical Scenario
A 72-year-old male with a history of chronic kidney disease
stage 3 (baseline serum creatinine 1.8 mg/dL) is admitted
with sepsis secondary to a healthcare-associated
pneumonia. The provider orders intravenous vancomycin 1
gram every 12 hours. The nurse reviews the morning
laboratory results: serum creatinine 2.6 mg/dL, BUN 42
mg/dL, and WBC 14,200/mm³. The most recent vancomycin
trough level drawn 30 minutes before the previous dose was
22 mcg/mL.
Question Stem
Which nursing action should the nurse take first?
,A. Administer the vancomycin as ordered and monitor for
signs of ototoxicity.
B. Notify the provider and hold the next dose of vancomycin.
C. Draw a vancomycin peak level 1 hour after the infusion
begins.
D. Increase the vancomycin infusion rate to complete
administration within 30 minutes.
Correct Answer: B. Notify the provider and hold the next
dose of vancomycin.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic with a narrow
therapeutic index and significant nephrotoxic potential. It is
primarily eliminated by the kidneys, making patients with
renal impairment particularly vulnerable to drug
accumulation and toxicity. The therapeutic vancomycin
trough level for most serious infections is 10-20 mcg/mL;
levels above this range increase the risk of nephrotoxicity
and ototoxicity . This patient's trough level of 22 mcg/mL is
above the therapeutic threshold, and his serum creatinine
has risen from 1.8 to 2.6 mg/dL—indicating worsening renal
function likely from drug accumulation. Administering
,another dose would further increase drug levels and
potentially cause irreversible kidney damage.
Option A is incorrect because administering a nephrotoxic
medication when renal function is declining and trough
levels are elevated is unsafe and violates the principle of "do
no harm." Option C is incorrect because vancomycin
monitoring primarily relies on trough levels (drawn
immediately before the next dose) to guide dosing and
prevent toxicity, not peak levels . Option D is incorrect
because vancomycin should be infused over at least 60
minutes to prevent Vancomycin Flushing Syndrome (Red
Man Syndrome); rapid infusion increases histamine release
and reaction risk.
Nurses must monitor renal function, trough levels, and signs
of ototoxicity (tinnitus, hearing loss) throughout vancomycin
therapy. In this case, the provider should be notified for dose
adjustment, extended dosing intervals, or alternative
antibiotic selection.
Learning Objectives
After completing this question, the learner should be able
to:
, • Identify patients at increased risk for vancomycin-
induced nephrotoxicity.
• Interpret vancomycin trough levels and determine
appropriate nursing actions.
• Prioritize medication safety interventions for
nephrotoxic high-alert medications.
Medication Safety Focus: Monitoring Parameters
Question 2
Clinical Scenario
A 26-year-old female is prescribed doxycycline 100 mg twice
daily for 14 days to treat a confirmed Mycoplasma
pneumoniae respiratory infection. She reports taking a daily
calcium supplement with vitamin D and frequently drinks
milk with meals. She also takes combined oral
contraceptives. The nurse is providing discharge medication
education.
Question Stem
Which statement by the patient indicates a need for
additional teaching?
A. "I'll wear sunscreen and protective clothing when I'm
outdoors."
