NCLEX-RN Pharmacology Practice
Questions |
20 Infection Medications MCQs with
Rationales |
Antibiotics, Antifungals & Antivirals |
ATI & NGN Style
Question 1
Clinical Scenario
A 62-year-old female client is admitted with a severe bone
and joint infection (osteomyelitis) and is prescribed
intravenous daptomycin 6 mg/kg daily. Her baseline
laboratory results are:
• Serum creatinine: 1.4 mg/dL (Normal: 0.5–1.1 mg/dL)
• Blood urea nitrogen (BUN): 24 mg/dL (Normal: 10–20
mg/dL)
• Creatine kinase (CK): 120 U/L (Normal: 30–135 U/L)
,The client also takes atorvastatin 40 mg daily at bedtime for
hyperlipidemia.
Question Stem
Which action should the nurse take first before
administering the first dose of daptomycin?
A. Hold the daptomycin and request a lower dose due to
elevated serum creatinine.
B. Hold the atorvastatin and collaborate with the provider
regarding statin therapy.
C. Administer the daptomycin and schedule a creatine
kinase (CK) level for next month.
D. Obtain a blood specimen to repeat the creatine kinase
(CK) level immediately.
Correct Answer
Correct Answer: B. Hold the atorvastatin and collaborate
with the provider regarding statin therapy.
Detailed Rationale
Daptomycin is a cyclic lipopeptide antibiotic used to treat
complicated skin, structure, and blood infections, including
osteomyelitis. A major, well-documented adverse effect of
daptomycin is skeletal muscle toxicity, which can manifest
as myopathy, muscle pain or weakness, and a significant
,rise in serum creatine kinase (CK) levels, potentially leading
to life-threatening rhabdomyolysis. HMG-CoA reductase
inhibitors (statins), such as atorvastatin, also carry a well-
known risk of myopathy and rhabdomyolysis.
When daptomycin and a statin are administered
concurrently, the risk of severe muscle toxicity and
rhabdomyolysis is exponentially increased. Therefore, the
nurse must hold the atorvastatin and consult with the
healthcare provider. The standard clinical intervention is to
temporarily suspend statin therapy for the duration of the
daptomycin course.
While the client's creatinine is mildly elevated (1.4 mg/dL),
daptomycin doses are adjusted based on calculated
creatinine clearance ($CrCl$), typically requiring adjustment
if $CrCl$ is less than 30 mL/min, which requires calculation
rather than an immediate blind hold of the drug. CK levels
must be monitored weekly—not monthly—during
daptomycin therapy. Repeating the baseline CK immediately
is unnecessary because the baseline value of 120 U/L is
within normal limits.
Learning Objectives
After completing this question, the learner should be able
to:
, • Identify the potential for cumulative muscle toxicity
when combining daptomycin with statin medications.
• Recognize clinical and laboratory indicators of drug-
induced rhabdomyolysis.
• Implement appropriate monitoring parameters,
specifically weekly creatine kinase (CK) assessments,
during cyclic lipopeptide therapy.
Medication Safety Focus
Drug interaction
Question 2
Clinical Scenario
A 43-year-old male client with a history of alcohol use
disorder is hospitalized with severe pelvic and abdominal
wound infections following a trauma. He is receiving
intravenous metronidazole 500 mg every 8 hours. During the
morning assessment, the nurse notes that the client has
developed new-onset ataxia (unsteady gait), slurred speech,
and peripheral numbness and tingling in his lower
extremities.
Question Stem
Which action should the nurse take first?
Questions |
20 Infection Medications MCQs with
Rationales |
Antibiotics, Antifungals & Antivirals |
ATI & NGN Style
Question 1
Clinical Scenario
A 62-year-old female client is admitted with a severe bone
and joint infection (osteomyelitis) and is prescribed
intravenous daptomycin 6 mg/kg daily. Her baseline
laboratory results are:
• Serum creatinine: 1.4 mg/dL (Normal: 0.5–1.1 mg/dL)
• Blood urea nitrogen (BUN): 24 mg/dL (Normal: 10–20
mg/dL)
• Creatine kinase (CK): 120 U/L (Normal: 30–135 U/L)
,The client also takes atorvastatin 40 mg daily at bedtime for
hyperlipidemia.
Question Stem
Which action should the nurse take first before
administering the first dose of daptomycin?
A. Hold the daptomycin and request a lower dose due to
elevated serum creatinine.
B. Hold the atorvastatin and collaborate with the provider
regarding statin therapy.
C. Administer the daptomycin and schedule a creatine
kinase (CK) level for next month.
D. Obtain a blood specimen to repeat the creatine kinase
(CK) level immediately.
Correct Answer
Correct Answer: B. Hold the atorvastatin and collaborate
with the provider regarding statin therapy.
Detailed Rationale
Daptomycin is a cyclic lipopeptide antibiotic used to treat
complicated skin, structure, and blood infections, including
osteomyelitis. A major, well-documented adverse effect of
daptomycin is skeletal muscle toxicity, which can manifest
as myopathy, muscle pain or weakness, and a significant
,rise in serum creatine kinase (CK) levels, potentially leading
to life-threatening rhabdomyolysis. HMG-CoA reductase
inhibitors (statins), such as atorvastatin, also carry a well-
known risk of myopathy and rhabdomyolysis.
When daptomycin and a statin are administered
concurrently, the risk of severe muscle toxicity and
rhabdomyolysis is exponentially increased. Therefore, the
nurse must hold the atorvastatin and consult with the
healthcare provider. The standard clinical intervention is to
temporarily suspend statin therapy for the duration of the
daptomycin course.
While the client's creatinine is mildly elevated (1.4 mg/dL),
daptomycin doses are adjusted based on calculated
creatinine clearance ($CrCl$), typically requiring adjustment
if $CrCl$ is less than 30 mL/min, which requires calculation
rather than an immediate blind hold of the drug. CK levels
must be monitored weekly—not monthly—during
daptomycin therapy. Repeating the baseline CK immediately
is unnecessary because the baseline value of 120 U/L is
within normal limits.
Learning Objectives
After completing this question, the learner should be able
to:
, • Identify the potential for cumulative muscle toxicity
when combining daptomycin with statin medications.
• Recognize clinical and laboratory indicators of drug-
induced rhabdomyolysis.
• Implement appropriate monitoring parameters,
specifically weekly creatine kinase (CK) assessments,
during cyclic lipopeptide therapy.
Medication Safety Focus
Drug interaction
Question 2
Clinical Scenario
A 43-year-old male client with a history of alcohol use
disorder is hospitalized with severe pelvic and abdominal
wound infections following a trauma. He is receiving
intravenous metronidazole 500 mg every 8 hours. During the
morning assessment, the nurse notes that the client has
developed new-onset ataxia (unsteady gait), slurred speech,
and peripheral numbness and tingling in his lower
extremities.
Question Stem
Which action should the nurse take first?
