NCLEX-RN Pharmacology Practice Questions |
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old male is admitted with methicillin-resistant
Staphylococcus aureus (MRSA) bacteremia. He is receiving
intravenous vancomycin. His current serum vancomycin
trough level is 22 mcg/mL. His blood urea nitrogen (BUN) is
35 mg/dL, and serum creatinine is 1.8 mg/dL. He reports a
new onset of ringing in his ears.
Question Stem
Which action should the nurse take first?
A. Administer the next scheduled dose of vancomycin as
prescribed.
B. Hold the vancomycin dose and notify the healthcare
,provider.
C. Increase the intravenous fluid rate to 150 mL/hr.
D. Request an order for an audiometry test.
Correct Answer
Correct Answer: B. Hold the vancomycin dose and notify the
healthcare provider.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic used for serious
Gram-positive infections, including MRSA. It has a narrow
therapeutic index and is known to be nephrotoxic and
ototoxic. A therapeutic vancomycin trough level for serious
infections is typically 15–20 mcg/mL. A trough of 22 mcg/mL
is supratherapeutic and increases the risk of toxicity, which
is corroborated by the client's elevated BUN (35 mg/dL),
elevated creatinine (1.8 mg/dL), and new-onset tinnitus
(ringing in the ears), a classic sign of ototoxicity. The priority
nursing action is to hold the medication to prevent further
renal and auditory damage and immediately notify the
healthcare provider for dosage adjustment or alternative
therapy.
Option A is incorrect because administering the next dose
would exacerbate toxicity. Option C is incorrect because
while hydration is important for renal protection, increasing
the IV fluid rate without a provider's order while the client is
,already showing signs of toxicity is not the priority action.
Option D is incorrect because while an audiometry test may
eventually be ordered to assess the extent of ototoxicity, it is
not the immediate priority; preventing further harm by
holding the dose takes precedence.
Learning Objective
• Interpret vancomycin trough levels and recognize early
signs of toxicity.
• Prioritize nursing interventions for suspected
medication-induced nephrotoxicity and ototoxicity.
• Apply clinical judgment in holding high-risk medications
when adverse effects are present.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 45-year-old female is prescribed oral ciprofloxacin for a
complicated urinary tract infection. She also takes a daily
multivitamin and an over-the-counter antacid for heartburn.
, Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I will drink plenty of fluids while taking this medication."
B. "I can take my antacid at the same time as the
ciprofloxacin to prevent stomach upset."
C. "I will report any new joint pain or tendon swelling
immediately."
D. "I will avoid direct sunlight and wear sunscreen when
going outside."
Correct Answer
Correct Answer: B. "I can take my antacid at the same time
as the ciprofloxacin to prevent stomach upset."
Detailed Rationale
Ciprofloxacin is a fluoroquinolone antibiotic.
Fluoroquinolones can chelate with multivalent cations (such
as calcium, magnesium, aluminum, and iron) found in
antacids, dairy products, and multivitamins, significantly
decreasing the absorption and therapeutic efficacy of the
antibiotic. The client should be taught to separate the
administration of ciprofloxacin and these products by at
least 2 hours before or 6 hours after the antibiotic.
Option A is correct teaching, as adequate hydration prevents
crystalluria. Option C is correct teaching, as
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old male is admitted with methicillin-resistant
Staphylococcus aureus (MRSA) bacteremia. He is receiving
intravenous vancomycin. His current serum vancomycin
trough level is 22 mcg/mL. His blood urea nitrogen (BUN) is
35 mg/dL, and serum creatinine is 1.8 mg/dL. He reports a
new onset of ringing in his ears.
Question Stem
Which action should the nurse take first?
A. Administer the next scheduled dose of vancomycin as
prescribed.
B. Hold the vancomycin dose and notify the healthcare
,provider.
C. Increase the intravenous fluid rate to 150 mL/hr.
D. Request an order for an audiometry test.
Correct Answer
Correct Answer: B. Hold the vancomycin dose and notify the
healthcare provider.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic used for serious
Gram-positive infections, including MRSA. It has a narrow
therapeutic index and is known to be nephrotoxic and
ototoxic. A therapeutic vancomycin trough level for serious
infections is typically 15–20 mcg/mL. A trough of 22 mcg/mL
is supratherapeutic and increases the risk of toxicity, which
is corroborated by the client's elevated BUN (35 mg/dL),
elevated creatinine (1.8 mg/dL), and new-onset tinnitus
(ringing in the ears), a classic sign of ototoxicity. The priority
nursing action is to hold the medication to prevent further
renal and auditory damage and immediately notify the
healthcare provider for dosage adjustment or alternative
therapy.
Option A is incorrect because administering the next dose
would exacerbate toxicity. Option C is incorrect because
while hydration is important for renal protection, increasing
the IV fluid rate without a provider's order while the client is
,already showing signs of toxicity is not the priority action.
Option D is incorrect because while an audiometry test may
eventually be ordered to assess the extent of ototoxicity, it is
not the immediate priority; preventing further harm by
holding the dose takes precedence.
Learning Objective
• Interpret vancomycin trough levels and recognize early
signs of toxicity.
• Prioritize nursing interventions for suspected
medication-induced nephrotoxicity and ototoxicity.
• Apply clinical judgment in holding high-risk medications
when adverse effects are present.
Medication Safety Focus
Monitoring
Question 2
Clinical Scenario
A 45-year-old female is prescribed oral ciprofloxacin for a
complicated urinary tract infection. She also takes a daily
multivitamin and an over-the-counter antacid for heartburn.
, Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I will drink plenty of fluids while taking this medication."
B. "I can take my antacid at the same time as the
ciprofloxacin to prevent stomach upset."
C. "I will report any new joint pain or tendon swelling
immediately."
D. "I will avoid direct sunlight and wear sunscreen when
going outside."
Correct Answer
Correct Answer: B. "I can take my antacid at the same time
as the ciprofloxacin to prevent stomach upset."
Detailed Rationale
Ciprofloxacin is a fluoroquinolone antibiotic.
Fluoroquinolones can chelate with multivalent cations (such
as calcium, magnesium, aluminum, and iron) found in
antacids, dairy products, and multivitamins, significantly
decreasing the absorption and therapeutic efficacy of the
antibiotic. The client should be taught to separate the
administration of ciprofloxacin and these products by at
least 2 hours before or 6 hours after the antibiotic.
Option A is correct teaching, as adequate hydration prevents
crystalluria. Option C is correct teaching, as
