NCLEX-RN Pharmacology Practice Questions &
Rationales |
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original NCLEX-Style MCQs with Detailed
Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman is admitted with fever, productive cough,
shortness of breath, and right lower lobe pneumonia. Her
medical history includes chronic kidney disease stage 3,
hypertension, and type 2 diabetes mellitus. She is prescribed
intravenous vancomycin for suspected methicillin-resistant
Staphylococcus aureus (MRSA). Baseline laboratory results
include:
• Serum creatinine: 2.0 mg/dL
, • BUN: 38 mg/dL
• WBC: 16,500/mm³
• Temperature: 38.8°C (101.8°F)
The nurse reviews the medication administration record before
administering the next dose.
Question Stem
Which nursing action is the highest priority before
administering the next dose of vancomycin?
A. Encourage increased oral fluid intake.
B. Review the most recent vancomycin trough concentration
and renal function.
C. Administer the medication over 30 minutes.
D. Hold the medication if the WBC count remains elevated.
Correct Answer
Correct Answer: B. Review the most recent vancomycin trough
concentration and renal function.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic commonly used to treat
serious gram-positive infections, including MRSA. Because it is
primarily eliminated by the kidneys, impaired renal function
significantly increases the risk of drug accumulation and
, nephrotoxicity. Reviewing the most recent vancomycin trough
level and renal function before administering the next dose
helps determine whether dosage adjustment or delayed
administration is necessary. This patient already has chronic
kidney disease and an elevated serum creatinine, making
therapeutic drug monitoring a priority for safe medication
administration.
Option A is incorrect because hydration may support renal
function, but it does not replace assessment of serum drug
concentrations or kidney function before dosing. Oral fluids may
also be restricted depending on the patient's overall condition.
Option C is incorrect because vancomycin should generally be
infused over at least 60 minutes, and longer infusion times may
be required for larger doses to reduce infusion-related reactions
such as "red man syndrome." Administering over only 30
minutes increases this risk.
Option D is incorrect because an elevated WBC count reflects
the infection and is not an indication to withhold therapy. The
medication should continue unless contraindications or toxic
levels are identified.
Medication safety requires evaluating renal function,
therapeutic drug levels, urine output, and signs of toxicity
before administering nephrotoxic medications.
Learning Objectives
Rationales |
Infection Medications (Antibiotics, Antifungals
& Antivirals) |
20 Original NCLEX-Style MCQs with Detailed
Rationales |
Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old woman is admitted with fever, productive cough,
shortness of breath, and right lower lobe pneumonia. Her
medical history includes chronic kidney disease stage 3,
hypertension, and type 2 diabetes mellitus. She is prescribed
intravenous vancomycin for suspected methicillin-resistant
Staphylococcus aureus (MRSA). Baseline laboratory results
include:
• Serum creatinine: 2.0 mg/dL
, • BUN: 38 mg/dL
• WBC: 16,500/mm³
• Temperature: 38.8°C (101.8°F)
The nurse reviews the medication administration record before
administering the next dose.
Question Stem
Which nursing action is the highest priority before
administering the next dose of vancomycin?
A. Encourage increased oral fluid intake.
B. Review the most recent vancomycin trough concentration
and renal function.
C. Administer the medication over 30 minutes.
D. Hold the medication if the WBC count remains elevated.
Correct Answer
Correct Answer: B. Review the most recent vancomycin trough
concentration and renal function.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic commonly used to treat
serious gram-positive infections, including MRSA. Because it is
primarily eliminated by the kidneys, impaired renal function
significantly increases the risk of drug accumulation and
, nephrotoxicity. Reviewing the most recent vancomycin trough
level and renal function before administering the next dose
helps determine whether dosage adjustment or delayed
administration is necessary. This patient already has chronic
kidney disease and an elevated serum creatinine, making
therapeutic drug monitoring a priority for safe medication
administration.
Option A is incorrect because hydration may support renal
function, but it does not replace assessment of serum drug
concentrations or kidney function before dosing. Oral fluids may
also be restricted depending on the patient's overall condition.
Option C is incorrect because vancomycin should generally be
infused over at least 60 minutes, and longer infusion times may
be required for larger doses to reduce infusion-related reactions
such as "red man syndrome." Administering over only 30
minutes increases this risk.
Option D is incorrect because an elevated WBC count reflects
the infection and is not an indication to withhold therapy. The
medication should continue unless contraindications or toxic
levels are identified.
Medication safety requires evaluating renal function,
therapeutic drug levels, urine output, and signs of toxicity
before administering nephrotoxic medications.
Learning Objectives
