NCLEX-RN Pharmacology Infection
Practice Exam |
20 Original Antibiotics, Antifungals &
Antivirals Questions with Detailed
Rationales |
ATI & NGN Style
Question 1
Clinical Scenario
A 72-year-old male patient is admitted with community-
acquired pneumonia. His medical history includes
hypertension, type 2 diabetes, and chronic kidney disease
stage 3 (baseline serum creatinine 1.6 mg/dL). The provider
orders intravenous vancomycin 1 gram every 12 hours. The
nurse reviews the electronic health record and notes that
the patient received his first dose 10 hours ago. The most
recent laboratory results show:
• Serum creatinine: 2.4 mg/dL (increased from 1.8 mg/dL
this morning)
, • BUN: 42 mg/dL
• Vancomycin trough: 18.5 mcg/mL (drawn 1 hour ago)
• WBC: 14,200/mm³
Question Stem
Which action should the nurse take next?
A. Administer the next scheduled vancomycin dose as
ordered.
B. Hold the next vancomycin dose and notify the healthcare
provider.
C. Increase the patient's IV fluid rate to promote renal
clearance.
D. Document the findings and continue to monitor the
patient.
Correct Answer: B. Hold the next vancomycin dose and
notify the healthcare provider.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic with a narrow
therapeutic index and significant nephrotoxicity risk,
especially in patients with pre-existing renal impairment.
,This patient's serum creatinine has risen from 1.8 mg/dL to
2.4 mg/dL within a short period, indicating acute kidney
injury. Additionally, the vancomycin trough level of 18.5
mcg/mL is above the typical target range of 10-15 mcg/mL
for most infections (though some institutions may target
higher troughs for specific severe infections like meningitis
or endocarditis). The combination of rising creatinine and
elevated trough level suggests drug accumulation and
potential toxicity .
Option B is correct because holding the next dose is
essential to prevent further nephrotoxic injury. The nurse
must immediately notify the provider, who will likely adjust
the dose based on renal function, extend the dosing interval,
or consider alternative therapy. Vancomycin is primarily
eliminated by the kidneys, and accumulation can lead to
irreversible renal damage and ototoxicity.
Option A is incorrect because administering another dose
when the trough level is elevated and creatinine is rising
places the patient at significant risk for harm. Option C is
incorrect; while maintaining adequate hydration is
important, increasing IV fluid rates without a provider order
could worsen fluid overload, particularly in patients with
renal impairment or heart failure. Option D is incorrect
because withholding action when laboratory values indicate
, toxicity represents a failure to advocate for patient safety
and could result in permanent kidney damage.
Nursing Considerations: The nurse should also assess for
signs of ototoxicity (tinnitus, hearing changes), monitor urine
output, and prepare for possible vancomycin dose
adjustments based on therapeutic drug monitoring. Trough
levels are drawn immediately before the next dose—ideally
30-60 minutes prior—to guide dosing .
Learning Objectives
After completing this question, the learner should be able
to:
• Identify the therapeutic range and toxicity parameters
for vancomycin therapy.
• Recognize acute kidney injury indicators during
nephrotoxic antibiotic administration.
• Prioritize safe medication administration by interpreting
laboratory values and therapeutic drug monitoring
results.
• Implement appropriate nursing interventions when
medication toxicity is suspected.
Practice Exam |
20 Original Antibiotics, Antifungals &
Antivirals Questions with Detailed
Rationales |
ATI & NGN Style
Question 1
Clinical Scenario
A 72-year-old male patient is admitted with community-
acquired pneumonia. His medical history includes
hypertension, type 2 diabetes, and chronic kidney disease
stage 3 (baseline serum creatinine 1.6 mg/dL). The provider
orders intravenous vancomycin 1 gram every 12 hours. The
nurse reviews the electronic health record and notes that
the patient received his first dose 10 hours ago. The most
recent laboratory results show:
• Serum creatinine: 2.4 mg/dL (increased from 1.8 mg/dL
this morning)
, • BUN: 42 mg/dL
• Vancomycin trough: 18.5 mcg/mL (drawn 1 hour ago)
• WBC: 14,200/mm³
Question Stem
Which action should the nurse take next?
A. Administer the next scheduled vancomycin dose as
ordered.
B. Hold the next vancomycin dose and notify the healthcare
provider.
C. Increase the patient's IV fluid rate to promote renal
clearance.
D. Document the findings and continue to monitor the
patient.
Correct Answer: B. Hold the next vancomycin dose and
notify the healthcare provider.
Detailed Rationale
Vancomycin is a glycopeptide antibiotic with a narrow
therapeutic index and significant nephrotoxicity risk,
especially in patients with pre-existing renal impairment.
,This patient's serum creatinine has risen from 1.8 mg/dL to
2.4 mg/dL within a short period, indicating acute kidney
injury. Additionally, the vancomycin trough level of 18.5
mcg/mL is above the typical target range of 10-15 mcg/mL
for most infections (though some institutions may target
higher troughs for specific severe infections like meningitis
or endocarditis). The combination of rising creatinine and
elevated trough level suggests drug accumulation and
potential toxicity .
Option B is correct because holding the next dose is
essential to prevent further nephrotoxic injury. The nurse
must immediately notify the provider, who will likely adjust
the dose based on renal function, extend the dosing interval,
or consider alternative therapy. Vancomycin is primarily
eliminated by the kidneys, and accumulation can lead to
irreversible renal damage and ototoxicity.
Option A is incorrect because administering another dose
when the trough level is elevated and creatinine is rising
places the patient at significant risk for harm. Option C is
incorrect; while maintaining adequate hydration is
important, increasing IV fluid rates without a provider order
could worsen fluid overload, particularly in patients with
renal impairment or heart failure. Option D is incorrect
because withholding action when laboratory values indicate
, toxicity represents a failure to advocate for patient safety
and could result in permanent kidney damage.
Nursing Considerations: The nurse should also assess for
signs of ototoxicity (tinnitus, hearing changes), monitor urine
output, and prepare for possible vancomycin dose
adjustments based on therapeutic drug monitoring. Trough
levels are drawn immediately before the next dose—ideally
30-60 minutes prior—to guide dosing .
Learning Objectives
After completing this question, the learner should be able
to:
• Identify the therapeutic range and toxicity parameters
for vancomycin therapy.
• Recognize acute kidney injury indicators during
nephrotoxic antibiotic administration.
• Prioritize safe medication administration by interpreting
laboratory values and therapeutic drug monitoring
results.
• Implement appropriate nursing interventions when
medication toxicity is suspected.
