NCLEX-RN Pharmacology Practice
Questions: Infection Medications
(Antibiotics, Antifungals & Antivirals) |
20 ATI & NGN-Style Exam Prep MCQs with
Rationales
Question 1
Clinical Scenario
A 72-year-old male with a history of chronic kidney disease
stage 3 (baseline creatinine 1.6 mg/dL) is admitted with
healthcare-associated pneumonia. The provider prescribes
intravenous vancomycin 1 gram every 12 hours. The nurse
reviews the morning laboratory results before administering
the scheduled dose:
• Serum creatinine: 2.4 mg/dL (baseline 1.6 mg/dL)
• BUN: 42 mg/dL
• Vancomycin trough level: 24 mcg/mL (drawn 30 minutes
before the scheduled dose; typical therapeutic goal for
pneumonia is 10-20 mcg/mL)
, • WBC: 14,500/mm³
• Temperature: 37.8°C (100.0°F)
Question Stem
Which nursing action is the highest priority?
A. Administer the vancomycin as prescribed and monitor for
signs of infusion reaction.
B. Hold the vancomycin dose and notify the healthcare
provider immediately.
C. Increase the intravenous fluid rate to improve renal
perfusion.
D. Draw a vancomycin peak level 60 minutes after the
infusion begins.
Correct Answer
B. Hold the vancomycin dose and notify the healthcare
provider immediately.
Detailed Rationale
The correct answer is B. Vancomycin is a glycopeptide
antibiotic with a narrow therapeutic index that is primarily
eliminated renally. The patient's trough level of 24 mcg/mL is
significantly above the typical therapeutic range of 10-20
mcg/mL for pneumonia, and his serum creatinine has risen
from 1.6 to 2.4 mg/dL, indicating worsening renal function.
,These findings suggest drug accumulation and potential
nephrotoxicity . Administering the next dose could lead to
further kidney injury, ototoxicity, or other serious adverse
effects. The nurse should hold the dose and notify the
provider so that the vancomycin regimen can be adjusted
based on renal function and serum drug levels .
Option A is incorrect because administering the medication
despite evidence of toxicity could cause additional harm.
Option C, while generally supportive, does not address the
immediate safety concern of supratherapeutic drug levels
and worsening renal function. Increased fluids alone will not
correct the underlying accumulation of vancomycin. Option
D is incorrect because vancomycin monitoring relies
primarily on trough levels (drawn immediately before the
next dose), not peak levels, to guide dosing and assess for
toxicity .
Nurses must recognize that vancomycin requires
therapeutic drug monitoring, particularly in patients with
renal impairment. Trough levels should be drawn 30 minutes
before the next scheduled dose. Patients should be
monitored for nephrotoxicity (rising creatinine, decreased
urine output), ototoxicity (tinnitus, hearing loss), and
infusion-related reactions .
Learning Objectives
, After completing this question, the learner should be able
to:
• Interpret vancomycin trough levels and identify values
outside the therapeutic range.
• Recognize signs of vancomycin-induced nephrotoxicity.
• Prioritize nursing actions when a patient develops
evidence of medication toxicity.
• Explain the importance of therapeutic drug monitoring
for high-alert medications.
Medication Safety Focus
Monitoring Parameters
Question 2
Clinical Scenario
A 28-year-old female is prescribed doxycycline 100 mg orally
twice daily for Lyme disease. During discharge teaching, the
nurse reviews proper medication administration. The patient
reports taking a daily calcium supplement for bone health
and frequently consumes dairy products.
Question Stem
Questions: Infection Medications
(Antibiotics, Antifungals & Antivirals) |
20 ATI & NGN-Style Exam Prep MCQs with
Rationales
Question 1
Clinical Scenario
A 72-year-old male with a history of chronic kidney disease
stage 3 (baseline creatinine 1.6 mg/dL) is admitted with
healthcare-associated pneumonia. The provider prescribes
intravenous vancomycin 1 gram every 12 hours. The nurse
reviews the morning laboratory results before administering
the scheduled dose:
• Serum creatinine: 2.4 mg/dL (baseline 1.6 mg/dL)
• BUN: 42 mg/dL
• Vancomycin trough level: 24 mcg/mL (drawn 30 minutes
before the scheduled dose; typical therapeutic goal for
pneumonia is 10-20 mcg/mL)
, • WBC: 14,500/mm³
• Temperature: 37.8°C (100.0°F)
Question Stem
Which nursing action is the highest priority?
A. Administer the vancomycin as prescribed and monitor for
signs of infusion reaction.
B. Hold the vancomycin dose and notify the healthcare
provider immediately.
C. Increase the intravenous fluid rate to improve renal
perfusion.
D. Draw a vancomycin peak level 60 minutes after the
infusion begins.
Correct Answer
B. Hold the vancomycin dose and notify the healthcare
provider immediately.
Detailed Rationale
The correct answer is B. Vancomycin is a glycopeptide
antibiotic with a narrow therapeutic index that is primarily
eliminated renally. The patient's trough level of 24 mcg/mL is
significantly above the typical therapeutic range of 10-20
mcg/mL for pneumonia, and his serum creatinine has risen
from 1.6 to 2.4 mg/dL, indicating worsening renal function.
,These findings suggest drug accumulation and potential
nephrotoxicity . Administering the next dose could lead to
further kidney injury, ototoxicity, or other serious adverse
effects. The nurse should hold the dose and notify the
provider so that the vancomycin regimen can be adjusted
based on renal function and serum drug levels .
Option A is incorrect because administering the medication
despite evidence of toxicity could cause additional harm.
Option C, while generally supportive, does not address the
immediate safety concern of supratherapeutic drug levels
and worsening renal function. Increased fluids alone will not
correct the underlying accumulation of vancomycin. Option
D is incorrect because vancomycin monitoring relies
primarily on trough levels (drawn immediately before the
next dose), not peak levels, to guide dosing and assess for
toxicity .
Nurses must recognize that vancomycin requires
therapeutic drug monitoring, particularly in patients with
renal impairment. Trough levels should be drawn 30 minutes
before the next scheduled dose. Patients should be
monitored for nephrotoxicity (rising creatinine, decreased
urine output), ototoxicity (tinnitus, hearing loss), and
infusion-related reactions .
Learning Objectives
, After completing this question, the learner should be able
to:
• Interpret vancomycin trough levels and identify values
outside the therapeutic range.
• Recognize signs of vancomycin-induced nephrotoxicity.
• Prioritize nursing actions when a patient develops
evidence of medication toxicity.
• Explain the importance of therapeutic drug monitoring
for high-alert medications.
Medication Safety Focus
Monitoring Parameters
Question 2
Clinical Scenario
A 28-year-old female is prescribed doxycycline 100 mg orally
twice daily for Lyme disease. During discharge teaching, the
nurse reviews proper medication administration. The patient
reports taking a daily calcium supplement for bone health
and frequently consumes dairy products.
Question Stem
