NCLEX-RN Pharmacology Infection Practice
Questions |
20 Original Antibiotics, Antifungals & Antivirals
NCLEX NGN-Style MCQs with Rationales |
ATI Pharmacology Made Easy Nursing Exam
Prep
Question 1
Clinical Scenario
A 72-year-old male with a history of heart failure (ejection
fraction 35%) and chronic kidney disease stage 3b (baseline
creatinine 1.6 mg/dL) is admitted with sepsis secondary to a
healthcare-associated pneumonia. Blood cultures are
pending. The provider prescribes intravenous vancomycin 15
mg/kg every 12 hours and piperacillin-tazobactam 4.5 g
every 6 hours. The nurse reviews the morning laboratory
results: serum creatinine has increased to 2.3 mg/dL
(baseline 1.6 mg/dL), BUN is 42 mg/dL, and the most recent
vancomycin trough level drawn 12 hours ago is 22 mcg/mL.
Question Stem
,Which action should the nurse take first?
A. Administer the vancomycin as prescribed and monitor the
next trough level.
B. Hold the vancomycin dose and notify the healthcare
provider immediately.
C. Increase the patient's IV fluid rate to 150 mL/hr to
promote renal clearance.
D. Administer the vancomycin over 4 hours instead of the
standard 1-hour infusion.
Correct Answer: B. Hold the vancomycin dose and notify
the healthcare provider immediately.
Detailed Rationale
Why B is correct: Vancomycin is a glycopeptide antibiotic
with significant nephrotoxic potential, particularly when
combined with other nephrotoxic agents such as
piperacillin-tazobactam. This patient's serum creatinine has
risen from 1.6 mg/dL to 2.3 mg/dL, indicating acute kidney
injury (AKI). The trough level of 22 mcg/mL is above the
therapeutic target (typically 10-20 mcg/mL for most
infections, though some guidelines recommend 15-20
,mcg/mL for MRSA pneumonia). With declining renal
function, continued vancomycin administration risks further
drug accumulation, worsening nephrotoxicity, and potential
permanent renal damage. The nurse's priority is to hold the
dose and notify the provider for dose adjustment, alternative
therapy, or enhanced monitoring. Delaying notification could
lead to irreversible kidney injury .
Why A is incorrect: Administering the dose as prescribed
would be unsafe given the rising creatinine and elevated
trough level. This action disregards critical safety data and
could worsen renal injury.
Why C is incorrect: Increasing IV fluids may be beneficial
for some patients with AKI, but it does not address the
underlying problem of vancomycin accumulation and
nephrotoxicity. Fluid administration requires careful
consideration in a patient with heart failure (EF 35%) due to
fluid overload risk. The priority is to hold the nephrotoxic
agent, not to attempt "flushing" the drug.
Why D is incorrect: Slowing the infusion rate reduces the
risk of infusion-related reactions (Red Man Syndrome) but
does not affect the nephrotoxic potential or drug
accumulation. The issue is drug level and renal function, not
infusion rate .
, Nursing Considerations: Therapeutic drug monitoring is
essential for vancomycin. Trough levels should be drawn
immediately before the next dose (within 30 minutes).
Patients receiving vancomycin require regular renal function
monitoring, especially when combined with other
nephrotoxic agents . Signs of nephrotoxicity include rising
serum creatinine, decreased urine output, and elevated
trough levels.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify when vancomycin trough levels and renal
function warrant holding a dose.
• Prioritize nursing actions for patients at risk for acute
kidney injury.
• Recognize the synergistic nephrotoxic risk of concurrent
vancomycin and piperacillin-tazobactam therapy.
Medication Safety Focus
Monitoring Parameters / High-Alert Medication
Questions |
20 Original Antibiotics, Antifungals & Antivirals
NCLEX NGN-Style MCQs with Rationales |
ATI Pharmacology Made Easy Nursing Exam
Prep
Question 1
Clinical Scenario
A 72-year-old male with a history of heart failure (ejection
fraction 35%) and chronic kidney disease stage 3b (baseline
creatinine 1.6 mg/dL) is admitted with sepsis secondary to a
healthcare-associated pneumonia. Blood cultures are
pending. The provider prescribes intravenous vancomycin 15
mg/kg every 12 hours and piperacillin-tazobactam 4.5 g
every 6 hours. The nurse reviews the morning laboratory
results: serum creatinine has increased to 2.3 mg/dL
(baseline 1.6 mg/dL), BUN is 42 mg/dL, and the most recent
vancomycin trough level drawn 12 hours ago is 22 mcg/mL.
Question Stem
,Which action should the nurse take first?
A. Administer the vancomycin as prescribed and monitor the
next trough level.
B. Hold the vancomycin dose and notify the healthcare
provider immediately.
C. Increase the patient's IV fluid rate to 150 mL/hr to
promote renal clearance.
D. Administer the vancomycin over 4 hours instead of the
standard 1-hour infusion.
Correct Answer: B. Hold the vancomycin dose and notify
the healthcare provider immediately.
Detailed Rationale
Why B is correct: Vancomycin is a glycopeptide antibiotic
with significant nephrotoxic potential, particularly when
combined with other nephrotoxic agents such as
piperacillin-tazobactam. This patient's serum creatinine has
risen from 1.6 mg/dL to 2.3 mg/dL, indicating acute kidney
injury (AKI). The trough level of 22 mcg/mL is above the
therapeutic target (typically 10-20 mcg/mL for most
infections, though some guidelines recommend 15-20
,mcg/mL for MRSA pneumonia). With declining renal
function, continued vancomycin administration risks further
drug accumulation, worsening nephrotoxicity, and potential
permanent renal damage. The nurse's priority is to hold the
dose and notify the provider for dose adjustment, alternative
therapy, or enhanced monitoring. Delaying notification could
lead to irreversible kidney injury .
Why A is incorrect: Administering the dose as prescribed
would be unsafe given the rising creatinine and elevated
trough level. This action disregards critical safety data and
could worsen renal injury.
Why C is incorrect: Increasing IV fluids may be beneficial
for some patients with AKI, but it does not address the
underlying problem of vancomycin accumulation and
nephrotoxicity. Fluid administration requires careful
consideration in a patient with heart failure (EF 35%) due to
fluid overload risk. The priority is to hold the nephrotoxic
agent, not to attempt "flushing" the drug.
Why D is incorrect: Slowing the infusion rate reduces the
risk of infusion-related reactions (Red Man Syndrome) but
does not affect the nephrotoxic potential or drug
accumulation. The issue is drug level and renal function, not
infusion rate .
, Nursing Considerations: Therapeutic drug monitoring is
essential for vancomycin. Trough levels should be drawn
immediately before the next dose (within 30 minutes).
Patients receiving vancomycin require regular renal function
monitoring, especially when combined with other
nephrotoxic agents . Signs of nephrotoxicity include rising
serum creatinine, decreased urine output, and elevated
trough levels.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify when vancomycin trough levels and renal
function warrant holding a dose.
• Prioritize nursing actions for patients at risk for acute
kidney injury.
• Recognize the synergistic nephrotoxic risk of concurrent
vancomycin and piperacillin-tazobactam therapy.
Medication Safety Focus
Monitoring Parameters / High-Alert Medication
