NSG 318 Exam 4 – GCU Pharmacology – 2026 Actual Questions & Answers.
Section 1: Antibiotics (Questions 1–30)
1. A patient with a MRSA infection is ordered vancomycin. Which assessment is
most critical before initiating therapy?
A. Blood pressure
B. Serum creatinine
C. Liver enzymes
D. Hemoglobin
Answer: B – Vancomycin is nephrotoxic; baseline renal function (serum
creatinine) is essential to adjust dosing and prevent kidney injury.
2. A nurse administering IV vancomycin notes the patient developing flushing and
rash on the neck and chest. What is the priority action?
A. Stop the infusion and notify the provider
B. Slow the infusion rate
C. Administer diphenhydramine
D. Continue the infusion and monitor
Answer: A – This describes “Red Man Syndrome” caused by rapid infusion.
Stopping or slowing the infusion is the priority; then notify provider.
,3. Which drug requires a trough level to be drawn 30 minutes before the next
dose?
A. Ciprofloxacin
B. Gentamicin
C. Azithromycin
D. Doxycycline
Answer: B – Aminoglycosides (gentamicin) require trough levels to prevent
toxicity.
4. A patient on piperacillin-tazobactam develops watery diarrhea 10 times/day, 7
days after starting therapy. What is the most likely cause?
A. Viral gastroenteritis
B. Clostridioides difficile infection
C. Drug intolerance
D. Lactose intolerance
Answer: B – Broad-spectrum antibiotics disrupt normal flora, allowing C. diff
overgrowth. Onset after 5–10 days of antibiotics is classic.
5. Which antibiotic is contraindicated in children under 8 years due to tooth
discoloration?
,A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Trimethoprim-sulfamethoxazole
Answer: C – Tetracycline binds to calcium in developing teeth, causing permanent
brown staining.
6. A patient with a penicillin allergy reports anaphylaxis. Which antibiotic is safest
to prescribe?
A. Cephalexin
B. Amoxicillin
C. Aztreonam
D. Imipenem
Answer: C – Aztreonam has a different structure and minimal cross-reactivity with
penicillins. Cephalosporins and carbapenems have 1–10% cross-reactivity.
7. A patient is prescribed doxycycline for Lyme disease. What instruction should
be given?
A. Take with dairy products
B. Avoid sunlight and wear sunscreen
, C. Take on an empty stomach
D. Expect urine to turn orange
Answer: B – Doxycycline causes photosensitivity; patients must avoid prolonged
sun exposure.
8. Which fluoroquinolone carries a black box warning for tendon rupture?
A. Ciprofloxacin
B. Levofloxacin
C. Moxifloxacin
D. All of the above
Answer: D – All fluoroquinolones have increased risk of tendinitis/tendon rupture,
especially in older adults and those on corticosteroids.
9. A patient on linezolid develops serotonin syndrome. Which concurrent
medication is most likely responsible?
A. Lisinopril
B. Sertraline (SSRI)
C. Metformin
D. Levothyroxine
Section 1: Antibiotics (Questions 1–30)
1. A patient with a MRSA infection is ordered vancomycin. Which assessment is
most critical before initiating therapy?
A. Blood pressure
B. Serum creatinine
C. Liver enzymes
D. Hemoglobin
Answer: B – Vancomycin is nephrotoxic; baseline renal function (serum
creatinine) is essential to adjust dosing and prevent kidney injury.
2. A nurse administering IV vancomycin notes the patient developing flushing and
rash on the neck and chest. What is the priority action?
A. Stop the infusion and notify the provider
B. Slow the infusion rate
C. Administer diphenhydramine
D. Continue the infusion and monitor
Answer: A – This describes “Red Man Syndrome” caused by rapid infusion.
Stopping or slowing the infusion is the priority; then notify provider.
,3. Which drug requires a trough level to be drawn 30 minutes before the next
dose?
A. Ciprofloxacin
B. Gentamicin
C. Azithromycin
D. Doxycycline
Answer: B – Aminoglycosides (gentamicin) require trough levels to prevent
toxicity.
4. A patient on piperacillin-tazobactam develops watery diarrhea 10 times/day, 7
days after starting therapy. What is the most likely cause?
A. Viral gastroenteritis
B. Clostridioides difficile infection
C. Drug intolerance
D. Lactose intolerance
Answer: B – Broad-spectrum antibiotics disrupt normal flora, allowing C. diff
overgrowth. Onset after 5–10 days of antibiotics is classic.
5. Which antibiotic is contraindicated in children under 8 years due to tooth
discoloration?
,A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Trimethoprim-sulfamethoxazole
Answer: C – Tetracycline binds to calcium in developing teeth, causing permanent
brown staining.
6. A patient with a penicillin allergy reports anaphylaxis. Which antibiotic is safest
to prescribe?
A. Cephalexin
B. Amoxicillin
C. Aztreonam
D. Imipenem
Answer: C – Aztreonam has a different structure and minimal cross-reactivity with
penicillins. Cephalosporins and carbapenems have 1–10% cross-reactivity.
7. A patient is prescribed doxycycline for Lyme disease. What instruction should
be given?
A. Take with dairy products
B. Avoid sunlight and wear sunscreen
, C. Take on an empty stomach
D. Expect urine to turn orange
Answer: B – Doxycycline causes photosensitivity; patients must avoid prolonged
sun exposure.
8. Which fluoroquinolone carries a black box warning for tendon rupture?
A. Ciprofloxacin
B. Levofloxacin
C. Moxifloxacin
D. All of the above
Answer: D – All fluoroquinolones have increased risk of tendinitis/tendon rupture,
especially in older adults and those on corticosteroids.
9. A patient on linezolid develops serotonin syndrome. Which concurrent
medication is most likely responsible?
A. Lisinopril
B. Sertraline (SSRI)
C. Metformin
D. Levothyroxine
