NU 578 Unit 3 Exam Advanced Pathophysiology
Pharmacology University of South Alabama
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
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SECTION 1: ANTI-INFECTIVE PHARMACOLOGY Q1 – Q10
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Question 1 of 50
A 34-year-old woman with a history of anaphylaxis after receiving amoxicillin for
streptococcal pharyngitis five years ago presents with a painful, erythematous facial cellulitis
following a cat bite. She is afebrile but has significant surrounding edema. Her wound culture
grows Pasteurella multocida. She requests oral antibiotic therapy and has no renal
impairment.
A. Prescribe cephalexin 500 mg PO every 6 hours for 7 days
B. Prescribe amoxicillin-clavulanate 875/125 mg PO every 12 hours for 7 days
C. Prescribe trimethoprim-sulfamethoxazole DS 1 tablet PO every 12 hours for 7 days
D. Prescribe azithromycin 500 mg PO on day 1, then 250 mg daily for 4 days
Correct Answer: B
Rationale: Amoxicillin-clavulanate provides excellent coverage against Pasteurella multocida,
Staphylococcus aureus, and anaerobes commonly associated with cat bites, making it the
first-line agent for outpatient management of mild-to-moderate animal bite wounds.
Cephalexin lacks reliable activity against Pasteurella and anaerobes, while TMP-SMX and
azithromycin do not provide adequate anaerobic coverage for this polymicrobial wound.
Although the patient reports a history of anaphylaxis to amoxicillin, current literature
indicates that approximately 10% of patients with penicillin allergy labels are truly allergic,
and the benefits of appropriate first-line therapy in a reliable patient with close follow-up often
outweigh the risks of alternative agents with inferior coverage.
Question 2 of 50
A 68-year-old man with a prosthetic hip joint develops a surgical site infection three weeks
postoperatively. Intraoperative cultures grow methicillin-sensitive Staphylococcus aureus
,(MSSA). The infectious disease consultant recommends IV therapy with a first-generation
cephalosporin. The patient has normal renal function and no drug allergies.
A. Initiate cefepime 2 g IV every 12 hours
B. Initiate ceftriaxone 1 g IV every 24 hours
C. Initiate cefazolin 2 g IV every 8 hours
D. Initiate ceftazidime 2 g IV every 8 hours
Correct Answer: C
Rationale: Cefazolin is a first-generation cephalosporin with excellent activity against MSSA
and is the preferred agent for prosthetic joint infections caused by this organism due to its
reliable beta-lactam coverage and favorable bone penetration. Cefepime and ceftazidime are
fourth- and third-generation agents with enhanced gram-negative activity but poorer MSSA
coverage, while ceftriaxone has inferior staphylococcal activity compared with cefazolin.
Selecting an agent with targeted gram-positive coverage reduces unnecessary
broad-spectrum exposure and preserves antimicrobial stewardship.
Question 3 of 50
A 55-year-old man with community-acquired pneumonia is prescribed azithromycin 500 mg
daily. On day 3 of therapy, he develops palpitations and lightheadedness. His EKG reveals a
new QTc interval of 520 msec. He has a history of hypertension controlled with lisinopril and
hyperlipidemia treated with atorvastatin.
A. Discontinue azithromycin immediately and switch to levofloxacin 750 mg daily
B. Discontinue azithromycin immediately and switch to doxycycline 100 mg twice daily
C. Continue azithromycin and add metoprolol 25 mg twice daily for rate control
D. Continue azithromycin and obtain a serum magnesium level before deciding next steps
Correct Answer: B
Rationale: Azithromycin is a known cause of QT prolongation through blockade of the hERG
potassium channel, and discontinuation with substitution to a non-QT-prolonging agent is
required when the QTc exceeds 500 msec or increases by more than 60 msec from baseline.
Doxycycline provides adequate atypical coverage for community-acquired pneumonia without
significant QT liability, whereas levofloxacin also prolongs the QT interval and would
compound the risk of torsades de pointes. Continuing azithromycin or adding a beta-blocker
without addressing the underlying pharmacologic trigger leaves the patient at risk for
life-threatening ventricular arrhythmias.
Question 4 of 50
A 28-year-old woman at 14 weeks gestation presents with a painful facial rash consistent
with early Lyme disease after a confirmed deer tick bite in an endemic region. She has no
drug allergies and normal renal function. She is concerned about fetal safety.
, A. Prescribe doxycycline 100 mg PO twice daily for 10 days
B. Prescribe ciprofloxacin 500 mg PO twice daily for 14 days
C. Prescribe amoxicillin 500 mg PO three times daily for 14 days
D. Prescribe azithromycin 500 mg PO daily for 7 days
Correct Answer: C
Rationale: Amoxicillin is the preferred agent for early localized Lyme disease in pregnant
patients because it effectively targets Borrelia burgdorferi while maintaining an established
safety profile in pregnancy, unlike doxycycline which is contraindicated after the first
trimester due to fetal bone and tooth discoloration risks. Ciprofloxacin is not recommended
for Lyme disease and carries potential cartilage toxicity concerns in pregnancy, while
azithromycin has inferior efficacy against Borrelia compared with beta-lactam therapy.
Treating Lyme disease promptly in pregnancy prevents disseminated infection and protects
both maternal and fetal outcomes.
Question 5 of 50
A 62-year-old man with type 2 diabetes and diabetic nephropathy is prescribed ciprofloxacin
750 mg twice daily for a complicated urinary tract infection. Three days into therapy, he calls
the clinic reporting severe left shoulder pain and difficulty walking due to Achilles tendon
tenderness.
A. Continue ciprofloxacin and recommend acetaminophen for pain management
B. Discontinue ciprofloxacin immediately and switch to ceftriaxone 1 g IV daily
C. Reduce the ciprofloxacin dose to 500 mg twice daily and monitor symptoms
D. Discontinue ciprofloxacin and switch to nitrofurantoin 100 mg twice daily
Correct Answer: B
Rationale: Fluoroquinolones increase the risk of tendinopathy and tendon rupture, particularly
in patients over 60 years of age, those with renal impairment, and patients receiving
concurrent corticosteroids, necessitating immediate discontinuation upon symptom onset.
Ceftriaxone provides reliable gram-negative coverage for complicated UTIs and is an
appropriate alternative in patients with renal dysfunction where fluoroquinolones are
contraindicated. Nitrofurantoin should not be used in complicated UTIs or in patients with
creatinine clearance below 30 mL/min, and continuing or dose-reducing ciprofloxacin
exposes the patient to progressive tendon injury.
Question 6 of 50
A 71-year-old woman with a history of recurrent gram-negative bacteremia is started on
tobramycin 5 mg/kg IV daily for suspected pseudomonal sepsis. She weighs 60 kg and has a
serum creatinine of 1.4 mg/dL. On day 5, her trough level is reported as 3.2 mcg/mL.
A. Continue the current dose and recheck levels in 48 hours
Pharmacology University of South Alabama
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: ANTI-INFECTIVE PHARMACOLOGY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old woman with a history of anaphylaxis after receiving amoxicillin for
streptococcal pharyngitis five years ago presents with a painful, erythematous facial cellulitis
following a cat bite. She is afebrile but has significant surrounding edema. Her wound culture
grows Pasteurella multocida. She requests oral antibiotic therapy and has no renal
impairment.
A. Prescribe cephalexin 500 mg PO every 6 hours for 7 days
B. Prescribe amoxicillin-clavulanate 875/125 mg PO every 12 hours for 7 days
C. Prescribe trimethoprim-sulfamethoxazole DS 1 tablet PO every 12 hours for 7 days
D. Prescribe azithromycin 500 mg PO on day 1, then 250 mg daily for 4 days
Correct Answer: B
Rationale: Amoxicillin-clavulanate provides excellent coverage against Pasteurella multocida,
Staphylococcus aureus, and anaerobes commonly associated with cat bites, making it the
first-line agent for outpatient management of mild-to-moderate animal bite wounds.
Cephalexin lacks reliable activity against Pasteurella and anaerobes, while TMP-SMX and
azithromycin do not provide adequate anaerobic coverage for this polymicrobial wound.
Although the patient reports a history of anaphylaxis to amoxicillin, current literature
indicates that approximately 10% of patients with penicillin allergy labels are truly allergic,
and the benefits of appropriate first-line therapy in a reliable patient with close follow-up often
outweigh the risks of alternative agents with inferior coverage.
Question 2 of 50
A 68-year-old man with a prosthetic hip joint develops a surgical site infection three weeks
postoperatively. Intraoperative cultures grow methicillin-sensitive Staphylococcus aureus
,(MSSA). The infectious disease consultant recommends IV therapy with a first-generation
cephalosporin. The patient has normal renal function and no drug allergies.
A. Initiate cefepime 2 g IV every 12 hours
B. Initiate ceftriaxone 1 g IV every 24 hours
C. Initiate cefazolin 2 g IV every 8 hours
D. Initiate ceftazidime 2 g IV every 8 hours
Correct Answer: C
Rationale: Cefazolin is a first-generation cephalosporin with excellent activity against MSSA
and is the preferred agent for prosthetic joint infections caused by this organism due to its
reliable beta-lactam coverage and favorable bone penetration. Cefepime and ceftazidime are
fourth- and third-generation agents with enhanced gram-negative activity but poorer MSSA
coverage, while ceftriaxone has inferior staphylococcal activity compared with cefazolin.
Selecting an agent with targeted gram-positive coverage reduces unnecessary
broad-spectrum exposure and preserves antimicrobial stewardship.
Question 3 of 50
A 55-year-old man with community-acquired pneumonia is prescribed azithromycin 500 mg
daily. On day 3 of therapy, he develops palpitations and lightheadedness. His EKG reveals a
new QTc interval of 520 msec. He has a history of hypertension controlled with lisinopril and
hyperlipidemia treated with atorvastatin.
A. Discontinue azithromycin immediately and switch to levofloxacin 750 mg daily
B. Discontinue azithromycin immediately and switch to doxycycline 100 mg twice daily
C. Continue azithromycin and add metoprolol 25 mg twice daily for rate control
D. Continue azithromycin and obtain a serum magnesium level before deciding next steps
Correct Answer: B
Rationale: Azithromycin is a known cause of QT prolongation through blockade of the hERG
potassium channel, and discontinuation with substitution to a non-QT-prolonging agent is
required when the QTc exceeds 500 msec or increases by more than 60 msec from baseline.
Doxycycline provides adequate atypical coverage for community-acquired pneumonia without
significant QT liability, whereas levofloxacin also prolongs the QT interval and would
compound the risk of torsades de pointes. Continuing azithromycin or adding a beta-blocker
without addressing the underlying pharmacologic trigger leaves the patient at risk for
life-threatening ventricular arrhythmias.
Question 4 of 50
A 28-year-old woman at 14 weeks gestation presents with a painful facial rash consistent
with early Lyme disease after a confirmed deer tick bite in an endemic region. She has no
drug allergies and normal renal function. She is concerned about fetal safety.
, A. Prescribe doxycycline 100 mg PO twice daily for 10 days
B. Prescribe ciprofloxacin 500 mg PO twice daily for 14 days
C. Prescribe amoxicillin 500 mg PO three times daily for 14 days
D. Prescribe azithromycin 500 mg PO daily for 7 days
Correct Answer: C
Rationale: Amoxicillin is the preferred agent for early localized Lyme disease in pregnant
patients because it effectively targets Borrelia burgdorferi while maintaining an established
safety profile in pregnancy, unlike doxycycline which is contraindicated after the first
trimester due to fetal bone and tooth discoloration risks. Ciprofloxacin is not recommended
for Lyme disease and carries potential cartilage toxicity concerns in pregnancy, while
azithromycin has inferior efficacy against Borrelia compared with beta-lactam therapy.
Treating Lyme disease promptly in pregnancy prevents disseminated infection and protects
both maternal and fetal outcomes.
Question 5 of 50
A 62-year-old man with type 2 diabetes and diabetic nephropathy is prescribed ciprofloxacin
750 mg twice daily for a complicated urinary tract infection. Three days into therapy, he calls
the clinic reporting severe left shoulder pain and difficulty walking due to Achilles tendon
tenderness.
A. Continue ciprofloxacin and recommend acetaminophen for pain management
B. Discontinue ciprofloxacin immediately and switch to ceftriaxone 1 g IV daily
C. Reduce the ciprofloxacin dose to 500 mg twice daily and monitor symptoms
D. Discontinue ciprofloxacin and switch to nitrofurantoin 100 mg twice daily
Correct Answer: B
Rationale: Fluoroquinolones increase the risk of tendinopathy and tendon rupture, particularly
in patients over 60 years of age, those with renal impairment, and patients receiving
concurrent corticosteroids, necessitating immediate discontinuation upon symptom onset.
Ceftriaxone provides reliable gram-negative coverage for complicated UTIs and is an
appropriate alternative in patients with renal dysfunction where fluoroquinolones are
contraindicated. Nitrofurantoin should not be used in complicated UTIs or in patients with
creatinine clearance below 30 mL/min, and continuing or dose-reducing ciprofloxacin
exposes the patient to progressive tendon injury.
Question 6 of 50
A 71-year-old woman with a history of recurrent gram-negative bacteremia is started on
tobramycin 5 mg/kg IV daily for suspected pseudomonal sepsis. She weighs 60 kg and has a
serum creatinine of 1.4 mg/dL. On day 5, her trough level is reported as 3.2 mcg/mL.
A. Continue the current dose and recheck levels in 48 hours
