NUR 2474 EXAM 2 – COMPLETE
REVIEW TEST QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Topic Area 1: Antibiotics (Penicillins, Cephalosporins,
Macrolides, Tetracyclines, Aminoglycosides, Fluoroquinolones)
1. A patient with a severe penicillin allergy (anaphylaxis) is ordered cefazolin. What is
the nurse’s priority action?
a) Administer as ordered
b) Hold medication and notify provider
c) Give with diphenhydramine
d) Administer a test dose
Rationale: Cross-sensitivity between penicillins and cephalosporins occurs in ~1-
10% of patients with a history of anaphylaxis to penicillin. Holding and notifying the
provider is essential.
2. Which instruction is most important for a patient prescribed doxycycline?
a) Take with milk or antacids
b) Avoid sun exposure; use sunscreen
c) Take on a full stomach
d) Expect orange-red discoloration of urine
Rationale: Doxycycline causes photosensitivity; patients must avoid prolonged sun
exposure and use high-SPF sunscreen.
3. A patient receiving gentamicin reports tinnitus and vertigo. The nurse suspects:
a) Nephrotoxicity
b) Ototoxicity
c) Hepatotoxicity
d) Cardiotoxicity
,Rationale: Aminoglycosides (gentamicin) cause irreversible ototoxicity affecting
cochlear and vestibular function. Tinnitus and vertigo are early signs.
4. Which lab value requires immediate holding of vancomycin?
a) Serum creatinine 1.0 mg/dL
b) Vancomycin trough 22 mcg/mL
c) WBC 8,000/mm³
d) Hemoglobin 12 g/dL
Rationale: Vancomycin trough should be 10-15 mcg/mL (or 15-20 for serious
infections). Trough >20 increases risk of nephrotoxicity and ototoxicity.
5. A patient on azithromycin develops new-onset QT prolongation on ECG. The nurse
should:
a) Continue drug; this is expected
b) Notify provider and prepare for cardiac monitoring
c) Administer potassium immediately
d) Increase IV fluid rate
Rationale: Macrolides (azithromycin) can prolong QT interval, increasing risk of
torsades de pointes. Provider notification and cardiac monitoring are indicated.
Topic Area 2: Antivirals & Antifungals
6. A patient with HIV on tenofovir/emtricitabine + dolutegravir has a viral load of 50
copies/mL after 6 months. This indicates:
a) Treatment failure
b) Virologic suppression
c) Need for resistance testing
d) Non-adherence
Rationale: Viral load <200 copies/mL indicates virologic suppression; <50 is optimal.
This is treatment success, not failure.
7. Amphotericin B infusion is complicated by fever, chills, and hypotension. The nurse
should:
a) Stop infusion immediately
b) Administer premedications (acetaminophen, diphenhydramine, meperidine if
rigors)
c) Flush with heparin
d) Change to oral fluconazole
Rationale: Amphotericin B causes infusion-related reactions. Premedication and
slowing infusion rate are standard; stopping is not needed unless severe.
, 8. Patient on acyclovir for shingles reports confusion and hallucinations. The nurse’s
priority is:
a) Reassure patient as normal side effect
b) Assess renal function and hold dose
c) Increase fluid intake to 3L/day
d) Administer naloxone
Rationale: Neurotoxicity from acyclovir occurs in renal impairment. Holding dose
and assessing renal function (creatinine, BUN) is priority.
Topic Area 3: Anticoagulants & Antiplatelets
9. A patient on warfarin has an INR of 4.5 without bleeding. The nurse expects:
a) Administer vitamin K 10 mg IV
b) Hold warfarin and consider low-dose oral vitamin K
c) Give fresh frozen plasma
d) Increase warfarin dose
Rationale: INR 4.5 – no bleeding: hold warfarin; low-dose oral vitamin K (1-2.5 mg)
may be given per protocol. IV vitamin K is for bleeding or very high INR >10.
10. Which statement indicates correct understanding of apixaban?
a) “I will need monthly INR checks”
b) “I should stop taking it 24 hours before a dental procedure”
c) “It works by blocking vitamin K”
d) “Eating spinach affects its action”
Rationale: Apixaban (DOAC) does not require INR monitoring; hold 24 hours before
minor procedures (48 hours for major). It directly inhibits factor Xa.
11. Enoxaparin 1 mg/kg subcut every 12 hours is ordered for a 70 kg patient with
DVT. The available syringe is 80 mg/0.8 mL. How many mL should the nurse
administer?
a) 0.7 mL
b) 0.7 mL (70 mg dose → 0.7 mL)
c) 0.8 mL
d) 0.6 mL
Rationale: 70 kg × 1 mg/kg = 70 mg. Concentration 80 mg/0.8 mL = 100 mg/mL. 70
mg = 0.7 mL.
12. A patient on clopidogrel is scheduled for surgery. The nurse knows it should be
stopped ____ days before surgery.
a) 2
b) 5
REVIEW TEST QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Topic Area 1: Antibiotics (Penicillins, Cephalosporins,
Macrolides, Tetracyclines, Aminoglycosides, Fluoroquinolones)
1. A patient with a severe penicillin allergy (anaphylaxis) is ordered cefazolin. What is
the nurse’s priority action?
a) Administer as ordered
b) Hold medication and notify provider
c) Give with diphenhydramine
d) Administer a test dose
Rationale: Cross-sensitivity between penicillins and cephalosporins occurs in ~1-
10% of patients with a history of anaphylaxis to penicillin. Holding and notifying the
provider is essential.
2. Which instruction is most important for a patient prescribed doxycycline?
a) Take with milk or antacids
b) Avoid sun exposure; use sunscreen
c) Take on a full stomach
d) Expect orange-red discoloration of urine
Rationale: Doxycycline causes photosensitivity; patients must avoid prolonged sun
exposure and use high-SPF sunscreen.
3. A patient receiving gentamicin reports tinnitus and vertigo. The nurse suspects:
a) Nephrotoxicity
b) Ototoxicity
c) Hepatotoxicity
d) Cardiotoxicity
,Rationale: Aminoglycosides (gentamicin) cause irreversible ototoxicity affecting
cochlear and vestibular function. Tinnitus and vertigo are early signs.
4. Which lab value requires immediate holding of vancomycin?
a) Serum creatinine 1.0 mg/dL
b) Vancomycin trough 22 mcg/mL
c) WBC 8,000/mm³
d) Hemoglobin 12 g/dL
Rationale: Vancomycin trough should be 10-15 mcg/mL (or 15-20 for serious
infections). Trough >20 increases risk of nephrotoxicity and ototoxicity.
5. A patient on azithromycin develops new-onset QT prolongation on ECG. The nurse
should:
a) Continue drug; this is expected
b) Notify provider and prepare for cardiac monitoring
c) Administer potassium immediately
d) Increase IV fluid rate
Rationale: Macrolides (azithromycin) can prolong QT interval, increasing risk of
torsades de pointes. Provider notification and cardiac monitoring are indicated.
Topic Area 2: Antivirals & Antifungals
6. A patient with HIV on tenofovir/emtricitabine + dolutegravir has a viral load of 50
copies/mL after 6 months. This indicates:
a) Treatment failure
b) Virologic suppression
c) Need for resistance testing
d) Non-adherence
Rationale: Viral load <200 copies/mL indicates virologic suppression; <50 is optimal.
This is treatment success, not failure.
7. Amphotericin B infusion is complicated by fever, chills, and hypotension. The nurse
should:
a) Stop infusion immediately
b) Administer premedications (acetaminophen, diphenhydramine, meperidine if
rigors)
c) Flush with heparin
d) Change to oral fluconazole
Rationale: Amphotericin B causes infusion-related reactions. Premedication and
slowing infusion rate are standard; stopping is not needed unless severe.
, 8. Patient on acyclovir for shingles reports confusion and hallucinations. The nurse’s
priority is:
a) Reassure patient as normal side effect
b) Assess renal function and hold dose
c) Increase fluid intake to 3L/day
d) Administer naloxone
Rationale: Neurotoxicity from acyclovir occurs in renal impairment. Holding dose
and assessing renal function (creatinine, BUN) is priority.
Topic Area 3: Anticoagulants & Antiplatelets
9. A patient on warfarin has an INR of 4.5 without bleeding. The nurse expects:
a) Administer vitamin K 10 mg IV
b) Hold warfarin and consider low-dose oral vitamin K
c) Give fresh frozen plasma
d) Increase warfarin dose
Rationale: INR 4.5 – no bleeding: hold warfarin; low-dose oral vitamin K (1-2.5 mg)
may be given per protocol. IV vitamin K is for bleeding or very high INR >10.
10. Which statement indicates correct understanding of apixaban?
a) “I will need monthly INR checks”
b) “I should stop taking it 24 hours before a dental procedure”
c) “It works by blocking vitamin K”
d) “Eating spinach affects its action”
Rationale: Apixaban (DOAC) does not require INR monitoring; hold 24 hours before
minor procedures (48 hours for major). It directly inhibits factor Xa.
11. Enoxaparin 1 mg/kg subcut every 12 hours is ordered for a 70 kg patient with
DVT. The available syringe is 80 mg/0.8 mL. How many mL should the nurse
administer?
a) 0.7 mL
b) 0.7 mL (70 mg dose → 0.7 mL)
c) 0.8 mL
d) 0.6 mL
Rationale: 70 kg × 1 mg/kg = 70 mg. Concentration 80 mg/0.8 mL = 100 mg/mL. 70
mg = 0.7 mL.
12. A patient on clopidogrel is scheduled for surgery. The nurse knows it should be
stopped ____ days before surgery.
a) 2
b) 5
