NURS 300 (Pharmacology) Comprehensive Final Exam
Latest 2026/2027 | Newly Released.
San Diego State University (SDSU).
100 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient with type 2 diabetes is prescribed metformin. Which laboratory value should the
nurse monitor before initiating therapy and annually thereafter?
A. Serum creatinine and estimated glomerular filtration rate (eGFR)
B. Liver function tests
C. Complete blood count
D. Thyroid-stimulating hormone (TSH)
Correct Answer: A
Correct because metformin is primarily excreted unchanged by the kidneys, and accumulation
occurs in renal impairment, increasing the risk of lactic acidosis. According to SDSU NURS 300
curriculum, metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² and
requires dose reduction when eGFR is 30–45 mL/min/1.73 m². The mechanism of action for
metformin involves decreasing hepatic glucose production and improving peripheral insulin
sensitivity, but its safety profile is entirely dependent on adequate renal function for elimination.
Q2. A patient receiving vancomycin has a trough level of 8 mcg/mL. The therapeutic trough
range for serious MRSA infections is 15–20 mcg/mL. What is the nurse's priority action?
A. Continue the current dosing regimen
B. Hold the next dose and notify the provider
C. Administer the next dose with an extended infusion time
D. Obtain a peak level before the next dose
Correct Answer: B
Correct because a vancomycin trough of 8 mcg/mL is subtherapeutic for serious MRSA
infections and increases the risk of treatment failure and antimicrobial resistance. According to
SDSU NURS 300 curriculum, therapeutic drug monitoring of vancomycin requires trough levels
to be drawn immediately before the fourth or fifth dose to ensure steady-state concentrations.
When administering this drug, the priority assessment is verifying that trough levels fall within
the therapeutic range before administering subsequent doses.
,Q3. A patient with Graves' disease is prescribed methimazole. Which adverse effect requires
immediate discontinuation of the medication?
A. Mild pruritus
B. Agranulocytosis
C. Transient elevation of liver enzymes
D. Mild gastrointestinal upset
Correct Answer: B
Correct because agranulocytosis is a rare but life-threatening adverse effect of methimazole that
presents with fever, sore throat, and signs of infection due to severe neutropenia. According to
SDSU NURS 300 curriculum, patient teaching for this medication includes instructing patients
to report any signs of infection immediately and to obtain baseline and periodic complete blood
counts. The mechanism of action for methimazole involves inhibiting thyroid peroxidase, which
blocks iodine organification and coupling, but its immunomodulatory effects can trigger severe
bone marrow suppression.
Q4. A patient with community-acquired pneumonia is prescribed azithromycin. The patient is
also taking warfarin. What is the nurse's primary concern?
A. Decreased absorption of azithromycin
B. Increased INR and bleeding risk due to CYP3A4 inhibition
C. Reduced effectiveness of warfarin
D. Increased risk of hypoglycemia
Correct Answer: B
Correct because azithromycin inhibits CYP3A4 metabolism, which can increase warfarin plasma
concentrations and prolong the INR, significantly increasing bleeding risk. According to SDSU
NURS 300 curriculum, macrolide antibiotics are known to interact with warfarin through both
CYP450 inhibition and disruption of gut flora that produce vitamin K. When administering this
drug, the priority assessment is monitoring INR more frequently during and shortly after
azithromycin therapy, and educating the patient to report signs of bleeding immediately.
,Q5. A patient with chemotherapy-induced nausea is receiving a regimen that includes cisplatin.
The nurse is preparing to administer ondansetron, dexamethasone, and aprepitant. Which
medication in this regimen blocks neurokinin-1 receptors?
A. Ondansetron
B. Dexamethasone
C. Aprepitant
D. Cisplatin
Correct Answer: C
Correct because aprepitant is a neurokinin-1 receptor antagonist that blocks substance P in the
central nervous system, specifically preventing delayed chemotherapy-induced nausea and
vomiting. According to SDSU NURS 300 curriculum, the three-drug antiemetic regimen targets
different receptor pathways: ondansetron blocks 5-HT3 receptors, dexamethasone provides broad
antiemetic effects through anti-inflammatory mechanisms, and aprepitant addresses the delayed
phase via NK1 receptor blockade. Patient teaching for this medication includes informing the
patient that aprepitant can interact with oral contraceptives and warfarin due to CYP3A4
inhibition.
Q6. A patient with heart failure is prescribed digoxin 0.125 mg daily. The nurse notes the
patient's serum potassium is 3.0 mEq/L and the digoxin level is 1.5 ng/mL. What is the nurse's
priority action?
A. Administer the scheduled digoxin dose
B. Hold the digoxin dose and notify the provider
C. Administer potassium supplementation and give digoxin
D. Obtain a repeat digoxin level
Correct Answer: B
Correct because hypokalemia significantly increases myocardial sensitivity to digoxin,
predisposing the patient to digitalis toxicity even when serum digoxin levels appear within the
therapeutic range of 0.8–2.0 ng/mL. According to SDSU NURS 300 curriculum, the mechanism
of action for digoxin involves inhibition of the Na+/K+-ATPase pump, and low extracellular
potassium competes with digoxin for binding sites, increasing toxicity risk. When administering
this drug, the priority assessment is verifying serum potassium levels before each dose, as
hypokalemia can precipitate fatal arrhythmias even with therapeutic digoxin concentrations.
, Q7. A patient with a fungal infection is prescribed fluconazole. The nurse should monitor for
which adverse effect?
A. Nephrotoxicity
B. Hepatotoxicity
C. Ototoxicity
D. Myelosuppression
Correct Answer: B
Correct because fluconazole, a triazole antifungal, can cause dose-dependent hepatotoxicity
ranging from asymptomatic transaminase elevations to severe hepatic necrosis. According to
SDSU NURS 300 curriculum, patient teaching for this medication includes instructing patients
to report symptoms of hepatotoxicity such as jaundice, dark urine, fatigue, and abdominal pain.
The mechanism of action for fluconazole involves inhibiting fungal cytochrome P450-dependent
lanosterol 14-alpha-demethylase, disrupting ergosterol synthesis in the fungal cell membrane.
Q8. A patient with rheumatoid arthritis is prescribed methotrexate. Which medication should the
nurse ensure is co-prescribed to reduce toxicity?
A. Vitamin B12
B. Folic acid
C. Vitamin D
D. Iron supplementation
Correct Answer: B
Correct because folic acid supplementation reduces methotrexate toxicity, including stomatitis,
gastrointestinal adverse effects, and hepatotoxicity, without significantly compromising its
immunosuppressive efficacy. According to SDSU NURS 300 curriculum, methotrexate is a
folate antagonist that inhibits dihydrofolate reductase, and supplemental folic acid bypasses this
blocked pathway in normal cells while malignant and inflammatory cells remain affected. When
administering this drug, the priority assessment is monitoring complete blood counts and liver
function tests, as methotrexate is a high-alert medication with narrow therapeutic index.
Q9. A patient with a penicillin allergy (anaphylaxis history) develops a severe infection requiring
antibiotic therapy. Which antibiotic class is the safest alternative?
A. Cephalosporin (first-generation)
B. Carbapenem
C. Fluoroquinolone
D. Aminoglycoside
Latest 2026/2027 | Newly Released.
San Diego State University (SDSU).
100 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient with type 2 diabetes is prescribed metformin. Which laboratory value should the
nurse monitor before initiating therapy and annually thereafter?
A. Serum creatinine and estimated glomerular filtration rate (eGFR)
B. Liver function tests
C. Complete blood count
D. Thyroid-stimulating hormone (TSH)
Correct Answer: A
Correct because metformin is primarily excreted unchanged by the kidneys, and accumulation
occurs in renal impairment, increasing the risk of lactic acidosis. According to SDSU NURS 300
curriculum, metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² and
requires dose reduction when eGFR is 30–45 mL/min/1.73 m². The mechanism of action for
metformin involves decreasing hepatic glucose production and improving peripheral insulin
sensitivity, but its safety profile is entirely dependent on adequate renal function for elimination.
Q2. A patient receiving vancomycin has a trough level of 8 mcg/mL. The therapeutic trough
range for serious MRSA infections is 15–20 mcg/mL. What is the nurse's priority action?
A. Continue the current dosing regimen
B. Hold the next dose and notify the provider
C. Administer the next dose with an extended infusion time
D. Obtain a peak level before the next dose
Correct Answer: B
Correct because a vancomycin trough of 8 mcg/mL is subtherapeutic for serious MRSA
infections and increases the risk of treatment failure and antimicrobial resistance. According to
SDSU NURS 300 curriculum, therapeutic drug monitoring of vancomycin requires trough levels
to be drawn immediately before the fourth or fifth dose to ensure steady-state concentrations.
When administering this drug, the priority assessment is verifying that trough levels fall within
the therapeutic range before administering subsequent doses.
,Q3. A patient with Graves' disease is prescribed methimazole. Which adverse effect requires
immediate discontinuation of the medication?
A. Mild pruritus
B. Agranulocytosis
C. Transient elevation of liver enzymes
D. Mild gastrointestinal upset
Correct Answer: B
Correct because agranulocytosis is a rare but life-threatening adverse effect of methimazole that
presents with fever, sore throat, and signs of infection due to severe neutropenia. According to
SDSU NURS 300 curriculum, patient teaching for this medication includes instructing patients
to report any signs of infection immediately and to obtain baseline and periodic complete blood
counts. The mechanism of action for methimazole involves inhibiting thyroid peroxidase, which
blocks iodine organification and coupling, but its immunomodulatory effects can trigger severe
bone marrow suppression.
Q4. A patient with community-acquired pneumonia is prescribed azithromycin. The patient is
also taking warfarin. What is the nurse's primary concern?
A. Decreased absorption of azithromycin
B. Increased INR and bleeding risk due to CYP3A4 inhibition
C. Reduced effectiveness of warfarin
D. Increased risk of hypoglycemia
Correct Answer: B
Correct because azithromycin inhibits CYP3A4 metabolism, which can increase warfarin plasma
concentrations and prolong the INR, significantly increasing bleeding risk. According to SDSU
NURS 300 curriculum, macrolide antibiotics are known to interact with warfarin through both
CYP450 inhibition and disruption of gut flora that produce vitamin K. When administering this
drug, the priority assessment is monitoring INR more frequently during and shortly after
azithromycin therapy, and educating the patient to report signs of bleeding immediately.
,Q5. A patient with chemotherapy-induced nausea is receiving a regimen that includes cisplatin.
The nurse is preparing to administer ondansetron, dexamethasone, and aprepitant. Which
medication in this regimen blocks neurokinin-1 receptors?
A. Ondansetron
B. Dexamethasone
C. Aprepitant
D. Cisplatin
Correct Answer: C
Correct because aprepitant is a neurokinin-1 receptor antagonist that blocks substance P in the
central nervous system, specifically preventing delayed chemotherapy-induced nausea and
vomiting. According to SDSU NURS 300 curriculum, the three-drug antiemetic regimen targets
different receptor pathways: ondansetron blocks 5-HT3 receptors, dexamethasone provides broad
antiemetic effects through anti-inflammatory mechanisms, and aprepitant addresses the delayed
phase via NK1 receptor blockade. Patient teaching for this medication includes informing the
patient that aprepitant can interact with oral contraceptives and warfarin due to CYP3A4
inhibition.
Q6. A patient with heart failure is prescribed digoxin 0.125 mg daily. The nurse notes the
patient's serum potassium is 3.0 mEq/L and the digoxin level is 1.5 ng/mL. What is the nurse's
priority action?
A. Administer the scheduled digoxin dose
B. Hold the digoxin dose and notify the provider
C. Administer potassium supplementation and give digoxin
D. Obtain a repeat digoxin level
Correct Answer: B
Correct because hypokalemia significantly increases myocardial sensitivity to digoxin,
predisposing the patient to digitalis toxicity even when serum digoxin levels appear within the
therapeutic range of 0.8–2.0 ng/mL. According to SDSU NURS 300 curriculum, the mechanism
of action for digoxin involves inhibition of the Na+/K+-ATPase pump, and low extracellular
potassium competes with digoxin for binding sites, increasing toxicity risk. When administering
this drug, the priority assessment is verifying serum potassium levels before each dose, as
hypokalemia can precipitate fatal arrhythmias even with therapeutic digoxin concentrations.
, Q7. A patient with a fungal infection is prescribed fluconazole. The nurse should monitor for
which adverse effect?
A. Nephrotoxicity
B. Hepatotoxicity
C. Ototoxicity
D. Myelosuppression
Correct Answer: B
Correct because fluconazole, a triazole antifungal, can cause dose-dependent hepatotoxicity
ranging from asymptomatic transaminase elevations to severe hepatic necrosis. According to
SDSU NURS 300 curriculum, patient teaching for this medication includes instructing patients
to report symptoms of hepatotoxicity such as jaundice, dark urine, fatigue, and abdominal pain.
The mechanism of action for fluconazole involves inhibiting fungal cytochrome P450-dependent
lanosterol 14-alpha-demethylase, disrupting ergosterol synthesis in the fungal cell membrane.
Q8. A patient with rheumatoid arthritis is prescribed methotrexate. Which medication should the
nurse ensure is co-prescribed to reduce toxicity?
A. Vitamin B12
B. Folic acid
C. Vitamin D
D. Iron supplementation
Correct Answer: B
Correct because folic acid supplementation reduces methotrexate toxicity, including stomatitis,
gastrointestinal adverse effects, and hepatotoxicity, without significantly compromising its
immunosuppressive efficacy. According to SDSU NURS 300 curriculum, methotrexate is a
folate antagonist that inhibits dihydrofolate reductase, and supplemental folic acid bypasses this
blocked pathway in normal cells while malignant and inflammatory cells remain affected. When
administering this drug, the priority assessment is monitoring complete blood counts and liver
function tests, as methotrexate is a high-alert medication with narrow therapeutic index.
Q9. A patient with a penicillin allergy (anaphylaxis history) develops a severe infection requiring
antibiotic therapy. Which antibiotic class is the safest alternative?
A. Cephalosporin (first-generation)
B. Carbapenem
C. Fluoroquinolone
D. Aminoglycoside
