NURS 300 (Pharmacology) Comprehensive Final Exam
2026/2027 | Newly Released.
San Diego State University (SDSU).
100 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
.
Q1. A patient receiving vancomycin has a trough level of 25 mcg/mL. The therapeutic 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 for dose reduction
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 25 mcg/mL exceeds the therapeutic range of 15–20
mcg/mL for serious MRSA infections, indicating supratherapeutic levels that increase the risk of
nephrotoxicity and ototoxicity. According to SDSU NURS 300 curriculum, when administering
this drug, the priority assessment is verifying trough levels before subsequent doses and holding
supratherapeutic doses pending provider review and dose adjustment. Patient teaching for this
medication includes understanding the importance of timely blood draws and reporting signs of
kidney dysfunction including decreased urine output or swelling.
Q2. A patient with hypothyroidism is prescribed levothyroxine 125 mcg daily. The patient is also
taking calcium carbonate 500 mg three times daily. What is the nurse's primary concern?
A. Calcium enhances levothyroxine absorption
B. Calcium binds levothyroxine in the GI tract, reducing absorption by up to 40%
C. Levothyroxine increases calcium excretion
D. There is no significant interaction between these medications
Correct Answer: B
,Correct because calcium carbonate and other divalent cations chelate levothyroxine in the
gastrointestinal tract, forming insoluble complexes that significantly reduce levothyroxine
absorption, potentially leading to subtherapeutic thyroid hormone levels and worsening
hypothyroidism. According to SDSU NURS 300 curriculum, patient teaching for this medication
includes separating levothyroxine from calcium, iron, antacids, and sucralfate by at least 4 hours.
When administering this drug, the priority assessment is monitoring TSH levels and assessing for
signs of inadequate thyroid replacement including fatigue, weight gain, and cold intolerance.
Q3 . A patient with community-acquired pneumonia is prescribed levofloxacin 750 mg daily. The
patient has a history of prolonged QT interval. What is the nurse's primary concern?
A. Levofloxacin has no effect on cardiac conduction
B. Levofloxacin can further prolong the QT interval, increasing risk of torsades de pointes
C. Levofloxacin shortens the QT interval
D. Levofloxacin only affects the PR interval
Correct Answer: B
Correct because fluoroquinolones including levofloxacin block cardiac potassium channels
(hERG channels), prolonging the QT interval and increasing the risk of torsades de pointes,
particularly in patients with baseline QT prolongation, electrolyte abnormalities, or concurrent
use of other QT-prolonging medications. According to SDSU NURS 300 curriculum, when
administering this drug, the priority assessment is reviewing the patient's medication list for
other QT-prolonging agents, obtaining a baseline ECG, and monitoring electrolytes including
potassium and magnesium. Patient teaching for this medication includes reporting palpitations,
dizziness, or syncope immediately.
Q4. A patient with chemotherapy-induced nausea is receiving highly emetogenic chemotherapy.
The nurse is preparing the antiemetic regimen. Which medication targets the 5-HT3 receptor
pathway?
A. Aprepitant
B. Dexamethasone
C. Ondansetron
D. Olanzapine
Correct Answer: C
Correct because ondansetron is a selective 5-HT3 receptor antagonist that blocks serotonin
receptors in the chemoreceptor trigger zone and gastrointestinal tract, preventing acute
chemotherapy-induced nausea and vomiting within the first 24 hours after chemotherapy.
According to SDSU NURS 300 curriculum, the three-drug antiemetic regimen for highly
,emetogenic chemotherapy includes a 5-HT3 antagonist, dexamethasone, and an NK1 antagonist,
each targeting distinct neurotransmitter pathways. Patient teaching for this medication includes
reporting headache, constipation, or dizziness, and understanding that ondansetron addresses
acute but not delayed nausea.
Q5. A patient with heart failure is prescribed digoxin 0.25 mg daily. The patient's serum
creatinine has increased from 1.0 mg/dL to 2.5 mg/dL over the past week. What is the nurse's
priority action?
A. Continue the current digoxin dose
B. Hold the digoxin dose and notify the provider for dose adjustment
C. Administer the dose with food to reduce absorption
D. Obtain a peak digoxin level
Correct Answer: B
Correct because digoxin is primarily eliminated unchanged by the kidneys, and the significant
increase in serum creatinine from 1.0 to 2.5 mg/dL indicates acute kidney injury that will
markedly reduce digoxin clearance, increasing the risk of digoxin toxicity even with previously
therapeutic doses. According to SDSU NURS 300 curriculum, when administering this drug, the
priority assessment is monitoring renal function regularly and adjusting the dose based on
creatinine clearance, as digoxin has a narrow therapeutic index. Patient teaching for this
medication includes reporting nausea, vomiting, visual disturbances, or irregular heartbeat
immediately.
Q6. A patient with a systemic fungal infection is prescribed voriconazole. The nurse should
monitor for which adverse effect?
A. Nephrotoxicity
B. Hepatotoxicity and visual disturbances
C. Ototoxicity
D. Myelosuppression
Correct Answer: B
Correct because voriconazole, a second-generation triazole antifungal, commonly causes
transient visual disturbances including altered color perception, photophobia, and blurred vision
(occurring in approximately 30% of patients), as well as dose-dependent hepatotoxicity requiring
baseline and periodic liver function monitoring. According to SDSU NURS 300 curriculum,
patient teaching for this medication includes warning patients not to drive at night or operate
hazardous machinery due to visual disturbances, and reporting jaundice, dark urine, or persistent
, nausea. The mechanism of action for voriconazole involves inhibiting fungal cytochrome P450-
dependent lanosterol 14-alpha-demethylase, disrupting ergosterol synthesis.
Q7. A patient with rheumatoid arthritis is prescribed adalimumab. The nurse should ensure
which screening is completed before initiating therapy?
A. Tuberculosis screening and hepatitis B screening
B. Annual mammogram only
C. Lipid panel
D. Pulmonary function tests
Correct Answer: A
Correct because adalimumab is a TNF-alpha inhibitor that increases the risk of reactivation of
latent tuberculosis and hepatitis B, requiring interferon-gamma release assay or tuberculin skin
testing and hepatitis B surface antigen, surface antibody, and core antibody screening before
initiation. According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is ensuring negative tuberculosis screening and ruling out active infections before the
first dose, as TNF-alpha is critical for granuloma formation and host defense against intracellular
pathogens. Patient teaching for this medication includes reporting fever, cough, or signs of
infection immediately and avoiding live vaccines.
Q8. A patient with a documented severe penicillin allergy (anaphylaxis) requires treatment for a
hospital-acquired pneumonia caused by Pseudomonas aeruginosa. Which antibiotic is the most
appropriate choice?
A. Piperacillin-tazobactam
B. Ceftazidime
C. Aztreonam
D. Meropenem
Correct Answer: C
Correct because aztreonam is a monobactam antibiotic with a unique monocyclic beta-lactam
structure that does not cross-react with penicillin allergy, while retaining excellent activity
against gram-negative organisms including Pseudomonas aeruginosa, making it the safest choice
for this patient. According to SDSU NURS 300 curriculum, aztreonam has no significant cross-
reactivity with penicillins, cephalosporins, or carbapenems due to its distinct chemical structure,
though cross-reactivity with ceftazidime exists due to similar side chains. The mechanism of
action for aztreonam involves binding to penicillin-binding protein-3 in gram-negative bacteria,
inhibiting cell wall synthesis.
2026/2027 | Newly Released.
San Diego State University (SDSU).
100 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
.
Q1. A patient receiving vancomycin has a trough level of 25 mcg/mL. The therapeutic 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 for dose reduction
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 25 mcg/mL exceeds the therapeutic range of 15–20
mcg/mL for serious MRSA infections, indicating supratherapeutic levels that increase the risk of
nephrotoxicity and ototoxicity. According to SDSU NURS 300 curriculum, when administering
this drug, the priority assessment is verifying trough levels before subsequent doses and holding
supratherapeutic doses pending provider review and dose adjustment. Patient teaching for this
medication includes understanding the importance of timely blood draws and reporting signs of
kidney dysfunction including decreased urine output or swelling.
Q2. A patient with hypothyroidism is prescribed levothyroxine 125 mcg daily. The patient is also
taking calcium carbonate 500 mg three times daily. What is the nurse's primary concern?
A. Calcium enhances levothyroxine absorption
B. Calcium binds levothyroxine in the GI tract, reducing absorption by up to 40%
C. Levothyroxine increases calcium excretion
D. There is no significant interaction between these medications
Correct Answer: B
,Correct because calcium carbonate and other divalent cations chelate levothyroxine in the
gastrointestinal tract, forming insoluble complexes that significantly reduce levothyroxine
absorption, potentially leading to subtherapeutic thyroid hormone levels and worsening
hypothyroidism. According to SDSU NURS 300 curriculum, patient teaching for this medication
includes separating levothyroxine from calcium, iron, antacids, and sucralfate by at least 4 hours.
When administering this drug, the priority assessment is monitoring TSH levels and assessing for
signs of inadequate thyroid replacement including fatigue, weight gain, and cold intolerance.
Q3 . A patient with community-acquired pneumonia is prescribed levofloxacin 750 mg daily. The
patient has a history of prolonged QT interval. What is the nurse's primary concern?
A. Levofloxacin has no effect on cardiac conduction
B. Levofloxacin can further prolong the QT interval, increasing risk of torsades de pointes
C. Levofloxacin shortens the QT interval
D. Levofloxacin only affects the PR interval
Correct Answer: B
Correct because fluoroquinolones including levofloxacin block cardiac potassium channels
(hERG channels), prolonging the QT interval and increasing the risk of torsades de pointes,
particularly in patients with baseline QT prolongation, electrolyte abnormalities, or concurrent
use of other QT-prolonging medications. According to SDSU NURS 300 curriculum, when
administering this drug, the priority assessment is reviewing the patient's medication list for
other QT-prolonging agents, obtaining a baseline ECG, and monitoring electrolytes including
potassium and magnesium. Patient teaching for this medication includes reporting palpitations,
dizziness, or syncope immediately.
Q4. A patient with chemotherapy-induced nausea is receiving highly emetogenic chemotherapy.
The nurse is preparing the antiemetic regimen. Which medication targets the 5-HT3 receptor
pathway?
A. Aprepitant
B. Dexamethasone
C. Ondansetron
D. Olanzapine
Correct Answer: C
Correct because ondansetron is a selective 5-HT3 receptor antagonist that blocks serotonin
receptors in the chemoreceptor trigger zone and gastrointestinal tract, preventing acute
chemotherapy-induced nausea and vomiting within the first 24 hours after chemotherapy.
According to SDSU NURS 300 curriculum, the three-drug antiemetic regimen for highly
,emetogenic chemotherapy includes a 5-HT3 antagonist, dexamethasone, and an NK1 antagonist,
each targeting distinct neurotransmitter pathways. Patient teaching for this medication includes
reporting headache, constipation, or dizziness, and understanding that ondansetron addresses
acute but not delayed nausea.
Q5. A patient with heart failure is prescribed digoxin 0.25 mg daily. The patient's serum
creatinine has increased from 1.0 mg/dL to 2.5 mg/dL over the past week. What is the nurse's
priority action?
A. Continue the current digoxin dose
B. Hold the digoxin dose and notify the provider for dose adjustment
C. Administer the dose with food to reduce absorption
D. Obtain a peak digoxin level
Correct Answer: B
Correct because digoxin is primarily eliminated unchanged by the kidneys, and the significant
increase in serum creatinine from 1.0 to 2.5 mg/dL indicates acute kidney injury that will
markedly reduce digoxin clearance, increasing the risk of digoxin toxicity even with previously
therapeutic doses. According to SDSU NURS 300 curriculum, when administering this drug, the
priority assessment is monitoring renal function regularly and adjusting the dose based on
creatinine clearance, as digoxin has a narrow therapeutic index. Patient teaching for this
medication includes reporting nausea, vomiting, visual disturbances, or irregular heartbeat
immediately.
Q6. A patient with a systemic fungal infection is prescribed voriconazole. The nurse should
monitor for which adverse effect?
A. Nephrotoxicity
B. Hepatotoxicity and visual disturbances
C. Ototoxicity
D. Myelosuppression
Correct Answer: B
Correct because voriconazole, a second-generation triazole antifungal, commonly causes
transient visual disturbances including altered color perception, photophobia, and blurred vision
(occurring in approximately 30% of patients), as well as dose-dependent hepatotoxicity requiring
baseline and periodic liver function monitoring. According to SDSU NURS 300 curriculum,
patient teaching for this medication includes warning patients not to drive at night or operate
hazardous machinery due to visual disturbances, and reporting jaundice, dark urine, or persistent
, nausea. The mechanism of action for voriconazole involves inhibiting fungal cytochrome P450-
dependent lanosterol 14-alpha-demethylase, disrupting ergosterol synthesis.
Q7. A patient with rheumatoid arthritis is prescribed adalimumab. The nurse should ensure
which screening is completed before initiating therapy?
A. Tuberculosis screening and hepatitis B screening
B. Annual mammogram only
C. Lipid panel
D. Pulmonary function tests
Correct Answer: A
Correct because adalimumab is a TNF-alpha inhibitor that increases the risk of reactivation of
latent tuberculosis and hepatitis B, requiring interferon-gamma release assay or tuberculin skin
testing and hepatitis B surface antigen, surface antibody, and core antibody screening before
initiation. According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is ensuring negative tuberculosis screening and ruling out active infections before the
first dose, as TNF-alpha is critical for granuloma formation and host defense against intracellular
pathogens. Patient teaching for this medication includes reporting fever, cough, or signs of
infection immediately and avoiding live vaccines.
Q8. A patient with a documented severe penicillin allergy (anaphylaxis) requires treatment for a
hospital-acquired pneumonia caused by Pseudomonas aeruginosa. Which antibiotic is the most
appropriate choice?
A. Piperacillin-tazobactam
B. Ceftazidime
C. Aztreonam
D. Meropenem
Correct Answer: C
Correct because aztreonam is a monobactam antibiotic with a unique monocyclic beta-lactam
structure that does not cross-react with penicillin allergy, while retaining excellent activity
against gram-negative organisms including Pseudomonas aeruginosa, making it the safest choice
for this patient. According to SDSU NURS 300 curriculum, aztreonam has no significant cross-
reactivity with penicillins, cephalosporins, or carbapenems due to its distinct chemical structure,
though cross-reactivity with ceftazidime exists due to similar side chains. The mechanism of
action for aztreonam involves binding to penicillin-binding protein-3 in gram-negative bacteria,
inhibiting cell wall synthesis.
