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 with community-acquired pneumonia is prescribed levofloxacin 750 mg IV daily.
The nurse notes the patient has a history of prolonged QT interval and is taking haloperidol.
What is the nurse's priority action?
A. Continue levofloxacin and monitor for arrhythmias
B. Hold the levofloxacin and notify the provider immediately due to additive QT prolongation
risk
C. Administer the dose with magnesium supplementation
D. Switch to oral levofloxacin to reduce cardiac risk
Correct Answer: A
Correct because while the nurse should be vigilant, levofloxacin can be continued with close
cardiac monitoring when the benefit outweighs the risk; the priority is notifying the provider to
assess the need for ECG monitoring and possible alternative antibiotics rather than independently
holding the dose. According to SDSU NURS 300 curriculum, when administering this drug, the
priority assessment is reviewing all QT-prolonging medications and obtaining baseline and
follow-up ECGs. Patient teaching for this medication includes reporting palpitations, dizziness,
or syncope immediately, as torsades de pointes can occur with concurrent QT-prolonging agents.
Q2. A patient with a solid tumor is receiving pembrolizumab for metastatic melanoma. The
patient develops a dry cough, dyspnea, and bilateral infiltrates on chest X-ray 8 weeks after
starting therapy. What is the nurse's priority concern?
A. Progressive metastatic disease
B. Immune-mediated pneumonitis requiring corticosteroid therapy
C. Bacterial pneumonia from immunosuppression
D. Radiation recall pneumonitis
,Correct Answer: D
Correct because immune-mediated pneumonitis is a serious immune-related adverse event of
PD-1 inhibitors such as pembrolizumab, characterized by dry cough, dyspnea, and radiographic
infiltrates, requiring prompt corticosteroid therapy and discontinuation of the checkpoint
inhibitor. According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is educating patients to report new or worsening respiratory symptoms immediately,
as early recognition and treatment with corticosteroids can be life-saving. Patient teaching for
this medication includes understanding that immune-related adverse events can occur months
after discontinuation.
Q3. A patient with chronic heart failure is prescribed sacubitril/valsartan (Entresto). The patient
was taking lisinopril 20 mg daily until yesterday. What is the nurse's priority action before
administering the first dose?
A. Administer Entresto immediately since lisinopril was stopped yesterday
B. Verify that at least 36 hours have elapsed since the last ACE inhibitor dose
C. Give a test dose of Entresto and monitor for 6 hours
D. Continue lisinopril concurrently at half the previous dose
Correct Answer: B
Correct because concurrent use of ACE inhibitors and neprilysin inhibitors increases the risk of
angioedema due to dual effects on bradykinin and natriuretic peptide metabolism, requiring a
minimum 36-hour washout period between discontinuing an ACE inhibitor and initiating
sacubitril/valsartan. According to SDSU NURS 300 curriculum, when administering this drug,
the priority assessment is verifying the timing of the last ACE inhibitor dose and ensuring
adequate washout before Entresto initiation. Patient teaching for this medication includes
understanding that angioedema is a rare but serious risk requiring immediate medical attention.
Q4. A patient with a bacterial infection is prescribed ceftaroline fosamil. The nurse understands
this cephalosporin has activity against which organism that other cephalosporins typically do
not?
A. Pseudomonas aeruginosa
B. Methicillin-resistant Staphylococcus aureus (MRSA)
C. Extended-spectrum beta-lactamase-producing Enterobacterales
D. Vancomycin-resistant Enterococcus
Correct Answer: B
Correct because ceftaroline is a fifth-generation cephalosporin with unique affinity for penicillin-
binding protein-2a (PBP2a), the altered target responsible for methicillin resistance in
,Staphylococcus aureus, providing reliable activity against MRSA that is lacking in other
cephalosporin generations. According to SDSU NURS 300 curriculum, ceftaroline is approved
for acute bacterial skin and skin structure infections and community-acquired bacterial
pneumonia, including MRSA coverage. The mechanism of action for ceftaroline involves
binding to penicillin-binding proteins and inhibiting bacterial cell wall synthesis.
Q5. A patient with hypertension is prescribed chlorthalidone 25 mg daily. After 4 weeks, the
patient's blood pressure is controlled but serum potassium is 3.2 mEq/L. What is the nurse's
priority teaching point?
A. "Increase your dietary potassium intake and we will recheck your levels in 2 weeks."
B. "Stop the chlorthalidone immediately and switch to a different antihypertensive."
C. "Your potassium level is normal; no action is needed."
D. "Take potassium supplements only on days you feel weak."
Correct Answer: C
Correct because a serum potassium of 3.2 mEq/L indicates mild hypokalemia that can be
managed with dietary potassium supplementation and close monitoring; abrupt discontinuation
of effective antihypertensive therapy is unnecessary and may destabilize blood pressure control.
According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is monitoring electrolytes regularly and educating patients about potassium-rich
foods including bananas, oranges, potatoes, and leafy greens. Patient teaching for this medication
includes understanding that thiazide-like diuretics cause potassium wasting, and that persistent or
severe hypokalemia may require prescription potassium supplementation or a potassium-sparing
agent.
Q6. A patient with a seizure disorder is prescribed perampanel 4 mg daily. The patient's family
reports increased irritability, aggressive outbursts, and verbal hostility over the past 2 weeks.
What is the nurse's priority action?
A. Reassure the family that these are normal adjustment symptoms
B. Notify the provider immediately as these may be neuropsychiatric adverse effects requiring
dose reduction or discontinuation
C. Increase the perampanel dose to improve seizure control, which may reduce irritability
D. Recommend family counseling without medication changes
Correct Answer: B
Correct because perampanel carries a black box warning for serious neuropsychiatric adverse
events including irritability, aggression, hostility, and suicidal behavior, which require immediate
provider notification for dose reduction or discontinuation to prevent progression to more severe
, outcomes. According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is monitoring for behavioral changes, particularly during the first few weeks of
therapy and with dose escalations. Patient teaching for this medication includes instructing
family members to report any personality changes, mood swings, or aggressive behavior
immediately.
Q7. A patient with type 1 diabetes is prescribed insulin degludec. The patient asks about the
flexibility of dosing time. What is the nurse's best response?
A. "You must take it at exactly the same time every day without exception."
B. "You have flexibility to dose once daily at any time, but should aim for consistency; if you
miss a dose, take it when remembered if at least 8 hours before the next dose."
C. "You can take it whenever you remember, even if it's close to the next scheduled dose."
D. "You should take it only when your blood sugar is above 200 mg/dL."
Correct Answer: C
Correct because insulin degludec is an ultra-long-acting basal insulin with a half-life exceeding
25 hours and a flat pharmacokinetic profile, allowing flexible once-daily dosing at any time of
day with a minimum 8-hour interval between doses if a dose is missed. According to SDSU
NURS 300 curriculum, patient teaching for this medication includes understanding that degludec
provides steady basal coverage for more than 42 hours, reducing hypoglycemia risk compared to
older long-acting insulins. The mechanism of action for insulin degludec involves forming
soluble multihexamers at the injection site that slowly dissociate, providing a consistent and
prolonged release of monomers.
Q8. A patient with a solid tumor is receiving trastuzumab emtansine (T-DM1). The nurse should
monitor for which adverse effect related to the cytotoxic payload?
A. Nephrotoxicity
B. Thrombocytopenia and hepatotoxicity
C. Pulmonary fibrosis
D. Ototoxicity
Correct Answer: B
Correct because trastuzumab emtansine is an antibody-drug conjugate consisting of trastuzumab
linked to DM1, a maytansinoid microtubule inhibitor; the payload causes dose-limiting
thrombocytopenia and hepatotoxicity including nodular regenerative hyperplasia and portal
hypertension. According to SDSU NURS 300 curriculum, when administering this drug, the
priority assessment is monitoring platelet counts and liver function tests before each dose, with
2026/2027 | Newly Released.
San Diego State University (SDSU).
100 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient with community-acquired pneumonia is prescribed levofloxacin 750 mg IV daily.
The nurse notes the patient has a history of prolonged QT interval and is taking haloperidol.
What is the nurse's priority action?
A. Continue levofloxacin and monitor for arrhythmias
B. Hold the levofloxacin and notify the provider immediately due to additive QT prolongation
risk
C. Administer the dose with magnesium supplementation
D. Switch to oral levofloxacin to reduce cardiac risk
Correct Answer: A
Correct because while the nurse should be vigilant, levofloxacin can be continued with close
cardiac monitoring when the benefit outweighs the risk; the priority is notifying the provider to
assess the need for ECG monitoring and possible alternative antibiotics rather than independently
holding the dose. According to SDSU NURS 300 curriculum, when administering this drug, the
priority assessment is reviewing all QT-prolonging medications and obtaining baseline and
follow-up ECGs. Patient teaching for this medication includes reporting palpitations, dizziness,
or syncope immediately, as torsades de pointes can occur with concurrent QT-prolonging agents.
Q2. A patient with a solid tumor is receiving pembrolizumab for metastatic melanoma. The
patient develops a dry cough, dyspnea, and bilateral infiltrates on chest X-ray 8 weeks after
starting therapy. What is the nurse's priority concern?
A. Progressive metastatic disease
B. Immune-mediated pneumonitis requiring corticosteroid therapy
C. Bacterial pneumonia from immunosuppression
D. Radiation recall pneumonitis
,Correct Answer: D
Correct because immune-mediated pneumonitis is a serious immune-related adverse event of
PD-1 inhibitors such as pembrolizumab, characterized by dry cough, dyspnea, and radiographic
infiltrates, requiring prompt corticosteroid therapy and discontinuation of the checkpoint
inhibitor. According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is educating patients to report new or worsening respiratory symptoms immediately,
as early recognition and treatment with corticosteroids can be life-saving. Patient teaching for
this medication includes understanding that immune-related adverse events can occur months
after discontinuation.
Q3. A patient with chronic heart failure is prescribed sacubitril/valsartan (Entresto). The patient
was taking lisinopril 20 mg daily until yesterday. What is the nurse's priority action before
administering the first dose?
A. Administer Entresto immediately since lisinopril was stopped yesterday
B. Verify that at least 36 hours have elapsed since the last ACE inhibitor dose
C. Give a test dose of Entresto and monitor for 6 hours
D. Continue lisinopril concurrently at half the previous dose
Correct Answer: B
Correct because concurrent use of ACE inhibitors and neprilysin inhibitors increases the risk of
angioedema due to dual effects on bradykinin and natriuretic peptide metabolism, requiring a
minimum 36-hour washout period between discontinuing an ACE inhibitor and initiating
sacubitril/valsartan. According to SDSU NURS 300 curriculum, when administering this drug,
the priority assessment is verifying the timing of the last ACE inhibitor dose and ensuring
adequate washout before Entresto initiation. Patient teaching for this medication includes
understanding that angioedema is a rare but serious risk requiring immediate medical attention.
Q4. A patient with a bacterial infection is prescribed ceftaroline fosamil. The nurse understands
this cephalosporin has activity against which organism that other cephalosporins typically do
not?
A. Pseudomonas aeruginosa
B. Methicillin-resistant Staphylococcus aureus (MRSA)
C. Extended-spectrum beta-lactamase-producing Enterobacterales
D. Vancomycin-resistant Enterococcus
Correct Answer: B
Correct because ceftaroline is a fifth-generation cephalosporin with unique affinity for penicillin-
binding protein-2a (PBP2a), the altered target responsible for methicillin resistance in
,Staphylococcus aureus, providing reliable activity against MRSA that is lacking in other
cephalosporin generations. According to SDSU NURS 300 curriculum, ceftaroline is approved
for acute bacterial skin and skin structure infections and community-acquired bacterial
pneumonia, including MRSA coverage. The mechanism of action for ceftaroline involves
binding to penicillin-binding proteins and inhibiting bacterial cell wall synthesis.
Q5. A patient with hypertension is prescribed chlorthalidone 25 mg daily. After 4 weeks, the
patient's blood pressure is controlled but serum potassium is 3.2 mEq/L. What is the nurse's
priority teaching point?
A. "Increase your dietary potassium intake and we will recheck your levels in 2 weeks."
B. "Stop the chlorthalidone immediately and switch to a different antihypertensive."
C. "Your potassium level is normal; no action is needed."
D. "Take potassium supplements only on days you feel weak."
Correct Answer: C
Correct because a serum potassium of 3.2 mEq/L indicates mild hypokalemia that can be
managed with dietary potassium supplementation and close monitoring; abrupt discontinuation
of effective antihypertensive therapy is unnecessary and may destabilize blood pressure control.
According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is monitoring electrolytes regularly and educating patients about potassium-rich
foods including bananas, oranges, potatoes, and leafy greens. Patient teaching for this medication
includes understanding that thiazide-like diuretics cause potassium wasting, and that persistent or
severe hypokalemia may require prescription potassium supplementation or a potassium-sparing
agent.
Q6. A patient with a seizure disorder is prescribed perampanel 4 mg daily. The patient's family
reports increased irritability, aggressive outbursts, and verbal hostility over the past 2 weeks.
What is the nurse's priority action?
A. Reassure the family that these are normal adjustment symptoms
B. Notify the provider immediately as these may be neuropsychiatric adverse effects requiring
dose reduction or discontinuation
C. Increase the perampanel dose to improve seizure control, which may reduce irritability
D. Recommend family counseling without medication changes
Correct Answer: B
Correct because perampanel carries a black box warning for serious neuropsychiatric adverse
events including irritability, aggression, hostility, and suicidal behavior, which require immediate
provider notification for dose reduction or discontinuation to prevent progression to more severe
, outcomes. According to SDSU NURS 300 curriculum, when administering this drug, the priority
assessment is monitoring for behavioral changes, particularly during the first few weeks of
therapy and with dose escalations. Patient teaching for this medication includes instructing
family members to report any personality changes, mood swings, or aggressive behavior
immediately.
Q7. A patient with type 1 diabetes is prescribed insulin degludec. The patient asks about the
flexibility of dosing time. What is the nurse's best response?
A. "You must take it at exactly the same time every day without exception."
B. "You have flexibility to dose once daily at any time, but should aim for consistency; if you
miss a dose, take it when remembered if at least 8 hours before the next dose."
C. "You can take it whenever you remember, even if it's close to the next scheduled dose."
D. "You should take it only when your blood sugar is above 200 mg/dL."
Correct Answer: C
Correct because insulin degludec is an ultra-long-acting basal insulin with a half-life exceeding
25 hours and a flat pharmacokinetic profile, allowing flexible once-daily dosing at any time of
day with a minimum 8-hour interval between doses if a dose is missed. According to SDSU
NURS 300 curriculum, patient teaching for this medication includes understanding that degludec
provides steady basal coverage for more than 42 hours, reducing hypoglycemia risk compared to
older long-acting insulins. The mechanism of action for insulin degludec involves forming
soluble multihexamers at the injection site that slowly dissociate, providing a consistent and
prolonged release of monomers.
Q8. A patient with a solid tumor is receiving trastuzumab emtansine (T-DM1). The nurse should
monitor for which adverse effect related to the cytotoxic payload?
A. Nephrotoxicity
B. Thrombocytopenia and hepatotoxicity
C. Pulmonary fibrosis
D. Ototoxicity
Correct Answer: B
Correct because trastuzumab emtansine is an antibody-drug conjugate consisting of trastuzumab
linked to DM1, a maytansinoid microtubule inhibitor; the payload causes dose-limiting
thrombocytopenia and hepatotoxicity including nodular regenerative hyperplasia and portal
hypertension. According to SDSU NURS 300 curriculum, when administering this drug, the
priority assessment is monitoring platelet counts and liver function tests before each dose, with
