NR 293 Pharmacology Exam 2 | 75 Questions And Answers
With Detailed Rationale | 2026/2027 Updates
Question 1.
A patient is prescribed amoxicillin-clavulanate for a skin infection. The nurse understands that
clavulanate is added to amoxicillin to:
A. Increase the spectrum of activity against gram-negative organisms
B. Inhibit bacterial beta-lactamase enzymes that destroy amoxicillin
C. Reduce the incidence of allergic reactions
D. Enhance absorption from the gastrointestinal tract
Correct Answer: B
Rationale:
Clavulanate is a beta-lactamase inhibitor that protects amoxicillin from destruction by bacterial beta-lactamase enzymes,
thereby extending its effectiveness against beta-lactamase-producing organisms. A is incorrect because clavulanate itself
has minimal antibacterial activity and does not directly expand the spectrum. C is incorrect because clavulanate does not
reduce allergic reactions; patients allergic to penicillin are still allergic to amoxicillin-clavulanate. D is incorrect because
clavulanate does not enhance GI absorption.
Question 2.
A nurse is administering cefazolin preoperatively for surgical prophylaxis. The nurse knows this
medication belongs to which antibiotic class?
A. Aminoglycosides
B. Macrolides
C. Cephalosporins
D. Fluoroquinolones
Correct Answer: C
Rationale:
Cefazolin is a first-generation cephalosporin commonly used for surgical prophylaxis due to its activity against gram-
positive organisms including Staphylococcus aureus. A is incorrect because aminoglycosides include gentamicin and
tobramycin. B is incorrect because macrolides include erythromycin and azithromycin. D is incorrect because
fluoroquinolones include ciprofloxacin and levofloxacin.
Question 3.
A patient receiving clindamycin develops severe, watery diarrhea. The nurse suspects Clostridioides
difficile infection and knows that the appropriate treatment includes:
A. Discontinuing clindamycin and initiating oral vancomycin or fidaxomicin
B. Continuing clindamycin and adding loperamide
C. Switching to a broad-spectrum cephalosporin
D. Administering an antidiarrheal agent only
Correct Answer: A
Rationale:
Page 1
,Clindamycin is highly associated with C. difficile infection due to disruption of normal gut flora. Treatment involves
discontinuing the offending antibiotic and initiating oral vancomycin or fidaxomicin. B is incorrect because loperamide can
worsen toxin retention. C is incorrect because broad-spectrum antibiotics can further disrupt flora. D is incorrect because
antidiarrheals alone do not treat the underlying infection.
Question 4.
A nurse is teaching a patient about rifampin therapy for tuberculosis. The nurse should inform the
patient that a harmless but expected side effect is:
A. Red-orange discoloration of body fluids
B. Permanent hearing loss
C. Blue-gray skin discoloration
D. Severe photosensitivity
Correct Answer: A
Rationale:
Rifampin causes harmless red-orange discoloration of urine, sweat, tears, and saliva. Patients should be warned to avoid
contact lenses as tears may stain them. B is incorrect because hearing loss is associated with aminoglycosides, not
rifampin. C is incorrect because blue-gray discoloration is associated with amiodarone. D is incorrect because while
rifampin can cause mild photosensitivity, it is not severe or characteristic.
Question 5.
A patient is prescribed acyclovir for herpes simplex virus infection. The nurse should monitor for which
adverse effect during intravenous administration?
A. Nephrotoxicity
B. Ototoxicity
C. Pulmonary fibrosis
D. Cardiomyopathy
Correct Answer: A
Rationale:
IV acyclovir can crystallize in renal tubules causing nephrotoxicity. Adequate hydration and slow infusion are essential. B
is incorrect because ototoxicity is associated with aminoglycosides. C is incorrect because pulmonary fibrosis is associated
with bleomycin and amiodarone. D is incorrect because cardiomyopathy is not a characteristic adverse effect of acyclovir.
Question 6.
A nurse is caring for a patient with HIV who is starting combination antiretroviral therapy. The nurse
understands that the primary goal of this therapy is to:
A. Cure the HIV infection completely
B. Suppress viral replication to undetectable levels and preserve immune function
C. Prevent opportunistic infections only
D. Eradicate the virus from latent reservoirs
Correct Answer: B
Rationale:
Page 2
,The goal of antiretroviral therapy is to suppress HIV replication to undetectable levels, increase CD4 counts, and prevent
disease progression. A is incorrect because there is currently no cure for HIV. C is incorrect because while preventing
opportunistic infections is a benefit, it is not the primary goal of ART. D is incorrect because current therapy cannot
eradicate latent reservoirs.
Question 7.
A patient is prescribed fluconazole for a systemic Candida infection. The nurse should monitor for
which adverse effect?
A. Hepatotoxicity
B. Ototoxicity
C. Pulmonary embolism
D. Retinal detachment
Correct Answer: A
Rationale:
Fluconazole is an azole antifungal that can cause hepatotoxicity. Liver function tests should be monitored during prolonged
therapy. B is incorrect because ototoxicity is not associated with azole antifungals. C is incorrect because pulmonary
embolism is not an adverse effect of fluconazole. D is incorrect because retinal detachment is not associated with
fluconazole.
Question 8.
A nurse is reviewing a prescription for metronidazole for a patient with bacterial vaginosis. The nurse
should instruct the patient to:
A. Avoid alcohol during treatment and for 48-72 hours after the last dose
B. Take the medication with dairy products to enhance absorption
C. Expect orange-red urine discoloration
D. Take the medication on an empty stomach only
Correct Answer: A
Rationale:
Metronidazole has a disulfiram-like reaction with alcohol, causing severe nausea, vomiting, flushing, and headache.
Patients must avoid alcohol during and for at least 48-72 hours after therapy. B is incorrect because dairy products do not
enhance metronidazole absorption. C is incorrect because dark urine is associated with metronidazole, but orange-red is
associated with rifampin. D is incorrect because metronidazole can be taken with food to reduce GI upset.
Question 9.
A patient is prescribed oseltamivir for influenza. The nurse should inform the patient that this
medication is most effective when started within:
A. 72 hours of symptom onset
B. 48 hours of symptom onset
C. 5 days of symptom onset
D. 1 week of symptom onset
Page 3
, Correct Answer: B
Rationale:
Oseltamivir (Tamiflu) is a neuraminidase inhibitor most effective when started within 48 hours of influenza symptom onset.
Early initiation reduces symptom duration and complications. A is incorrect because 72 hours is beyond the optimal
window. C and D are incorrect because starting at these times provides minimal benefit.
Question 10.
A nurse is preparing to administer pentamidine via inhalation for Pneumocystis jirovecii pneumonia
prophylaxis. The nurse knows that an alternative prophylactic regimen is:
A. Oral trimethoprim-sulfamethoxazole
B. Intravenous vancomycin
C. Oral amoxicillin
D. Topical nystatin
Correct Answer: A
Rationale:
Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for PJP prophylaxis in immunocompromised patients.
Pentamidine inhalation is an alternative for patients who cannot tolerate TMP-SMX. B is incorrect because vancomycin
has no activity against PJP. C is incorrect because amoxicillin is ineffective against PJP. D is incorrect because nystatin is
a topical antifungal for candidiasis.
Question 11.
A patient with atrial fibrillation is prescribed dabigatran. The nurse understands that an advantage of
dabigatran over warfarin is that dabigatran:
A. Has a specific reversal agent available
B. Does not require INR monitoring
C. Is safe to use during pregnancy
D. Has no risk of bleeding
Correct Answer: B
Rationale:
Dabigatran is a direct thrombin inhibitor with a predictable anticoagulant effect that does not require routine INR monitoring,
unlike warfarin. A is incorrect because while idarucizumab is a reversal agent, this is not the primary advantage over
warfarin. C is incorrect because dabigatran is contraindicated in pregnancy. D is incorrect because all anticoagulants carry
bleeding risk.
Question 12.
A nurse is caring for a patient who received tissue plasminogen activator (tPA) for an acute ischemic
stroke. The nurse should monitor for which complication?
A. Hemorrhagic transformation of the stroke
B. Severe hypertension only
C. Bradycardia
D. Hyperglycemia
Page 4
With Detailed Rationale | 2026/2027 Updates
Question 1.
A patient is prescribed amoxicillin-clavulanate for a skin infection. The nurse understands that
clavulanate is added to amoxicillin to:
A. Increase the spectrum of activity against gram-negative organisms
B. Inhibit bacterial beta-lactamase enzymes that destroy amoxicillin
C. Reduce the incidence of allergic reactions
D. Enhance absorption from the gastrointestinal tract
Correct Answer: B
Rationale:
Clavulanate is a beta-lactamase inhibitor that protects amoxicillin from destruction by bacterial beta-lactamase enzymes,
thereby extending its effectiveness against beta-lactamase-producing organisms. A is incorrect because clavulanate itself
has minimal antibacterial activity and does not directly expand the spectrum. C is incorrect because clavulanate does not
reduce allergic reactions; patients allergic to penicillin are still allergic to amoxicillin-clavulanate. D is incorrect because
clavulanate does not enhance GI absorption.
Question 2.
A nurse is administering cefazolin preoperatively for surgical prophylaxis. The nurse knows this
medication belongs to which antibiotic class?
A. Aminoglycosides
B. Macrolides
C. Cephalosporins
D. Fluoroquinolones
Correct Answer: C
Rationale:
Cefazolin is a first-generation cephalosporin commonly used for surgical prophylaxis due to its activity against gram-
positive organisms including Staphylococcus aureus. A is incorrect because aminoglycosides include gentamicin and
tobramycin. B is incorrect because macrolides include erythromycin and azithromycin. D is incorrect because
fluoroquinolones include ciprofloxacin and levofloxacin.
Question 3.
A patient receiving clindamycin develops severe, watery diarrhea. The nurse suspects Clostridioides
difficile infection and knows that the appropriate treatment includes:
A. Discontinuing clindamycin and initiating oral vancomycin or fidaxomicin
B. Continuing clindamycin and adding loperamide
C. Switching to a broad-spectrum cephalosporin
D. Administering an antidiarrheal agent only
Correct Answer: A
Rationale:
Page 1
,Clindamycin is highly associated with C. difficile infection due to disruption of normal gut flora. Treatment involves
discontinuing the offending antibiotic and initiating oral vancomycin or fidaxomicin. B is incorrect because loperamide can
worsen toxin retention. C is incorrect because broad-spectrum antibiotics can further disrupt flora. D is incorrect because
antidiarrheals alone do not treat the underlying infection.
Question 4.
A nurse is teaching a patient about rifampin therapy for tuberculosis. The nurse should inform the
patient that a harmless but expected side effect is:
A. Red-orange discoloration of body fluids
B. Permanent hearing loss
C. Blue-gray skin discoloration
D. Severe photosensitivity
Correct Answer: A
Rationale:
Rifampin causes harmless red-orange discoloration of urine, sweat, tears, and saliva. Patients should be warned to avoid
contact lenses as tears may stain them. B is incorrect because hearing loss is associated with aminoglycosides, not
rifampin. C is incorrect because blue-gray discoloration is associated with amiodarone. D is incorrect because while
rifampin can cause mild photosensitivity, it is not severe or characteristic.
Question 5.
A patient is prescribed acyclovir for herpes simplex virus infection. The nurse should monitor for which
adverse effect during intravenous administration?
A. Nephrotoxicity
B. Ototoxicity
C. Pulmonary fibrosis
D. Cardiomyopathy
Correct Answer: A
Rationale:
IV acyclovir can crystallize in renal tubules causing nephrotoxicity. Adequate hydration and slow infusion are essential. B
is incorrect because ototoxicity is associated with aminoglycosides. C is incorrect because pulmonary fibrosis is associated
with bleomycin and amiodarone. D is incorrect because cardiomyopathy is not a characteristic adverse effect of acyclovir.
Question 6.
A nurse is caring for a patient with HIV who is starting combination antiretroviral therapy. The nurse
understands that the primary goal of this therapy is to:
A. Cure the HIV infection completely
B. Suppress viral replication to undetectable levels and preserve immune function
C. Prevent opportunistic infections only
D. Eradicate the virus from latent reservoirs
Correct Answer: B
Rationale:
Page 2
,The goal of antiretroviral therapy is to suppress HIV replication to undetectable levels, increase CD4 counts, and prevent
disease progression. A is incorrect because there is currently no cure for HIV. C is incorrect because while preventing
opportunistic infections is a benefit, it is not the primary goal of ART. D is incorrect because current therapy cannot
eradicate latent reservoirs.
Question 7.
A patient is prescribed fluconazole for a systemic Candida infection. The nurse should monitor for
which adverse effect?
A. Hepatotoxicity
B. Ototoxicity
C. Pulmonary embolism
D. Retinal detachment
Correct Answer: A
Rationale:
Fluconazole is an azole antifungal that can cause hepatotoxicity. Liver function tests should be monitored during prolonged
therapy. B is incorrect because ototoxicity is not associated with azole antifungals. C is incorrect because pulmonary
embolism is not an adverse effect of fluconazole. D is incorrect because retinal detachment is not associated with
fluconazole.
Question 8.
A nurse is reviewing a prescription for metronidazole for a patient with bacterial vaginosis. The nurse
should instruct the patient to:
A. Avoid alcohol during treatment and for 48-72 hours after the last dose
B. Take the medication with dairy products to enhance absorption
C. Expect orange-red urine discoloration
D. Take the medication on an empty stomach only
Correct Answer: A
Rationale:
Metronidazole has a disulfiram-like reaction with alcohol, causing severe nausea, vomiting, flushing, and headache.
Patients must avoid alcohol during and for at least 48-72 hours after therapy. B is incorrect because dairy products do not
enhance metronidazole absorption. C is incorrect because dark urine is associated with metronidazole, but orange-red is
associated with rifampin. D is incorrect because metronidazole can be taken with food to reduce GI upset.
Question 9.
A patient is prescribed oseltamivir for influenza. The nurse should inform the patient that this
medication is most effective when started within:
A. 72 hours of symptom onset
B. 48 hours of symptom onset
C. 5 days of symptom onset
D. 1 week of symptom onset
Page 3
, Correct Answer: B
Rationale:
Oseltamivir (Tamiflu) is a neuraminidase inhibitor most effective when started within 48 hours of influenza symptom onset.
Early initiation reduces symptom duration and complications. A is incorrect because 72 hours is beyond the optimal
window. C and D are incorrect because starting at these times provides minimal benefit.
Question 10.
A nurse is preparing to administer pentamidine via inhalation for Pneumocystis jirovecii pneumonia
prophylaxis. The nurse knows that an alternative prophylactic regimen is:
A. Oral trimethoprim-sulfamethoxazole
B. Intravenous vancomycin
C. Oral amoxicillin
D. Topical nystatin
Correct Answer: A
Rationale:
Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for PJP prophylaxis in immunocompromised patients.
Pentamidine inhalation is an alternative for patients who cannot tolerate TMP-SMX. B is incorrect because vancomycin
has no activity against PJP. C is incorrect because amoxicillin is ineffective against PJP. D is incorrect because nystatin is
a topical antifungal for candidiasis.
Question 11.
A patient with atrial fibrillation is prescribed dabigatran. The nurse understands that an advantage of
dabigatran over warfarin is that dabigatran:
A. Has a specific reversal agent available
B. Does not require INR monitoring
C. Is safe to use during pregnancy
D. Has no risk of bleeding
Correct Answer: B
Rationale:
Dabigatran is a direct thrombin inhibitor with a predictable anticoagulant effect that does not require routine INR monitoring,
unlike warfarin. A is incorrect because while idarucizumab is a reversal agent, this is not the primary advantage over
warfarin. C is incorrect because dabigatran is contraindicated in pregnancy. D is incorrect because all anticoagulants carry
bleeding risk.
Question 12.
A nurse is caring for a patient who received tissue plasminogen activator (tPA) for an acute ischemic
stroke. The nurse should monitor for which complication?
A. Hemorrhagic transformation of the stroke
B. Severe hypertension only
C. Bradycardia
D. Hyperglycemia
Page 4
