UNIVERSITY OF SOUTH CAROLINA
NURS 711 - Pharmacotherapies
Exam 3 Practice Examination – 2026\2027 update
70 Questions and Answer with rationales
Name: Date: Score _____ / 100
INSTRUCTIONS
• Each question has four options; select the single best answer (A-D). One point is awarded per question.
• The correct answer and rationale appear in the shaded box immediately below each question, so cover them while
attempting each item for the most accurate self-assessment.
• Content spans antimicrobials, cardiovascular, endocrine, neurologic and psychiatric, pain, respiratory, gastrointestinal,
and renal pharmacotherapies at the graduate application level.
• A suggested passing standard is 70 points. Use the rationales to direct remediation toward weak drug-class areas before
retesting.
1. A 68-year-old man with MRSA bacteremia has been receiving intravenous
vancomycin for 72 hours. Which pharmacodynamic target is currently
recommended by consensus guidelines to guide vancomycin dosing and to predict
clinical efficacy?
A. An AUC24/MIC ratio of at least 400 to 600 mg-hr/L
B. A random serum concentration drawn 4 hours after the third dose
C. Normalization of C-reactive protein within 72 hours of initiation
D. A peak serum concentration of 30 to 40 mg/L drawn 60 minutes after infusion
Correct Answer: A
Contemporary consensus guidelines (ASHP/IDSA/PIDS/SIDP) endorse an AUC24/MIC ratio of 400 to 600 mg-hr/L for
serious MRSA infections such as bacteremia, because this ratio correlates with bacterial killing and a lower risk of
nephrotoxicity than trough-driven targets. Peak concentrations were never validated as vancomycin efficacy targets, and
random levels cannot describe total drug exposure. C-reactive protein is a useful inflammatory marker for trending clinical
response, but it is not a pharmacodynamic surrogate for antibiotic exposure.
1
,NURS 711 - Pharmacotherapies (2026) Exam 3 Practice Examination
2. A 44-year-old woman reports a diffuse maculopapular rash that occurred 25 years ago
after taking amoxicillin. She now has community-acquired pneumonia for which
intravenous ceftriaxone is recommended. Which statement best reflects the appropriate
pharmacotherapeutic approach?
A. Cross-reactivity between penicillins and third-generation cephalosporins is
approximately 1 to 2 percent, so ceftriaxone may be administered with standard
monitoring
B. Ceftriaxone should be avoided because cephalosporins carry a 10 percent cross-
reactivity risk
C. She should receive azithromycin for all future infections because
desensitization is never appropriate in adults
D. Penicillin allergy absolutely contraindicates all beta-lactam antibiotics for life
Correct Answer: A
The feared 10 percent cross-reactivity figure derives from studies using early cephalosporins contaminated with trace
penicillin. Current data show cross-reactivity of roughly 1 to 2 percent between penicillins and later-generation cephalosporins,
driven mainly by similarity of the R1 side chains rather than the shared beta-lactam ring; ceftriaxone shares no side-chain
similarity with amoxicillin. A remote, mild, undocumented rash does not represent a life-long contraindication, and graded
challenge or desensitization remains appropriate when no effective alternative exists. Substituting a broader-spectrum or less
effective agent solely on the basis of an unreliable remote history promotes collateral damage such as resistant organisms and
C. difficile infection.
3. A 74-year-old woman is receiving extended-interval gentamicin for enterococcal
endocarditis synergy. Which laboratory finding is the earliest indicator of
gentamicin-induced nephrotoxicity and should prompt immediate reassessment of
therapy?
A. An elevated international normalized ratio
B. A rising serum creatinine and blood urea nitrogen with a decreased creatinine
clearance
C. A declining serum creatinine from baseline
D. A decreased white blood cell count
Correct Answer: B
Aminoglycosides accumulate in the proximal renal tubular epithelium, producing a nonoliguric, dose-dependent tubular
necrosis whose earliest laboratory signature is a slowly rising serum creatinine and BUN with falling creatinine clearance.
Rising levels also reduce gentamicin clearance and raise the risk of vestibular and cochlear toxicity, so renal decline mandates
2
interval monitoring and possible discontinuation or dose reduction. The INR and white cell count are unrelated to
aminoglycoside nephrotoxicity, and a declining creatinine would indicate improving, not worsening, renal function.
,NURS 711 - Pharmacotherapies (2026) Exam 3 Practice Examination
4. A 62-year-old woman develops profuse watery diarrhea 8 days after completing a
clindamycin course. Stool testing is positive for C. difficile toxin, her white blood cell
count is 18,000 cells/mm3, and her creatinine is 1.0 mg/dL. Which therapy is the most
appropriate first-line choice?
A. Intravenous vancomycin 1 g every 12 hours
B. Loperamide 4 mg after each loose stool
C. Oral metronidazole 500 mg three times daily
D. Oral vancomycin 125 mg four times daily
Correct Answer: D
A white blood cell count of 15,000 cells/mm3 or greater is one definition of severe C. difficile infection, and current
IDSA/SHEA guidelines recommend fidaxomicin or oral vancomycin over metronidazole for the initial episode of severe
disease because of superior sustained clinical response. Intravenous vancomycin does not reach the colonic lumen and is not
effective against C. difficile. Antimotility agents such as loperamide are contraindicated in acute severe infection because
slowing colonic motility risks toxic megacolon.
5. A 58-year-old man with septic shock was empirically started on vancomycin plus
piperacillin-tazobactam. At 72 hours, blood and urine cultures remain negative, he is
hemodynamically stable on no vasopressors, and his source is believed to be a
catheter-related infection now removed. Which action best reflects antimicrobial
stewardship principles?
A. De-escalate or discontinue broad-spectrum coverage based on culture data and
clinical response
B. Continue the empiric regimen for a full 14 days to prevent resistant superinfection
C. Add empiric fluconazole because cultures are negative
D. Escalate to meropenem to broaden coverage against resistant gram-negatives
Correct Answer: A
Stewardship requires reassessment of empiric therapy at 48 to 72 hours using culture results, source control status, and clinical
trajectory. In a culture-negative, improving patient with the suspected source controlled, broad-spectrum agents should be
narrowed or stopped, which reduces resistance pressure, C. difficile risk, and drug toxicity without compromising outcomes.
Fixed prolonged courses justified only as a precaution, reflexive antifungal addition, and escalation to broader agents in the
absence of data all contradict stewardship evidence and increase patient harm.
3
, NURS 711 - Pharmacotherapies (2026) Exam 3 Practice Examination
6. A 39-year-old man is starting standard four-drug therapy for active pulmonary
tuberculosis. Which agent requires baseline and monthly assessment of visual acuity
and red-green color discrimination?
A. Ethambutol
B. Isoniazid
C. Rifampin
D. Pyrazinamide
Correct Answer: A
Ethambutol causes a dose-dependent retrobulbar optic neuritis that presents as decreased visual acuity and red-green color
blindness, so baseline and monthly visual testing is required, particularly at higher doses or with renal impairment. Isoniazid is
monitored for hepatotoxicity and peripheral neuropathy, rifampin for hepatitis and dramatic drug-drug interactions through
CYP induction (plus the harmless orange discoloration of secretions), and pyrazinamide for hepatotoxicity and hyperuricemia.
None of those three agents affects the optic nerve.
7. A58-year-old man with atrial fibrillation takes warfarin with a stable INR of 2.5.
His provider prescribes fluconazole 200 mg daily for oropharyngeal candidiasis.
What is the most likely consequence of this combination?
A. Fluconazole has no clinically significant interaction with warfarin
B. The interaction only matters with intravenous fluconazole
C. The INR will decrease, increasing thrombotic risk
D. The INR will increase due to inhibition of warfarin metabolism
Correct Answer: D
Fluconazole is a potent inhibitor of CYP2C9 (with additional 3A4 effects) and decreases the hepatic metabolism of the more
potent S-warfarin enantiomer, producing a predictable rise in INR and bleeding risk within days of combination.
Recommended actions include more frequent INR monitoring and empiric warfarin dose reduction when the azole course is
prolonged. Rifampin, not fluconazole, induces metabolism and would lower INR, and the interaction is dose- and
route-independent because oral fluconazole achieves the same hepatic enzyme exposure.
8. A 34-year-old woman is newly diagnosed with HIV infection. Her CD4 count is 310
cells/mm3 and her viral load is 88,000 copies/mL. Which statement reflects current
antiretroviral therapy standards?
4
NURS 711 - Pharmacotherapies
Exam 3 Practice Examination – 2026\2027 update
70 Questions and Answer with rationales
Name: Date: Score _____ / 100
INSTRUCTIONS
• Each question has four options; select the single best answer (A-D). One point is awarded per question.
• The correct answer and rationale appear in the shaded box immediately below each question, so cover them while
attempting each item for the most accurate self-assessment.
• Content spans antimicrobials, cardiovascular, endocrine, neurologic and psychiatric, pain, respiratory, gastrointestinal,
and renal pharmacotherapies at the graduate application level.
• A suggested passing standard is 70 points. Use the rationales to direct remediation toward weak drug-class areas before
retesting.
1. A 68-year-old man with MRSA bacteremia has been receiving intravenous
vancomycin for 72 hours. Which pharmacodynamic target is currently
recommended by consensus guidelines to guide vancomycin dosing and to predict
clinical efficacy?
A. An AUC24/MIC ratio of at least 400 to 600 mg-hr/L
B. A random serum concentration drawn 4 hours after the third dose
C. Normalization of C-reactive protein within 72 hours of initiation
D. A peak serum concentration of 30 to 40 mg/L drawn 60 minutes after infusion
Correct Answer: A
Contemporary consensus guidelines (ASHP/IDSA/PIDS/SIDP) endorse an AUC24/MIC ratio of 400 to 600 mg-hr/L for
serious MRSA infections such as bacteremia, because this ratio correlates with bacterial killing and a lower risk of
nephrotoxicity than trough-driven targets. Peak concentrations were never validated as vancomycin efficacy targets, and
random levels cannot describe total drug exposure. C-reactive protein is a useful inflammatory marker for trending clinical
response, but it is not a pharmacodynamic surrogate for antibiotic exposure.
1
,NURS 711 - Pharmacotherapies (2026) Exam 3 Practice Examination
2. A 44-year-old woman reports a diffuse maculopapular rash that occurred 25 years ago
after taking amoxicillin. She now has community-acquired pneumonia for which
intravenous ceftriaxone is recommended. Which statement best reflects the appropriate
pharmacotherapeutic approach?
A. Cross-reactivity between penicillins and third-generation cephalosporins is
approximately 1 to 2 percent, so ceftriaxone may be administered with standard
monitoring
B. Ceftriaxone should be avoided because cephalosporins carry a 10 percent cross-
reactivity risk
C. She should receive azithromycin for all future infections because
desensitization is never appropriate in adults
D. Penicillin allergy absolutely contraindicates all beta-lactam antibiotics for life
Correct Answer: A
The feared 10 percent cross-reactivity figure derives from studies using early cephalosporins contaminated with trace
penicillin. Current data show cross-reactivity of roughly 1 to 2 percent between penicillins and later-generation cephalosporins,
driven mainly by similarity of the R1 side chains rather than the shared beta-lactam ring; ceftriaxone shares no side-chain
similarity with amoxicillin. A remote, mild, undocumented rash does not represent a life-long contraindication, and graded
challenge or desensitization remains appropriate when no effective alternative exists. Substituting a broader-spectrum or less
effective agent solely on the basis of an unreliable remote history promotes collateral damage such as resistant organisms and
C. difficile infection.
3. A 74-year-old woman is receiving extended-interval gentamicin for enterococcal
endocarditis synergy. Which laboratory finding is the earliest indicator of
gentamicin-induced nephrotoxicity and should prompt immediate reassessment of
therapy?
A. An elevated international normalized ratio
B. A rising serum creatinine and blood urea nitrogen with a decreased creatinine
clearance
C. A declining serum creatinine from baseline
D. A decreased white blood cell count
Correct Answer: B
Aminoglycosides accumulate in the proximal renal tubular epithelium, producing a nonoliguric, dose-dependent tubular
necrosis whose earliest laboratory signature is a slowly rising serum creatinine and BUN with falling creatinine clearance.
Rising levels also reduce gentamicin clearance and raise the risk of vestibular and cochlear toxicity, so renal decline mandates
2
interval monitoring and possible discontinuation or dose reduction. The INR and white cell count are unrelated to
aminoglycoside nephrotoxicity, and a declining creatinine would indicate improving, not worsening, renal function.
,NURS 711 - Pharmacotherapies (2026) Exam 3 Practice Examination
4. A 62-year-old woman develops profuse watery diarrhea 8 days after completing a
clindamycin course. Stool testing is positive for C. difficile toxin, her white blood cell
count is 18,000 cells/mm3, and her creatinine is 1.0 mg/dL. Which therapy is the most
appropriate first-line choice?
A. Intravenous vancomycin 1 g every 12 hours
B. Loperamide 4 mg after each loose stool
C. Oral metronidazole 500 mg three times daily
D. Oral vancomycin 125 mg four times daily
Correct Answer: D
A white blood cell count of 15,000 cells/mm3 or greater is one definition of severe C. difficile infection, and current
IDSA/SHEA guidelines recommend fidaxomicin or oral vancomycin over metronidazole for the initial episode of severe
disease because of superior sustained clinical response. Intravenous vancomycin does not reach the colonic lumen and is not
effective against C. difficile. Antimotility agents such as loperamide are contraindicated in acute severe infection because
slowing colonic motility risks toxic megacolon.
5. A 58-year-old man with septic shock was empirically started on vancomycin plus
piperacillin-tazobactam. At 72 hours, blood and urine cultures remain negative, he is
hemodynamically stable on no vasopressors, and his source is believed to be a
catheter-related infection now removed. Which action best reflects antimicrobial
stewardship principles?
A. De-escalate or discontinue broad-spectrum coverage based on culture data and
clinical response
B. Continue the empiric regimen for a full 14 days to prevent resistant superinfection
C. Add empiric fluconazole because cultures are negative
D. Escalate to meropenem to broaden coverage against resistant gram-negatives
Correct Answer: A
Stewardship requires reassessment of empiric therapy at 48 to 72 hours using culture results, source control status, and clinical
trajectory. In a culture-negative, improving patient with the suspected source controlled, broad-spectrum agents should be
narrowed or stopped, which reduces resistance pressure, C. difficile risk, and drug toxicity without compromising outcomes.
Fixed prolonged courses justified only as a precaution, reflexive antifungal addition, and escalation to broader agents in the
absence of data all contradict stewardship evidence and increase patient harm.
3
, NURS 711 - Pharmacotherapies (2026) Exam 3 Practice Examination
6. A 39-year-old man is starting standard four-drug therapy for active pulmonary
tuberculosis. Which agent requires baseline and monthly assessment of visual acuity
and red-green color discrimination?
A. Ethambutol
B. Isoniazid
C. Rifampin
D. Pyrazinamide
Correct Answer: A
Ethambutol causes a dose-dependent retrobulbar optic neuritis that presents as decreased visual acuity and red-green color
blindness, so baseline and monthly visual testing is required, particularly at higher doses or with renal impairment. Isoniazid is
monitored for hepatotoxicity and peripheral neuropathy, rifampin for hepatitis and dramatic drug-drug interactions through
CYP induction (plus the harmless orange discoloration of secretions), and pyrazinamide for hepatotoxicity and hyperuricemia.
None of those three agents affects the optic nerve.
7. A58-year-old man with atrial fibrillation takes warfarin with a stable INR of 2.5.
His provider prescribes fluconazole 200 mg daily for oropharyngeal candidiasis.
What is the most likely consequence of this combination?
A. Fluconazole has no clinically significant interaction with warfarin
B. The interaction only matters with intravenous fluconazole
C. The INR will decrease, increasing thrombotic risk
D. The INR will increase due to inhibition of warfarin metabolism
Correct Answer: D
Fluconazole is a potent inhibitor of CYP2C9 (with additional 3A4 effects) and decreases the hepatic metabolism of the more
potent S-warfarin enantiomer, producing a predictable rise in INR and bleeding risk within days of combination.
Recommended actions include more frequent INR monitoring and empiric warfarin dose reduction when the azole course is
prolonged. Rifampin, not fluconazole, induces metabolism and would lower INR, and the interaction is dose- and
route-independent because oral fluconazole achieves the same hepatic enzyme exposure.
8. A 34-year-old woman is newly diagnosed with HIV infection. Her CD4 count is 310
cells/mm3 and her viral load is 88,000 copies/mL. Which statement reflects current
antiretroviral therapy standards?
4
