WILKES UNIVERSITY | GRADUATE NURSING | ADVANCED PRACTICE EDUCATION
NSG533 / NSG 533 Exam 3 (Latest )
Advanced Pharmacology
Questions and Verified Answers | 100% Correct | Grade A - Wilkes
Aligned with the Wilkes University NSG 533 Course Syllabus, the AACN Essentials of Master's Education, and Advanced
Pharmacology Competencies (2026/2027 Edition)
100 Questions | Six Sections | Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | 75% Scenario-Based, 25%
Direct Knowledge
The correct option for each question is marked [CORRECT]; a verified rationale referencing NSG 533 curriculum concepts
and advanced pharmacology principles follows every answer.
Section 1: Anti-infective Pharmacology (Questions 1-20)
Q1: A 54-year-old adult presents with community-acquired pneumonia requiring oral antibiotic
therapy. The medication history documents a remote anaphylactic reaction to amoxicillin
(generalized urticaria and laryngeal edema). Which prescription is the most appropriate initial
choice?
A. Amoxicillin-clavulanate 875/125 mg twice daily
B. Cefuroxime 500 mg twice daily without further allergy assessment
C. Ceftriaxone 1 g daily, since cephalosporins never cross-react with penicillins
D. Azithromycin 500 mg on day 1, then 250 mg daily, with referral for formal penicillin allergy
evaluation [CORRECT]
Correct Answer: D
Rationale: With a documented IgE-mediated anaphylactic reaction to a penicillin, NSG 533 antimicrobial
principles direct the APRN to avoid re-challenging with penicillins and to use caution with cephalosporins,
because cross-reactivity (about 1-2 percent, highest with shared R-1 side chains) can be life-threatening.
Azithromycin covers the common atypical pathogens of community-acquired pneumonia while carrying no
beta-lactam cross-reactivity risk. Options A and B re-expose the patient to beta-lactams, and option C states a
myth that contradicts the cross-reactivity concepts taught in advanced pharmacology.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 1
,NSG533 / NSG 533 Exam 3 (Latest ) | Advanced Pharmacology | Questions and Verified Answers
Q2: A 68-year-old adult with MRSA bacteremia has been receiving IV vancomycin for 48 hours.
Which monitoring plan reflects current advanced pharmacology standards?
A. Obtain a random serum vancomycin level once weekly and a peak level 30 minutes after each
infusion
B. Monitor trough concentrations only after the entire course is completed
C. Use AUC24/MIC-guided dosing targeting 400-600 mg*h/L, with serum creatinine and levels
assessed near steady state and at least daily early in therapy [CORRECT]
D. Rely on urinalysis alone to detect nephrotoxicity
Correct Answer: C
Rationale: Current consensus guidelines, reflected in the NSG 533 curriculum, replaced trough-only targets
with AUC24/MIC-guided dosing of 400-600 mg*h/L for serious MRSA infections, paired with close serum
creatinine surveillance. Peak levels are not routinely monitored because they correlate poorly with efficacy and
toxicity, and delayed or urine-only monitoring would miss evolving nephrotoxicity. This reflects the AACN
Essentials competency of using advanced assessment data to individualize drug therapy.
Q3: A 71-year-old adult with a creatinine clearance of 38 mL/min is receiving gentamicin for
enterococcal pyelonephritis. On day 4 the patient reports new tinnitus, a sensation of
room-spinning, and unsteadiness while walking. What is the nurse practitioner's best action?
A. Reassure the patient that vestibular symptoms are transient and expected
B. Notify the prescriber to discontinue gentamicin, obtain a pre-dose (trough) level, and request
audiologic and vestibular assessment [CORRECT]
C. Add furosemide to accelerate gentamicin clearance
D. Continue the full course unchanged and re-evaluate at follow-up in 2 weeks
Correct Answer: B
Rationale: Aminoglycoside ototoxicity is dose-related and frequently irreversible, and risk rises sharply with
advanced age and reduced renal clearance, so new vestibular or cochlear symptoms demand immediate drug
discontinuation and objective assessment. Trough (pre-dose) levels best predict accumulation and toxicity.
Furosemide would compound ototoxicity because loop diuretics act synergistically with aminoglycosides on the
inner ear, and delayed re-evaluation ignores a serious adverse drug event requiring prompt action under
medication-safety standards.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 2
,NSG533 / NSG 533 Exam 3 (Latest ) | Advanced Pharmacology | Questions and Verified Answers
Q4: A 77-year-old adult with a COPD exacerbation is prescribed levofloxacin. The history
includes a 6 cm abdominal aortic aneurysm and chronic prednisone 10 mg daily. Which counseling
point takes highest priority?
A. Stop the drug and call the clinic immediately for new heel, calf, shoulder, or neck pain or
swelling, and report any sudden chest, back, or abdominal pain [CORRECT]
B. Take the tablet with milk or an antacid to prevent stomach upset
C. Expect harmless orange discoloration of the urine
D. Take an extra levofloxacin dose if wheezing worsens
Correct Answer: A
Rationale: Fluoroquinolones carry boxed warnings for tendinitis and tendon rupture and for aortic aneurysm
and dissection; age over 60 years and concurrent corticosteroids are the strongest potentiating factors, making
early symptom recognition the top safety priority. Dairy products and antacids chelate fluoroquinolones and
reduce absorption, orange urine is associated with rifampin rather than levofloxacin, and antibiotics are never
self-titrated, consistent with NSG 533 patient-education competencies.
Q5: A 59-year-old woman with pneumonia has a history of congenital long QT syndrome and
takes flecainide for paroxysmal atrial fibrillation. Which antibiotic should the APRN avoid
because it would add the greatest risk of torsades de pointes?
A. Cephalexin
B. Amoxicillin
C. Doxycycline
D. Azithromycin [CORRECT]
Correct Answer: D
Rationale: Macrolides such as azithromycin block cardiac delayed-rectifier potassium channels, prolong
repolarization, and can precipitate torsades de pointes, an effect that is synergistic with the patient's underlying
long QT syndrome. Beta-lactams such as cephalexin and amoxicillin and the tetracycline doxycycline have
minimal QT-prolonging potential. This analysis-level item applies electrophysiologic drug mechanisms from the
NSG 533 anti-infective module to a high-risk cardiac substrate, a hallmark AACN Essentials application
competency.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 3
, NSG533 / NSG 533 Exam 3 (Latest ) | Advanced Pharmacology | Questions and Verified Answers
Q6: A 22-year-old woman starting doxycycline 100 mg twice daily for acne vulgaris states she
usually takes medications at bedtime with a glass of milk. Which teaching is most appropriate?
A. Take doxycycline with milk and an antacid to protect the stomach
B. Swallow the capsule with a full glass of water, remain upright for at least 30 minutes, avoid
dairy, iron, and antacids within 2 hours, and apply daily sunscreen [CORRECT]
C. Discontinue the drug as soon as the skin improves, usually within 1 week
D. Doxycycline is the tetracycline of choice during pregnancy
Correct Answer: B
Rationale: Doxycycline can cause pill-induced esophagitis and photosensitivity, and divalent and trivalent
cations (calcium, iron, magnesium, aluminum) chelate tetracyclines and sharply reduce absorption, so hydration,
upright posture, timing separation, and sun protection are core counseling points. Stopping early promotes
resistance and relapse, and tetracyclines are avoided in pregnancy and in children under 8 years because they
discolor teeth and impair bone growth, a classic NSG 533 high-alert teaching point.
Q7: A 44-year-old woman is prescribed oral metronidazole 500 mg twice daily for bacterial
vaginosis and tells the nurse practitioner that she drinks two glasses of wine on weekends. Which
instruction is essential?
A. Wine has no interaction as long as the dose is taken in the morning
B. Only intravenous metronidazole interacts with alcohol
C. Avoid all alcohol during therapy and for at least 3 days after the last dose because of a possible
disulfiram-like reaction with flushing, vomiting, and tachycardia [CORRECT]
D. Consume extra tyramine-containing foods to prevent hypotension
Correct Answer: C
Rationale: Metronidazole inhibits aldehyde dehydrogenase, producing a classic disulfiram-like reaction when
alcohol is ingested during treatment and for about 3 days afterward, so abstinence counseling is mandatory and
appears on the NSG 533 patient-education blueprint. The reaction is not route-specific, tyramine is the concern
with MAO inhibitors rather than metronidazole, and minimizing the interaction does not depend on the time of
day the dose is taken.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 4
NSG533 / NSG 533 Exam 3 (Latest )
Advanced Pharmacology
Questions and Verified Answers | 100% Correct | Grade A - Wilkes
Aligned with the Wilkes University NSG 533 Course Syllabus, the AACN Essentials of Master's Education, and Advanced
Pharmacology Competencies (2026/2027 Edition)
100 Questions | Six Sections | Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | 75% Scenario-Based, 25%
Direct Knowledge
The correct option for each question is marked [CORRECT]; a verified rationale referencing NSG 533 curriculum concepts
and advanced pharmacology principles follows every answer.
Section 1: Anti-infective Pharmacology (Questions 1-20)
Q1: A 54-year-old adult presents with community-acquired pneumonia requiring oral antibiotic
therapy. The medication history documents a remote anaphylactic reaction to amoxicillin
(generalized urticaria and laryngeal edema). Which prescription is the most appropriate initial
choice?
A. Amoxicillin-clavulanate 875/125 mg twice daily
B. Cefuroxime 500 mg twice daily without further allergy assessment
C. Ceftriaxone 1 g daily, since cephalosporins never cross-react with penicillins
D. Azithromycin 500 mg on day 1, then 250 mg daily, with referral for formal penicillin allergy
evaluation [CORRECT]
Correct Answer: D
Rationale: With a documented IgE-mediated anaphylactic reaction to a penicillin, NSG 533 antimicrobial
principles direct the APRN to avoid re-challenging with penicillins and to use caution with cephalosporins,
because cross-reactivity (about 1-2 percent, highest with shared R-1 side chains) can be life-threatening.
Azithromycin covers the common atypical pathogens of community-acquired pneumonia while carrying no
beta-lactam cross-reactivity risk. Options A and B re-expose the patient to beta-lactams, and option C states a
myth that contradicts the cross-reactivity concepts taught in advanced pharmacology.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 1
,NSG533 / NSG 533 Exam 3 (Latest ) | Advanced Pharmacology | Questions and Verified Answers
Q2: A 68-year-old adult with MRSA bacteremia has been receiving IV vancomycin for 48 hours.
Which monitoring plan reflects current advanced pharmacology standards?
A. Obtain a random serum vancomycin level once weekly and a peak level 30 minutes after each
infusion
B. Monitor trough concentrations only after the entire course is completed
C. Use AUC24/MIC-guided dosing targeting 400-600 mg*h/L, with serum creatinine and levels
assessed near steady state and at least daily early in therapy [CORRECT]
D. Rely on urinalysis alone to detect nephrotoxicity
Correct Answer: C
Rationale: Current consensus guidelines, reflected in the NSG 533 curriculum, replaced trough-only targets
with AUC24/MIC-guided dosing of 400-600 mg*h/L for serious MRSA infections, paired with close serum
creatinine surveillance. Peak levels are not routinely monitored because they correlate poorly with efficacy and
toxicity, and delayed or urine-only monitoring would miss evolving nephrotoxicity. This reflects the AACN
Essentials competency of using advanced assessment data to individualize drug therapy.
Q3: A 71-year-old adult with a creatinine clearance of 38 mL/min is receiving gentamicin for
enterococcal pyelonephritis. On day 4 the patient reports new tinnitus, a sensation of
room-spinning, and unsteadiness while walking. What is the nurse practitioner's best action?
A. Reassure the patient that vestibular symptoms are transient and expected
B. Notify the prescriber to discontinue gentamicin, obtain a pre-dose (trough) level, and request
audiologic and vestibular assessment [CORRECT]
C. Add furosemide to accelerate gentamicin clearance
D. Continue the full course unchanged and re-evaluate at follow-up in 2 weeks
Correct Answer: B
Rationale: Aminoglycoside ototoxicity is dose-related and frequently irreversible, and risk rises sharply with
advanced age and reduced renal clearance, so new vestibular or cochlear symptoms demand immediate drug
discontinuation and objective assessment. Trough (pre-dose) levels best predict accumulation and toxicity.
Furosemide would compound ototoxicity because loop diuretics act synergistically with aminoglycosides on the
inner ear, and delayed re-evaluation ignores a serious adverse drug event requiring prompt action under
medication-safety standards.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 2
,NSG533 / NSG 533 Exam 3 (Latest ) | Advanced Pharmacology | Questions and Verified Answers
Q4: A 77-year-old adult with a COPD exacerbation is prescribed levofloxacin. The history
includes a 6 cm abdominal aortic aneurysm and chronic prednisone 10 mg daily. Which counseling
point takes highest priority?
A. Stop the drug and call the clinic immediately for new heel, calf, shoulder, or neck pain or
swelling, and report any sudden chest, back, or abdominal pain [CORRECT]
B. Take the tablet with milk or an antacid to prevent stomach upset
C. Expect harmless orange discoloration of the urine
D. Take an extra levofloxacin dose if wheezing worsens
Correct Answer: A
Rationale: Fluoroquinolones carry boxed warnings for tendinitis and tendon rupture and for aortic aneurysm
and dissection; age over 60 years and concurrent corticosteroids are the strongest potentiating factors, making
early symptom recognition the top safety priority. Dairy products and antacids chelate fluoroquinolones and
reduce absorption, orange urine is associated with rifampin rather than levofloxacin, and antibiotics are never
self-titrated, consistent with NSG 533 patient-education competencies.
Q5: A 59-year-old woman with pneumonia has a history of congenital long QT syndrome and
takes flecainide for paroxysmal atrial fibrillation. Which antibiotic should the APRN avoid
because it would add the greatest risk of torsades de pointes?
A. Cephalexin
B. Amoxicillin
C. Doxycycline
D. Azithromycin [CORRECT]
Correct Answer: D
Rationale: Macrolides such as azithromycin block cardiac delayed-rectifier potassium channels, prolong
repolarization, and can precipitate torsades de pointes, an effect that is synergistic with the patient's underlying
long QT syndrome. Beta-lactams such as cephalexin and amoxicillin and the tetracycline doxycycline have
minimal QT-prolonging potential. This analysis-level item applies electrophysiologic drug mechanisms from the
NSG 533 anti-infective module to a high-risk cardiac substrate, a hallmark AACN Essentials application
competency.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 3
, NSG533 / NSG 533 Exam 3 (Latest ) | Advanced Pharmacology | Questions and Verified Answers
Q6: A 22-year-old woman starting doxycycline 100 mg twice daily for acne vulgaris states she
usually takes medications at bedtime with a glass of milk. Which teaching is most appropriate?
A. Take doxycycline with milk and an antacid to protect the stomach
B. Swallow the capsule with a full glass of water, remain upright for at least 30 minutes, avoid
dairy, iron, and antacids within 2 hours, and apply daily sunscreen [CORRECT]
C. Discontinue the drug as soon as the skin improves, usually within 1 week
D. Doxycycline is the tetracycline of choice during pregnancy
Correct Answer: B
Rationale: Doxycycline can cause pill-induced esophagitis and photosensitivity, and divalent and trivalent
cations (calcium, iron, magnesium, aluminum) chelate tetracyclines and sharply reduce absorption, so hydration,
upright posture, timing separation, and sun protection are core counseling points. Stopping early promotes
resistance and relapse, and tetracyclines are avoided in pregnancy and in children under 8 years because they
discolor teeth and impair bone growth, a classic NSG 533 high-alert teaching point.
Q7: A 44-year-old woman is prescribed oral metronidazole 500 mg twice daily for bacterial
vaginosis and tells the nurse practitioner that she drinks two glasses of wine on weekends. Which
instruction is essential?
A. Wine has no interaction as long as the dose is taken in the morning
B. Only intravenous metronidazole interacts with alcohol
C. Avoid all alcohol during therapy and for at least 3 days after the last dose because of a possible
disulfiram-like reaction with flushing, vomiting, and tachycardia [CORRECT]
D. Consume extra tyramine-containing foods to prevent hypotension
Correct Answer: C
Rationale: Metronidazole inhibits aldehyde dehydrogenase, producing a classic disulfiram-like reaction when
alcohol is ingested during treatment and for about 3 days afterward, so abstinence counseling is mandatory and
appears on the NSG 533 patient-education blueprint. The reaction is not route-specific, tyramine is the concern
with MAO inhibitors rather than metronidazole, and minimizing the interaction does not depend on the time of
day the dose is taken.
Wilkes University | NSG 533 Advanced Pharmacology | Exam 3 (2026/2027) 4
