BSN 315 Pharmacology HESI V5 — COMPREHENSIVE
EXAM QUESTIONS AND ANSWERS|NEW 2026-2027
UPDATE
Question 1
A patient with community-acquired pneumonia (CAP) is prescribed amoxicillin-
clavulanate 875/125 mg BID. The nurse understands that clavulanate is added to
amoxicillin to:
A. Increase the spectrum to cover Pseudomonas aeruginosa
B. Inhibit beta-lactamase enzymes produced by bacteria, protecting amoxicillin from
destruction
C. Reduce the risk of allergic reactions
D. Enhance absorption from the GI tract
Correct Answer: B
Rationale: Clavulanate is a beta-lactamase inhibitor that protects amoxicillin from
destruction by bacterial beta-lactamase enzymes (produced by H. influenzae, M.
catarrhalis, and some S. aureus). This extends the spectrum of amoxicillin. It does
NOT cover Pseudomonas, reduce allergy risk, or enhance absorption.
Question 2
A patient with a severe penicillin allergy (anaphylaxis) needs antibiotic therapy for
community-acquired pneumonia. Which antibiotic is MOST appropriate?
A. Amoxicillin
B. Azithromycin
C. Doxycycline or levofloxacin
D. Cefuroxime
Correct Answer: C
Rationale: For CAP with severe penicillin allergy (anaphylaxis), doxycycline or a
respiratory fluoroquinolone (levofloxacin, moxifloxacin) are recommended
, alternatives. Azithromycin monotherapy is NOT recommended due to high
pneumococcal resistance (>30% in many areas). Amoxicillin and cefuroxime are
contraindicated in anaphylactic penicillin allergy (approximately 10% cross-reactivity
with cephalosporins).
Question 3
A patient receiving vancomycin IV develops flushing, pruritus, and hypotension during
infusion. The nurse recognizes this as:
A. Anaphylactic allergy to vancomycin requiring permanent discontinuation
B. Red man syndrome — a rate-related histamine release reaction; slow the infusion
C. Septic shock from the underlying infection
D. Vancomycin-resistant organism colonization
Correct Answer: B
Rationale: Red man syndrome is a histamine-mediated infusion reaction to
vancomycin caused by rapid infusion. It is NOT a true IgE-mediated allergy.
Management: stop or slow the infusion, administer antihistamines
(diphenhydramine), and restart at a slower rate (infuse 1g over at least 60 minutes).
True vancomycin allergy (rare) causes urticaria, angioedema, or anaphylaxis.
Question 4
A patient with a complicated UTI is prescribed ciprofloxacin 500 mg BID. The nurse
should instruct the patient to:
A. Take with dairy products to reduce stomach upset
B. Take with a full glass of water and avoid antacids, dairy, and iron supplements
within 2 hours
C. Take at bedtime to improve absorption
D. Take with grapefruit juice to enhance efficacy
Correct Answer: B
EXAM QUESTIONS AND ANSWERS|NEW 2026-2027
UPDATE
Question 1
A patient with community-acquired pneumonia (CAP) is prescribed amoxicillin-
clavulanate 875/125 mg BID. The nurse understands that clavulanate is added to
amoxicillin to:
A. Increase the spectrum to cover Pseudomonas aeruginosa
B. Inhibit beta-lactamase enzymes produced by bacteria, protecting amoxicillin from
destruction
C. Reduce the risk of allergic reactions
D. Enhance absorption from the GI tract
Correct Answer: B
Rationale: Clavulanate is a beta-lactamase inhibitor that protects amoxicillin from
destruction by bacterial beta-lactamase enzymes (produced by H. influenzae, M.
catarrhalis, and some S. aureus). This extends the spectrum of amoxicillin. It does
NOT cover Pseudomonas, reduce allergy risk, or enhance absorption.
Question 2
A patient with a severe penicillin allergy (anaphylaxis) needs antibiotic therapy for
community-acquired pneumonia. Which antibiotic is MOST appropriate?
A. Amoxicillin
B. Azithromycin
C. Doxycycline or levofloxacin
D. Cefuroxime
Correct Answer: C
Rationale: For CAP with severe penicillin allergy (anaphylaxis), doxycycline or a
respiratory fluoroquinolone (levofloxacin, moxifloxacin) are recommended
, alternatives. Azithromycin monotherapy is NOT recommended due to high
pneumococcal resistance (>30% in many areas). Amoxicillin and cefuroxime are
contraindicated in anaphylactic penicillin allergy (approximately 10% cross-reactivity
with cephalosporins).
Question 3
A patient receiving vancomycin IV develops flushing, pruritus, and hypotension during
infusion. The nurse recognizes this as:
A. Anaphylactic allergy to vancomycin requiring permanent discontinuation
B. Red man syndrome — a rate-related histamine release reaction; slow the infusion
C. Septic shock from the underlying infection
D. Vancomycin-resistant organism colonization
Correct Answer: B
Rationale: Red man syndrome is a histamine-mediated infusion reaction to
vancomycin caused by rapid infusion. It is NOT a true IgE-mediated allergy.
Management: stop or slow the infusion, administer antihistamines
(diphenhydramine), and restart at a slower rate (infuse 1g over at least 60 minutes).
True vancomycin allergy (rare) causes urticaria, angioedema, or anaphylaxis.
Question 4
A patient with a complicated UTI is prescribed ciprofloxacin 500 mg BID. The nurse
should instruct the patient to:
A. Take with dairy products to reduce stomach upset
B. Take with a full glass of water and avoid antacids, dairy, and iron supplements
within 2 hours
C. Take at bedtime to improve absorption
D. Take with grapefruit juice to enhance efficacy
Correct Answer: B
