NUR 257 / NR 566 Final Examination
Advanced Pharmacology - Care of the Family
Comprehensive Review 2026: Units 9-12 / Weeks
1-8
Instructions: Select the best answer for each question. Detailed
rationales are provided to reinforce key pharmacologic concepts
essential for family practice.
SECTION I: INFECTIOUS DISEASE & ANTIMICROBIAL THERAPY
1. A 24-year-old female comes to the clinic with complaints of
lower abdominal pain for the past three days. She reports some
spotting between periods and pain during intercourse. Her
temperature is 100.4°F, and on exam you note cervical motion
tenderness and adnexal tenderness. You diagnose Pelvic
Inflammatory Disease (PID). According to current CDC guidelines,
which outpatient regimen would you prescribe?
A. Ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 10-
14 days, with or without metronidazole 500 mg BID for 14 days
B. Azithromycin 2 grams PO once plus metronidazole 500 mg BID
for 7 days
,C. Ofloxacin 400 mg PO BID for 14 days as monotherapy
D. Cefixime 400 mg PO once plus azithromycin 1 gram PO once
Answer: A
Rationale: The CDC recommends IM ceftriaxone plus oral
doxycycline for 14 days as the backbone of outpatient PID
treatment. Metronidazole is added to cover anaerobes, particularly
if BV is suspected. This regimen covers N. gonorrhoeae, C.
trachomatis, and anaerobes. Option B is incorrect—azithromycin
is not first-line for PID. Option C (fluoroquinolone monotherapy)
is no longer recommended due to resistance. Option D is
inadequate for PID treatment duration.
2. A 32-year-old man presents with a three-day history of urethral
discharge and dysuria. A Gram stain reveals Gram-negative
intracellular diplococci. You plan to treat for gonorrhea. Besides
treating the patient, what else must you do?
A. Prescribe azithromycin 1 gram PO once for the patient only
B. Treat the patient with ceftriaxone 500 mg IM plus doxycycline
100 mg BID for 7 days, and initiate partner notification and
treatment
,C. Obtain a urine pregnancy test
D. Prescribe fluconazole 150 mg PO once for possible co-infection
Answer: B
Rationale: Current guidelines require dual therapy for gonorrhea:
ceftriaxone IM plus doxycycline for 7 days to cover frequent co-
infection with chlamydia. Partner treatment and notification are
essential to prevent reinfection and community spread.
Azithromycin is no longer recommended as the second agent—
doxycycline is now preferred. Pregnancy testing is not immediately
relevant here. Fluconazole treats yeast, not relevant to this
presentation.
3. A 19-year-old female is diagnosed with bacterial vaginosis (BV)
based on Amsel criteria. She is not pregnant and has no drug
allergies. She asks for the "most effective" treatment. Which
regimen would you select?
A. Metronidazole 2 grams PO once
B. Metronidazole 500 mg PO BID for 7 days
C. Clindamycin 2% vaginal cream once daily for 7 days
D. Tinidazole 1 gram PO daily for 5 days
, Answer: B
Rationale: While multiple regimens exist for BV, oral
metronidazole 500 mg BID for 7 days has the highest cure rate and
is considered first-line. The single 2-gram dose (option A) has
lower efficacy. Topical clindamycin (option C) is effective but may
be less convenient and can weaken latex condoms. Tinidazole
(option D) is an alternative but not first-line.
Clinical Pearl: Tell patients to avoid alcohol during treatment and
for 48-72 hours after completing metronidazole to prevent
disulfiram-like reactions.
4. A 28-year-old pregnant woman at 32 weeks gestation presents
with a malodorous vaginal discharge. Wet mount shows clue cells
and a positive whiff test. She is diagnosed with BV. Which
statement is correct regarding treatment during pregnancy?
A. Treatment is optional since BV often resolves spontaneously
B. Oral metronidazole is safe and recommended for symptomatic
pregnant women
C. Doxycycline is the preferred agent in pregnancy
D. Topical clindamycin is preferred over oral therapy in the third
trimester
Advanced Pharmacology - Care of the Family
Comprehensive Review 2026: Units 9-12 / Weeks
1-8
Instructions: Select the best answer for each question. Detailed
rationales are provided to reinforce key pharmacologic concepts
essential for family practice.
SECTION I: INFECTIOUS DISEASE & ANTIMICROBIAL THERAPY
1. A 24-year-old female comes to the clinic with complaints of
lower abdominal pain for the past three days. She reports some
spotting between periods and pain during intercourse. Her
temperature is 100.4°F, and on exam you note cervical motion
tenderness and adnexal tenderness. You diagnose Pelvic
Inflammatory Disease (PID). According to current CDC guidelines,
which outpatient regimen would you prescribe?
A. Ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 10-
14 days, with or without metronidazole 500 mg BID for 14 days
B. Azithromycin 2 grams PO once plus metronidazole 500 mg BID
for 7 days
,C. Ofloxacin 400 mg PO BID for 14 days as monotherapy
D. Cefixime 400 mg PO once plus azithromycin 1 gram PO once
Answer: A
Rationale: The CDC recommends IM ceftriaxone plus oral
doxycycline for 14 days as the backbone of outpatient PID
treatment. Metronidazole is added to cover anaerobes, particularly
if BV is suspected. This regimen covers N. gonorrhoeae, C.
trachomatis, and anaerobes. Option B is incorrect—azithromycin
is not first-line for PID. Option C (fluoroquinolone monotherapy)
is no longer recommended due to resistance. Option D is
inadequate for PID treatment duration.
2. A 32-year-old man presents with a three-day history of urethral
discharge and dysuria. A Gram stain reveals Gram-negative
intracellular diplococci. You plan to treat for gonorrhea. Besides
treating the patient, what else must you do?
A. Prescribe azithromycin 1 gram PO once for the patient only
B. Treat the patient with ceftriaxone 500 mg IM plus doxycycline
100 mg BID for 7 days, and initiate partner notification and
treatment
,C. Obtain a urine pregnancy test
D. Prescribe fluconazole 150 mg PO once for possible co-infection
Answer: B
Rationale: Current guidelines require dual therapy for gonorrhea:
ceftriaxone IM plus doxycycline for 7 days to cover frequent co-
infection with chlamydia. Partner treatment and notification are
essential to prevent reinfection and community spread.
Azithromycin is no longer recommended as the second agent—
doxycycline is now preferred. Pregnancy testing is not immediately
relevant here. Fluconazole treats yeast, not relevant to this
presentation.
3. A 19-year-old female is diagnosed with bacterial vaginosis (BV)
based on Amsel criteria. She is not pregnant and has no drug
allergies. She asks for the "most effective" treatment. Which
regimen would you select?
A. Metronidazole 2 grams PO once
B. Metronidazole 500 mg PO BID for 7 days
C. Clindamycin 2% vaginal cream once daily for 7 days
D. Tinidazole 1 gram PO daily for 5 days
, Answer: B
Rationale: While multiple regimens exist for BV, oral
metronidazole 500 mg BID for 7 days has the highest cure rate and
is considered first-line. The single 2-gram dose (option A) has
lower efficacy. Topical clindamycin (option C) is effective but may
be less convenient and can weaken latex condoms. Tinidazole
(option D) is an alternative but not first-line.
Clinical Pearl: Tell patients to avoid alcohol during treatment and
for 48-72 hours after completing metronidazole to prevent
disulfiram-like reactions.
4. A 28-year-old pregnant woman at 32 weeks gestation presents
with a malodorous vaginal discharge. Wet mount shows clue cells
and a positive whiff test. She is diagnosed with BV. Which
statement is correct regarding treatment during pregnancy?
A. Treatment is optional since BV often resolves spontaneously
B. Oral metronidazole is safe and recommended for symptomatic
pregnant women
C. Doxycycline is the preferred agent in pregnancy
D. Topical clindamycin is preferred over oral therapy in the third
trimester
