NUR 2407 Pharmacology Exam 2
2026/2027| Verified Q&A with Rationales
Rasmussen University
100% Correct | Grade A | Pass Guaranteed - A+ Graded
Section 1: Antibacterial Medications (Questions 1-15)
Q1: A patient is prescribed vancomycin for MRSA pneumonia. Which laboratory finding requires the
most immediate nursing intervention?
A. Vancomycin trough 8 mcg/mL
B. Serum creatinine increased from 0.8 to 1.8 mg/dL
C. White blood cell count 12,000/mm³
D. Hemoglobin 12 g/dL
Correct Answer: B
Rationale: [CORRECT] Vancomycin is nephrotoxic; a doubling of serum creatinine indicates acute
kidney injury requiring immediate dose adjustment or discontinuation and provider notification. Option A
is incorrect because a trough of 8 mcg/mL is below the therapeutic range (10-20 mcg/mL) but is not an
immediate safety threat compared to acute kidney injury. Option C is incorrect because an elevated WBC
is an expected finding in a patient with pneumonia. Option D is incorrect because a hemoglobin of 12
g/dL is a mild, non-urgent finding.
Q2: Which of the following are true regarding cephalosporin antibiotics? (Select all that apply)
A. First-generation cephalosporins are primarily effective against gram-positive bacteria.
B. There is approximately a 10% cross-reactivity between penicillins and cephalosporins.
C. Ceftriaxone should never be mixed with calcium-containing IV solutions due to the risk of precipitate
formation.
D. Cefotetan can cause a disulfiram-like reaction when mixed with alcohol.
E. Fourth-generation cephalosporins have decreased gram-negative coverage compared to first-
generation.
Correct Answer: A, B, C, D
,Rationale: [CORRECT] First-generation cephalosporins (e.g., cephalexin) target gram-positives. Cross-
reactivity with penicillins is around 10%. Ceftriaxone and calcium form a lethal precipitate in neonates.
Cefotetan and cefoperazone block aldehyde dehydrogenase, causing a disulfiram-like reaction. Option E
is incorrect because higher generations have increased gram-negative coverage.
Q3: A patient is taking simvastatin, a CYP3A4 substrate, and the provider prescribes clarithromycin for
pneumonia. What is the primary concern with this drug interaction?
A. Decreased effectiveness of the antibiotic leading to treatment failure
B. Increased risk of statin-induced myopathy and rhabdomyolysis
C. Increased risk of QT prolongation and torsades de pointes
D. Decreased statin levels leading to hyperlipidemia
Correct Answer: B
Rationale: [CORRECT] Macrolides like clarithromycin are strong CYP3A4 inhibitors. Inhibiting the
metabolism of simvastatin leads to drastically elevated statin levels, increasing the risk of severe muscle
toxicity (myopathy/rhabdomyolysis). Option A is incorrect because the interaction does not significantly
decrease antibiotic effectiveness. Option C is incorrect because while macrolides can prolong the QT
interval, the specific, classic interaction highlighted with statins is myopathy. Option D is incorrect
because the levels of the statin will increase, not decrease.
Q4: A patient with a severe gram-negative infection is receiving gentamicin. Which nursing intervention
is most critical to prevent adverse effects?
A. Monitoring serum peak and trough levels
B. Administering the medication over 5 minutes IV push
C. Encouraging high-calcium foods to prevent neuromuscular blockade
D. Assessing for severe watery diarrhea
Correct Answer: A
Rationale: [CORRECT] Aminoglycosides have a narrow therapeutic index and cause nephrotoxicity and
ototoxicity. Monitoring peak and trough levels ensures the drug is effective while preventing toxic
accumulation. Option B is incorrect because aminoglycosides must be infused over 30-60 minutes; rapid
infusion increases the risk of neuromuscular blockade. Option C is incorrect because calcium is used to
treat neuromuscular blockade if it occurs, but high-calcium foods do not prevent it; hydration is the
preventative measure. Option D is incorrect because watery diarrhea is associated with clindamycin, not
aminoglycosides.
Q5: Which of the following are adverse effects of fluoroquinolones (e.g., ciprofloxacin)? (Select all that
apply)
, A. Tendonitis and tendon rupture
B. QT prolongation
C. Cartilage damage in pediatric patients
D. Severe photosensitivity
E. Gray baby syndrome
Correct Answer: A, B, C, D
Rationale: [CORRECT] Fluoroquinolones carry black box warnings for tendon rupture and are
contraindicated in children due to cartilage damage. They also prolong the QT interval and cause
photosensitivity. Option E is incorrect because gray baby syndrome is associated with chloramphenicol.
Q6: A patient with HIV is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis
jirovecii pneumonia (PJP). Which of the following are adverse effects of this medication? (Select all that
apply)
A. Stevens-Johnson syndrome (SJS)
B. Crystalluria
C. Hyperkalemia
D. Kernicterus in neonates
E. Red man syndrome
Correct Answer: A, B, C, D
Rationale: [CORRECT] TMP-SMX can cause severe skin reactions (SJS), crystal formation in the urine
(requiring hydration), hyperkalemia (because TMP acts like a potassium-sparing diuretic), and kernicterus
in neonates due to displacement of bilirubin from albumin. Option E is incorrect because Red Man
Syndrome is an infusion-related histamine reaction associated with vancomycin.
Q7: The nurse is providing discharge teaching to a patient prescribed doxycycline. Which statements
should the nurse include? (Select all that apply)
A. "Take this medication with a full glass of water and remain upright for 30 minutes."
B. "Avoid direct sunlight and wear protective clothing when outdoors."
C. "This medication is safe to take if you are pregnant."
D. "Do not take this medication with dairy products or antacids."
E. "Do not give this medication to children under 8 years old."
Correct Answer: A, B, D, E
2026/2027| Verified Q&A with Rationales
Rasmussen University
100% Correct | Grade A | Pass Guaranteed - A+ Graded
Section 1: Antibacterial Medications (Questions 1-15)
Q1: A patient is prescribed vancomycin for MRSA pneumonia. Which laboratory finding requires the
most immediate nursing intervention?
A. Vancomycin trough 8 mcg/mL
B. Serum creatinine increased from 0.8 to 1.8 mg/dL
C. White blood cell count 12,000/mm³
D. Hemoglobin 12 g/dL
Correct Answer: B
Rationale: [CORRECT] Vancomycin is nephrotoxic; a doubling of serum creatinine indicates acute
kidney injury requiring immediate dose adjustment or discontinuation and provider notification. Option A
is incorrect because a trough of 8 mcg/mL is below the therapeutic range (10-20 mcg/mL) but is not an
immediate safety threat compared to acute kidney injury. Option C is incorrect because an elevated WBC
is an expected finding in a patient with pneumonia. Option D is incorrect because a hemoglobin of 12
g/dL is a mild, non-urgent finding.
Q2: Which of the following are true regarding cephalosporin antibiotics? (Select all that apply)
A. First-generation cephalosporins are primarily effective against gram-positive bacteria.
B. There is approximately a 10% cross-reactivity between penicillins and cephalosporins.
C. Ceftriaxone should never be mixed with calcium-containing IV solutions due to the risk of precipitate
formation.
D. Cefotetan can cause a disulfiram-like reaction when mixed with alcohol.
E. Fourth-generation cephalosporins have decreased gram-negative coverage compared to first-
generation.
Correct Answer: A, B, C, D
,Rationale: [CORRECT] First-generation cephalosporins (e.g., cephalexin) target gram-positives. Cross-
reactivity with penicillins is around 10%. Ceftriaxone and calcium form a lethal precipitate in neonates.
Cefotetan and cefoperazone block aldehyde dehydrogenase, causing a disulfiram-like reaction. Option E
is incorrect because higher generations have increased gram-negative coverage.
Q3: A patient is taking simvastatin, a CYP3A4 substrate, and the provider prescribes clarithromycin for
pneumonia. What is the primary concern with this drug interaction?
A. Decreased effectiveness of the antibiotic leading to treatment failure
B. Increased risk of statin-induced myopathy and rhabdomyolysis
C. Increased risk of QT prolongation and torsades de pointes
D. Decreased statin levels leading to hyperlipidemia
Correct Answer: B
Rationale: [CORRECT] Macrolides like clarithromycin are strong CYP3A4 inhibitors. Inhibiting the
metabolism of simvastatin leads to drastically elevated statin levels, increasing the risk of severe muscle
toxicity (myopathy/rhabdomyolysis). Option A is incorrect because the interaction does not significantly
decrease antibiotic effectiveness. Option C is incorrect because while macrolides can prolong the QT
interval, the specific, classic interaction highlighted with statins is myopathy. Option D is incorrect
because the levels of the statin will increase, not decrease.
Q4: A patient with a severe gram-negative infection is receiving gentamicin. Which nursing intervention
is most critical to prevent adverse effects?
A. Monitoring serum peak and trough levels
B. Administering the medication over 5 minutes IV push
C. Encouraging high-calcium foods to prevent neuromuscular blockade
D. Assessing for severe watery diarrhea
Correct Answer: A
Rationale: [CORRECT] Aminoglycosides have a narrow therapeutic index and cause nephrotoxicity and
ototoxicity. Monitoring peak and trough levels ensures the drug is effective while preventing toxic
accumulation. Option B is incorrect because aminoglycosides must be infused over 30-60 minutes; rapid
infusion increases the risk of neuromuscular blockade. Option C is incorrect because calcium is used to
treat neuromuscular blockade if it occurs, but high-calcium foods do not prevent it; hydration is the
preventative measure. Option D is incorrect because watery diarrhea is associated with clindamycin, not
aminoglycosides.
Q5: Which of the following are adverse effects of fluoroquinolones (e.g., ciprofloxacin)? (Select all that
apply)
, A. Tendonitis and tendon rupture
B. QT prolongation
C. Cartilage damage in pediatric patients
D. Severe photosensitivity
E. Gray baby syndrome
Correct Answer: A, B, C, D
Rationale: [CORRECT] Fluoroquinolones carry black box warnings for tendon rupture and are
contraindicated in children due to cartilage damage. They also prolong the QT interval and cause
photosensitivity. Option E is incorrect because gray baby syndrome is associated with chloramphenicol.
Q6: A patient with HIV is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis
jirovecii pneumonia (PJP). Which of the following are adverse effects of this medication? (Select all that
apply)
A. Stevens-Johnson syndrome (SJS)
B. Crystalluria
C. Hyperkalemia
D. Kernicterus in neonates
E. Red man syndrome
Correct Answer: A, B, C, D
Rationale: [CORRECT] TMP-SMX can cause severe skin reactions (SJS), crystal formation in the urine
(requiring hydration), hyperkalemia (because TMP acts like a potassium-sparing diuretic), and kernicterus
in neonates due to displacement of bilirubin from albumin. Option E is incorrect because Red Man
Syndrome is an infusion-related histamine reaction associated with vancomycin.
Q7: The nurse is providing discharge teaching to a patient prescribed doxycycline. Which statements
should the nurse include? (Select all that apply)
A. "Take this medication with a full glass of water and remain upright for 30 minutes."
B. "Avoid direct sunlight and wear protective clothing when outdoors."
C. "This medication is safe to take if you are pregnant."
D. "Do not take this medication with dairy products or antacids."
E. "Do not give this medication to children under 8 years old."
Correct Answer: A, B, D, E
