PHARMACOLOGY NURS 251 MODULE 6 EXAM 2026/2027
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Anti-infectives: Antibiotics (Questions 1-30)
Q1: A patient with a known severe penicillin allergy (anaphylaxis) is diagnosed with
Pseudomonas aeruginosa pneumonia. Which antibiotic is the safest choice for this patient?
A. Amoxicillin-clavulanate
B. Piperacillin-tazobactam
C. Aztreonam **[CORRECT]**
D. Imipenem-cilastatin
Correct Answer: C
Rationale: Aztreonam is a monobactam that inhibits cell wall synthesis (transpeptidase) and is
structurally distinct from penicillins, making it safe for patients with severe penicillin allergies
despite its beta-lactam ring. Amoxicillin, piperacillin, and imipenem are all beta-lactams with a
shared core structure that carry a significant cross-reactivity risk and are contraindicated.
Module 6 Exam Insight: Portage Learning heavily tests monobactams as the "get out of jail free"
card for penicillin-allergic patients needing gram-negative coverage.
Q2: A patient receiving intravenous piperacillin-tazobactam reports sudden onset of throat
tightness, dyspnea, and facial flushing. What is the nurse's priority action?
A. Administer diphenhydramine orally and reassess in 15 minutes
B. Stop the infusion immediately and prepare to administer epinephrine **[CORRECT]**
C. Slow the infusion rate and apply a warm compress to the face
D. Document the reaction and switch to an oral equivalent
Correct Answer: B
Rationale: These manifestations indicate anaphylaxis, a severe hypersensitivity reaction and
black box warning for all beta-lactams, requiring immediate cessation of the drug and
epinephrine to secure the airway and reverse hemodynamic instability. Slowing the rate or
giving oral diphenhydramine is inadequate for anaphylaxis, and switching to oral is dangerous
without stabilization. Module 6 Exam Insight: ABCnursing patterns consistently require
recognizing anaphylaxis as a rapid, life-threatening response needing epinephrine over
antihistamines alone.
,Q3: A nurse is reviewing the medication profile of a patient prescribed cefazolin for surgical
prophylaxis. Which patient history finding requires the most immediate clarification with the
prescribing provider?
A. Mild penicillin allergy manifesting as a maculopapular rash
B. Severe penicillin allergy with angioedema and bronchospasm **[CORRECT]**
C. Recent completion of oral metronidazole for bacterial vaginosis
D. History of mild, intermittent constipation
Correct Answer: B
Rationale: Cross-reactivity between penicillins and cephalosporins is approximately 1-3%, but
increases significantly in patients with a history of severe penicillin allergies (anaphylaxis),
making cefazolin relatively contraindicated without careful consideration. A mild rash does not
pose the same anaphylactic risk, recent metronidazole has no interaction, and constipation is
irrelevant. Module 6 Exam Insight: Geneva College exams focus heavily on the degree of
penicillin allergy (rash vs. anaphylaxis) dictating cephalosporin safety.
Q4: A patient is receiving ceftaroline for complicated skin and soft tissue infection caused by
MRSA. What is the mechanism of action of this fifth-generation cephalosporin?
A. Inhibition of protein synthesis at the 50S ribosome
B. Binding to penicillin-binding protein 2a (PBP2a) **[CORRECT]**
C. Inhibition of dihydrofolate reductase
D. Disruption of the bacterial cell membrane
Correct Answer: B
Rationale: Ceftaroline uniquely binds to PBP2a, the altered penicillin-binding protein that
confers methicillin resistance in MRSA, making it the only cephalosporin effective against
MRSA. Protein synthesis inhibition is the mechanism of macrolides, dihydrofolate reductase
inhibition is for trimethoprim, and cell membrane disruption is for polymyxins. Module 6 Exam
Insight: NURS 251 expects you to know that 5th-generation cephalosporins bridge the gap to
cover MRSA via PBP2a affinity.
Q5: A patient on meropenem therapy develops a temperature of 38.9°C (102°F), tachycardia,
and hypotension during the infusion. The nurse should prepare to administer which medication?
A. Naloxone
B. Protamine sulfate
C. Diphenhydramine and hydrocortisone **[CORRECT]**
D. Flumazenil
Correct Answer: C
Rationale: The patient is experiencing an infusion reaction, a known adverse effect of
carbapenems like meropenem, which is managed by stopping the infusion and administering
antihistamines and corticosteroids. Naloxone reverses opioids, protamine reverses heparin, and
flumazenil reverses benzodiazepines. Module 6 Exam Insight: Portage Learning tests
carbapenem infusion reactions alongside hypersensitivity, expecting you to differentiate them
from anaphylaxis and other drug-specific antidotes.
,Q6: A patient diagnosed with community-acquired pneumonia is prescribed azithromycin. The
nurse should assess the patient's medication profile for which potential critical interaction?
A. Warfarin, leading to decreased INR
B. Statins, leading to increased risk of rhabdomyolysis **[CORRECT]**
C. Metformin, leading to lactic acidosis
D. Lisinopril, leading to hyperkalemia
Correct Answer: B
Rationale: Azithromycin is a macrolide that inhibits CYP3A4, which can significantly increase
serum levels of statins metabolized by this pathway, raising the risk of rhabdomyolysis.
Macrolides increase warfarin effects (raising INR), do not directly cause metformin-induced
lactic acidosis, and do not directly cause ACE inhibitor-induced hyperkalemia. Module 6 Exam
Insight: ABCnursing frequently tests macrolide CYP3A4 interactions with statins as a primary
safety concern over other drug pairs.
Q7: A nurse is educating a patient starting doxycycline for a tick-borne illness. Which statement
by the patient indicates a need for further teaching?
A. "I will take this medication with a full glass of water and sit upright for 30 minutes."
B. "I should use sunscreen and wear protective clothing when going outside." **[CORRECT]**
C. "I can take this medication with dairy products to prevent stomach upset."
D. "I understand I should not give this to my teenage daughter if she gets sick."
Correct Answer: C
Rationale: Doxycycline, a tetracycline, chelates with divalent and trivalent cations like calcium in
dairy products, significantly reducing its absorption, so it must be taken on an empty stomach or
with water. Sitting upright prevents esophageal ulceration, sunscreen prevents photosensitivity
(an adverse effect), and it is contraindicated in children under 8 due to teeth discoloration.
Module 6 Exam Insight: Geneva College exams use "need for further teaching" questions to test
dairy interactions with tetracyclines as a classic pharmacokinetic concept.
Q8: A patient is receiving intravenous gentamicin for a severe gram-negative infection. Which
laboratory result requires the most immediate nursing intervention?
A. Serum creatinine increased from 0.9 to 1.4 mg/dL **[CORRECT]**
B. White blood cell count decreased from 15,000 to 9,000/mm³
C. Hemoglobin decreased from 12 to 11 g/dL
D. Platelet count increased from 250,000 to 350,000/mm³
Correct Answer: A
Rationale: Gentamicin is an aminoglycoside with a well-known black box warning for
nephrotoxicity, indicated by a rising serum creatinine, which requires immediate intervention
such as holding the dose and notifying the provider. A decreasing WBC indicates the infection is
resolving, and minor changes in Hgb or platelets are not specific adverse effects of
aminoglycosides. Module 6 Exam Insight: Portage Learning heavily links aminoglycosides to
peak/trough monitoring where rising creatinine is an early indicator of the dose-limiting
nephrotoxicity.
, Q9: The nurse is reviewing the medication administration record for a patient receiving
tobramycin. When should the nurse draw the trough level?
A. 30 minutes before the next dose **[CORRECT]**
B. 1 hour after the infusion is complete
C. 2 hours after the infusion is complete
D. 30 minutes after the infusion is started
Correct Answer: A
Rationale: Trough levels for aminoglycosides like tobramycin are drawn 30 minutes prior to the
next dose to ensure the drug concentration has fallen below the toxic threshold, guiding safe
dosing. Peak levels are drawn 30-60 minutes after the infusion finishes to ensure efficacy.
Module 6 Exam Insight: NURS 251 Module 6 strictly tests timing of peak (efficacy) and trough
(toxicity prevention) levels for aminoglycosides as a critical application skill.
Q10: A patient receiving linezolid for VRE infection reports confusion, diaphoresis, and muscle
twitching. Which medication in the patient's history is most likely causing this interaction?
A. Lisinopril
B. Sertraline **[CORRECT]**
C. Metformin
D. Omeprazole
Correct Answer: B
Rationale: Linezolid has a black box warning for serotonin syndrome, which occurs when it is
combined with serotonergic drugs like SSRIs (sertraline), manifesting as confusion, autonomic
instability, and neuromuscular hyperactivity. Lisinopril, metformin, and omeprazole do not cause
this interaction. Module 6 Exam Insight: ABCnursing patterns specifically target linezolid's
serotonin syndrome risk with SSRIs as a high-yield adverse effect recognition question.
Q11: A patient is prescribed ciprofloxacin for a complicated urinary tract infection. Which
statement by the patient demonstrates understanding of the black box warning associated with
this drug?
A. "I will drink extra fluids to prevent kidney stones."
B. "I will stop taking the medication immediately if I experience tendon pain or swelling."
**[CORRECT]**
C. "I will avoid eating green leafy vegetables while on this medication."
D. "I will take an antacid 30 minutes before my dose to protect my stomach."
Correct Answer: B
Rationale: Fluoroquinolones like ciprofloxacin carry an FDA black box warning for tendonitis and
tendon rupture, requiring immediate discontinuation at the first sign of tendon pain. Drinking
fluids is good but not the black box warning, avoiding vitamin K is for warfarin, and antacids
chelate fluoroquinolones and should be spaced out, not taken together. Module 6 Exam Insight:
Portage Learning expects you to match "tendon rupture" exclusively to fluoroquinolones as their
primary black box warning among antibiotics.
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Anti-infectives: Antibiotics (Questions 1-30)
Q1: A patient with a known severe penicillin allergy (anaphylaxis) is diagnosed with
Pseudomonas aeruginosa pneumonia. Which antibiotic is the safest choice for this patient?
A. Amoxicillin-clavulanate
B. Piperacillin-tazobactam
C. Aztreonam **[CORRECT]**
D. Imipenem-cilastatin
Correct Answer: C
Rationale: Aztreonam is a monobactam that inhibits cell wall synthesis (transpeptidase) and is
structurally distinct from penicillins, making it safe for patients with severe penicillin allergies
despite its beta-lactam ring. Amoxicillin, piperacillin, and imipenem are all beta-lactams with a
shared core structure that carry a significant cross-reactivity risk and are contraindicated.
Module 6 Exam Insight: Portage Learning heavily tests monobactams as the "get out of jail free"
card for penicillin-allergic patients needing gram-negative coverage.
Q2: A patient receiving intravenous piperacillin-tazobactam reports sudden onset of throat
tightness, dyspnea, and facial flushing. What is the nurse's priority action?
A. Administer diphenhydramine orally and reassess in 15 minutes
B. Stop the infusion immediately and prepare to administer epinephrine **[CORRECT]**
C. Slow the infusion rate and apply a warm compress to the face
D. Document the reaction and switch to an oral equivalent
Correct Answer: B
Rationale: These manifestations indicate anaphylaxis, a severe hypersensitivity reaction and
black box warning for all beta-lactams, requiring immediate cessation of the drug and
epinephrine to secure the airway and reverse hemodynamic instability. Slowing the rate or
giving oral diphenhydramine is inadequate for anaphylaxis, and switching to oral is dangerous
without stabilization. Module 6 Exam Insight: ABCnursing patterns consistently require
recognizing anaphylaxis as a rapid, life-threatening response needing epinephrine over
antihistamines alone.
,Q3: A nurse is reviewing the medication profile of a patient prescribed cefazolin for surgical
prophylaxis. Which patient history finding requires the most immediate clarification with the
prescribing provider?
A. Mild penicillin allergy manifesting as a maculopapular rash
B. Severe penicillin allergy with angioedema and bronchospasm **[CORRECT]**
C. Recent completion of oral metronidazole for bacterial vaginosis
D. History of mild, intermittent constipation
Correct Answer: B
Rationale: Cross-reactivity between penicillins and cephalosporins is approximately 1-3%, but
increases significantly in patients with a history of severe penicillin allergies (anaphylaxis),
making cefazolin relatively contraindicated without careful consideration. A mild rash does not
pose the same anaphylactic risk, recent metronidazole has no interaction, and constipation is
irrelevant. Module 6 Exam Insight: Geneva College exams focus heavily on the degree of
penicillin allergy (rash vs. anaphylaxis) dictating cephalosporin safety.
Q4: A patient is receiving ceftaroline for complicated skin and soft tissue infection caused by
MRSA. What is the mechanism of action of this fifth-generation cephalosporin?
A. Inhibition of protein synthesis at the 50S ribosome
B. Binding to penicillin-binding protein 2a (PBP2a) **[CORRECT]**
C. Inhibition of dihydrofolate reductase
D. Disruption of the bacterial cell membrane
Correct Answer: B
Rationale: Ceftaroline uniquely binds to PBP2a, the altered penicillin-binding protein that
confers methicillin resistance in MRSA, making it the only cephalosporin effective against
MRSA. Protein synthesis inhibition is the mechanism of macrolides, dihydrofolate reductase
inhibition is for trimethoprim, and cell membrane disruption is for polymyxins. Module 6 Exam
Insight: NURS 251 expects you to know that 5th-generation cephalosporins bridge the gap to
cover MRSA via PBP2a affinity.
Q5: A patient on meropenem therapy develops a temperature of 38.9°C (102°F), tachycardia,
and hypotension during the infusion. The nurse should prepare to administer which medication?
A. Naloxone
B. Protamine sulfate
C. Diphenhydramine and hydrocortisone **[CORRECT]**
D. Flumazenil
Correct Answer: C
Rationale: The patient is experiencing an infusion reaction, a known adverse effect of
carbapenems like meropenem, which is managed by stopping the infusion and administering
antihistamines and corticosteroids. Naloxone reverses opioids, protamine reverses heparin, and
flumazenil reverses benzodiazepines. Module 6 Exam Insight: Portage Learning tests
carbapenem infusion reactions alongside hypersensitivity, expecting you to differentiate them
from anaphylaxis and other drug-specific antidotes.
,Q6: A patient diagnosed with community-acquired pneumonia is prescribed azithromycin. The
nurse should assess the patient's medication profile for which potential critical interaction?
A. Warfarin, leading to decreased INR
B. Statins, leading to increased risk of rhabdomyolysis **[CORRECT]**
C. Metformin, leading to lactic acidosis
D. Lisinopril, leading to hyperkalemia
Correct Answer: B
Rationale: Azithromycin is a macrolide that inhibits CYP3A4, which can significantly increase
serum levels of statins metabolized by this pathway, raising the risk of rhabdomyolysis.
Macrolides increase warfarin effects (raising INR), do not directly cause metformin-induced
lactic acidosis, and do not directly cause ACE inhibitor-induced hyperkalemia. Module 6 Exam
Insight: ABCnursing frequently tests macrolide CYP3A4 interactions with statins as a primary
safety concern over other drug pairs.
Q7: A nurse is educating a patient starting doxycycline for a tick-borne illness. Which statement
by the patient indicates a need for further teaching?
A. "I will take this medication with a full glass of water and sit upright for 30 minutes."
B. "I should use sunscreen and wear protective clothing when going outside." **[CORRECT]**
C. "I can take this medication with dairy products to prevent stomach upset."
D. "I understand I should not give this to my teenage daughter if she gets sick."
Correct Answer: C
Rationale: Doxycycline, a tetracycline, chelates with divalent and trivalent cations like calcium in
dairy products, significantly reducing its absorption, so it must be taken on an empty stomach or
with water. Sitting upright prevents esophageal ulceration, sunscreen prevents photosensitivity
(an adverse effect), and it is contraindicated in children under 8 due to teeth discoloration.
Module 6 Exam Insight: Geneva College exams use "need for further teaching" questions to test
dairy interactions with tetracyclines as a classic pharmacokinetic concept.
Q8: A patient is receiving intravenous gentamicin for a severe gram-negative infection. Which
laboratory result requires the most immediate nursing intervention?
A. Serum creatinine increased from 0.9 to 1.4 mg/dL **[CORRECT]**
B. White blood cell count decreased from 15,000 to 9,000/mm³
C. Hemoglobin decreased from 12 to 11 g/dL
D. Platelet count increased from 250,000 to 350,000/mm³
Correct Answer: A
Rationale: Gentamicin is an aminoglycoside with a well-known black box warning for
nephrotoxicity, indicated by a rising serum creatinine, which requires immediate intervention
such as holding the dose and notifying the provider. A decreasing WBC indicates the infection is
resolving, and minor changes in Hgb or platelets are not specific adverse effects of
aminoglycosides. Module 6 Exam Insight: Portage Learning heavily links aminoglycosides to
peak/trough monitoring where rising creatinine is an early indicator of the dose-limiting
nephrotoxicity.
, Q9: The nurse is reviewing the medication administration record for a patient receiving
tobramycin. When should the nurse draw the trough level?
A. 30 minutes before the next dose **[CORRECT]**
B. 1 hour after the infusion is complete
C. 2 hours after the infusion is complete
D. 30 minutes after the infusion is started
Correct Answer: A
Rationale: Trough levels for aminoglycosides like tobramycin are drawn 30 minutes prior to the
next dose to ensure the drug concentration has fallen below the toxic threshold, guiding safe
dosing. Peak levels are drawn 30-60 minutes after the infusion finishes to ensure efficacy.
Module 6 Exam Insight: NURS 251 Module 6 strictly tests timing of peak (efficacy) and trough
(toxicity prevention) levels for aminoglycosides as a critical application skill.
Q10: A patient receiving linezolid for VRE infection reports confusion, diaphoresis, and muscle
twitching. Which medication in the patient's history is most likely causing this interaction?
A. Lisinopril
B. Sertraline **[CORRECT]**
C. Metformin
D. Omeprazole
Correct Answer: B
Rationale: Linezolid has a black box warning for serotonin syndrome, which occurs when it is
combined with serotonergic drugs like SSRIs (sertraline), manifesting as confusion, autonomic
instability, and neuromuscular hyperactivity. Lisinopril, metformin, and omeprazole do not cause
this interaction. Module 6 Exam Insight: ABCnursing patterns specifically target linezolid's
serotonin syndrome risk with SSRIs as a high-yield adverse effect recognition question.
Q11: A patient is prescribed ciprofloxacin for a complicated urinary tract infection. Which
statement by the patient demonstrates understanding of the black box warning associated with
this drug?
A. "I will drink extra fluids to prevent kidney stones."
B. "I will stop taking the medication immediately if I experience tendon pain or swelling."
**[CORRECT]**
C. "I will avoid eating green leafy vegetables while on this medication."
D. "I will take an antacid 30 minutes before my dose to protect my stomach."
Correct Answer: B
Rationale: Fluoroquinolones like ciprofloxacin carry an FDA black box warning for tendonitis and
tendon rupture, requiring immediate discontinuation at the first sign of tendon pain. Drinking
fluids is good but not the black box warning, avoiding vitamin K is for warfarin, and antacids
chelate fluoroquinolones and should be spaced out, not taken together. Module 6 Exam Insight:
Portage Learning expects you to match "tendon rupture" exclusively to fluoroquinolones as their
primary black box warning among antibiotics.
