1
NR566 Week 8 Final Exam Review Advanced
Pharmacology for Care of the Family 100
Comprehensive Practice Questions | 2026 Edition
SECTION 1: ANTIBIOTICS & INFECTIOUS DISEASE (15 Questions)
Q1. A 28-year-old female presents with dysuria, frequency, and urgency for 2 days. Urinalysis
shows positive nitrites, leukocyte esterase, and >10 WBC/hpf. She has no fever or flank pain. She
takes oral contraceptives and has a sulfa allergy (hives with Bactrim at age 12). Which is the
most appropriate first-line treatment?
A. Trimethoprim-sulfamethoxazole DS BID x 3 days
B. Ciprofloxacin 250mg BID x 3 days
C. Nitrofurantoin monohydrate/macrocrystals 100mg BID x 5 days [CORRECT]
D. Amoxicillin-clavulanate 875/125mg BID x 7 days
Correct Answer: C
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis per IDSA/ESCMID 2024
guidelines and is safe in sulfa-allergic patients. Option A is contraindicated due to sulfa allergy.
Option B is a fluoroquinolone—avoided as first-line due to tendon rupture risk, QT
prolongation, and bacterial resistance promotion; reserved for complicated cases or when other
agents contraindicated. Option D has inferior E. coli coverage and is not first-line. Nitrofurantoin
concentrates in urine with minimal systemic absorption, making it ideal for lower UTIs.
Q2. A 45-year-old male with diabetic foot infection (Wagner Grade 2, no osteomyelitis) has
purulent drainage. Cultures grow MRSA and Pseudomonas aeruginosa. He has normal renal
function. Which empiric regimen is most appropriate?
, 2
A. Vancomycin + Ceftriaxone
B. Doxycycline + Ciprofloxacin
C. Vancomycin + Piperacillin-tazobactam [CORRECT]
D. Linezolid + Aztreonam
Correct Answer: C
Rationale: Diabetic foot infections with MRSA and Pseudomonas require coverage for both
pathogens. Vancomycin covers MRSA; piperacillin-tazobactam provides broad gram-negative
coverage including Pseudomonas and anaerobes. Option A fails against Pseudomonas
(ceftriaxone has no Pseudomonas coverage). Option B provides inadequate MRSA coverage
(doxycycline not reliable for diabetic foot MRSA) and suboptimal Pseudomonas coverage.
Option D—linezolid is unnecessary when vancomycin suffices, and aztreonam lacks anaerobic
coverage needed in diabetic foot infections.
Q3. A 32-year-old female at 16 weeks gestation presents with community-acquired pneumonia.
She has no drug allergies. Which antibiotic regimen is safest and most appropriate?
A. Levofloxacin 750mg daily x 5 days
B. Azithromycin 500mg day 1, then 250mg daily x 4 days [CORRECT]
C. Doxycycline 100mg BID x 7 days
D. Moxifloxacin 400mg daily x 7 days
Correct Answer: B
Rationale: Azithromycin is the preferred macrolide for pregnant patients (Category B) with
community-acquired pneumonia per ATS/IDSA guidelines. Options A and D are
fluoroquinolones—contraindicated in pregnancy due to cartilage damage risk in fetus and
potential arthropathy. Option C (doxycycline) is Category D in pregnancy, causing fetal bone
growth inhibition and teeth discoloration; absolutely contraindicated after 15 weeks gestation.
Azithromycin provides atypical coverage and is well-studied in pregnancy.
, 3
Q4. [SATA] A 62-year-old male is prescribed amoxicillin-clavulanate for acute bacterial sinusitis.
Which counseling points should the nurse practitioner provide? (Select all that apply)
A. Take with food to reduce gastrointestinal upset [CORRECT]
B. Report dark urine, yellowing of skin, or severe diarrhea immediately [CORRECT]
C. This medication may reduce effectiveness of oral contraceptives
D. Complete the full 10-day course even if symptoms resolve [CORRECT]
E. Separate dosing from levothyroxine by at least 4 hours [CORRECT]
Correct Answers: A, B, D, E
Rationale: Amoxicillin-clavulanate commonly causes GI upset; food reduces this without
affecting absorption (A). Clavulanate has higher hepatotoxicity risk than amoxicillin alone—
monitor for hepatic injury signs (B). Unlike rifampin, amoxicillin does not significantly reduce oral
contraceptive efficacy (C incorrect). Full course completion prevents resistance and recurrence
(D). All antibiotics can bind levothyroxine in gut; separate by 4 hours (E).
Q5. A 24-year-old college student presents with pharyngitis, fever 101.2°F, tonsillar exudates,
and tender anterior cervical adenopathy. Rapid strep test is positive. Patient has penicillin allergy
(anaphylaxis with childhood amoxicillin). Which is the best treatment option?
A. Azithromycin 500mg day 1, then 250mg daily x 4 days
B. Clindamycin 300mg TID x 10 days [CORRECT]
C. Cephalexin 500mg QID x 10 days
D. Levofloxacin 500mg daily x 10 days
Correct Answer: B
Rationale: With Type I hypersensitivity (anaphylaxis) to penicillin, avoid all beta-lactams
including cephalosporins due to ~10% cross-reactivity (eliminating C). Clindamycin is the
preferred alternative for group A streptococcal pharyngitis in severe penicillin allergy per IDSA
guidelines, with comparable eradication rates. Option A (azithromycin) has 20-30% resistance
rates to S. pyogenes and is not recommended. Option D is inappropriate—fluoroquinolones
have poor streptococcal coverage and are not indicated for pharyngitis.
, 4
Q6. A patient is prescribed isoniazid for latent tuberculosis infection. Which monitoring is
essential?
A. Monthly CBC and liver function tests
B. Baseline and monthly visual acuity testing
C. Baseline and periodic liver function tests [CORRECT]
D. Weekly therapeutic drug monitoring
Correct Answer: C
Rationale: Isoniazid carries a black box warning for hepatotoxicity. Baseline LFTs establish
normal values; periodic monitoring (every 4-8 weeks) detects drug-induced liver injury. Monthly
CBC is unnecessary (A). Visual testing is required for ethambutol, not isoniazid (B). Isoniazid does
not require therapeutic drug monitoring (D). Patients should be counseled to report symptoms
of hepatitis: fatigue, anorexia, nausea, jaundice.
Q7. A 55-year-old male with HIV (CD4 180, viral load undetectable on ART) develops
Pneumocystis jirovecii pneumonia (PCP). He has G6PD deficiency. Which prophylactic regimen is
contraindicated and which should be selected?
A. Trimethoprim-sulfamethoxazole—contraindicated; use dapsone instead
B. Dapsone—contraindicated; use trimethoprim-sulfamethoxazole instead
C. Trimethoprim-sulfamethoxazole—contraindicated; use atovaquone instead [CORRECT]
D. Atovaquone—contraindicated; use pentamidine instead
Correct Answer: C
Rationale: Both trimethoprim-sulfamethoxazole AND dapsone are contraindicated in G6PD
deficiency due to hemolytic anemia risk. Atovaquone is the preferred alternative for PCP
prophylaxis in this scenario. Pentamidine (inhaled) is an option but requires monthly nebulizer
treatments and carries bronchospasm risk; atovaquone is oral and better tolerated. The question
requires recognizing that two commonly used agents are unsafe in G6PD deficiency.
NR566 Week 8 Final Exam Review Advanced
Pharmacology for Care of the Family 100
Comprehensive Practice Questions | 2026 Edition
SECTION 1: ANTIBIOTICS & INFECTIOUS DISEASE (15 Questions)
Q1. A 28-year-old female presents with dysuria, frequency, and urgency for 2 days. Urinalysis
shows positive nitrites, leukocyte esterase, and >10 WBC/hpf. She has no fever or flank pain. She
takes oral contraceptives and has a sulfa allergy (hives with Bactrim at age 12). Which is the
most appropriate first-line treatment?
A. Trimethoprim-sulfamethoxazole DS BID x 3 days
B. Ciprofloxacin 250mg BID x 3 days
C. Nitrofurantoin monohydrate/macrocrystals 100mg BID x 5 days [CORRECT]
D. Amoxicillin-clavulanate 875/125mg BID x 7 days
Correct Answer: C
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis per IDSA/ESCMID 2024
guidelines and is safe in sulfa-allergic patients. Option A is contraindicated due to sulfa allergy.
Option B is a fluoroquinolone—avoided as first-line due to tendon rupture risk, QT
prolongation, and bacterial resistance promotion; reserved for complicated cases or when other
agents contraindicated. Option D has inferior E. coli coverage and is not first-line. Nitrofurantoin
concentrates in urine with minimal systemic absorption, making it ideal for lower UTIs.
Q2. A 45-year-old male with diabetic foot infection (Wagner Grade 2, no osteomyelitis) has
purulent drainage. Cultures grow MRSA and Pseudomonas aeruginosa. He has normal renal
function. Which empiric regimen is most appropriate?
, 2
A. Vancomycin + Ceftriaxone
B. Doxycycline + Ciprofloxacin
C. Vancomycin + Piperacillin-tazobactam [CORRECT]
D. Linezolid + Aztreonam
Correct Answer: C
Rationale: Diabetic foot infections with MRSA and Pseudomonas require coverage for both
pathogens. Vancomycin covers MRSA; piperacillin-tazobactam provides broad gram-negative
coverage including Pseudomonas and anaerobes. Option A fails against Pseudomonas
(ceftriaxone has no Pseudomonas coverage). Option B provides inadequate MRSA coverage
(doxycycline not reliable for diabetic foot MRSA) and suboptimal Pseudomonas coverage.
Option D—linezolid is unnecessary when vancomycin suffices, and aztreonam lacks anaerobic
coverage needed in diabetic foot infections.
Q3. A 32-year-old female at 16 weeks gestation presents with community-acquired pneumonia.
She has no drug allergies. Which antibiotic regimen is safest and most appropriate?
A. Levofloxacin 750mg daily x 5 days
B. Azithromycin 500mg day 1, then 250mg daily x 4 days [CORRECT]
C. Doxycycline 100mg BID x 7 days
D. Moxifloxacin 400mg daily x 7 days
Correct Answer: B
Rationale: Azithromycin is the preferred macrolide for pregnant patients (Category B) with
community-acquired pneumonia per ATS/IDSA guidelines. Options A and D are
fluoroquinolones—contraindicated in pregnancy due to cartilage damage risk in fetus and
potential arthropathy. Option C (doxycycline) is Category D in pregnancy, causing fetal bone
growth inhibition and teeth discoloration; absolutely contraindicated after 15 weeks gestation.
Azithromycin provides atypical coverage and is well-studied in pregnancy.
, 3
Q4. [SATA] A 62-year-old male is prescribed amoxicillin-clavulanate for acute bacterial sinusitis.
Which counseling points should the nurse practitioner provide? (Select all that apply)
A. Take with food to reduce gastrointestinal upset [CORRECT]
B. Report dark urine, yellowing of skin, or severe diarrhea immediately [CORRECT]
C. This medication may reduce effectiveness of oral contraceptives
D. Complete the full 10-day course even if symptoms resolve [CORRECT]
E. Separate dosing from levothyroxine by at least 4 hours [CORRECT]
Correct Answers: A, B, D, E
Rationale: Amoxicillin-clavulanate commonly causes GI upset; food reduces this without
affecting absorption (A). Clavulanate has higher hepatotoxicity risk than amoxicillin alone—
monitor for hepatic injury signs (B). Unlike rifampin, amoxicillin does not significantly reduce oral
contraceptive efficacy (C incorrect). Full course completion prevents resistance and recurrence
(D). All antibiotics can bind levothyroxine in gut; separate by 4 hours (E).
Q5. A 24-year-old college student presents with pharyngitis, fever 101.2°F, tonsillar exudates,
and tender anterior cervical adenopathy. Rapid strep test is positive. Patient has penicillin allergy
(anaphylaxis with childhood amoxicillin). Which is the best treatment option?
A. Azithromycin 500mg day 1, then 250mg daily x 4 days
B. Clindamycin 300mg TID x 10 days [CORRECT]
C. Cephalexin 500mg QID x 10 days
D. Levofloxacin 500mg daily x 10 days
Correct Answer: B
Rationale: With Type I hypersensitivity (anaphylaxis) to penicillin, avoid all beta-lactams
including cephalosporins due to ~10% cross-reactivity (eliminating C). Clindamycin is the
preferred alternative for group A streptococcal pharyngitis in severe penicillin allergy per IDSA
guidelines, with comparable eradication rates. Option A (azithromycin) has 20-30% resistance
rates to S. pyogenes and is not recommended. Option D is inappropriate—fluoroquinolones
have poor streptococcal coverage and are not indicated for pharyngitis.
, 4
Q6. A patient is prescribed isoniazid for latent tuberculosis infection. Which monitoring is
essential?
A. Monthly CBC and liver function tests
B. Baseline and monthly visual acuity testing
C. Baseline and periodic liver function tests [CORRECT]
D. Weekly therapeutic drug monitoring
Correct Answer: C
Rationale: Isoniazid carries a black box warning for hepatotoxicity. Baseline LFTs establish
normal values; periodic monitoring (every 4-8 weeks) detects drug-induced liver injury. Monthly
CBC is unnecessary (A). Visual testing is required for ethambutol, not isoniazid (B). Isoniazid does
not require therapeutic drug monitoring (D). Patients should be counseled to report symptoms
of hepatitis: fatigue, anorexia, nausea, jaundice.
Q7. A 55-year-old male with HIV (CD4 180, viral load undetectable on ART) develops
Pneumocystis jirovecii pneumonia (PCP). He has G6PD deficiency. Which prophylactic regimen is
contraindicated and which should be selected?
A. Trimethoprim-sulfamethoxazole—contraindicated; use dapsone instead
B. Dapsone—contraindicated; use trimethoprim-sulfamethoxazole instead
C. Trimethoprim-sulfamethoxazole—contraindicated; use atovaquone instead [CORRECT]
D. Atovaquone—contraindicated; use pentamidine instead
Correct Answer: C
Rationale: Both trimethoprim-sulfamethoxazole AND dapsone are contraindicated in G6PD
deficiency due to hemolytic anemia risk. Atovaquone is the preferred alternative for PCP
prophylaxis in this scenario. Pentamidine (inhaled) is an option but requires monthly nebulizer
treatments and carries bronchospasm risk; atovaquone is oral and better tolerated. The question
requires recognizing that two commonly used agents are unsafe in G6PD deficiency.
