Amoxicillin, an aminopenicillin, kills susceptible bacteria by which mechanism?
Inhibiting cell wall synthesis
✓
Inhibiting DNA gyrase
Blocking folic acid synthesis
Blocking ribosomal protein synthesis
Correct Answer
Inhibiting cell wall synthesis
Penicillins are beta-lactam antibiotics that bind penicillin-binding proteins and prevent cross-linking of the bacterial cell wall, so the weakened cell bursts. Inhibiting DNA gyrase is the action of fluoroquinolones such as ciprofloxacin. Blocking folic acid synthesis describes sulfamethoxazole-trimethoprim. Blocking ribosomal protein synthesis is how macrolides, tetracyclines and aminoglycosides work.
Category: Antibacterial Drugs
Question 2
A patient taking levofloxacin reports new pain and swelling at the back of the ankle. Which adverse effect should the nurse suspect?
Gout flare
Tendon injury
✓
Stress fracture
Muscle cramp from hypokalemia
Correct Answer
Tendon injury
Fluoroquinolones carry a boxed warning for tendinitis and tendon rupture, and the Achilles tendon is the classic site; the drug should be stopped and the prescriber notified. Gout flare is linked to drugs that raise uric acid, such as pyrazinamide, not fluoroquinolones. Stress fracture is not an adverse effect of this class. Muscle cramp from hypokalemia does not explain localized swelling over the tendon.
Category: Antibiotic Safety
Question 3
Flushing and an itchy red rash over the face, neck and upper body during a rapid IV infusion is a known reaction to which antibiotic?
Ceftriaxone
Azithromycin
Vancomycin
✓
Gentamicin
Correct Answer
Vancomycin
Vancomycin flushing syndrome is an infusion-rate reaction caused by histamine release; it can look like an allergy and is prevented by infusing the drug slowly. Ceftriaxone is not associated with this rate-related flushing. Azithromycin is better known for GI upset and QT prolongation. Gentamicin is known for nephrotoxicity and ototoxicity.
Category: Antibiotic Safety
Question 4
A patient prescribed doxycycline should be taught not to take it at the same time as which product?
Acetaminophen
Vitamin C tablets
A stool softener
Calcium supplements
✓
Correct Answer
Calcium supplements
Tetracyclines bind calcium and other metal ions such as iron, magnesium and aluminum, forming complexes that are poorly absorbed, so doses must be separated from these products and from dairy. Acetaminophen does not block tetracycline absorption. Vitamin C tablets do not chelate the drug. A stool softener such as docusate does not interfere with its absorption.
Category: Antibacterial Drugs
Question 5
Gentamicin therapy requires close monitoring for which pair of toxicities?
Nephrotoxicity and ototoxicity
✓
Hepatotoxicity and pancreatitis
Cardiotoxicity and neutropenia
Photosensitivity and tooth staining
Correct Answer
Nephrotoxicity and ototoxicity
Aminoglycosides such as gentamicin are cleared by the kidneys and can damage both the kidneys and the inner ear, so renal function and serum drug levels are monitored and patients are asked about hearing loss, tinnitus or dizziness. Hepatotoxicity and pancreatitis are not the hallmark risks of this class. Cardiotoxicity and neutropenia are not typical aminoglycoside effects. Photosensitivity and tooth staining are tetracycline effects.
Category: Antibiotic Safety
Question 6
Clarithromycin can raise blood levels of simvastatin through which action?
Inducing CYP3A4 enzymes
Inhibiting CYP3A4 enzymes
✓
Blocking renal tubular secretion
Displacing it from albumin
Correct Answer
Inhibiting CYP3A4 enzymes
Macrolides such as clarithromycin and erythromycin inhibit CYP3A4, so drugs metabolized by that enzyme, including simvastatin, accumulate and can cause toxicity. Inducing CYP3A4 enzymes would lower simvastatin levels, which is what rifampin does. Blocking renal tubular secretion is not how this interaction occurs. Displacing it from albumin is not the mechanism of the macrolide-statin interaction.
Category: Antibacterial Drugs
Question 7
On day 6 of clindamycin therapy, a patient develops frequent, watery, foul-smelling diarrhea. Which complication should the nurse suspect?
Lactose intolerance
Irritable bowel syndrome
Clostridioides difficile infection
✓
Vitamin K deficiency
Correct Answer
Clostridioides difficile infection
Antibiotics disrupt normal colonic flora and allow C. difficile to overgrow, and clindamycin is strongly linked to this superinfection; the nurse reports it and obtains a stool test if ordered. Lactose intolerance does not appear suddenly during antibiotic therapy. Irritable bowel syndrome is a chronic functional disorder, not an antibiotic complication. Vitamin K deficiency causes bleeding problems, not watery diarrhea.
Category: Antibiotic Safety
Question 8
To lower the risk of kidney injury during IV acyclovir therapy, which nursing action is appropriate?
Restrict oral fluid intake
Give it with an antacid
Keep the patient on bed rest
Maintain adequate hydration
✓
Correct Answer
Maintain adequate hydration
Acyclovir is eliminated by the kidneys and can crystallize in the renal tubules, so good hydration and monitoring of kidney function protect the patient. Restricting oral fluid intake would increase the risk of crystal formation. Giving it with an antacid does nothing to protect the kidneys. Keeping the patient on bed rest has no effect on drug-induced kidney injury.
Category: Antiviral Drugs
Question 9
Which inhaled influenza antiviral should be avoided in patients with asthma or COPD because it can trigger bronchospasm?
Zanamivir
✓
Oseltamivir
Acyclovir
Valacyclovir
Correct Answer
Zanamivir
Zanamivir is a neuraminidase inhibitor given by oral inhalation, and it can cause bronchospasm in people with underlying airway disease. Oseltamivir is the oral neuraminidase inhibitor and does not carry this airway risk. Acyclovir treats herpes viruses, not influenza. Valacyclovir is the oral prodrug of acyclovir, also used for herpes infections.
Category: Antiviral Drugs
Question 10
Which adverse effect is a major concern with IV amphotericin B?
Orange body fluids
Nephrotoxicity
✓
Tooth discoloration
Tendon rupture
Correct Answer
Nephrotoxicity
Amphotericin B is highly toxic; it damages the kidneys, causes electrolyte losses such as low potassium and magnesium, and produces fever and chills during infusion. Orange body fluids are an effect of rifampin. Tooth discoloration is caused by tetracyclines in children. Tendon rupture is a fluoroquinolone risk.
Category: Antifungal Drugs
Question 11
Fluconazole stops fungal growth by blocking production of which fungal cell membrane component?
Cholesterol
Peptidoglycan
Ergosterol
✓
Chitin
Correct Answer
Ergosterol
Azole antifungals inhibit a fungal cytochrome P450 enzyme (14-alpha-demethylase) needed to make ergosterol, the main sterol of fungal membranes. Cholesterol is the sterol in human cell membranes, not the azole target. Peptidoglycan forms bacterial cell walls, not fungal membranes. Chitin is part of the fungal cell wall rather than the membrane.
Category: Antifungal Drugs
Question 12
Oral nystatin treats oral candidiasis but is not used for systemic fungal infections. What explains this limitation?
It is rapidly broken down by the liver
It causes severe kidney damage
It only kills molds, not yeasts
It is not absorbed from the GI tract
✓
Correct Answer
It is not absorbed from the GI tract
Nystatin is a polyene that stays in the mouth and gut, so it acts locally on Candida but cannot reach infections in the blood or organs. It is rapidly broken down by the liver is wrong because the drug is essentially not absorbed in the first place. It causes severe kidney damage describes IV amphotericin B. It only kills molds, not yeasts is wrong because Candida is a yeast and is the main target of nystatin.
Category: Antifungal Drugs
Question 13
Before abacavir is started, the patient should be screened for which genetic marker to reduce the risk of a serious hypersensitivity reaction?
HLA-B*5701
✓
Factor V Leiden
BRCA1 mutation
CYP2C19 variant
Correct Answer
HLA-B*5701
Abacavir carries a boxed warning for serious, sometimes fatal hypersensitivity reactions, and carriers of the HLA-B*5701 allele are at much higher risk, so patients are screened first. Factor V Leiden is a clotting disorder marker unrelated to abacavir. BRCA1 mutation is a breast and ovarian cancer risk marker. CYP2C19 variant affects drugs such as clopidogrel, not abacavir hypersensitivity.
Category: HIV Antiretrovirals
Question 14
Dolutegravir, an integrase strand transfer inhibitor, prevents HIV replication by blocking which step?
Conversion of viral RNA into DNA
Insertion of viral DNA into host DNA
✓
Cleavage of viral protein chains
Fusion of the virus with the CD4 cell
Correct Answer
Insertion of viral DNA into host DNA
The HIV integrase enzyme splices viral DNA into the host chromosome, and integrase inhibitors block that step. Conversion of viral RNA into DNA is the job of reverse transcriptase, targeted by NRTIs and NNRTIs. Cleavage of viral protein chains is performed by protease, targeted by protease inhibitors. Fusion of the virus with the CD4 cell is blocked by enfuvirtide.
Category: HIV Antiretrovirals
Question 15
Low-dose ritonavir is added to some HIV regimens for what purpose?
To treat opportunistic fungal infections
To prevent lactic acidosis
To raise levels of other antiretrovirals
✓
To lower serum lipid levels
Correct Answer
To raise levels of other antiretrovirals
Ritonavir strongly inhibits CYP3A4, so it boosts blood levels of other antiretrovirals and allows fewer pills, but it also causes many drug interactions. To treat opportunistic fungal infections is the role of antifungals, not ritonavir. To prevent lactic acidosis is wrong because ritonavir has no such effect. To lower serum lipid levels is wrong because protease inhibitors tend to raise lipids.
Category: HIV Antiretrovirals
Question 16
A patient starting rifampin should be told to expect which harmless effect?
Blue-tinted vision
Dark brown tooth stains
Green-colored stools
Red-orange urine, sweat and tears
✓
Correct Answer
Red-orange urine, sweat and tears
Rifampin colors body fluids red-orange; this is harmless, though it can permanently stain soft contact lenses. Blue-tinted vision is not a rifampin effect. Dark brown tooth stains are linked to tetracyclines in children. Green-colored stools are not a recognized effect of rifampin.
Category: Tuberculosis Drugs
Question 17
A patient taking ethambutol needs regular testing of which function?
Visual acuity and color vision
✓
Hearing and balance
Thyroid function
Bone density
Correct Answer
Visual acuity and color vision
Ethambutol can cause optic neuritis, which shows up as decreased visual acuity and trouble telling red from green, so vision is checked and patients report any visual change. Hearing and balance are monitored with aminoglycosides, not ethambutol. Thyroid function is not affected by ethambutol. Bone density is not a concern with this drug.
Category: Tuberculosis Drugs
Question 18
Pyridoxine (vitamin B6) is often given with isoniazid to prevent which adverse effect?
Hepatotoxicity
Peripheral neuropathy
✓
Optic neuritis
Hyperuricemia
Correct Answer
Peripheral neuropathy
Isoniazid interferes with pyridoxine, and the deficiency causes numbness and tingling in the hands and feet; supplementation prevents this, especially in pregnant patients and people who drink heavily. Hepatotoxicity is not prevented by pyridoxine and requires liver monitoring. Optic neuritis is an ethambutol effect. Hyperuricemia is caused by pyrazinamide.
Category: Tuberculosis Drugs
Question 19
A patient taking metronidazole is taught to avoid alcohol. What can happen if the two are combined?
Serotonin syndrome
Acute tendon rupture
A disulfiram-like reaction
✓
Severe hypoglycemia
Correct Answer
A disulfiram-like reaction
Metronidazole and tinidazole labeling warns that alcohol can provoke a disulfiram-like reaction, with flushing, nausea, vomiting, headache and a rapid heartbeat in some patients, so alcohol is avoided during therapy and for a short time afterward. Serotonin syndrome is a risk with linezolid combined with serotonergic drugs. Acute tendon rupture is a fluoroquinolone risk. Severe hypoglycemia is not the expected result of combining metronidazole with alcohol.
Category: STI and Parasite Drugs
Question 20
Which drug is the treatment of choice for syphilis?
Ceftriaxone
Metronidazole
Acyclovir
Benzathine penicillin G
✓
Correct Answer
Benzathine penicillin G
Benzathine penicillin G is a long-acting intramuscular penicillin that remains the treatment of choice for syphilis caused by Treponema pallidum. Ceftriaxone is the standard treatment for gonorrhea. Metronidazole treats trichomoniasis and bacterial vaginosis. Acyclovir is an antiviral for herpes simplex and has no effect on bacteria.
Category: STI and Parasite Drugs