NUR 615 Module 2: Antibiotics & Antimicrobial Therapy 2026 Update – Comprehensive Exam Q&A
Covering Pathogen Coverage, Drug Classes, Mechanisms, Black Box Warnings, Adverse Effects, Drug
Interactions, and Key Clinical Prescribing Scenarios.
Instructions
For each question, select all that apply. Correct answers are bolded. Explanations are provided for each
answer choice.
Questions 1–150
1. Which statements about beta-lactam antibiotics are correct?
A) They inhibit bacterial cell wall synthesis – Correct; this is their primary mechanism.
B) They are primarily bacteriostatic – Incorrect; they are bactericidal.
C) Clavulanate is a beta-lactamase inhibitor – Correct; it extends amoxicillin's spectrum.
D) They are effective against Mycoplasma – Incorrect; Mycoplasma lacks a cell wall.
E) Cross-reactivity among penicillins and cephalosporins is possible – Correct; risk is low but exists.
✅ Correct: A, C, E
2. Which cephalosporins provide Pseudomonas coverage?
A) Cephalexin – Incorrect; 1st generation, no Pseudomonas coverage.
B) Ceftazidime – *Correct; 3rd generation anti-pseudomonal.*
C) Ceftriaxone – Incorrect; no Pseudomonas coverage.
D) Cefepime – Correct; 4th generation covers Pseudomonas.
E) Cefazolin – Incorrect; 1st generation, no Pseudomonas coverage.
✅ Correct: B, D
3. True statements about vancomycin include:
A) It is a glycopeptide antibiotic – Correct; this is its drug class.
B) Oral vancomycin treats systemic MRSA – Incorrect; oral is only for C. diff (not absorbed).
C) Red Man Syndrome is caused by histamine release – Correct; from rapid IV infusion.
D) Vancomycin is nephrotoxic and ototoxic – Correct; monitor levels closely.
E) Infusion should be over <30 minutes to avoid toxicity – Incorrect; infuse over ≥60 minutes.
,✅ Correct: A, C, D
4. Carbapenem characteristics include:
A) Imipenem lowers seizure threshold – Correct; CNS toxicity is a known risk.
B) Ertapenem covers Pseudomonas – Incorrect; only imipenem and meropenem do.
C) They are extremely broad-spectrum – Correct; covers gram-positives, gram-negatives, anaerobes.
D) They are beta-lactams – Correct; they belong to this class.
E) They are safe in penicillin allergy – Incorrect; cross-reaction is possible.
✅ Correct: A, C, D
5. Which are true about penicillin allergies?
A) Anaphylaxis rate is ~0.01% – Correct; severe reactions are rare.
B) Cephalosporins are always safe – *Incorrect; low cross-reactivity exists (1-2%).*
C) Carbapenems can be used cautiously – Correct; monitor for reaction.
D) Aztreonam is safe in IgE-mediated PCN allergy – Correct; different structure, no cross-reactivity.
E) Skin testing is never useful – Incorrect; it can help confirm allergy.
✅ Correct: A, C, D
6. Which beta-lactams are safe in mild penicillin allergy (non-IgE)?
A) Cephalexin – Correct; with caution.
B) Aztreonam – Correct; no cross-reactivity.
C) Imipenem – Incorrect; risk exists; avoid if severe allergy.
D) Amoxicillin – Incorrect; direct penicillin.
E) Ceftriaxone – *Correct; cross-reactivity <1%.*
✅ Correct: A, B, E
7. Indications for IV vancomycin include:
A) MRSA bacteremia – Correct; first-line treatment.
B) MSSA endocarditis in PCN-allergic patient – Correct; alternative therapy.
C) C. difficile colitis – Incorrect; oral vancomycin only for this indication.
D) Empiric coverage for nosocomial pneumonia – Correct; covers MRSA.
E) Prophylaxis for joint replacement in MRSA-colonized patient – Correct; guideline-supported.
✅ Correct: A, B, D, E
8. Which cephalosporins have good gram-negative coverage?
A) Cefazolin – *Incorrect; 1st generation – mainly gram-positive.*
, B) Ceftriaxone – *Correct; 3rd generation with excellent gram-negative coverage.*
C) Cefoxitin – Correct; 2nd generation with anaerobe coverage.
D) Cefepime – *Correct; 4th generation broad gram-negative coverage.*
E) Cephalexin – Incorrect; 1st generation.
✅ Correct: B, C, D
9. Adverse effects common to all beta-lactams include:
A) Diarrhea – Correct; due to microbiome disruption.
B) Nephrotoxicity – Incorrect; not common except high-dose methicillin.
C) Hypersensitivity reactions – Correct; rash, anaphylaxis possible.
D) Seizures (high doses) – Correct; especially penicillins and imipenem.
E) QT prolongation – Incorrect; not a class effect.
✅ Correct: A, C, D
10. Which drugs require renal dose adjustment?
A) Vancomycin – Correct; renally excreted.
B) Ceftriaxone – Incorrect; biliary excretion, no adjustment needed.
C) Gentamicin – Correct; aminoglycosides require adjustment.
D) Amoxicillin – *Correct; adjust if CrCl <10 mL/min.*
E) Doxycycline – Incorrect; fecal excretion.
✅ Correct: A, C, D
11. Macrolides (azithromycin, clarithromycin) are associated with:
A) QT prolongation – Correct; arrhythmia risk.
B) Safe in all arrhythmias – Incorrect; avoid in prolonged QT.
C) GI upset – Correct; nausea, diarrhea common.
D) CYP450 inhibition – Correct; drug interactions (statins, warfarin).
E) Bactericidal action – Incorrect; primarily bacteriostatic.
✅ Correct: A, C, D
12. Tetracycline-related warnings include:
A) Avoid in pregnancy – Correct; Category D.
B) Safe in children <8 years – Incorrect; tooth discoloration.
C) Photosensitivity – Correct; use sun protection.
D) Treats Lyme disease – Correct; doxycycline is first-line.
E) Increases tendon rupture risk – Incorrect; that's fluoroquinolones.
, ✅ Correct: A, C, D
13. Aminoglycosides (gentamicin, tobramycin) require monitoring for:
A) Nephrotoxicity – Correct; dose-related.
B) Ototoxicity – Correct; irreversible hearing loss.
C) Red Man Syndrome – Incorrect; that's vancomycin.
D) Therapeutic drug levels – Correct; peak and trough.
E) Hepatotoxicity – Incorrect; rare, not primary.
✅ Correct: A, B, D
14. Which drugs treat atypical pneumonia (Mycoplasma, Chlamydia)?
A) Azithromycin – Correct; macrolide.
B) Doxycycline – Correct; tetracycline.
C) Amoxicillin – Incorrect; ineffective against atypicals (no cell wall).
D) Levofloxacin – Correct; respiratory fluoroquinolone.
E) Vancomycin – Incorrect; no atypical coverage.
✅ Correct: A, B, D
15. Clindamycin is associated with:
A) High risk of C. diff colitis – Correct; one of the highest risks.
B) Excellent gram-negative coverage – Incorrect; mainly gram-positive and anaerobes.
C) Use in aspiration pneumonia – Correct; covers oral anaerobes.
D) Safe in penicillin allergy – Correct; alternative for strep/staph.
E) Bactericidal action – Incorrect; bacteriostatic.
✅ Correct: A, C, D
16. Which statements about linezolid are correct?
A) Oxazolidinone antibiotic – Correct; drug class.
B) Bacteriostatic against most, bactericidal against some – Correct; e.g., strep.
C) MAOI activity – Correct; avoid tyramine, SSRIs.
D) Myelosuppression (thrombocytopenia) – Correct; monitor CBC.
E) First-line for VRE – Correct; along with daptomycin.
✅ Correct: A, B, C, D, E
17. To prevent aminoglycoside toxicity, the nurse should:
A) Monitor peak and trough levels – Correct; ensure therapeutic range.
Covering Pathogen Coverage, Drug Classes, Mechanisms, Black Box Warnings, Adverse Effects, Drug
Interactions, and Key Clinical Prescribing Scenarios.
Instructions
For each question, select all that apply. Correct answers are bolded. Explanations are provided for each
answer choice.
Questions 1–150
1. Which statements about beta-lactam antibiotics are correct?
A) They inhibit bacterial cell wall synthesis – Correct; this is their primary mechanism.
B) They are primarily bacteriostatic – Incorrect; they are bactericidal.
C) Clavulanate is a beta-lactamase inhibitor – Correct; it extends amoxicillin's spectrum.
D) They are effective against Mycoplasma – Incorrect; Mycoplasma lacks a cell wall.
E) Cross-reactivity among penicillins and cephalosporins is possible – Correct; risk is low but exists.
✅ Correct: A, C, E
2. Which cephalosporins provide Pseudomonas coverage?
A) Cephalexin – Incorrect; 1st generation, no Pseudomonas coverage.
B) Ceftazidime – *Correct; 3rd generation anti-pseudomonal.*
C) Ceftriaxone – Incorrect; no Pseudomonas coverage.
D) Cefepime – Correct; 4th generation covers Pseudomonas.
E) Cefazolin – Incorrect; 1st generation, no Pseudomonas coverage.
✅ Correct: B, D
3. True statements about vancomycin include:
A) It is a glycopeptide antibiotic – Correct; this is its drug class.
B) Oral vancomycin treats systemic MRSA – Incorrect; oral is only for C. diff (not absorbed).
C) Red Man Syndrome is caused by histamine release – Correct; from rapid IV infusion.
D) Vancomycin is nephrotoxic and ototoxic – Correct; monitor levels closely.
E) Infusion should be over <30 minutes to avoid toxicity – Incorrect; infuse over ≥60 minutes.
,✅ Correct: A, C, D
4. Carbapenem characteristics include:
A) Imipenem lowers seizure threshold – Correct; CNS toxicity is a known risk.
B) Ertapenem covers Pseudomonas – Incorrect; only imipenem and meropenem do.
C) They are extremely broad-spectrum – Correct; covers gram-positives, gram-negatives, anaerobes.
D) They are beta-lactams – Correct; they belong to this class.
E) They are safe in penicillin allergy – Incorrect; cross-reaction is possible.
✅ Correct: A, C, D
5. Which are true about penicillin allergies?
A) Anaphylaxis rate is ~0.01% – Correct; severe reactions are rare.
B) Cephalosporins are always safe – *Incorrect; low cross-reactivity exists (1-2%).*
C) Carbapenems can be used cautiously – Correct; monitor for reaction.
D) Aztreonam is safe in IgE-mediated PCN allergy – Correct; different structure, no cross-reactivity.
E) Skin testing is never useful – Incorrect; it can help confirm allergy.
✅ Correct: A, C, D
6. Which beta-lactams are safe in mild penicillin allergy (non-IgE)?
A) Cephalexin – Correct; with caution.
B) Aztreonam – Correct; no cross-reactivity.
C) Imipenem – Incorrect; risk exists; avoid if severe allergy.
D) Amoxicillin – Incorrect; direct penicillin.
E) Ceftriaxone – *Correct; cross-reactivity <1%.*
✅ Correct: A, B, E
7. Indications for IV vancomycin include:
A) MRSA bacteremia – Correct; first-line treatment.
B) MSSA endocarditis in PCN-allergic patient – Correct; alternative therapy.
C) C. difficile colitis – Incorrect; oral vancomycin only for this indication.
D) Empiric coverage for nosocomial pneumonia – Correct; covers MRSA.
E) Prophylaxis for joint replacement in MRSA-colonized patient – Correct; guideline-supported.
✅ Correct: A, B, D, E
8. Which cephalosporins have good gram-negative coverage?
A) Cefazolin – *Incorrect; 1st generation – mainly gram-positive.*
, B) Ceftriaxone – *Correct; 3rd generation with excellent gram-negative coverage.*
C) Cefoxitin – Correct; 2nd generation with anaerobe coverage.
D) Cefepime – *Correct; 4th generation broad gram-negative coverage.*
E) Cephalexin – Incorrect; 1st generation.
✅ Correct: B, C, D
9. Adverse effects common to all beta-lactams include:
A) Diarrhea – Correct; due to microbiome disruption.
B) Nephrotoxicity – Incorrect; not common except high-dose methicillin.
C) Hypersensitivity reactions – Correct; rash, anaphylaxis possible.
D) Seizures (high doses) – Correct; especially penicillins and imipenem.
E) QT prolongation – Incorrect; not a class effect.
✅ Correct: A, C, D
10. Which drugs require renal dose adjustment?
A) Vancomycin – Correct; renally excreted.
B) Ceftriaxone – Incorrect; biliary excretion, no adjustment needed.
C) Gentamicin – Correct; aminoglycosides require adjustment.
D) Amoxicillin – *Correct; adjust if CrCl <10 mL/min.*
E) Doxycycline – Incorrect; fecal excretion.
✅ Correct: A, C, D
11. Macrolides (azithromycin, clarithromycin) are associated with:
A) QT prolongation – Correct; arrhythmia risk.
B) Safe in all arrhythmias – Incorrect; avoid in prolonged QT.
C) GI upset – Correct; nausea, diarrhea common.
D) CYP450 inhibition – Correct; drug interactions (statins, warfarin).
E) Bactericidal action – Incorrect; primarily bacteriostatic.
✅ Correct: A, C, D
12. Tetracycline-related warnings include:
A) Avoid in pregnancy – Correct; Category D.
B) Safe in children <8 years – Incorrect; tooth discoloration.
C) Photosensitivity – Correct; use sun protection.
D) Treats Lyme disease – Correct; doxycycline is first-line.
E) Increases tendon rupture risk – Incorrect; that's fluoroquinolones.
, ✅ Correct: A, C, D
13. Aminoglycosides (gentamicin, tobramycin) require monitoring for:
A) Nephrotoxicity – Correct; dose-related.
B) Ototoxicity – Correct; irreversible hearing loss.
C) Red Man Syndrome – Incorrect; that's vancomycin.
D) Therapeutic drug levels – Correct; peak and trough.
E) Hepatotoxicity – Incorrect; rare, not primary.
✅ Correct: A, B, D
14. Which drugs treat atypical pneumonia (Mycoplasma, Chlamydia)?
A) Azithromycin – Correct; macrolide.
B) Doxycycline – Correct; tetracycline.
C) Amoxicillin – Incorrect; ineffective against atypicals (no cell wall).
D) Levofloxacin – Correct; respiratory fluoroquinolone.
E) Vancomycin – Incorrect; no atypical coverage.
✅ Correct: A, B, D
15. Clindamycin is associated with:
A) High risk of C. diff colitis – Correct; one of the highest risks.
B) Excellent gram-negative coverage – Incorrect; mainly gram-positive and anaerobes.
C) Use in aspiration pneumonia – Correct; covers oral anaerobes.
D) Safe in penicillin allergy – Correct; alternative for strep/staph.
E) Bactericidal action – Incorrect; bacteriostatic.
✅ Correct: A, C, D
16. Which statements about linezolid are correct?
A) Oxazolidinone antibiotic – Correct; drug class.
B) Bacteriostatic against most, bactericidal against some – Correct; e.g., strep.
C) MAOI activity – Correct; avoid tyramine, SSRIs.
D) Myelosuppression (thrombocytopenia) – Correct; monitor CBC.
E) First-line for VRE – Correct; along with daptomycin.
✅ Correct: A, B, C, D, E
17. To prevent aminoglycoside toxicity, the nurse should:
A) Monitor peak and trough levels – Correct; ensure therapeutic range.
