NUR 615 Module 2: Antibiotics & Antimicrobial Therapy 2026 Update – Second Comprehensive
Exam Set Covering Antifungals, Antivirals, Pharmacodynamics, Nursing Implications, Resistance,
and Clinical Case Applications.
Instructions
Select all that apply for each question. Correct answers are bolded. Explanations follow each choice.
Questions 1–150
1. Which statements about antifungal drug classes are correct?
A) Polyenes (amphotericin B) bind ergosterol – Correct; disrupts fungal cell membrane.
B) Azoles inhibit ergosterol synthesis – *Correct; via 14-alpha-demethylase.*
C) Echinocandins inhibit beta-glucan synthase – Correct; disrupts cell wall.
D) Flucytosine inhibits DNA synthesis – *Correct; converted to 5-FU.*
E) All antifungals are bactericidal – Incorrect; many are fungistatic.
✅ Correct: A, B, C, D
2. Amphotericin B adverse effects include:
A) Infusion-related reactions (fever, chills) – Correct; common.
B) Nephrotoxicity – Correct; dose-limiting.
C) Hypokalemia – Correct; renal tubular wasting.
D) Hypomagnesemia – Correct; also from renal loss.
E) Hepatotoxicity – Less common; not primary.
✅ Correct: A, B, C, D
3. To reduce amphotericin B infusion reactions, the nurse should:
A) Premedicate with acetaminophen and diphenhydramine – Correct.
B) Administer a test dose – Correct; for severe reactions.
C) Infuse rapidly over 15 minutes – *Incorrect; infuse over 2-6 hours.*
D) Add hydrocortisone to infusion – Correct; reduces reactions.
E) Use liposomal formulation – Correct; better tolerated.
✅ Correct: A, B, D, E
,4. Which azole antifungals require therapeutic drug monitoring?
A) Voriconazole – Correct; nonlinear pharmacokinetics.
B) Itraconazole – Correct; erratic absorption.
C) Posaconazole – Correct; for prophylaxis/treatment.
D) Fluconazole – Incorrect; predictable, rarely needs TDM.
E) Isavuconazole – Incorrect; predictable, no TDM needed.
✅ Correct: A, B, C
5. Echinocandins (caspofungin, micafungin, anidulafungin) are used for:
A) Candida infections (including azole-resistant) – Correct.
B) Invasive aspergillosis (salvage therapy) – Correct.
C) First-line for candidemia in non-neutropenic – Correct.
D) Cryptococcal meningitis – Incorrect; use amphotericin + flucytosine.
E) Mucormycosis – Incorrect; no activity.
✅ Correct: A, B, C
6. Fluconazole is appropriate for:
A) Oropharyngeal candidiasis (thrush) – Correct.
B) Candida vulvovaginitis – Correct; single 150 mg dose.
C) Cryptococcal meningitis (maintenance) – Correct; after induction.
D) Aspergillosis – Incorrect; no activity.
E) Candida glabrata (if susceptible) – Variable; often resistant.
✅ Correct: A, B, C
7. Voriconazole is the drug of choice for:
A) Invasive aspergillosis – Correct; first-line.
B) Candida krusei (intrinsically resistant to fluconazole) – Correct.
C) Scedosporium – Correct.
D) Mucormycosis – Incorrect; no activity.
E) Coccidioidomycosis (Valley fever) – Correct; alternative.
✅ Correct: A, B, C, E
8. Which statements about posaconazole are correct?
A) Extended-release tablet has better absorption – Correct.
B) Requires administration with high-fat meal or acidic beverage – Correct.
, C) Used for prophylaxis in neutropenia – Correct.
D) Used for oropharyngeal candidiasis – Incorrect; fluconazole first.
E) Drug levels should be monitored – Correct.
✅ Correct: A, B, C, E
9. Isavuconazole has which advantages?
A) No significant QT prolongation – Correct; unlike voriconazole.
B) Excellent oral bioavailability – Correct.
C) Fewer drug interactions than voriconazole – Correct; still CYP3A4 substrate.
D) Active against mucormycosis – Correct; unique among azoles.
E) No need for TDM – Correct; predictable.
✅ Correct: A, B, C, D, E
10. Flucytosine (5-FC) is used in combination with amphotericin B for:
A) Cryptococcal meningitis – Correct; synergistic.
B) Candida endophthalmitis – Correct.
C) Candida urinary tract infection – Correct.
D) Aspergillosis – Incorrect; not effective.
E) Mucormycosis – Incorrect.
✅ Correct: A, B, C
11. Which statements about cryptococcal meningitis treatment are correct?
A) Induction phase: amphotericin B + flucytosine x 2 weeks – Correct.
B) Consolidation: fluconazole 400 mg daily x 8 weeks – Correct.
C) Maintenance: fluconazole 200 mg daily for ≥1 year – Correct.
D) Amphotericin B alone is preferred – Incorrect; inferior to combination.
E) Echinocandins are first-line – Incorrect; no CNS penetration.
✅ Correct: A, B, C
12. A patient with HIV and oropharyngeal candidiasis (thrush) who fails fluconazole should receive:
A) Clotrimazole troches – Correct; topical.
B) Nystatin suspension – Correct; topical.
C) Caspofungin IV – Correct; for refractory.
D) Amphotericin B IV – Correct; last-line.
E) Voriconazole – Correct; broader spectrum.
, ✅ Correct: A, B, C, D, E
13. Which statements about nystatin are correct?
A) Topical only (oral suspension, cream, powder) – Correct.
B) Not absorbed systemically – Correct.
C) Used for oral thrush – Correct.
D) Used for diaper rash (candidal) – Correct.
E) Effective for systemic candidiasis – Incorrect; no absorption.
✅ Correct: A, B, C, D
14. Which antifungals require dose adjustment in renal failure?
A) Flucytosine – Correct; renally excreted.
B) Amphotericin B (avoid if possible) – Correct; nephrotoxic.
C) Fluconazole – Correct; 70% renally excreted.
D) Voriconazole – Incorrect; hepatically metabolized.
E) Caspofungin – Incorrect; no adjustment.
✅ Correct: A, B, C
15. Which antifungals are associated with hepatotoxicity?
A) Voriconazole – Correct; elevated LFTs common.
B) Itraconazole – Correct; cholestatic hepatitis.
C) Ketoconazole – Correct; black box warning for hepatotoxicity.
D) Fluconazole – Rare; mild.
E) Caspofungin – Correct; can elevate LFTs.
✅ Correct: A, B, C, D, E
16. A patient on voriconazole develops visual disturbances (photopsia, blurred vision). The nurse
should:
A) Recognize this as a common side effect – Correct; occurs in ~30%.
B) Advise patient not to drive at night – Correct.
C) Discontinue voriconazole immediately – Incorrect; usually reversible.
D) Monitor for optic neuritis – Correct; rare but serious.
E) Switch to isavuconazole if intolerable – Correct.
✅ Correct: A, B, D, E
17. Which antifungals cause significant QT prolongation?
Exam Set Covering Antifungals, Antivirals, Pharmacodynamics, Nursing Implications, Resistance,
and Clinical Case Applications.
Instructions
Select all that apply for each question. Correct answers are bolded. Explanations follow each choice.
Questions 1–150
1. Which statements about antifungal drug classes are correct?
A) Polyenes (amphotericin B) bind ergosterol – Correct; disrupts fungal cell membrane.
B) Azoles inhibit ergosterol synthesis – *Correct; via 14-alpha-demethylase.*
C) Echinocandins inhibit beta-glucan synthase – Correct; disrupts cell wall.
D) Flucytosine inhibits DNA synthesis – *Correct; converted to 5-FU.*
E) All antifungals are bactericidal – Incorrect; many are fungistatic.
✅ Correct: A, B, C, D
2. Amphotericin B adverse effects include:
A) Infusion-related reactions (fever, chills) – Correct; common.
B) Nephrotoxicity – Correct; dose-limiting.
C) Hypokalemia – Correct; renal tubular wasting.
D) Hypomagnesemia – Correct; also from renal loss.
E) Hepatotoxicity – Less common; not primary.
✅ Correct: A, B, C, D
3. To reduce amphotericin B infusion reactions, the nurse should:
A) Premedicate with acetaminophen and diphenhydramine – Correct.
B) Administer a test dose – Correct; for severe reactions.
C) Infuse rapidly over 15 minutes – *Incorrect; infuse over 2-6 hours.*
D) Add hydrocortisone to infusion – Correct; reduces reactions.
E) Use liposomal formulation – Correct; better tolerated.
✅ Correct: A, B, D, E
,4. Which azole antifungals require therapeutic drug monitoring?
A) Voriconazole – Correct; nonlinear pharmacokinetics.
B) Itraconazole – Correct; erratic absorption.
C) Posaconazole – Correct; for prophylaxis/treatment.
D) Fluconazole – Incorrect; predictable, rarely needs TDM.
E) Isavuconazole – Incorrect; predictable, no TDM needed.
✅ Correct: A, B, C
5. Echinocandins (caspofungin, micafungin, anidulafungin) are used for:
A) Candida infections (including azole-resistant) – Correct.
B) Invasive aspergillosis (salvage therapy) – Correct.
C) First-line for candidemia in non-neutropenic – Correct.
D) Cryptococcal meningitis – Incorrect; use amphotericin + flucytosine.
E) Mucormycosis – Incorrect; no activity.
✅ Correct: A, B, C
6. Fluconazole is appropriate for:
A) Oropharyngeal candidiasis (thrush) – Correct.
B) Candida vulvovaginitis – Correct; single 150 mg dose.
C) Cryptococcal meningitis (maintenance) – Correct; after induction.
D) Aspergillosis – Incorrect; no activity.
E) Candida glabrata (if susceptible) – Variable; often resistant.
✅ Correct: A, B, C
7. Voriconazole is the drug of choice for:
A) Invasive aspergillosis – Correct; first-line.
B) Candida krusei (intrinsically resistant to fluconazole) – Correct.
C) Scedosporium – Correct.
D) Mucormycosis – Incorrect; no activity.
E) Coccidioidomycosis (Valley fever) – Correct; alternative.
✅ Correct: A, B, C, E
8. Which statements about posaconazole are correct?
A) Extended-release tablet has better absorption – Correct.
B) Requires administration with high-fat meal or acidic beverage – Correct.
, C) Used for prophylaxis in neutropenia – Correct.
D) Used for oropharyngeal candidiasis – Incorrect; fluconazole first.
E) Drug levels should be monitored – Correct.
✅ Correct: A, B, C, E
9. Isavuconazole has which advantages?
A) No significant QT prolongation – Correct; unlike voriconazole.
B) Excellent oral bioavailability – Correct.
C) Fewer drug interactions than voriconazole – Correct; still CYP3A4 substrate.
D) Active against mucormycosis – Correct; unique among azoles.
E) No need for TDM – Correct; predictable.
✅ Correct: A, B, C, D, E
10. Flucytosine (5-FC) is used in combination with amphotericin B for:
A) Cryptococcal meningitis – Correct; synergistic.
B) Candida endophthalmitis – Correct.
C) Candida urinary tract infection – Correct.
D) Aspergillosis – Incorrect; not effective.
E) Mucormycosis – Incorrect.
✅ Correct: A, B, C
11. Which statements about cryptococcal meningitis treatment are correct?
A) Induction phase: amphotericin B + flucytosine x 2 weeks – Correct.
B) Consolidation: fluconazole 400 mg daily x 8 weeks – Correct.
C) Maintenance: fluconazole 200 mg daily for ≥1 year – Correct.
D) Amphotericin B alone is preferred – Incorrect; inferior to combination.
E) Echinocandins are first-line – Incorrect; no CNS penetration.
✅ Correct: A, B, C
12. A patient with HIV and oropharyngeal candidiasis (thrush) who fails fluconazole should receive:
A) Clotrimazole troches – Correct; topical.
B) Nystatin suspension – Correct; topical.
C) Caspofungin IV – Correct; for refractory.
D) Amphotericin B IV – Correct; last-line.
E) Voriconazole – Correct; broader spectrum.
, ✅ Correct: A, B, C, D, E
13. Which statements about nystatin are correct?
A) Topical only (oral suspension, cream, powder) – Correct.
B) Not absorbed systemically – Correct.
C) Used for oral thrush – Correct.
D) Used for diaper rash (candidal) – Correct.
E) Effective for systemic candidiasis – Incorrect; no absorption.
✅ Correct: A, B, C, D
14. Which antifungals require dose adjustment in renal failure?
A) Flucytosine – Correct; renally excreted.
B) Amphotericin B (avoid if possible) – Correct; nephrotoxic.
C) Fluconazole – Correct; 70% renally excreted.
D) Voriconazole – Incorrect; hepatically metabolized.
E) Caspofungin – Incorrect; no adjustment.
✅ Correct: A, B, C
15. Which antifungals are associated with hepatotoxicity?
A) Voriconazole – Correct; elevated LFTs common.
B) Itraconazole – Correct; cholestatic hepatitis.
C) Ketoconazole – Correct; black box warning for hepatotoxicity.
D) Fluconazole – Rare; mild.
E) Caspofungin – Correct; can elevate LFTs.
✅ Correct: A, B, C, D, E
16. A patient on voriconazole develops visual disturbances (photopsia, blurred vision). The nurse
should:
A) Recognize this as a common side effect – Correct; occurs in ~30%.
B) Advise patient not to drive at night – Correct.
C) Discontinue voriconazole immediately – Incorrect; usually reversible.
D) Monitor for optic neuritis – Correct; rare but serious.
E) Switch to isavuconazole if intolerable – Correct.
✅ Correct: A, B, D, E
17. Which antifungals cause significant QT prolongation?
