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HARD MEDS

Total questions: 52

Worksheet time: 26mins

Name
Class
Date
1.

A patient prescribed sulfamethoxazole-trimethoprim for a UTI reports new skin blistering. Which priority action should the nurse take?

a)

Encourage fluids

b)

Discontinue the drug and notify the provider

c)

Apply topical ointment

d)

Reassure the patient that this is normal

2.

Which laboratory result should be monitored most closely in a patient on long-term sulfonamide therapy?

a)

Serum calcium

b)

BUN and creatinine

c)

Blood glucose

d)

Liver enzymes

3.

Sulfonamides are avoided in infants younger than 2 months primarily because they:

a)

Cause teeth discoloration

b)

Reduce gastric motility

c)

Increase bilirubin levels causing kernicterus

d)

Interfere with renal tubular function

4.

Which statement indicates understanding of amoxicillin therapy?

a)

I’ll take the full course even if I feel better.

b)

If I get diarrhea, I’ll just stop the medication.

c)

I’ll take this with grapefruit juice for best results.

d)

I can skip doses if my symptoms improve.

5.

The nurse knows penicillin is bactericidal because it:

a)

Inhibits folate synthesis

b)

Inhibits bacterial cell wall synthesis

c)

Alters DNA replication

d)

Disrupts ribosomal protein synthesis

6.

A patient with a history of rash after ceftriaxone injection is prescribed ampicillin. What should the nurse do?

a)

Administer the drug and monitor for rash

b)

Notify the provider before administration

c)

Give half the dose

d)

Administer with diphenhydramine

7.

Which cephalosporin can cross the blood–brain barrier to treat meningitis?

a)

Cefazolin

b)

Cefoxitin

c)

Ceftriaxone

d)

Cefepime

8.

Which patient is at greatest risk for an adverse reaction to ceftriaxone?

a)

A 40-year-old with hypertension

b)

A 2-week-old neonate

c)

A 30-year-old with asthma

d)

A 55-year-old with diabetes

9.

The nurse should withhold cephalosporin therapy and notify the provider if the patient reports:

a)

Mild headache

b)

Previous anaphylaxis to penicillin

c)

Drowsiness

d)

Diarrhea

10.

Which statement best describes the role of cilastatin when combined with imipenem?

a)

Enhances bactericidal effect

b)

Prevents hypersensitivity

c)

Inhibits renal breakdown of imipenem

d)

Prevents hepatic metabolism

11.

Carbapenems are reserved for which clinical scenario?

a)

Complicated intra-abdominal infection in a critically ill patient

b)

Mild otitis media

c)

Uncomplicated UTI

d)

Acne vulgaris

12.

Which adverse effect is most associated with carbapenem therapy?

a)

Photosensitivity

b)

Seizures in high doses or renal impairment

c)

Tooth discoloration

d)

QT prolongation

13.

Which organism is most susceptible to aztreonam?

a)

Staphylococcus aureus

b)

Pseudomonas aeruginosa

c)

Streptococcus pneumoniae

d)

Clostridium difficile

14.

Aztreonam differs from penicillin because it:

a)

Covers only aerobic Gram-negative bacteria

b)

Has anaerobic coverage

c)

Causes cross-allergy with penicillins

d)

Is used for fungal infections

15.

The nurse should monitor which lab for a patient on aztreonam with chronic kidney disease?

a)

Platelet count

b)

Serum creatinine

c)

Hemoglobin

d)

Sodium

16.

Which of the following is a unique property of erythromycin?

a)

Causes tendon rupture

b)

Increases GI motility

c)

Causes tooth staining

d)

Induces bone marrow suppression

17.

A nurse should instruct a patient taking clarithromycin to avoid:

a)

Dairy products

b)

Simvastatin (Zocor)

c)

Vitamin D

d)

Iron supplements

18.

A major concern when administering macrolides is:

a)

Hypokalemia

b)

Hypoglycemia

c)

QT interval prolongation

d)

Hypotension

19.

Tetracyclines should not be given to children under 8 because of:

a)

Permanent teeth discoloration and bone growth inhibition

b)

Liver necrosis

c)

Hair loss

d)

Muscle weakness

20.

Which teaching should the nurse include for doxycycline?

a)

“Take with milk to reduce stomach upset.”

b)

“It is safe during pregnancy.”

c)

“Avoid dairy and antacids; they reduce absorption.”

d)

“Take before bedtime.”

21.

Tetracyclines act by:

a)

Disrupting DNA synthesis

b)

Inhibiting cell wall synthesis

c)

Inhibiting protein synthesis at the 30S ribosome

d)

Increasing folate synthesis

22.

The nurse recognizes which adverse effect as most serious with gentamicin therapy?

a)

Rash

b)

Nausea

c)

Ototoxicity and nephrotoxicity

d)

Diarrhea

23.

The nurse plans to draw a trough level for a patient on gentamicin. When is this drawn?

a)

Immediately before the next dose

b)

30 minutes after infusion

c)

2 hours after administration

d)

Midway between doses

24.

Which combination enhances the effectiveness of aminoglycosides?

a)

A beta-lactam antibiotic

b)

A macrolide

c)

A sulfonamide

d)

A tetracycline

25.

A 60-year-old on ciprofloxacin reports calf pain and swelling. The nurse should:

a)

Reassure and continue therapy

b)

Stop the drug; possible tendon rupture

c)

Apply warm compresses

d)

Encourage ambulation

26.

Fluoroquinolones kill bacteria by:

a)

Blocking folate synthesis

b)

Inhibiting DNA gyrase and topoisomerase IV

c)

Inhibiting ribosomal function

d)

Disrupting cell wall formation

27.

Which patient should avoid fluoroquinolones?

a)

COPD

b)

Hypertension

c)

Myasthenia gravis

d)

Hypothyroidism

28.

A patient develops severe watery diarrhea after clindamycin. Which is the likely cause?

a)

Clostridioides difficile infection

b)

GI intolerance

c)

Lactose intolerance

d)

Dehydration

29.

Which mechanism best describes clindamycin’s antibacterial effect?

a)

Inhibits cell wall synthesis

b)

Inhibits bacterial protein synthesis

c)

Alters DNA replication

d)

Prevents folate formation

30.

Clindamycin is most effective against which type of organisms?

a)

Aerobic Gram-negative

b)

Anaerobic bacteria

c)

Mycobacteria

d)

Fungal infections

31.

Which condition is metronidazole primarily used to treat?

a)

Viral pneumonia

b)

Trichomonas vaginalis infection

c)

MRSA

d)

Tuberculosis

32.

A patient on metronidazole reports drinking wine with dinner. The nurse expects:

a)

Sedation

b)

Disulfiram-like reaction with vomiting and flushing

c)

Bradycardia

d)

Constipation

33.

Metronidazole should be avoided during which trimester?

a)

First trimester

b)

Second

c)

Third

d)

Postpartum

34.

Linezolid is reserved for which infection?

a)

Vancomycin-resistant Enterococcus (VRE)

b)

Strep throat

c)

Acne

d)

Otitis media

35.

The nurse should monitor a patient on linezolid for:

a)

Ototoxicity

b)

Myelosuppression and thrombocytopenia

c)

Hypokalemia

d)

Renal stones

36.

Which teaching is essential for a patient on linezolid taking sertraline?

a)

Increase protein intake

b)

Report headaches or confusion due to serotonin syndrome

c)

Avoid dairy

d)

Limit fluids

37.

Vancomycin is the drug of choice for:

a)

MRSA and C. difficile

b)

E. coli sepsis

c)

Viral infections

d)

Fungal meningitis

38.

Rapid infusion of IV vancomycin can cause:

a)

Blue discoloration of skin

b)

Red Man Syndrome from histamine release

c)

Seizures

d)

Bradycardia

39.

Which parameter is most important to monitor during vancomycin therapy?

a)

White blood cell count

b)

Trough levels and renal function

c)

Hemoglobin

d)

Glucose

40.

Vancomycin’s mechanism of action involves:

a)

Blocking DNA replication

b)

Inhibiting protein synthesis

c)

Binding to cell wall precursors (D-Ala-D-Ala)

d)

Altering RNA transcription

41.

Which of the following antibiotics is most associated with QT prolongation?

a)

Penicillin G

b)

Azithromycin

c)

Gentamicin

d)

Vancomycin

42.

Which antibiotic is safest to use during pregnancy?

a)

Penicillin

b)

Tetracycline

c)

Sulfonamide

d)

Fluoroquinolone

43.

Which antibiotic should the nurse associate with photosensitivity risk?

a)

Sulfonamides and tetracyclines

b)

Aminoglycosides

c)

Clindamycin

d)

Carbapenems

44.

A patient with renal impairment should avoid or use caution with which antibiotics?

a)

Macrolides

b)

Aminoglycosides and vancomycin

c)

Tetracyclines only

d)

Clindamycin

45.

Which class inhibits folate synthesis?

a)

Sulfonamides

b)

Macrolides

c)

Fluoroquinolones

d)

Cephalosporins

46.

Which antibiotic is bacteriostatic at usual doses but bactericidal at high doses?

a)

Penicillin

b)

Gentamicin

c)

Macrolides

d)

Vancomycin

47.

A patient with a history of epilepsy should be closely monitored when taking:

a)

Tetracycline

b)

Imipenem/cilastatin

c)

Azithromycin

d)

Doxycycline

48.

A nurse should withhold which antibiotic if a patient reports tinnitus?

a)

Amoxicillin

b)

Gentamicin

c)

Doxycycline

d)

Azithromycin

49.

Which class includes a drug effective against MRSA?

a)

Fluoroquinolones

b)

Cephalosporins (5th gen) and Vancomycin

c)

Sulfonamides only

d)

Macrolides

50.

Which combination is most likely to cause a drug-drug interaction leading to serotonin syndrome?

a)

Ciprofloxacin + lisinopril

b)

Linezolid + SSRI (e.g., sertraline)

c)

Azithromycin + acetaminophen

d)

Gentamicin + furosemide

51.

Which antibiotic is most likely to cause ototoxicity and nephrotoxicity?

a)

Ceftriaxone

b)

Azithromycin

c)

Amoxicillin

d)

Gentamicin

52.

Which antibiotic should be avoided in patients with a history of severe penicillin allergy?

a)

Aztreonam

b)

Clindamycin

c)

Cephalexin

d)

Vancomycin

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