NR 566
Midterm Exams
(3 Full Set Exams)
(Week’s 1 – 4 Covered)
(Advanced Pharmacology)
Exam-Style Qs that mirror the actual Exam
Chamberlain
,Table of Contents
NR 566 MIDTERM EXAM SET 1 ..................................... 2
NR 566 MIDTERM EXAM SET 2 ................................... 35
NR 566 MIDTERM EXAM SET 3 ................................... 68
NR 566 MIDTERM EXAM SET 1
Question 1: Which statement best explains why amphotericin B must be given
intravenously for systemic mycoses?
A. It is rapidly metabolized by the liver when taken orally.
B. It is poorly absorbed from the gastrointestinal tract.
C. It is inactivated by gastric acid.
D. It causes severe esophageal irritation when swallowed.
Answer: B. It is poorly absorbed from the gastrointestinal tract.
Expert Explanation: Amphotericin B has very poor GI absorption, so therapeutic serum
levels for systemic mycoses can only be achieved with IV administration. After leaving
the vascular space it binds extensively to sterol-containing membranes, but oral dosing
does not provide adequate bioavailability for systemic infection.
Question 2: Which intervention most effectively reduces the risk of amphotericin B–
induced nephrotoxicity?
A. Premedicating with acetaminophen
B. Administering the drug by rapid IV bolus
,C. Infusing 1 liter of normal saline on days of treatment
D. Giving a loop diuretic before each dose
Answer: C. Infusing 1 liter of normal saline on days of treatment
Expert Explanation: Hydration with 1 liter of saline on treatment days is specifically
recommended to minimize amphotericin B–related kidney damage. Additional
nephrotoxic drugs should also be avoided, but routine prehydration is the key
preventative strategy.
Question 3: An older adult on multiple medications is started on itraconazole. Which
concurrent drug is specifically contraindicated due to risk of fatal ventricular
dysrhythmias?
A. Digoxin
B. Warfarin
C. Cisapride
D. Sulfonylurea
Answer: C. Cisapride
Expert Explanation: Itraconazole strongly inhibits CYP450 and is contraindicated with
cisapride, pimozide, dofetilide, and quinidine because these combinations can
precipitate fatal ventricular dysrhythmias. Other drugs such as warfarin and digoxin may
be used with close monitoring of levels and effects.
Question 4: A patient taking a proton pump inhibitor is prescribed oral itraconazole
capsules. What is the most important counseling point?
A. Take itraconazole on an empty stomach with water.
B. Stop the proton pump inhibitor while on itraconazole.
C. Space itraconazole at least 1 hour before or 2 hours after the acid-suppressing drug.
D. Take both medications at bedtime together.
Answer: C. Space itraconazole at least 1 hour before or 2 hours after the acid-
suppressing drug.
Expert Explanation: Drugs that decrease gastric acidity (antacids, H2 blockers, PPIs)
markedly reduce itraconazole absorption. They should be administered at least 1 hour
before or 2 hours after itraconazole to maximize antifungal absorption.
Question 5: Which antifungal is taken orally to treat dermatophyte infections of the skin,
hair, and nails but is NOT active against Candida or systemic mycoses?
A. Caspofungin
, B. Griseofulvin
C. Amphotericin B
D. Fluconazole
Answer: B. Griseofulvin
Expert Explanation: Griseofulvin is given orally for dermatophytic infections of skin, hair,
and nails and is not effective against Candida species or systemic fungal infections.
Other systemic agents such as amphotericin B or azoles are used for invasive disease.
Question 6: Which patient teaching is most appropriate for tinea pedis being treated with
topical therapy?
A. “Limit foot washing to once weekly to avoid skin breakdown.”
B. “Wear absorbent cotton socks and change your shoes often.”
C. “Cover your feet with plastic wrap after applying medication.”
D. “Stop treatment as soon as the itching improves.”
Answer: B. “Wear absorbent cotton socks and change your shoes often.”
Expert Explanation: For tinea pedis, patients should keep feet dry by wearing absorbent
cotton socks, changing shoes frequently, and thoroughly drying the feet after bathing.
These measures, combined with topical antifungal therapy, enhance resolution and
prevent recurrence.
Question 7: Which statement best describes the mechanism of action of acyclovir?
A. It blocks viral entry by binding to cell surface receptors.
B. It inhibits viral protease, preventing maturation of virions.
C. It suppresses synthesis of viral DNA by inhibiting DNA polymerase and terminating
chain growth.
D. It stimulates host interferon production to block viral replication.
Answer: C. It suppresses synthesis of viral DNA by inhibiting DNA polymerase and
terminating chain growth.
Expert Explanation: After activation to acyclo-GTP, acyclovir inhibits viral DNA
polymerase and is incorporated into viral DNA, blocking further strand elongation. This
dual effect suppresses viral DNA synthesis and replication.
Question 8: Which infection is routinely treated with high-dose oral acyclovir in
immunocompetent older adults?
A. Herpes labialis
B. Herpes zoster (shingles)
Midterm Exams
(3 Full Set Exams)
(Week’s 1 – 4 Covered)
(Advanced Pharmacology)
Exam-Style Qs that mirror the actual Exam
Chamberlain
,Table of Contents
NR 566 MIDTERM EXAM SET 1 ..................................... 2
NR 566 MIDTERM EXAM SET 2 ................................... 35
NR 566 MIDTERM EXAM SET 3 ................................... 68
NR 566 MIDTERM EXAM SET 1
Question 1: Which statement best explains why amphotericin B must be given
intravenously for systemic mycoses?
A. It is rapidly metabolized by the liver when taken orally.
B. It is poorly absorbed from the gastrointestinal tract.
C. It is inactivated by gastric acid.
D. It causes severe esophageal irritation when swallowed.
Answer: B. It is poorly absorbed from the gastrointestinal tract.
Expert Explanation: Amphotericin B has very poor GI absorption, so therapeutic serum
levels for systemic mycoses can only be achieved with IV administration. After leaving
the vascular space it binds extensively to sterol-containing membranes, but oral dosing
does not provide adequate bioavailability for systemic infection.
Question 2: Which intervention most effectively reduces the risk of amphotericin B–
induced nephrotoxicity?
A. Premedicating with acetaminophen
B. Administering the drug by rapid IV bolus
,C. Infusing 1 liter of normal saline on days of treatment
D. Giving a loop diuretic before each dose
Answer: C. Infusing 1 liter of normal saline on days of treatment
Expert Explanation: Hydration with 1 liter of saline on treatment days is specifically
recommended to minimize amphotericin B–related kidney damage. Additional
nephrotoxic drugs should also be avoided, but routine prehydration is the key
preventative strategy.
Question 3: An older adult on multiple medications is started on itraconazole. Which
concurrent drug is specifically contraindicated due to risk of fatal ventricular
dysrhythmias?
A. Digoxin
B. Warfarin
C. Cisapride
D. Sulfonylurea
Answer: C. Cisapride
Expert Explanation: Itraconazole strongly inhibits CYP450 and is contraindicated with
cisapride, pimozide, dofetilide, and quinidine because these combinations can
precipitate fatal ventricular dysrhythmias. Other drugs such as warfarin and digoxin may
be used with close monitoring of levels and effects.
Question 4: A patient taking a proton pump inhibitor is prescribed oral itraconazole
capsules. What is the most important counseling point?
A. Take itraconazole on an empty stomach with water.
B. Stop the proton pump inhibitor while on itraconazole.
C. Space itraconazole at least 1 hour before or 2 hours after the acid-suppressing drug.
D. Take both medications at bedtime together.
Answer: C. Space itraconazole at least 1 hour before or 2 hours after the acid-
suppressing drug.
Expert Explanation: Drugs that decrease gastric acidity (antacids, H2 blockers, PPIs)
markedly reduce itraconazole absorption. They should be administered at least 1 hour
before or 2 hours after itraconazole to maximize antifungal absorption.
Question 5: Which antifungal is taken orally to treat dermatophyte infections of the skin,
hair, and nails but is NOT active against Candida or systemic mycoses?
A. Caspofungin
, B. Griseofulvin
C. Amphotericin B
D. Fluconazole
Answer: B. Griseofulvin
Expert Explanation: Griseofulvin is given orally for dermatophytic infections of skin, hair,
and nails and is not effective against Candida species or systemic fungal infections.
Other systemic agents such as amphotericin B or azoles are used for invasive disease.
Question 6: Which patient teaching is most appropriate for tinea pedis being treated with
topical therapy?
A. “Limit foot washing to once weekly to avoid skin breakdown.”
B. “Wear absorbent cotton socks and change your shoes often.”
C. “Cover your feet with plastic wrap after applying medication.”
D. “Stop treatment as soon as the itching improves.”
Answer: B. “Wear absorbent cotton socks and change your shoes often.”
Expert Explanation: For tinea pedis, patients should keep feet dry by wearing absorbent
cotton socks, changing shoes frequently, and thoroughly drying the feet after bathing.
These measures, combined with topical antifungal therapy, enhance resolution and
prevent recurrence.
Question 7: Which statement best describes the mechanism of action of acyclovir?
A. It blocks viral entry by binding to cell surface receptors.
B. It inhibits viral protease, preventing maturation of virions.
C. It suppresses synthesis of viral DNA by inhibiting DNA polymerase and terminating
chain growth.
D. It stimulates host interferon production to block viral replication.
Answer: C. It suppresses synthesis of viral DNA by inhibiting DNA polymerase and
terminating chain growth.
Expert Explanation: After activation to acyclo-GTP, acyclovir inhibits viral DNA
polymerase and is incorporated into viral DNA, blocking further strand elongation. This
dual effect suppresses viral DNA synthesis and replication.
Question 8: Which infection is routinely treated with high-dose oral acyclovir in
immunocompetent older adults?
A. Herpes labialis
B. Herpes zoster (shingles)
