ESTUDYR
NURS 5433 FNP II FINAL EXAM FINAL EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
1. Which organisms are classically considered gram-positive?
A. Escherichia, Pseudomonas, Klebsiella
B. Staphylococcus, Streptococcus, Enterococcus
C. Neisseria, Haemophilus, Legionella
D. Bacteroides, Fusobacterium, Prevotella
Rationale: Staph, Strep, and Enterococcus are common gram-positive cocci; many other
listed genera are gram-negative.
2. What is the primary mechanism of action of penicillins?
A. Inhibit bacterial protein synthesis at the 50S ribosomal subunit
B. Block DNA gyrase activity
C. Inhibit bacterial cell wall synthesis by binding penicillin-binding proteins
D. Disrupt bacterial folic acid synthesis
Rationale: Penicillins bind PBPs, interfering with peptidoglycan crosslinking and cell wall
synthesis.
3. Penicillins are most effective against which group of infections (classic examples)?
A. Mycobacterial infections like TB
B. Viral pharyngitis
C. Streptococcal pharyngitis, otitis media, and syphilis
D. Fungal skin infections
Rationale: Penicillins have strong activity against many gram-positive organisms causing
these conditions.
4. Cephalosporins principally act by:
A. Inhibiting folate synthesis
B. Interfering with DNA replication
C. Inhibiting cell wall synthesis (similar to penicillins)
D. Disrupting bacterial membranes
Rationale: Cephalosporins block PBPs and peptidoglycan synthesis, like penicillins.
5. Which sequence correctly lists cephalosporin generations (example drugs)?
A. 1-ceftriaxone, 2-cefepime, 3-cephalexin, 4-cefuroxime
B. 1-cefepime, 2-ceftriaxone, 3-cefuroxime, 4-cephalexin
C. 1-cephalexin, 2-cefuroxime, 3-ceftriaxone, 4-cefepime
,ESTUDYR
D. 1-cefuroxime, 2-cephalexin, 3-cefepime, 4-ceftriaxone
Rationale: Cephalexin is a 1st-gen, cefuroxime 2nd, ceftriaxone 3rd, cefepime 4th.
6. Macrolides (erythromycin, azithromycin, clarithromycin) primarily:
A. Interfere with cell wall synthesis
B. Inhibit bacterial protein synthesis (50S ribosomal subunit)
C. Inhibit DNA gyrase
D. Block folate synthesis
Rationale: Macrolides bind the 50S subunit and block translocation, inhibiting protein
synthesis.
7. Macrolides are commonly used to treat:
A. Uncomplicated urinary tract infections only
B. Respiratory infections (e.g., bronchitis, pneumonia), skin infections, and certain STIs
C. Severe sepsis due to gram-negative rods only
D. Fungal pneumonia
Rationale: Macrolides have good activity in respiratory pathogens and atypicals and are
used for certain STIs.
8. Fluoroquinolones’ mechanism of action is:
A. Inhibiting cell wall crosslinking
B. Blocking 30S ribosomal subunit
C. Inhibiting bacterial DNA synthesis by targeting DNA gyrase and topoisomerase IV
D. Disrupting folate metabolism
Rationale: Fluoroquinolones inhibit enzymes critical for DNA replication (gyrase/topo
IV).
9. Which adverse effect is strongly associated with fluoroquinolones?
A. Ototoxicity
B. Tendon rupture (esp. Achilles)
C. Bone marrow suppression
D. Hyperglycemia only in diabetics
Rationale: Fluoroquinolones increase risk of tendonitis and tendon rupture, especially in
older patients and those on steroids.
10. Tetracyclines (doxycycline, tetracycline, minocycline) act by:
A. Inhibiting cell wall synthesis
B. Inhibiting bacterial protein synthesis at the 30S ribosomal subunit
C. Affecting folate metabolism
,ESTUDYR
D. Inhibiting DNA replication
Rationale: Tetracyclines bind the 30S ribosomal subunit and block tRNA binding.
11. Tetracyclines are contraindicated in children <8 years old because they:
A. Cause severe renal failure in children
B. Bind developing teeth and bones causing discoloration and growth inhibition
C. Cause congenital cardiac defects
D. Increase risk of SIDS
Rationale: Tetracyclines deposit in bones/teeth, causing permanent discoloration and
enamel hypoplasia.
12. Aminoglycosides (gentamicin, tobramycin, amikacin) primarily target:
A. Gram-positive cocci only
B. Gram-negative bacilli by inhibiting protein synthesis at the 30S subunit
C. Fungi cell walls
D. Viral replication
Rationale: Aminoglycosides are bactericidal against many gram-negatives via 30S
ribosomal inhibition.
13. Major toxicities of aminoglycosides include:
A. Hepatotoxicity and pancreatitis
B. Ototoxicity and nephrotoxicity (+ neuromuscular blockade risk)
C. Retinopathy and cardiomyopathy
D. Tendon rupture
Rationale: Aminoglycosides are known for hearing/vestibular and renal toxicity and can
cause neuromuscular blockade.
14. Sulfonamides (e.g., sulfamethoxazole in Bactrim) work by:
A. Disrupting DNA synthesis directly
B. Inhibiting folic acid synthesis (dihydropteroate synthase)
C. Blocking cell wall assembly
D. Inhibiting protein synthesis
Rationale: Sulfonamides are structural analogs of PABA and inhibit folate synthesis in
bacteria.
15. Sulfonamides are commonly used to treat:
A. Viral infections
B. UTIs, some ear infections, and certain pneumonias (e.g., PCP
prophylaxis/treatment)
C. Severe systemic fungal infections
, ESTUDYR
D. Acute myocardial infarction
Rationale: TMP-SMX is effective for many urinary pathogens and used for PCP and some
skin infections.
16. Live attenuated vaccines include all EXCEPT:
A. MMR
B. Varicella
C. Yellow fever
D. Inactivated influenza (IM injectable)
Rationale: IM inactivated influenza is not live; nasal flu vaccine is live attenuated.
17. Live attenuated vaccines should NOT be administered:
A. To healthy adults
B. To pregnant or significantly immunocompromised individuals
C. To persons >65 years old only
D. If given same day as other vaccines
Rationale: Live vaccines risk causing disease in pregnancy or immunosuppression; same-
day administration with other live vaccines is allowed.
18. When should the influenza vaccine first be given to infants?
A. At birth
B. At 2 months
C. At 6 months of age
D. At 1 year
Rationale: Influenza vaccine is recommended starting at 6 months.
19. If a child has a mild illness or low-grade fever, should you give routine vaccines?
A. No, always defer until fully well
B. Yes — mild illness or low-grade fever is not a contraindication
C. Only delay live vaccines
D. Only give oral vaccines
Rationale: Minor illnesses are not contraindications to vaccination.
20. Kawasaki disease is best described as:
A. A chronic autoimmune arthritis
B. An acute vasculitis of young children that can cause coronary artery aneurysms
C. A bacterial sepsis syndrome in neonates
D. A congenital heart defect
Rationale: Kawasaki is an acute medium-vessel vasculitis in kids <5 with risk of coronary
complications.
NURS 5433 FNP II FINAL EXAM FINAL EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
1. Which organisms are classically considered gram-positive?
A. Escherichia, Pseudomonas, Klebsiella
B. Staphylococcus, Streptococcus, Enterococcus
C. Neisseria, Haemophilus, Legionella
D. Bacteroides, Fusobacterium, Prevotella
Rationale: Staph, Strep, and Enterococcus are common gram-positive cocci; many other
listed genera are gram-negative.
2. What is the primary mechanism of action of penicillins?
A. Inhibit bacterial protein synthesis at the 50S ribosomal subunit
B. Block DNA gyrase activity
C. Inhibit bacterial cell wall synthesis by binding penicillin-binding proteins
D. Disrupt bacterial folic acid synthesis
Rationale: Penicillins bind PBPs, interfering with peptidoglycan crosslinking and cell wall
synthesis.
3. Penicillins are most effective against which group of infections (classic examples)?
A. Mycobacterial infections like TB
B. Viral pharyngitis
C. Streptococcal pharyngitis, otitis media, and syphilis
D. Fungal skin infections
Rationale: Penicillins have strong activity against many gram-positive organisms causing
these conditions.
4. Cephalosporins principally act by:
A. Inhibiting folate synthesis
B. Interfering with DNA replication
C. Inhibiting cell wall synthesis (similar to penicillins)
D. Disrupting bacterial membranes
Rationale: Cephalosporins block PBPs and peptidoglycan synthesis, like penicillins.
5. Which sequence correctly lists cephalosporin generations (example drugs)?
A. 1-ceftriaxone, 2-cefepime, 3-cephalexin, 4-cefuroxime
B. 1-cefepime, 2-ceftriaxone, 3-cefuroxime, 4-cephalexin
C. 1-cephalexin, 2-cefuroxime, 3-ceftriaxone, 4-cefepime
,ESTUDYR
D. 1-cefuroxime, 2-cephalexin, 3-cefepime, 4-ceftriaxone
Rationale: Cephalexin is a 1st-gen, cefuroxime 2nd, ceftriaxone 3rd, cefepime 4th.
6. Macrolides (erythromycin, azithromycin, clarithromycin) primarily:
A. Interfere with cell wall synthesis
B. Inhibit bacterial protein synthesis (50S ribosomal subunit)
C. Inhibit DNA gyrase
D. Block folate synthesis
Rationale: Macrolides bind the 50S subunit and block translocation, inhibiting protein
synthesis.
7. Macrolides are commonly used to treat:
A. Uncomplicated urinary tract infections only
B. Respiratory infections (e.g., bronchitis, pneumonia), skin infections, and certain STIs
C. Severe sepsis due to gram-negative rods only
D. Fungal pneumonia
Rationale: Macrolides have good activity in respiratory pathogens and atypicals and are
used for certain STIs.
8. Fluoroquinolones’ mechanism of action is:
A. Inhibiting cell wall crosslinking
B. Blocking 30S ribosomal subunit
C. Inhibiting bacterial DNA synthesis by targeting DNA gyrase and topoisomerase IV
D. Disrupting folate metabolism
Rationale: Fluoroquinolones inhibit enzymes critical for DNA replication (gyrase/topo
IV).
9. Which adverse effect is strongly associated with fluoroquinolones?
A. Ototoxicity
B. Tendon rupture (esp. Achilles)
C. Bone marrow suppression
D. Hyperglycemia only in diabetics
Rationale: Fluoroquinolones increase risk of tendonitis and tendon rupture, especially in
older patients and those on steroids.
10. Tetracyclines (doxycycline, tetracycline, minocycline) act by:
A. Inhibiting cell wall synthesis
B. Inhibiting bacterial protein synthesis at the 30S ribosomal subunit
C. Affecting folate metabolism
,ESTUDYR
D. Inhibiting DNA replication
Rationale: Tetracyclines bind the 30S ribosomal subunit and block tRNA binding.
11. Tetracyclines are contraindicated in children <8 years old because they:
A. Cause severe renal failure in children
B. Bind developing teeth and bones causing discoloration and growth inhibition
C. Cause congenital cardiac defects
D. Increase risk of SIDS
Rationale: Tetracyclines deposit in bones/teeth, causing permanent discoloration and
enamel hypoplasia.
12. Aminoglycosides (gentamicin, tobramycin, amikacin) primarily target:
A. Gram-positive cocci only
B. Gram-negative bacilli by inhibiting protein synthesis at the 30S subunit
C. Fungi cell walls
D. Viral replication
Rationale: Aminoglycosides are bactericidal against many gram-negatives via 30S
ribosomal inhibition.
13. Major toxicities of aminoglycosides include:
A. Hepatotoxicity and pancreatitis
B. Ototoxicity and nephrotoxicity (+ neuromuscular blockade risk)
C. Retinopathy and cardiomyopathy
D. Tendon rupture
Rationale: Aminoglycosides are known for hearing/vestibular and renal toxicity and can
cause neuromuscular blockade.
14. Sulfonamides (e.g., sulfamethoxazole in Bactrim) work by:
A. Disrupting DNA synthesis directly
B. Inhibiting folic acid synthesis (dihydropteroate synthase)
C. Blocking cell wall assembly
D. Inhibiting protein synthesis
Rationale: Sulfonamides are structural analogs of PABA and inhibit folate synthesis in
bacteria.
15. Sulfonamides are commonly used to treat:
A. Viral infections
B. UTIs, some ear infections, and certain pneumonias (e.g., PCP
prophylaxis/treatment)
C. Severe systemic fungal infections
, ESTUDYR
D. Acute myocardial infarction
Rationale: TMP-SMX is effective for many urinary pathogens and used for PCP and some
skin infections.
16. Live attenuated vaccines include all EXCEPT:
A. MMR
B. Varicella
C. Yellow fever
D. Inactivated influenza (IM injectable)
Rationale: IM inactivated influenza is not live; nasal flu vaccine is live attenuated.
17. Live attenuated vaccines should NOT be administered:
A. To healthy adults
B. To pregnant or significantly immunocompromised individuals
C. To persons >65 years old only
D. If given same day as other vaccines
Rationale: Live vaccines risk causing disease in pregnancy or immunosuppression; same-
day administration with other live vaccines is allowed.
18. When should the influenza vaccine first be given to infants?
A. At birth
B. At 2 months
C. At 6 months of age
D. At 1 year
Rationale: Influenza vaccine is recommended starting at 6 months.
19. If a child has a mild illness or low-grade fever, should you give routine vaccines?
A. No, always defer until fully well
B. Yes — mild illness or low-grade fever is not a contraindication
C. Only delay live vaccines
D. Only give oral vaccines
Rationale: Minor illnesses are not contraindications to vaccination.
20. Kawasaki disease is best described as:
A. A chronic autoimmune arthritis
B. An acute vasculitis of young children that can cause coronary artery aneurysms
C. A bacterial sepsis syndrome in neonates
D. A congenital heart defect
Rationale: Kawasaki is an acute medium-vessel vasculitis in kids <5 with risk of coronary
complications.
