150 moderate-complexity MCQs for NURS715 exam prep
across the following topics: Anti-infectives, Vaccines,
Population Health, Polypharmacy & Deprescribing
Topics Covered
1. Anti-infectives (PK/PD, resistance, stewardship, drug classes)
2. Vaccines (types, mechanisms, development, COVID-19, hesitancy)
3. Population Health (determinants, public health measures,
epidemiology)
4. Polypharmacy & Deprescribing (risks, frameworks, case-based
pearls)
Each MCQ will include:
• A clinical-style question
• Four options (A–D)
• Correct answer
• Explanation + NP pearl
Block 1: Anti-Infectives (Q1–25)
Q1. Which of the following best describes the mechanism of action of beta-
lactam antibiotics such as penicillin?
A. Disrupts protein synthesis at the 30S ribosome
B. Inhibits bacterial DNA gyrase
C. Inhibits cell wall synthesis by binding to penicillin-binding proteins
(PBPs)
D. Alters bacterial folate metabolism
Answer: C
Explanation: Beta-lactams inhibit cell wall synthesis by blocking PBPs,
leading to bacterial lysis. NP Pearl: Use caution in renal impairment—adjust
dose accordingly.
,Q2. Which of the following bacteria is commonly associated with
community-acquired pneumonia and is typically covered by amoxicillin?
A. Escherichia coli
B. Streptococcus pneumoniae
C. Pseudomonas aeruginosa
D. Klebsiella oxytoca
Answer: B
Explanation: S. pneumoniae is a frequent CAP pathogen and is
susceptible to high-dose amoxicillin. NP Pearl: Watch for rising resistance—
check local antibiograms.
Q3. A major mechanism of antibiotic resistance in Gram-negative bacteria
is:
A. Efflux pumps and beta-lactamase enzyme production
B. Decreased macrophage activation
C. Overactivation of Toll-like receptors
D. Downregulation of MHC class II molecules
Answer: A
Explanation: Resistance often occurs via eflux of drugs or enzymatic
degradation. NP Pearl: Choose beta-lactamase inhibitors when resistant
organisms are suspected.
Q4. Which antibiotic is known to cause QT prolongation and should be
avoided in patients with arrhythmia history?
A. Amoxicillin
B. Ciprofloxacin
C. Cephalexin
D. Nitrofurantoin
Answer: B
Explanation: Fluoroquinolones like ciprofloxacin can cause QT
prolongation. NP Pearl: Monitor ECG in older adults or if on other QT-
prolonging meds.
Q5. Doxycycline is effective against which of the following pathogens?
A. MRSA
B. Pseudomonas
C. Enterococcus faecalis
,D. H. pylori
Answer: A
Explanation: Doxycycline covers CA-MRSA and atypicals. NP Pearl:
Avoid in pregnancy and children <8 years—risk of teeth discoloration.
Q6. Which pharmacokinetic parameter best predicts efficacy for
aminoglycosides?
A. AUC/MIC
B. Time > MIC
C. Peak/MIC ratio
D. Trough levels
Answer: C
Explanation: Aminoglycosides are concentration-dependent—high peak
levels are key. NP Pearl: Monitor renal function and auditory symptoms.
Q7. Which of the following best defines empiric antibiotic therapy?
A. Based on culture and sensitivity
B. Based on suspected pathogens and clinical judgment
C. Treatment of viral infections
D. Avoiding all antibiotics until lab confirmation
Answer: B
Explanation: Empiric therapy is based on probable pathogens and
clinical context. NP Pearl: Reassess therapy once culture data is available
(antibiotic timeout).
Q8. Which organism is typically resistant to nitrofurantoin?
A. E. coli
B. Enterobacter
C. Staphylococcus saprophyticus
D. Klebsiella pneumoniae
Answer: B
Explanation: Nitrofurantoin has poor activity against Enterobacter. NP
Pearl: Use only for uncomplicated lower UTIs with good renal function
(CrCl >60 mL/min).
, Q9. Clindamycin is associated with which adverse effect?
A. Nephrotoxicity
B. Ototoxicity
C. C. difficile-associated diarrhea
D. QT prolongation
Answer: C
Explanation: Clindamycin is a major risk factor for C. difi. NP Pearl:
Avoid long-term use in frail elders unless clearly indicated.
Q10. Fluoroquinolones like ciprofloxacin should be used with caution in
which population?
A. Patients with hypertension
B. Older adults due to risk of tendon rupture
C. Adolescents due to acne
D. Pregnant patients due to low toxicity
Answer: B
Explanation: Fluoroquinolones increase the risk of tendon rupture,
especially in older adults. NP Pearl: Reserve use for when safer alternatives
are not available.
Q11. What is the most appropriate first-line treatment for uncomplicated
streptococcal pharyngitis?
A. Azithromycin
B. Ciprofloxacin
C. Penicillin V
D. Cephalexin
Answer: C
Explanation: Penicillin remains first-line for Group A strep pharyngitis.
NP Pearl: In penicillin allergy, consider a macrolide like azithromycin.
Q12. Which class of antibiotics disrupts bacterial DNA replication?
A. Fluoroquinolones
B. Beta-lactams
C. Tetracyclines
D. Macrolides
Answer: A
Explanation: Fluoroquinolones inhibit DNA gyrase/topoisomerase. NP
across the following topics: Anti-infectives, Vaccines,
Population Health, Polypharmacy & Deprescribing
Topics Covered
1. Anti-infectives (PK/PD, resistance, stewardship, drug classes)
2. Vaccines (types, mechanisms, development, COVID-19, hesitancy)
3. Population Health (determinants, public health measures,
epidemiology)
4. Polypharmacy & Deprescribing (risks, frameworks, case-based
pearls)
Each MCQ will include:
• A clinical-style question
• Four options (A–D)
• Correct answer
• Explanation + NP pearl
Block 1: Anti-Infectives (Q1–25)
Q1. Which of the following best describes the mechanism of action of beta-
lactam antibiotics such as penicillin?
A. Disrupts protein synthesis at the 30S ribosome
B. Inhibits bacterial DNA gyrase
C. Inhibits cell wall synthesis by binding to penicillin-binding proteins
(PBPs)
D. Alters bacterial folate metabolism
Answer: C
Explanation: Beta-lactams inhibit cell wall synthesis by blocking PBPs,
leading to bacterial lysis. NP Pearl: Use caution in renal impairment—adjust
dose accordingly.
,Q2. Which of the following bacteria is commonly associated with
community-acquired pneumonia and is typically covered by amoxicillin?
A. Escherichia coli
B. Streptococcus pneumoniae
C. Pseudomonas aeruginosa
D. Klebsiella oxytoca
Answer: B
Explanation: S. pneumoniae is a frequent CAP pathogen and is
susceptible to high-dose amoxicillin. NP Pearl: Watch for rising resistance—
check local antibiograms.
Q3. A major mechanism of antibiotic resistance in Gram-negative bacteria
is:
A. Efflux pumps and beta-lactamase enzyme production
B. Decreased macrophage activation
C. Overactivation of Toll-like receptors
D. Downregulation of MHC class II molecules
Answer: A
Explanation: Resistance often occurs via eflux of drugs or enzymatic
degradation. NP Pearl: Choose beta-lactamase inhibitors when resistant
organisms are suspected.
Q4. Which antibiotic is known to cause QT prolongation and should be
avoided in patients with arrhythmia history?
A. Amoxicillin
B. Ciprofloxacin
C. Cephalexin
D. Nitrofurantoin
Answer: B
Explanation: Fluoroquinolones like ciprofloxacin can cause QT
prolongation. NP Pearl: Monitor ECG in older adults or if on other QT-
prolonging meds.
Q5. Doxycycline is effective against which of the following pathogens?
A. MRSA
B. Pseudomonas
C. Enterococcus faecalis
,D. H. pylori
Answer: A
Explanation: Doxycycline covers CA-MRSA and atypicals. NP Pearl:
Avoid in pregnancy and children <8 years—risk of teeth discoloration.
Q6. Which pharmacokinetic parameter best predicts efficacy for
aminoglycosides?
A. AUC/MIC
B. Time > MIC
C. Peak/MIC ratio
D. Trough levels
Answer: C
Explanation: Aminoglycosides are concentration-dependent—high peak
levels are key. NP Pearl: Monitor renal function and auditory symptoms.
Q7. Which of the following best defines empiric antibiotic therapy?
A. Based on culture and sensitivity
B. Based on suspected pathogens and clinical judgment
C. Treatment of viral infections
D. Avoiding all antibiotics until lab confirmation
Answer: B
Explanation: Empiric therapy is based on probable pathogens and
clinical context. NP Pearl: Reassess therapy once culture data is available
(antibiotic timeout).
Q8. Which organism is typically resistant to nitrofurantoin?
A. E. coli
B. Enterobacter
C. Staphylococcus saprophyticus
D. Klebsiella pneumoniae
Answer: B
Explanation: Nitrofurantoin has poor activity against Enterobacter. NP
Pearl: Use only for uncomplicated lower UTIs with good renal function
(CrCl >60 mL/min).
, Q9. Clindamycin is associated with which adverse effect?
A. Nephrotoxicity
B. Ototoxicity
C. C. difficile-associated diarrhea
D. QT prolongation
Answer: C
Explanation: Clindamycin is a major risk factor for C. difi. NP Pearl:
Avoid long-term use in frail elders unless clearly indicated.
Q10. Fluoroquinolones like ciprofloxacin should be used with caution in
which population?
A. Patients with hypertension
B. Older adults due to risk of tendon rupture
C. Adolescents due to acne
D. Pregnant patients due to low toxicity
Answer: B
Explanation: Fluoroquinolones increase the risk of tendon rupture,
especially in older adults. NP Pearl: Reserve use for when safer alternatives
are not available.
Q11. What is the most appropriate first-line treatment for uncomplicated
streptococcal pharyngitis?
A. Azithromycin
B. Ciprofloxacin
C. Penicillin V
D. Cephalexin
Answer: C
Explanation: Penicillin remains first-line for Group A strep pharyngitis.
NP Pearl: In penicillin allergy, consider a macrolide like azithromycin.
Q12. Which class of antibiotics disrupts bacterial DNA replication?
A. Fluoroquinolones
B. Beta-lactams
C. Tetracyclines
D. Macrolides
Answer: A
Explanation: Fluoroquinolones inhibit DNA gyrase/topoisomerase. NP
