NUR 521 ADVANCED PHARM EXAM 4 QUESTIONS AND
ANSWERS LATEST 2026 GUIDE
Basic Questions About Antifungals
1 Which of the following is an opportunistic systemic fungal infection?
• A) Sporotrichosis
• B) Aspergillosis
• C) Blastomycosis
• D) Histoplasmosis
Answer: B Rationale: Opportunistic systemic fungal infections occur in immunocompromised
patients and include Aspergillosis, Candidiasis, Cryptococcosis, and Mucormycosis. Non-
opportunistic infections, such as sporotrichosis, blastomycosis, and histoplasmosis, affect healthy
individuals.
2 What is the drug of choice (DOC) for most systemic fungal infections?
• A) Fluconazole
• B) Amphotericin B
• C) Itraconazole
• D) Ketoconazole
Answer: B Rationale: Amphotericin B is the DOC for most systemic fungal infections due to its
broad-spectrum antifungal activity, despite its high toxicity.
3 Which antifungal is effective against both systemic and superficial fungal infections but has
a black box warning for patients with heart failure?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Terbinafine
Answer: B Rationale: Itraconazole is effective for both systemic and superficial fungal infections
but has a BBW due to its negative inotropic effects, contraindicating its use in patients with
heart failure.
4 Which antifungal is primarily used to treat superficial fungal infections, such as candidiasis?
• A) Amphotericin B
• B) Fluconazole
• C) Itraconazole
• D) Ketoconazole
NUR 521 ADVANCED PHARM EXAM 4
,Answer: B Rationale: Fluconazole is a commonly prescribed antifungal for superficial infections
like candidiasis and cryptococcal meningitis.
5 Which organism is responsible for the majority of cases of superficial fungal infections?
• A) Candida albicans
• B) Aspergillus spp.
• C) Cryptococcus neoformans
• D) Mucorales spp.
Answer: A Rationale: Candida albicans is a common cause of superficial fungal infections,
particularly involving mucosal surfaces, skin, and nails.
6 What is the primary safety concern associated with Amphotericin B?
• A) Hepatotoxicity
• B) Nephrotoxicity and infusion reactions
• C) Cardiotoxicity
• D) Ototoxicity
Answer: B Rationale: Amphotericin B has significant nephrotoxicity and infusion-related
reactions, limiting its use to life-threatening fungal infections.
7 Which antifungal is the DOC for histoplasmosis and blastomycosis?
• A) Amphotericin B
• B) Fluconazole
• C) Itraconazole
• D) Ketoconazole
Answer: C Rationale: Itraconazole is the preferred agent for non-opportunistic systemic
infections such as histoplasmosis and blastomycosis.
8 What is the recommended antifungal for cryptococcal meningitis?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Terbinafine
Answer: C Rationale: Fluconazole is effective in treating cryptococcal meningitis, particularly in
immunocompromised patients.
9 Which antifungal carries the highest risk for systemic toxicity and is reserved for life-
threatening infections?
NUR 521 ADVANCED PHARM EXAM 4
, • A) Fluconazole
• B) Amphotericin B
• C) Itraconazole
• D) Voriconazole
Answer: B Rationale: Amphotericin B is highly effective but carries a significant risk of
nephrotoxicity and other adverse effects, making it reserved for severe infections.
10 What is the mechanism of action of Azole antifungals like Itraconazole and Fluconazole?
• A) Inhibit DNA synthesis
• B) Inhibit cell wall synthesis
• C) Inhibit ergosterol synthesis in fungal cell membranes
• D) Disrupt protein synthesis
Answer: C Rationale: Azole antifungals inhibit the synthesis of ergosterol, a critical component
of fungal cell membranes, disrupting fungal growth and survival.
Section 2: Patient Scenarios
11 A 55-year-old construction worker presents with pulmonary infiltrates and weight loss. A
biopsy confirms Histoplasma capsulatum. Which antifungal is the DOC for this systemic
infection?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Ketoconazole
Answer: B Rationale: Itraconazole is the preferred antifungal for treating systemic infections
like histoplasmosis, offering a less toxic alternative to Amphotericin B.
12 A 65-year-old diabetic man presents with fever, cough, and hemoptysis. Imaging reveals
lung nodules, and culture grows Aspergillus fumigatus. Which antifungal is most appropriate?
• A) Fluconazole
• B) Amphotericin B
• C) Itraconazole
• D) Ketoconazole
Answer: B Rationale: Amphotericin B is the DOC for systemic aspergillosis due to its broad-
spectrum activity and efficacy in life-threatening infections.
NUR 521 ADVANCED PHARM EXAM 4
, 13 A 35-year-old woman with HIV presents with headaches and stiff neck. Lumbar puncture
confirms Cryptococcus neoformans. What is the DOC for treatment?
• A) Amphotericin B
• B) Fluconazole
• C) Itraconazole
• D) Ketoconazole
Answer: B Rationale: Fluconazole is effective for treating cryptococcal meningitis and is often
used in immunocompromised patients.
14 A gardener reports developing nodular lesions along her arms after a prick from a rose bush.
A biopsy confirms sporotrichosis. What antifungal should be prescribed?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Ketoconazole
Answer: B Rationale: Itraconazole is the DOC for systemic infections like sporotrichosis due to
its excellent efficacy profile.
15 A patient presents with superficial white patches in the mouth diagnosed as oral thrush
caused by Candida albicans. Which antifungal is most appropriate?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Ketoconazole
Answer: C Rationale: Fluconazole is effective for superficial candidiasis, including oral thrush.
Section 1: Basic s About Antifungal Use in Pediatric and Elderly Patients
1 Which antifungal is commonly used to treat oral candidiasis in infants?
• A) Amphotericin B
• B) Nystatin
• C) Fluconazole
• D) Itraconazole
Answer: B Rationale: Nystatin is the preferred antifungal for treating oral candidiasis in
premature and full-term infants due to its safety and efficacy.
NUR 521 ADVANCED PHARM EXAM 4
ANSWERS LATEST 2026 GUIDE
Basic Questions About Antifungals
1 Which of the following is an opportunistic systemic fungal infection?
• A) Sporotrichosis
• B) Aspergillosis
• C) Blastomycosis
• D) Histoplasmosis
Answer: B Rationale: Opportunistic systemic fungal infections occur in immunocompromised
patients and include Aspergillosis, Candidiasis, Cryptococcosis, and Mucormycosis. Non-
opportunistic infections, such as sporotrichosis, blastomycosis, and histoplasmosis, affect healthy
individuals.
2 What is the drug of choice (DOC) for most systemic fungal infections?
• A) Fluconazole
• B) Amphotericin B
• C) Itraconazole
• D) Ketoconazole
Answer: B Rationale: Amphotericin B is the DOC for most systemic fungal infections due to its
broad-spectrum antifungal activity, despite its high toxicity.
3 Which antifungal is effective against both systemic and superficial fungal infections but has
a black box warning for patients with heart failure?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Terbinafine
Answer: B Rationale: Itraconazole is effective for both systemic and superficial fungal infections
but has a BBW due to its negative inotropic effects, contraindicating its use in patients with
heart failure.
4 Which antifungal is primarily used to treat superficial fungal infections, such as candidiasis?
• A) Amphotericin B
• B) Fluconazole
• C) Itraconazole
• D) Ketoconazole
NUR 521 ADVANCED PHARM EXAM 4
,Answer: B Rationale: Fluconazole is a commonly prescribed antifungal for superficial infections
like candidiasis and cryptococcal meningitis.
5 Which organism is responsible for the majority of cases of superficial fungal infections?
• A) Candida albicans
• B) Aspergillus spp.
• C) Cryptococcus neoformans
• D) Mucorales spp.
Answer: A Rationale: Candida albicans is a common cause of superficial fungal infections,
particularly involving mucosal surfaces, skin, and nails.
6 What is the primary safety concern associated with Amphotericin B?
• A) Hepatotoxicity
• B) Nephrotoxicity and infusion reactions
• C) Cardiotoxicity
• D) Ototoxicity
Answer: B Rationale: Amphotericin B has significant nephrotoxicity and infusion-related
reactions, limiting its use to life-threatening fungal infections.
7 Which antifungal is the DOC for histoplasmosis and blastomycosis?
• A) Amphotericin B
• B) Fluconazole
• C) Itraconazole
• D) Ketoconazole
Answer: C Rationale: Itraconazole is the preferred agent for non-opportunistic systemic
infections such as histoplasmosis and blastomycosis.
8 What is the recommended antifungal for cryptococcal meningitis?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Terbinafine
Answer: C Rationale: Fluconazole is effective in treating cryptococcal meningitis, particularly in
immunocompromised patients.
9 Which antifungal carries the highest risk for systemic toxicity and is reserved for life-
threatening infections?
NUR 521 ADVANCED PHARM EXAM 4
, • A) Fluconazole
• B) Amphotericin B
• C) Itraconazole
• D) Voriconazole
Answer: B Rationale: Amphotericin B is highly effective but carries a significant risk of
nephrotoxicity and other adverse effects, making it reserved for severe infections.
10 What is the mechanism of action of Azole antifungals like Itraconazole and Fluconazole?
• A) Inhibit DNA synthesis
• B) Inhibit cell wall synthesis
• C) Inhibit ergosterol synthesis in fungal cell membranes
• D) Disrupt protein synthesis
Answer: C Rationale: Azole antifungals inhibit the synthesis of ergosterol, a critical component
of fungal cell membranes, disrupting fungal growth and survival.
Section 2: Patient Scenarios
11 A 55-year-old construction worker presents with pulmonary infiltrates and weight loss. A
biopsy confirms Histoplasma capsulatum. Which antifungal is the DOC for this systemic
infection?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Ketoconazole
Answer: B Rationale: Itraconazole is the preferred antifungal for treating systemic infections
like histoplasmosis, offering a less toxic alternative to Amphotericin B.
12 A 65-year-old diabetic man presents with fever, cough, and hemoptysis. Imaging reveals
lung nodules, and culture grows Aspergillus fumigatus. Which antifungal is most appropriate?
• A) Fluconazole
• B) Amphotericin B
• C) Itraconazole
• D) Ketoconazole
Answer: B Rationale: Amphotericin B is the DOC for systemic aspergillosis due to its broad-
spectrum activity and efficacy in life-threatening infections.
NUR 521 ADVANCED PHARM EXAM 4
, 13 A 35-year-old woman with HIV presents with headaches and stiff neck. Lumbar puncture
confirms Cryptococcus neoformans. What is the DOC for treatment?
• A) Amphotericin B
• B) Fluconazole
• C) Itraconazole
• D) Ketoconazole
Answer: B Rationale: Fluconazole is effective for treating cryptococcal meningitis and is often
used in immunocompromised patients.
14 A gardener reports developing nodular lesions along her arms after a prick from a rose bush.
A biopsy confirms sporotrichosis. What antifungal should be prescribed?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Ketoconazole
Answer: B Rationale: Itraconazole is the DOC for systemic infections like sporotrichosis due to
its excellent efficacy profile.
15 A patient presents with superficial white patches in the mouth diagnosed as oral thrush
caused by Candida albicans. Which antifungal is most appropriate?
• A) Amphotericin B
• B) Itraconazole
• C) Fluconazole
• D) Ketoconazole
Answer: C Rationale: Fluconazole is effective for superficial candidiasis, including oral thrush.
Section 1: Basic s About Antifungal Use in Pediatric and Elderly Patients
1 Which antifungal is commonly used to treat oral candidiasis in infants?
• A) Amphotericin B
• B) Nystatin
• C) Fluconazole
• D) Itraconazole
Answer: B Rationale: Nystatin is the preferred antifungal for treating oral candidiasis in
premature and full-term infants due to its safety and efficacy.
NUR 521 ADVANCED PHARM EXAM 4
