A woman is being discharged on oral metronidazole for a pelvic infection. Which instruction is most important to include in her teaching?

Avoid alcohol during the course and for 3 days after it

Avoid direct sunlight for the duration of the course

Take a double dose if any loose stools develop

Avoid milk and antacids within 2 hours of each dose

Before a patient with tuberculosis is started on ethambutol, the nurse should make sure that which baseline test is done?

Visual acuity and colour vision

Twelve-lead ECG for QT interval

Antibiotics, antitubercular and antiretroviral drugs

18 AIIMS NORCET (Nursing Officer) practice questions on Antibiotics, antitubercular and antiretroviral drugs, part of Pharmacology. The first 18 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A patient two days into antitubercular treatment is worried because his urine and tears have turned orange-red. Which drug causes this?
1. AIsoniazid
2. BRifampicin
3. CPyrazinamide
4. DStreptomycin
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Answer: B · Rifampicin
Rifampicin and its metabolites are red-orange and colour urine, sweat, tears and saliva. The change is harmless and expected, so the patient should be told about it before the first dose. Soft contact lenses can be stained permanently. The nurse reassures the patient and encourages him to continue treatment.
- A: Isoniazid does not colour body fluids; its key effects are hepatitis and peripheral neuropathy.
- C: Pyrazinamide causes hepatotoxicity and raised uric acid, not coloured secretions.
- D: Streptomycin is ototoxic and nephrotoxic and does not discolour urine.
Question 2 · Medium
A woman is being discharged on oral metronidazole for a pelvic infection. Which instruction is most important to include in her teaching?
1. AAvoid direct sunlight for the duration of the course
2. BTake a double dose if any loose stools develop
3. CAvoid alcohol during the course and for 3 days after it
4. DAvoid milk and antacids within 2 hours of each dose
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Answer: C · Avoid alcohol during the course and for 3 days after it
Metronidazole inhibits aldehyde dehydrogenase, so alcohol causes a disulfiram-like reaction. Flushing, throbbing headache, vomiting, palpitations and a fall in blood pressure can follow. Alcohol, including alcohol-containing syrups, is avoided during treatment and for at least 48-72 hours after the last dose. A metallic taste is common and harmless.
- A: Photosensitivity is a problem mainly with doxycycline and fluoroquinolones.
- B: Doubling a dose for diarrhoea is unsafe and is never advised.
- D: Milk and antacids reduce absorption of tetracyclines and fluoroquinolones, not metronidazole.
Question 3 · Medium
Before a patient with tuberculosis is started on ethambutol, the nurse should make sure that which baseline test is done?
1. APure-tone audiometry
2. BNerve conduction study
3. CVisual acuity and colour vision
4. DTwelve-lead ECG for QT interval
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Answer: C · Visual acuity and colour vision
Ethambutol can cause optic neuritis, with blurred vision, loss of acuity and red-green colour blindness. The effect is dose related and usually reversible if the drug is stopped early. A baseline check lets later changes be detected, and patients are told to report any change in vision at once. Young children who cannot report vision changes need extra care.
- A: Audiometry is the baseline for streptomycin and other aminoglycosides.
- B: Nerve conduction studies are not routine; isoniazid neuropathy is prevented with pyridoxine.
- D: A baseline ECG for QT is needed for bedaquiline or delamanid in drug-resistant TB.
Question 4 · Hard
Ceftriaxone 1 g diluted in 100 mL of normal saline is ordered over 30 minutes. The infusion set delivers 20 drops/mL. At what rate should the nurse set the drip?
1. A33 drops/min
2. B67 drops/min
3. C3 drops/min
4. D200 drops/min
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Answer: B · 67 drops/min
Drops per minute = volume (mL) x drop factor / time (min). Here 100 x 20 / 30 = 2,000 / 30 = 66.7, which is rounded to 67 drops/min. The rate in mL is 100 / 30 = 3.3 mL/min, which must still be multiplied by the drop factor. Ceftriaxone must not be mixed or given in the same line with calcium-containing solutions.
- A: 33 drops/min uses 60 minutes instead of the ordered 30 minutes.
- C: 3 drops/min is the rate in mL per minute, without the drop factor.
- D: 200 drops/min multiplies by 60 instead of using the 20 drops/mL factor.
Question 5 · Easy
Pyridoxine (vitamin B6) is given along with isoniazid to prevent:
1. AHyperuricaemia
2. BDrug-induced hepatitis
3. COptic neuritis
4. DPeripheral neuropathy
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Answer: D · Peripheral neuropathy
Isoniazid increases the excretion of pyridoxine and interferes with its use, which leads to a peripheral neuropathy with tingling and numbness of the hands and feet. Supplemental pyridoxine prevents this. The risk is higher in malnourished patients, alcoholics, diabetics, people with HIV and pregnant women. Pyridoxine does not protect against isoniazid hepatitis.
- A: Raised uric acid is due to pyrazinamide and is unrelated to pyridoxine.
- B: Hepatitis from isoniazid is not prevented by pyridoxine and needs LFT monitoring.
- C: Optic neuritis is linked to ethambutol and is not prevented by vitamin B6.
Question 6 · Easy
During a course of gentamicin, the nurse should watch especially for:
1. ATendon pain and a prolonged QT interval
2. BOrange urine and a rising bilirubin
3. CTeeth staining and photosensitivity
4. DHearing loss and a falling urine output
Answer and explanation in LearnFree account
Question 7 · Medium
Under NACO's national guidelines, the preferred first-line antiretroviral regimen for adults and adolescents with HIV is:
1. ATenofovir, lamivudine and efavirenz
2. BTenofovir, lamivudine and dolutegravir
3. CAbacavir, lamivudine and lopinavir-ritonavir
4. DZidovudine, lamivudine and nevirapine
Answer and explanation in LearnFree account
Question 8 · Easy
Why is nystatin suspension for oral thrush swished around the mouth for some time before it is swallowed?
1. AIt irritates the stomach if swallowed at once
2. BIt must be absorbed through the oral mucosa
3. CIt is hardly absorbed and acts only on contact
4. DIt is destroyed by gastric acid once swallowed
Answer and explanation in LearnFree account
Question 9 · Medium
Under India's national malaria drug policy, uncomplicated P. falciparum malaria in an adult outside the north-eastern states is treated with:
1. AArtemether-lumefantrine for 3 days
2. BChloroquine for 3 days with primaquine for 14 days
3. CArtesunate with sulfadoxine-pyrimethamine for 3 days
4. DQuinine with doxycycline for 7 days
Answer and explanation in LearnFree account
Question 10 · Hard
A 60-kg patient is ordered gentamicin 5 mg/kg/day IV in three divided doses. The vial contains 80 mg in 2 mL. How much should the nurse draw up for each dose?
1. A3.75 mL
2. B1.25 mL
3. C2.5 mL
4. D7.5 mL
Answer and explanation in LearnFree account
Question 11 · Hard
A 40-year-old man on HRZE for pulmonary TB for 4 weeks has nausea, vomiting and yellow eyes. His ALT is 260 U/L (normal up to 40 U/L) and his total bilirubin is 3.6 mg/dL. What should the nurse do first?
1. AHalve the dose of every drug and continue daily treatment
2. BGive the next dose with an antiemetic and recheck the LFT in a week
3. CStop only pyrazinamide and continue the other three drugs
4. DWithhold all the anti-TB drugs and inform the doctor urgently
Answer and explanation in LearnFree account
Question 12 · Medium
A 25-year-old woman starting rifampicin-containing treatment for TB takes a combined oral contraceptive pill. What is the nurse's best advice?
1. ANo change is needed, as these drugs do not affect each other
2. BRifampicin can make the pill fail, so use a non-hormonal method
3. CThe pill raises isoniazid levels, so stop it until TB treatment ends
4. DTake the pill with the TB drugs so that both are absorbed better
Answer and explanation in LearnFree account
Question 13 · Medium
In a patient receiving conventional intravenous amphotericin B for mucormycosis, which results need the closest monitoring?
1. ASerum creatinine and potassium
2. BSerum amylase and lipase
3. CSerum bilirubin and ALT
4. DPlatelet count and INR
Answer and explanation in LearnFree account
Question 14 · Medium
A 70-year-old man on oral ciprofloxacin for a urinary infection complains of sudden pain and swelling just above his heel. What should the nurse do?
1. AApply a hot pack and encourage him to keep walking
2. BGive paracetamol and continue the antibiotic
3. CHold the next dose and report a possible tendinitis
4. DReassure him that it is a cramp from low fluids
Answer and explanation in LearnFree account
Question 15 · Hard
Ten minutes into a vancomycin 1 g infusion set to run over 15 minutes, a patient develops flushing and itching of the face, neck and upper chest. BP is 120/78 mmHg, SpO2 98%, and there is no wheeze, stridor or lip swelling. Which interpretation and action are correct?
1. AStevens-Johnson syndrome: stop and start IV steroids at once
2. BAnaphylaxis: give IM adrenaline and never give vancomycin again
3. CInfusion-rate reaction: stop, then re-run over at least 60 minutes
4. DPhlebitis: resite the cannula and continue at the same rate
Answer and explanation in LearnFree account
Question 16 · Easy
Tetracyclines are avoided in pregnancy and in children under 8 years mainly because they:
1. ADamage the eighth cranial nerve of the fetus
2. BStain developing teeth and slow bone growth
3. CCause grey baby syndrome in the newborn
4. DCause cartilage damage in weight-bearing joints
Answer and explanation in LearnFree account
Question 17 · Easy
Which antimalarial kills the dormant liver hypnozoites of Plasmodium vivax and so prevents relapse?
1. APrimaquine
2. BChloroquine
3. CQuinine
4. DArtesunate
Answer and explanation in LearnFree account
Question 18 · Hard
A 55-kg adult with severe falciparum malaria is started on IV artesunate at the standard dose of 2.4 mg/kg. Which dose and schedule are correct?
1. A132 mg at 0, 12 and 24 hours, then once daily
2. B264 mg at 0, 12 and 24 hours, then once daily
3. C66 mg at 0, 12 and 24 hours, then once daily
4. D132 mg once daily, starting from the first dose
Answer and explanation in LearnFree account

Antibiotics, antitubercular and antiretroviral drugs

A patient two days into antitubercular treatment is worried because his urine and tears have turned orange-red. Which drug causes this?

A woman is being discharged on oral metronidazole for a pelvic infection. Which instruction is most important to include in her teaching?

Before a patient with tuberculosis is started on ethambutol, the nurse should make sure that which baseline test is done?

Ceftriaxone 1 g diluted in 100 mL of normal saline is ordered over 30 minutes. The infusion set delivers 20 drops/mL. At what rate should the nurse set the drip?

Pyridoxine (vitamin B6) is given along with isoniazid to prevent:

During a course of gentamicin, the nurse should watch especially for:

Under NACO's national guidelines, the preferred first-line antiretroviral regimen for adults and adolescents with HIV is:

Why is nystatin suspension for oral thrush swished around the mouth for some time before it is swallowed?

Under India's national malaria drug policy, uncomplicated P. falciparum malaria in an adult outside the north-eastern states is treated with:

A 60-kg patient is ordered gentamicin 5 mg/kg/day IV in three divided doses. The vial contains 80 mg in 2 mL. How much should the nurse draw up for each dose?

A 40-year-old man on HRZE for pulmonary TB for 4 weeks has nausea, vomiting and yellow eyes. His ALT is 260 U/L (normal up to 40 U/L) and his total bilirubin is 3.6 mg/dL. What should the nurse do first?

A 25-year-old woman starting rifampicin-containing treatment for TB takes a combined oral contraceptive pill. What is the nurse's best advice?

In a patient receiving conventional intravenous amphotericin B for mucormycosis, which results need the closest monitoring?

A 70-year-old man on oral ciprofloxacin for a urinary infection complains of sudden pain and swelling just above his heel. What should the nurse do?

Ten minutes into a vancomycin 1 g infusion set to run over 15 minutes, a patient develops flushing and itching of the face, neck and upper chest. BP is 120/78 mmHg, SpO2 98%, and there is no wheeze, stridor or lip swelling. Which interpretation and action are correct?

Tetracyclines are avoided in pregnancy and in children under 8 years mainly because they:

Which antimalarial kills the dormant liver hypnozoites of Plasmodium vivax and so prevents relapse?

A 55-kg adult with severe falciparum malaria is started on IV artesunate at the standard dose of 2.4 mg/kg. Which dose and schedule are correct?