, NSG 533 EXAM 3
Advanced Pharmacology
Wilkes University
100-Question Original Practice Examination
2026/2027 Edition
Respiratory Pharmacology
1. At an asthma follow-up, a patient reports symptoms on most days and nighttime awakening once
weekly. Which controller strategy best matches contemporary stepwise care?
A) Scheduled oral albuterol
B) An inhaled corticosteroid-containing regimen, often ICS-formoterol based
C) Long-acting beta2 agonist monotherapy
D) Daily leukotriene modifier as the only preferred option
Correct Answer: B) An inhaled corticosteroid-containing regimen, often ICS-formoterol based
Rationale: Asthma treatment should include inhaled corticosteroid exposure because airway inflammation drives
exacerbation risk. ICS-formoterol-based strategies provide both anti-inflammatory control and rapid bronchodilation in
appropriate stepwise regimens. LABA monotherapy is unsafe in asthma, and oral beta2 agonists are not preferred
because of systemic adverse effects.
2. While counseling on rescue therapy, which pharmacologic property explains why albuterol relieves
acute bronchospasm?
A) Muscarinic M3 receptor blockade in airway glands
B) Irreversible inhibition of leukotriene synthesis
C) Suppression of eosinophil production in bone marrow
D) Selective stimulation of beta2 receptors in bronchial smooth muscle
Correct Answer: D) Selective stimulation of beta2 receptors in bronchial smooth muscle
Rationale: Albuterol is a short-acting beta2 agonist that rapidly relaxes bronchial smooth muscle by increasing
intracellular cyclic AMP. It is useful for quick symptom relief but does not treat the underlying airway inflammation.
Antimuscarinics, leukotriene modifiers, and biologics work through different mechanisms and have different roles.
3. For a patient using an inhaled corticosteroid every day, which teaching point most directly reduces
local adverse effects?
A) Take each dose with a high-fat meal
B) Avoid all vaccinations while using the inhaler
C) Rinse the mouth and spit after each dose
D) Use the inhaler only when symptoms are severe
Correct Answer: C) Rinse the mouth and spit after each dose
Rationale: Inhaled corticosteroids can cause oropharyngeal candidiasis and dysphonia from local drug deposition.
Rinsing the mouth and spitting after use reduces this exposure, and a spacer may help with metered-dose inhalers. ICS
therapy is preventive, so restricting use to severe symptoms undermines asthma control.
4. A patient with asthma is prescribed salmeterol. Which safety principle is most important?
A) It must always be combined with an oral corticosteroid
B) It is preferred for immediate relief of an acute attack
C) It should be stopped whenever exercise is planned
NSG 533 Exam 3 Practice Examination | 2026/2027 Edition | Page 1
, D) It should not be used as monotherapy without an inhaled corticosteroid
Correct Answer: D) It should not be used as monotherapy without an inhaled corticosteroid
Rationale: Long-acting beta2 agonists provide prolonged bronchodilation but do not adequately treat airway
inflammation. In asthma, a LABA should be paired with an inhaled corticosteroid to reduce risk of serious exacerbations.
Salmeterol has a slower onset than rescue agents and is not the preferred medication for acute symptom relief.
5. During a COPD medication review, which inhaled class is especially useful for sustained
bronchodilation through muscarinic receptor blockade?
A) Inhaled mast-cell stabilizers
B) Long-acting muscarinic antagonists
C) Oral antihistamines
D) Inhaled cromolyn as first-line maintenance
Correct Answer: B) Long-acting muscarinic antagonists
Rationale: Long-acting muscarinic antagonists such as tiotropium reduce cholinergic bronchoconstriction and are central
maintenance options in COPD. They improve airflow and symptoms and can reduce exacerbations. Antihistamines and
cromolyn do not provide the same evidence-based bronchodilator role in COPD maintenance therapy.
6. When tiotropium is initiated, which adverse effect should the clinician most reasonably anticipate?
A) Profound hypoglycemia
B) Severe neutropenia
C) Marked hyperkalemia
D) Dry mouth
Correct Answer: D) Dry mouth
Rationale: Tiotropium is an inhaled antimuscarinic. Anticholinergic effects such as dry mouth are common, and urinary
retention or worsening narrow-angle glaucoma can occur in susceptible patients. Hypoglycemia, neutropenia, and
hyperkalemia are not characteristic pharmacologic effects of inhaled muscarinic antagonists.
7. In a patient with frequent COPD exacerbations despite optimized inhaled therapy and chronic
bronchitis features, which oral agent may be considered to reduce exacerbation risk?
A) Montelukast as mandatory first-line COPD therapy
B) Oral cromolyn
C) Roflumilast
D) Daily diphenhydramine
Correct Answer: C) Roflumilast
Rationale: Roflumilast is a phosphodiesterase-4 inhibitor that can reduce COPD exacerbations in selected patients,
particularly those with chronic bronchitis and severe airflow limitation. It is not a bronchodilator and can cause weight loss
and gastrointestinal or neuropsychiatric effects. The other agents are not standard exacerbation-reduction therapies for
COPD.
8. A patient taking theophylline develops nausea, tremor, and palpitations after starting ciprofloxacin.
What best explains the change?
A) Enhanced renal excretion of theophylline
B) Loss of beta2 receptor sensitivity
C) Reduced theophylline clearance causing toxicity
D) Accelerated conversion of theophylline to inactive metabolites
NSG 533 Exam 3 Practice Examination | 2026/2027 Edition | Page 2
Advanced Pharmacology
Wilkes University
100-Question Original Practice Examination
2026/2027 Edition
Respiratory Pharmacology
1. At an asthma follow-up, a patient reports symptoms on most days and nighttime awakening once
weekly. Which controller strategy best matches contemporary stepwise care?
A) Scheduled oral albuterol
B) An inhaled corticosteroid-containing regimen, often ICS-formoterol based
C) Long-acting beta2 agonist monotherapy
D) Daily leukotriene modifier as the only preferred option
Correct Answer: B) An inhaled corticosteroid-containing regimen, often ICS-formoterol based
Rationale: Asthma treatment should include inhaled corticosteroid exposure because airway inflammation drives
exacerbation risk. ICS-formoterol-based strategies provide both anti-inflammatory control and rapid bronchodilation in
appropriate stepwise regimens. LABA monotherapy is unsafe in asthma, and oral beta2 agonists are not preferred
because of systemic adverse effects.
2. While counseling on rescue therapy, which pharmacologic property explains why albuterol relieves
acute bronchospasm?
A) Muscarinic M3 receptor blockade in airway glands
B) Irreversible inhibition of leukotriene synthesis
C) Suppression of eosinophil production in bone marrow
D) Selective stimulation of beta2 receptors in bronchial smooth muscle
Correct Answer: D) Selective stimulation of beta2 receptors in bronchial smooth muscle
Rationale: Albuterol is a short-acting beta2 agonist that rapidly relaxes bronchial smooth muscle by increasing
intracellular cyclic AMP. It is useful for quick symptom relief but does not treat the underlying airway inflammation.
Antimuscarinics, leukotriene modifiers, and biologics work through different mechanisms and have different roles.
3. For a patient using an inhaled corticosteroid every day, which teaching point most directly reduces
local adverse effects?
A) Take each dose with a high-fat meal
B) Avoid all vaccinations while using the inhaler
C) Rinse the mouth and spit after each dose
D) Use the inhaler only when symptoms are severe
Correct Answer: C) Rinse the mouth and spit after each dose
Rationale: Inhaled corticosteroids can cause oropharyngeal candidiasis and dysphonia from local drug deposition.
Rinsing the mouth and spitting after use reduces this exposure, and a spacer may help with metered-dose inhalers. ICS
therapy is preventive, so restricting use to severe symptoms undermines asthma control.
4. A patient with asthma is prescribed salmeterol. Which safety principle is most important?
A) It must always be combined with an oral corticosteroid
B) It is preferred for immediate relief of an acute attack
C) It should be stopped whenever exercise is planned
NSG 533 Exam 3 Practice Examination | 2026/2027 Edition | Page 1
, D) It should not be used as monotherapy without an inhaled corticosteroid
Correct Answer: D) It should not be used as monotherapy without an inhaled corticosteroid
Rationale: Long-acting beta2 agonists provide prolonged bronchodilation but do not adequately treat airway
inflammation. In asthma, a LABA should be paired with an inhaled corticosteroid to reduce risk of serious exacerbations.
Salmeterol has a slower onset than rescue agents and is not the preferred medication for acute symptom relief.
5. During a COPD medication review, which inhaled class is especially useful for sustained
bronchodilation through muscarinic receptor blockade?
A) Inhaled mast-cell stabilizers
B) Long-acting muscarinic antagonists
C) Oral antihistamines
D) Inhaled cromolyn as first-line maintenance
Correct Answer: B) Long-acting muscarinic antagonists
Rationale: Long-acting muscarinic antagonists such as tiotropium reduce cholinergic bronchoconstriction and are central
maintenance options in COPD. They improve airflow and symptoms and can reduce exacerbations. Antihistamines and
cromolyn do not provide the same evidence-based bronchodilator role in COPD maintenance therapy.
6. When tiotropium is initiated, which adverse effect should the clinician most reasonably anticipate?
A) Profound hypoglycemia
B) Severe neutropenia
C) Marked hyperkalemia
D) Dry mouth
Correct Answer: D) Dry mouth
Rationale: Tiotropium is an inhaled antimuscarinic. Anticholinergic effects such as dry mouth are common, and urinary
retention or worsening narrow-angle glaucoma can occur in susceptible patients. Hypoglycemia, neutropenia, and
hyperkalemia are not characteristic pharmacologic effects of inhaled muscarinic antagonists.
7. In a patient with frequent COPD exacerbations despite optimized inhaled therapy and chronic
bronchitis features, which oral agent may be considered to reduce exacerbation risk?
A) Montelukast as mandatory first-line COPD therapy
B) Oral cromolyn
C) Roflumilast
D) Daily diphenhydramine
Correct Answer: C) Roflumilast
Rationale: Roflumilast is a phosphodiesterase-4 inhibitor that can reduce COPD exacerbations in selected patients,
particularly those with chronic bronchitis and severe airflow limitation. It is not a bronchodilator and can cause weight loss
and gastrointestinal or neuropsychiatric effects. The other agents are not standard exacerbation-reduction therapies for
COPD.
8. A patient taking theophylline develops nausea, tremor, and palpitations after starting ciprofloxacin.
What best explains the change?
A) Enhanced renal excretion of theophylline
B) Loss of beta2 receptor sensitivity
C) Reduced theophylline clearance causing toxicity
D) Accelerated conversion of theophylline to inactive metabolites
NSG 533 Exam 3 Practice Examination | 2026/2027 Edition | Page 2
