NSG 533 – Advanced Pharmacology /
Pathophysiology Exam 3 Review (2025–2026
Edition) Focus: System-based pharmacology,
drug mechanisms, therapeutic uses, and clinical
decision-making.
1. A patient with heart failure is prescribed an ACE inhibitor. The primary pathophysiologic
rationale for this therapy is to:
A. Increase myocardial contractility
B. Block beta-1 adrenergic receptors in the heart
C. Inhibit the conversion of angiotensin I to angiotensin II ✓
D. Promote sodium and water excretion
2. Which drug class is considered first-line for rate control in stable atrial fibrillation due to its
effects on the AV node?
A. Class Ia antiarrhythmics (e.g., Quinidine)
B. Class III antiarrhythmics (e.g., Amiodarone)
C. Beta-blockers or Non-dihydropyridine Calcium Channel Blockers ✓
D. Digitalis glycosides
3. The therapeutic goal of using a statin (HMG-CoA reductase inhibitor) in a patient with
known coronary artery disease is primarily to:
A. Raise HDL cholesterol levels
B. Lower LDL cholesterol levels and stabilize plaques ✓
C. Prevent platelet aggregation
D. Reduce blood pressure
4. A patient taking warfarin has an INR of 6.5 without active bleeding. The most appropriate
initial action is to:
A. Administer Vitamin K orally
B. Administer fresh frozen plasma (FFP)
C. Hold the warfarin dose and consider oral Vitamin K ✓
D. Continue warfarin at a reduced dose
,5. The mechanism of action of clopidogrel (Plavix) is:
A. Inhibition of thrombin
B. Inhibition of the P2Y12 component of ADP receptors on platelets ✓
C. Inhibition of vitamin K epoxide reductase
D. Blockade of GP IIb/IIIa receptors
6. Which diuretic is most appropriate for acute pulmonary edema due to its rapid
venodilatory effect?
A. Hydrochlorothiazide
B. Spironolactone
C. Furosemide ✓
D. Acetazolamide
7. A patient with chronic stable angina is prescribed a beta-blocker. The primary mechanism
for angina relief is:
A. Coronary vasodilation
B. Reduction of heart rate and myocardial oxygen demand ✓
C. Increased force of cardiac contraction
D. Dilation of peripheral veins
8. Which medication is a direct vasodilator used for hypertensive emergencies that must be
shielded from light?
A. Nitroprusside ✓
B. Labetalol
C. Enalaprilat
D. Hydralazine
9. The pathophysiological rationale for using spironolactone in a patient with severe heart
failure (NYHA Class III-IV) is to:
A. Provide rapid diuresis
B. Antagonize the effects of aldosterone, reducing fibrosis and mortality ✓
C. Control ventricular rate
D. Lower afterload
10. Digoxin toxicity is strongly exacerbated by the presence of:
A. Hyperkalemia
B. Hypokalemia ✓
C. Hypercalcemia
D. Hypermagnesemia
,Respiratory System
11. A long-acting beta-2 agonist (LABA) like salmeterol should always be used in conjunction
with an inhaled corticosteroid (ICS) in asthma to:
A. Improve bronchodilation
B. Reduce the risk of severe asthma-related events and mortality ✓
C. Treat acute asthma attacks
D. Prevent thrush
12. The primary mechanism of action of montelukast (Singulair) is:
A. Beta-2 adrenergic receptor agonist
B. Muscarinic receptor antagonist
C. Inhibition of phosphodiesterase-4
D. Antagonism of leukotriene receptors ✓
13. Tiotropium, a long-acting muscarinic antagonist (LAMA), is a first-line maintenance
therapy for COPD because it:
A. Reduces airway inflammation
B. Blocks acetylcholine, causing bronchodilation ✓
C. Stimulates beta-2 receptors
D. Thins respiratory secretions
14. A patient on high-dose inhaled fluticasone for asthma presents with hoarseness and oral
candidiasis. The best preventative advice is to:
A. Switch to a systemic corticosteroid
B. Rinse the mouth with water after each use ✓
C. Discontinue the inhaler immediately
D. Use a spacer to improve lung deposition only
15. Theophylline requires therapeutic drug monitoring because it:
A. Is highly protein-bound
B. Has a narrow therapeutic index ✓
C. Is a prodrug
D. Causes hyperkalemia
Endocrine System
16. Metformin's first-line status in Type 2 Diabetes is due to its ability to:
A. Stimulate insulin secretion from the pancreas
B. Increase hepatic glucose output
, C. Improve insulin sensitivity and does not cause hypoglycemia or weight gain ✓
D. Delay carbohydrate absorption in the gut
17. The biggest concern with insulin therapy is:
A. Weight loss
B. Hypoglycemia ✓
C. Hepatotoxicity
D. Hyperkalemia
18. A patient with Type 2 Diabetes has persistent hyperglycemia on metformin. A GLP-1
receptor agonist (e.g., liraglutide) is added. What is a key advantage of this class?
A. It is the cheapest option.
B. It promotes weight loss and has a low risk of hypoglycemia ✓
C. It is administered once weekly for all agents.
D. It is safe in severe renal impairment.
19. Levothyroxine is used for hypothyroidism. Dosing is typically adjusted based on:
A. Weekly blood pressure readings
B. Serum TSH levels ✓
C. Random blood glucose
D. Heart rate
20. The mechanism of action of spironolactone when used for hormonal acne is:
A. Antibacterial effect
B. Androgen receptor blockade ✓
C. Inhibition of 5-alpha reductase
D. Estrogen agonism
21. Which drug is an SGLT2 inhibitor that promotes glucosuria and is also proven to have
cardiorenal protective benefits?
A. Glipizide
B. Pioglitazone
C. Empagliflozin ✓
D. Sitagliptin
22. The primary serious adverse effect of propylthiouracil (PTU) used for hyperthyroidism is:
A. Weight gain
B. Hepatotoxicity ✓
C. Hypocalcemia
D. Tachycardia
Pathophysiology Exam 3 Review (2025–2026
Edition) Focus: System-based pharmacology,
drug mechanisms, therapeutic uses, and clinical
decision-making.
1. A patient with heart failure is prescribed an ACE inhibitor. The primary pathophysiologic
rationale for this therapy is to:
A. Increase myocardial contractility
B. Block beta-1 adrenergic receptors in the heart
C. Inhibit the conversion of angiotensin I to angiotensin II ✓
D. Promote sodium and water excretion
2. Which drug class is considered first-line for rate control in stable atrial fibrillation due to its
effects on the AV node?
A. Class Ia antiarrhythmics (e.g., Quinidine)
B. Class III antiarrhythmics (e.g., Amiodarone)
C. Beta-blockers or Non-dihydropyridine Calcium Channel Blockers ✓
D. Digitalis glycosides
3. The therapeutic goal of using a statin (HMG-CoA reductase inhibitor) in a patient with
known coronary artery disease is primarily to:
A. Raise HDL cholesterol levels
B. Lower LDL cholesterol levels and stabilize plaques ✓
C. Prevent platelet aggregation
D. Reduce blood pressure
4. A patient taking warfarin has an INR of 6.5 without active bleeding. The most appropriate
initial action is to:
A. Administer Vitamin K orally
B. Administer fresh frozen plasma (FFP)
C. Hold the warfarin dose and consider oral Vitamin K ✓
D. Continue warfarin at a reduced dose
,5. The mechanism of action of clopidogrel (Plavix) is:
A. Inhibition of thrombin
B. Inhibition of the P2Y12 component of ADP receptors on platelets ✓
C. Inhibition of vitamin K epoxide reductase
D. Blockade of GP IIb/IIIa receptors
6. Which diuretic is most appropriate for acute pulmonary edema due to its rapid
venodilatory effect?
A. Hydrochlorothiazide
B. Spironolactone
C. Furosemide ✓
D. Acetazolamide
7. A patient with chronic stable angina is prescribed a beta-blocker. The primary mechanism
for angina relief is:
A. Coronary vasodilation
B. Reduction of heart rate and myocardial oxygen demand ✓
C. Increased force of cardiac contraction
D. Dilation of peripheral veins
8. Which medication is a direct vasodilator used for hypertensive emergencies that must be
shielded from light?
A. Nitroprusside ✓
B. Labetalol
C. Enalaprilat
D. Hydralazine
9. The pathophysiological rationale for using spironolactone in a patient with severe heart
failure (NYHA Class III-IV) is to:
A. Provide rapid diuresis
B. Antagonize the effects of aldosterone, reducing fibrosis and mortality ✓
C. Control ventricular rate
D. Lower afterload
10. Digoxin toxicity is strongly exacerbated by the presence of:
A. Hyperkalemia
B. Hypokalemia ✓
C. Hypercalcemia
D. Hypermagnesemia
,Respiratory System
11. A long-acting beta-2 agonist (LABA) like salmeterol should always be used in conjunction
with an inhaled corticosteroid (ICS) in asthma to:
A. Improve bronchodilation
B. Reduce the risk of severe asthma-related events and mortality ✓
C. Treat acute asthma attacks
D. Prevent thrush
12. The primary mechanism of action of montelukast (Singulair) is:
A. Beta-2 adrenergic receptor agonist
B. Muscarinic receptor antagonist
C. Inhibition of phosphodiesterase-4
D. Antagonism of leukotriene receptors ✓
13. Tiotropium, a long-acting muscarinic antagonist (LAMA), is a first-line maintenance
therapy for COPD because it:
A. Reduces airway inflammation
B. Blocks acetylcholine, causing bronchodilation ✓
C. Stimulates beta-2 receptors
D. Thins respiratory secretions
14. A patient on high-dose inhaled fluticasone for asthma presents with hoarseness and oral
candidiasis. The best preventative advice is to:
A. Switch to a systemic corticosteroid
B. Rinse the mouth with water after each use ✓
C. Discontinue the inhaler immediately
D. Use a spacer to improve lung deposition only
15. Theophylline requires therapeutic drug monitoring because it:
A. Is highly protein-bound
B. Has a narrow therapeutic index ✓
C. Is a prodrug
D. Causes hyperkalemia
Endocrine System
16. Metformin's first-line status in Type 2 Diabetes is due to its ability to:
A. Stimulate insulin secretion from the pancreas
B. Increase hepatic glucose output
, C. Improve insulin sensitivity and does not cause hypoglycemia or weight gain ✓
D. Delay carbohydrate absorption in the gut
17. The biggest concern with insulin therapy is:
A. Weight loss
B. Hypoglycemia ✓
C. Hepatotoxicity
D. Hyperkalemia
18. A patient with Type 2 Diabetes has persistent hyperglycemia on metformin. A GLP-1
receptor agonist (e.g., liraglutide) is added. What is a key advantage of this class?
A. It is the cheapest option.
B. It promotes weight loss and has a low risk of hypoglycemia ✓
C. It is administered once weekly for all agents.
D. It is safe in severe renal impairment.
19. Levothyroxine is used for hypothyroidism. Dosing is typically adjusted based on:
A. Weekly blood pressure readings
B. Serum TSH levels ✓
C. Random blood glucose
D. Heart rate
20. The mechanism of action of spironolactone when used for hormonal acne is:
A. Antibacterial effect
B. Androgen receptor blockade ✓
C. Inhibition of 5-alpha reductase
D. Estrogen agonism
21. Which drug is an SGLT2 inhibitor that promotes glucosuria and is also proven to have
cardiorenal protective benefits?
A. Glipizide
B. Pioglitazone
C. Empagliflozin ✓
D. Sitagliptin
22. The primary serious adverse effect of propylthiouracil (PTU) used for hyperthyroidism is:
A. Weight gain
B. Hepatotoxicity ✓
C. Hypocalcemia
D. Tachycardia
