NSG 6001 Week 4 Quiz 2 – Advanced Pharmacology
Graduate Nursing Program | Advanced Clinical
Decision-Making
Respiratory & Endocrine Pharmacology Focus
Q1: A 28-year-old female with newly diagnosed asthma is prescribed albuterol PRN for
exercise-induced symptoms. She reports using her inhaler 15 minutes before running
but still experiences wheezing. Which of the following is the MOST appropriate
modification to her therapy?
A. Switch to levalbuterol for better efficacy
B. Increase albuterol dose to 4 puffs before exercise
C. Add a daily inhaled corticosteroid (ICS) controller
D. Switch to oral albuterol tablets for longer duration
Correct Answer: C
Rationale: [CORRECT] C: Frequent use of rescue inhaler (>2 times/week) indicates poor
control and need for daily anti-inflammatory controller therapy (ICS). Albuterol is a
short-acting beta-2 agonist (SABA) that treats acute bronchospasm but does not
address underlying airway inflammation. A: Levalbuterol (R-albuterol) has similar
efficacy to racemic albuterol; no advantage for this patient. B: Increasing SABA dose
without controller therapy is inappropriate per GINA guidelines; increases risk of
exacerbations. D: Oral beta-agonists have more systemic side effects (tremor,
tachycardia) and are not recommended for asthma. Clinical Pearl: Need for controller
therapy determined by frequency of SABA use; exercise-induced bronchospasm more than
2x/week indicates persistent asthma requiring ICS.
,Q2: A 62-year-old male with COPD (GOLD Group B) is started on tiotropium 18 mcg
inhaled daily. Which of the following patient education points is MOST critical for safe
and effective use?
A. "Rinse your mouth after each use to prevent thrush"
B. "Take 2 puffs immediately if you feel short of breath"
C. "This is a long-acting bronchodilator; do not use for acute symptoms"
D. "Use a spacer device with this inhaler"
Correct Answer: C
Rationale: [CORRECT] C: Tiotropium is a long-acting muscarinic antagonist (LAMA) with
onset 30 minutes and duration 24 hours. It is maintenance therapy, NOT for rescue.
Patients must understand the difference between controller and reliever medications. A:
Rinsing mouth important for ICS (corticosteroids), not LAMAs. B: LAMAs do not provide
immediate relief; patient needs separate SABA for rescue. D: Tiotropium is a dry powder
inhaler (HandiHaler or Respimat) or soft mist inhaler; spacer not used with these
devices. Clinical Pearl: Confusing controller and reliever medications is a common cause
of COPD exacerbations and hospitalizations.
Q3: A patient with type 2 diabetes is prescribed insulin glargine 20 units at bedtime and
insulin lispro with meals. The patient asks why two different insulins are needed. Which
explanation is MOST accurate?
A. "The glargine covers your meals, and the lispro covers your baseline needs"
B. "The glargine provides basal coverage 24 hours, and the lispro covers mealtime
glucose spikes"
C. "The glargine is for morning use only, and the lispro is for evening meals"
D. "Using two insulins reduces the risk of allergic reactions"
Correct Answer: B
Rationale: [CORRECT] B: Basal-bolus insulin therapy mimics physiological insulin
secretion. Glargine (long-acting, peakless, 24-hour duration) provides basal coverage
, between meals and overnight. Lispro (rapid-acting, onset 15 minutes, peak 1 hour,
duration 3-4 hours) covers postprandial glucose excursions. A: Reversed explanation;
glargine is basal, not prandial. C: Glargine is typically given once daily at same time
(often bedtime or morning), not restricted to morning; lispro used with all meals. D: No
evidence that two insulins reduce allergy risk; insulin allergies are rare. Clinical Pearl:
Basal insulin suppresses hepatic glucose production; bolus insulin covers carbohydrate
intake.
Q4: A 45-year-old female with hypothyroidism has been stable on levothyroxine 100 mcg
daily for 2 years. She recently started taking calcium carbonate 1200 mg daily for
osteoporosis prevention. Her TSH is now 6.8 mIU/L (elevated). Which of the following is
the MOST likely explanation?
A. Development of thyroid hormone resistance
B. Calcium carbonate interfering with levothyroxine absorption
C. Progression to primary hyperthyroidism
D. Need for combination T3/T4 therapy
Correct Answer: B
Rationale: [CORRECT] B: Calcium carbonate, iron supplements, aluminum-containing
antacids, and proton pump inhibitors reduce levothyroxine absorption by 20-40%. These
should be separated by at least 4 hours from levothyroxine. A: Thyroid hormone
resistance is rare genetic condition presenting with elevated thyroid hormones, not
elevated TSH with standard replacement. C: Progression would show decreasing TSH
(if becoming hyperthyroid) or increasing TSH with inadequate replacement; not related
to calcium. D: Combination therapy not indicated for standard hypothyroidism;
desiccated thyroid or liothyronine not superior to levothyroxine monotherapy. Clinical
Pearl: Always review medication timing and interactions when TSH drifts in previously
stable hypothyroid patients.
Graduate Nursing Program | Advanced Clinical
Decision-Making
Respiratory & Endocrine Pharmacology Focus
Q1: A 28-year-old female with newly diagnosed asthma is prescribed albuterol PRN for
exercise-induced symptoms. She reports using her inhaler 15 minutes before running
but still experiences wheezing. Which of the following is the MOST appropriate
modification to her therapy?
A. Switch to levalbuterol for better efficacy
B. Increase albuterol dose to 4 puffs before exercise
C. Add a daily inhaled corticosteroid (ICS) controller
D. Switch to oral albuterol tablets for longer duration
Correct Answer: C
Rationale: [CORRECT] C: Frequent use of rescue inhaler (>2 times/week) indicates poor
control and need for daily anti-inflammatory controller therapy (ICS). Albuterol is a
short-acting beta-2 agonist (SABA) that treats acute bronchospasm but does not
address underlying airway inflammation. A: Levalbuterol (R-albuterol) has similar
efficacy to racemic albuterol; no advantage for this patient. B: Increasing SABA dose
without controller therapy is inappropriate per GINA guidelines; increases risk of
exacerbations. D: Oral beta-agonists have more systemic side effects (tremor,
tachycardia) and are not recommended for asthma. Clinical Pearl: Need for controller
therapy determined by frequency of SABA use; exercise-induced bronchospasm more than
2x/week indicates persistent asthma requiring ICS.
,Q2: A 62-year-old male with COPD (GOLD Group B) is started on tiotropium 18 mcg
inhaled daily. Which of the following patient education points is MOST critical for safe
and effective use?
A. "Rinse your mouth after each use to prevent thrush"
B. "Take 2 puffs immediately if you feel short of breath"
C. "This is a long-acting bronchodilator; do not use for acute symptoms"
D. "Use a spacer device with this inhaler"
Correct Answer: C
Rationale: [CORRECT] C: Tiotropium is a long-acting muscarinic antagonist (LAMA) with
onset 30 minutes and duration 24 hours. It is maintenance therapy, NOT for rescue.
Patients must understand the difference between controller and reliever medications. A:
Rinsing mouth important for ICS (corticosteroids), not LAMAs. B: LAMAs do not provide
immediate relief; patient needs separate SABA for rescue. D: Tiotropium is a dry powder
inhaler (HandiHaler or Respimat) or soft mist inhaler; spacer not used with these
devices. Clinical Pearl: Confusing controller and reliever medications is a common cause
of COPD exacerbations and hospitalizations.
Q3: A patient with type 2 diabetes is prescribed insulin glargine 20 units at bedtime and
insulin lispro with meals. The patient asks why two different insulins are needed. Which
explanation is MOST accurate?
A. "The glargine covers your meals, and the lispro covers your baseline needs"
B. "The glargine provides basal coverage 24 hours, and the lispro covers mealtime
glucose spikes"
C. "The glargine is for morning use only, and the lispro is for evening meals"
D. "Using two insulins reduces the risk of allergic reactions"
Correct Answer: B
Rationale: [CORRECT] B: Basal-bolus insulin therapy mimics physiological insulin
secretion. Glargine (long-acting, peakless, 24-hour duration) provides basal coverage
, between meals and overnight. Lispro (rapid-acting, onset 15 minutes, peak 1 hour,
duration 3-4 hours) covers postprandial glucose excursions. A: Reversed explanation;
glargine is basal, not prandial. C: Glargine is typically given once daily at same time
(often bedtime or morning), not restricted to morning; lispro used with all meals. D: No
evidence that two insulins reduce allergy risk; insulin allergies are rare. Clinical Pearl:
Basal insulin suppresses hepatic glucose production; bolus insulin covers carbohydrate
intake.
Q4: A 45-year-old female with hypothyroidism has been stable on levothyroxine 100 mcg
daily for 2 years. She recently started taking calcium carbonate 1200 mg daily for
osteoporosis prevention. Her TSH is now 6.8 mIU/L (elevated). Which of the following is
the MOST likely explanation?
A. Development of thyroid hormone resistance
B. Calcium carbonate interfering with levothyroxine absorption
C. Progression to primary hyperthyroidism
D. Need for combination T3/T4 therapy
Correct Answer: B
Rationale: [CORRECT] B: Calcium carbonate, iron supplements, aluminum-containing
antacids, and proton pump inhibitors reduce levothyroxine absorption by 20-40%. These
should be separated by at least 4 hours from levothyroxine. A: Thyroid hormone
resistance is rare genetic condition presenting with elevated thyroid hormones, not
elevated TSH with standard replacement. C: Progression would show decreasing TSH
(if becoming hyperthyroid) or increasing TSH with inadequate replacement; not related
to calcium. D: Combination therapy not indicated for standard hypothyroidism;
desiccated thyroid or liothyronine not superior to levothyroxine monotherapy. Clinical
Pearl: Always review medication timing and interactions when TSH drifts in previously
stable hypothyroid patients.
