Wilkes University NSG 533 Exam 3 (pdf) | 2026/2027 | Advanced
Pharmacology Q&A | Pharmacology
1. A 32-year-old patient with mild intermittent asthma reports using a rescue
inhaler less than twice per week and has no nighttime awakenings.
According to GINA guidelines, which treatment is most appropriate?
A) Daily low-dose inhaled corticosteroid (ICS)
B) As-needed low-dose ICS-formoterol OR as-needed low-dose ICS with SABA
C) Daily medium-dose ICS with LABA
D) Daily low-dose ICS-formoterol
Correct Answer: As-needed low-dose ICS-formoterol OR as-needed low-dose
ICS with SABA
Rationale: For patients with symptoms less than twice per month,
intermittent symptoms can be managed with as-needed controller
medication to reduce inflammation and prevent exacerbations. Formoterol is
a fast-acting LABA suitable for reliever use when combined with ICS. Daily
ICS is reserved for more frequent symptoms.
2. A patient with asthma reports daytime symptoms more than twice per
week but less than daily, with occasional nighttime awakenings. What is the
recommended step therapy according to GINA guidelines?
A) As-needed SABA only
B) Daily low-dose ICS and as-needed SABA OR as-needed low-dose ICS-
formoterol
C) Daily medium-dose ICS with LABA
D) Daily high-dose ICS with LABA
Correct Answer: Daily low-dose ICS and as-needed SABA OR as-needed low-
dose ICS-formoterol
,Rationale: More frequent symptoms (more than twice per month) require
daily anti-inflammatory control with ICS; SABAs provide symptom relief. As-
needed ICS-formoterol simplifies regimen and provides both reliever and
anti-inflammatory effects.
3. A 45-year-old patient with asthma reports symptoms on most days of the
week. Which treatment step is most appropriate?
A) Daily low-dose ICS and as-needed SABA
B) Daily low-dose ICS-formoterol and as-needed SABA OR daily medium-dose
ICS and SABA
C) Daily high-dose ICS with LABA
D) As-needed ICS-formoterol only
Correct Answer: Daily low-dose ICS-formoterol and as-needed SABA OR daily
medium-dose ICS and SABA
Rationale: Frequent symptoms indicate need for increased ICS dose or
combination with formoterol for better control; medium-dose ICS better
controls persistent inflammation. Daily low-dose ICS alone is insufficient for
symptoms on most days.
4. A patient with severe asthma has daily symptoms despite medium-dose
ICS-formoterol. What is the next step in therapy?
A) Add a leukotriene receptor antagonist
B) Daily medium-dose ICS-formoterol with reliever therapy OR daily high-
dose ICS with reliever therapy
C) Switch to oral corticosteroids
D) Add theophylline
Correct Answer: Daily medium-dose ICS-formoterol with reliever therapy OR
daily high-dose ICS with reliever therapy
,Rationale: Severe asthma requires higher anti-inflammatory doses combined
with fast-acting bronchodilators to manage persistent symptoms and reduce
exacerbations. Adding a leukotriene receptor antagonist or theophylline may
be considered as adjunctive therapy, but the primary step is increasing ICS
dose.
5. Which of the following symptoms indicates uncontrolled asthma according
to GINA guidelines? (Select all that apply)
A) Daytime asthma more than 2 times a week
B) Nighttime awakenings
C) Reliever therapy more than 2 times a week
D) Activity intolerance
Correct Answer: Daytime asthma more than 2 times a week, Nighttime
awakenings, Reliever therapy more than 2 times a week, Activity intolerance
Rationale: These symptoms indicate poor asthma control and higher risk of
exacerbations, thus requiring treatment step-up or reassessment. The
presence of at least three of these symptoms suggests uncontrolled asthma
requiring treatment escalation.
6. Which beta-blocker is contraindicated in patients with asthma due to non-
selective beta-blockade causing bronchospasm?
A) Metoprolol
B) Atenolol
C) Propranolol
D) Bisoprolol
Correct Answer: Propranolol
, Rationale: Non-selective beta-blockers (propranolol, nadolol, timolol, sotalol)
block β2 receptors in the lungs, causing bronchospasm in asthma patients.
Cardioselective beta-blockers (metoprolol, atenolol, bisoprolol) have lower
risk of bronchospasm and may be used with caution in asthma patients when
necessary.
7. A patient with COPD is classified as GOLD Group B. Which initial
pharmacotherapy is recommended?
A) LAMA alone OR LABA + LAMA
B) LABA alone
C) ICS + LABA
D) Theophylline
Correct Answer: LAMA alone OR LABA + LAMA
Rationale: GOLD Group B patients have more symptoms but low
exacerbation risk. LAMA or LABA + LAMA is recommended for initial therapy.
ICS-containing regimens are reserved for patients with higher exacerbation
risk (Groups D and E).
8. A patient with COPD and frequent exacerbations (≥2 per year) is classified
as GOLD Group E. Which treatment is most appropriate?
A) LAMA alone
B) LABA alone
C) LABA + LAMA OR LABA + ICS
D) Theophylline only
Correct Answer: LABA + LAMA OR LABA + ICS
Pharmacology Q&A | Pharmacology
1. A 32-year-old patient with mild intermittent asthma reports using a rescue
inhaler less than twice per week and has no nighttime awakenings.
According to GINA guidelines, which treatment is most appropriate?
A) Daily low-dose inhaled corticosteroid (ICS)
B) As-needed low-dose ICS-formoterol OR as-needed low-dose ICS with SABA
C) Daily medium-dose ICS with LABA
D) Daily low-dose ICS-formoterol
Correct Answer: As-needed low-dose ICS-formoterol OR as-needed low-dose
ICS with SABA
Rationale: For patients with symptoms less than twice per month,
intermittent symptoms can be managed with as-needed controller
medication to reduce inflammation and prevent exacerbations. Formoterol is
a fast-acting LABA suitable for reliever use when combined with ICS. Daily
ICS is reserved for more frequent symptoms.
2. A patient with asthma reports daytime symptoms more than twice per
week but less than daily, with occasional nighttime awakenings. What is the
recommended step therapy according to GINA guidelines?
A) As-needed SABA only
B) Daily low-dose ICS and as-needed SABA OR as-needed low-dose ICS-
formoterol
C) Daily medium-dose ICS with LABA
D) Daily high-dose ICS with LABA
Correct Answer: Daily low-dose ICS and as-needed SABA OR as-needed low-
dose ICS-formoterol
,Rationale: More frequent symptoms (more than twice per month) require
daily anti-inflammatory control with ICS; SABAs provide symptom relief. As-
needed ICS-formoterol simplifies regimen and provides both reliever and
anti-inflammatory effects.
3. A 45-year-old patient with asthma reports symptoms on most days of the
week. Which treatment step is most appropriate?
A) Daily low-dose ICS and as-needed SABA
B) Daily low-dose ICS-formoterol and as-needed SABA OR daily medium-dose
ICS and SABA
C) Daily high-dose ICS with LABA
D) As-needed ICS-formoterol only
Correct Answer: Daily low-dose ICS-formoterol and as-needed SABA OR daily
medium-dose ICS and SABA
Rationale: Frequent symptoms indicate need for increased ICS dose or
combination with formoterol for better control; medium-dose ICS better
controls persistent inflammation. Daily low-dose ICS alone is insufficient for
symptoms on most days.
4. A patient with severe asthma has daily symptoms despite medium-dose
ICS-formoterol. What is the next step in therapy?
A) Add a leukotriene receptor antagonist
B) Daily medium-dose ICS-formoterol with reliever therapy OR daily high-
dose ICS with reliever therapy
C) Switch to oral corticosteroids
D) Add theophylline
Correct Answer: Daily medium-dose ICS-formoterol with reliever therapy OR
daily high-dose ICS with reliever therapy
,Rationale: Severe asthma requires higher anti-inflammatory doses combined
with fast-acting bronchodilators to manage persistent symptoms and reduce
exacerbations. Adding a leukotriene receptor antagonist or theophylline may
be considered as adjunctive therapy, but the primary step is increasing ICS
dose.
5. Which of the following symptoms indicates uncontrolled asthma according
to GINA guidelines? (Select all that apply)
A) Daytime asthma more than 2 times a week
B) Nighttime awakenings
C) Reliever therapy more than 2 times a week
D) Activity intolerance
Correct Answer: Daytime asthma more than 2 times a week, Nighttime
awakenings, Reliever therapy more than 2 times a week, Activity intolerance
Rationale: These symptoms indicate poor asthma control and higher risk of
exacerbations, thus requiring treatment step-up or reassessment. The
presence of at least three of these symptoms suggests uncontrolled asthma
requiring treatment escalation.
6. Which beta-blocker is contraindicated in patients with asthma due to non-
selective beta-blockade causing bronchospasm?
A) Metoprolol
B) Atenolol
C) Propranolol
D) Bisoprolol
Correct Answer: Propranolol
, Rationale: Non-selective beta-blockers (propranolol, nadolol, timolol, sotalol)
block β2 receptors in the lungs, causing bronchospasm in asthma patients.
Cardioselective beta-blockers (metoprolol, atenolol, bisoprolol) have lower
risk of bronchospasm and may be used with caution in asthma patients when
necessary.
7. A patient with COPD is classified as GOLD Group B. Which initial
pharmacotherapy is recommended?
A) LAMA alone OR LABA + LAMA
B) LABA alone
C) ICS + LABA
D) Theophylline
Correct Answer: LAMA alone OR LABA + LAMA
Rationale: GOLD Group B patients have more symptoms but low
exacerbation risk. LAMA or LABA + LAMA is recommended for initial therapy.
ICS-containing regimens are reserved for patients with higher exacerbation
risk (Groups D and E).
8. A patient with COPD and frequent exacerbations (≥2 per year) is classified
as GOLD Group E. Which treatment is most appropriate?
A) LAMA alone
B) LABA alone
C) LABA + LAMA OR LABA + ICS
D) Theophylline only
Correct Answer: LABA + LAMA OR LABA + ICS
