NSG 533
EXAM 3
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
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Get the Complete PDF After Purchase
NSG 533 - EXAM 3 - Advanced Pharmacology
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or in need of any study resources,
feel free to Message me.
EXAM PREVIEW STUDY GUIDE FULL PDF LINKED
,Table of Contents
NSG 533 Exam 3 ................................................................................ 2
NSG 533 Exam 3 ............................................................................. 26
NSG 533 Exam 3 Focused Study Guide .............................. 49
NSG 533 Exam 3
Question 1
A 28-year-old patient with moderate persistent asthma is prescribed an inhaled
corticosteroid (ICS). Which of the following best describes the mechanism of action
of ICS?
A) Stimulate beta-2 adrenergic receptors causing bronchodilation
B) Inhibit acetylcholine on muscarinic receptors to prevent bronchoconstriction
C) Potent anti-inflammatory agents that decrease airway inflammation, attenuate airway
hyper-responsiveness, and minimize mucus production
D) Block leukotriene receptors to reduce bronchoconstriction
Correct Answer: C
Rationale: Inhaled corticosteroids (ICS) such as fluticasone, budesonide, beclomethasone,
and ciclesonide are the most potent anti-inflammatory agents for asthma. They work by
decreasing airway inflammation, attenuating airway hyper-responsiveness, and minimizing
mucus production and secretions. They also improve the actions of beta-agonists and target
the lungs directly. Option A describes LABA mechanism, Option B describes LAMA
mechanism, and Option D describes LTRA mechanism.
Question 2
Which of the following are examples of inhaled corticosteroids? (Select All That Apply)
,A) Fluticasone
B) Salmeterol
C) Budesonide
D) Tiotropium
E) Beclomethasone
F) Ciclesonide
Correct Answers: A, C, E, F
Rationale: Fluticasone, budesonide, beclomethasone, and ciclesonide are all inhaled
corticosteroids. Salmeterol (Option B) is a long-acting beta agonist (LABA), and tiotropium
(Option D) is a long-acting muscarinic antagonist (LAMA). It is critical to distinguish
between drug classes for safe prescribing.
Question 3
A patient with asthma not adequately controlled on an inhaled corticosteroid alone
is prescribed a long-acting beta agonist (LABA) as add-on therapy. What is the
primary mechanism of action of LABA?
A) Inhibit 5-lipoxygenase to reduce leukotriene production
B) Stimulate beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation)
C) Block muscarinic receptors to prevent cholinergic bronchoconstriction
D) Stabilize mast cell membranes to prevent degranulation
Correct Answer: B
Rationale: Long-acting beta agonists (LABA) such as salmeterol and vilanterol work by
stimulating beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation). Benefits include improved pulmonary function, more
symptom-free days, and decreased need for short-acting beta agonists (SABA). LABA
should NEVER be used as monotherapy for asthma—must always be combined with
ICS. Option A describes LTRA, Option C describes LAMA, and Option D describes
cromolyn/mast cell stabilizers.
Question 4
Which of the following are benefits of adding a long-acting beta agonist (LABA) to
inhaled corticosteroid therapy in asthma? (Select All That Apply)
,A) Improved pulmonary function
B) More symptom-free days
C) Decreased need for short-acting beta agonists (SABA)
D) Reduced airway inflammation independent of ICS
E) Replacement for inhaled corticosteroids
Correct Answers: A, B, C
Rationale: LABA add-on therapy to ICS provides improved pulmonary function, more
symptom-free days, and decreased need for SABA rescue inhalers. However, LABA does
NOT reduce airway inflammation independently (Option D)—that is the role of ICS. Most
importantly, LABA should NEVER replace ICS (Option E) due to safety concerns; LABA
monotherapy increases risk of asthma-related death.
Question 5
A patient with COPD is started on tiotropium. Which mechanism of action correctly
describes this medication?
A) Stimulates beta-2 receptors to increase cAMP and cause bronchodilation
B) Inhibits effects of acetylcholine on muscarinic receptors, protecting against cholinergic-
mediated bronchoconstriction
C) Blocks leukotriene D4 receptors to reduce inflammation
D) Inhibits phosphodiesterase to increase cAMP levels
Correct Answer: B
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA). It inhibits the effects
of acetylcholine on muscarinic receptors, protecting against cholinergic-mediated
bronchoconstriction. This is particularly useful in COPD where cholinergic tone is
increased. Option A describes beta-agonists, Option C describes LTRA (montelukast), and
Option D describes phosphodiesterase inhibitors like roflumilast.
Question 6
A patient newly started on tiotropium reports dry mouth and difficulty urinating. The nurse
practitioner should recognize these as:
A) Signs of an allergic reaction requiring immediate discontinuation
B) Expected antimuscarinic side effects that may improve with continued use
C) Indications that the dose is too high
D) Symptoms unrelated to the medication
,Correct Answer: B
Rationale: Tiotropium and other LAMAs may cause dry mouth, urinary retention, and
headache due to their antimuscarinic (anticholinergic) properties. These are expected side
effects. Dry mouth is the most common and often improves over time. Urinary retention
requires monitoring, especially in patients with benign prostatic hyperplasia (BPH). These
are not typically reasons for immediate discontinuation unless severe.
Question 7
Which of the following statements about leukotriene receptor antagonists (LTRA) is
CORRECT?
A) They are bronchodilators that work by stimulating beta-2 receptors
B) They are anti-inflammatories that inhibit 5-lipoxygenase or antagonize leukotriene D4
effects
C) They block muscarinic receptors to prevent bronchoconstriction
D) They are the most potent anti-inflammatory agents for asthma
Correct Answer: B
Rationale: Leukotriene receptor antagonists (LTRA) such as montelukast are anti-
inflammatories that either inhibit 5-lipoxygenase or completely antagonize the effect of
leukotriene D4. They improve forced expiratory volume (FEV), decrease symptoms, SABA
use, and exacerbations. However, they can cause neuropsychiatric events (suicidal
ideation, depression, agitation), which requires patient counseling and monitoring. Option
A describes LABA, Option C describes LAMA, and Option D describes ICS.
Question 8
A parent reports that their 10-year-old child on montelukast has become
increasingly irritable and anxious. What is the most appropriate action?
A) Reassure the parent that these are normal childhood behaviors
B) Discontinue montelukast immediately and consider alternative asthma therapy
C) Increase the dose of montelukast
D) Add a benzodiazepine for anxiety
Correct Answer: B
Rationale: Montelukast and other LTRAs carry an FDA black box warning for
neuropsychiatric events including suicidal ideation, depression, agitation, irritability, and
, NSG 533 Exam 3
Question 1
A 32-year-old patient with asthma uses albuterol for rescue inhaler use 4 days per
week and wakes up at night twice monthly with cough and wheezing. According to
GINA guidelines, what is the most appropriate next step in therapy?
A) Continue albuterol PRN only
B) Add a leukotriene receptor antagonist
C) Initiate daily low-dose inhaled corticosteroid (ICS)
D) Start high-dose ICS + LABA combination
Correct Answer: C
Rationale: This patient has symptoms >2 days per week and night awakenings, indicating
poorly controlled asthma that requires step-up to daily controller therapy. GINA
recommends low-dose ICS as initial controller therapy for persistent asthma. SABA-only
therapy (Option A) is inappropriate for persistent symptoms. LTRA (Option B) is less
effective than ICS as first-line controller. High-dose ICS + LABA (Option D) is excessive for
initial step-up; this would be Step 3-4 therapy.
Question 2
Which of the following medications is CONTRAINDICATED as monotherapy in asthma
due to increased risk of severe exacerbations and asthma-related death?
A) Albuterol
B) Fluticasone
C) Salmeterol
D) Montelukast
Correct Answer: C
Rationale: Long-acting beta-agonists (LABA) such as salmeterol and formoterol must
NEVER be used as monotherapy in asthma. They must always be combined with an inhaled
,corticosteroid due to the increased risk of severe exacerbations and asthma-related death
when used alone. This is an FDA black box warning. Albuterol (Option A) is appropriate for
acute rescue. Fluticasone (Option B) is a safe controller. Montelukast (Option D) can be
used as monotherapy but is less effective than ICS.
Question 3
A patient with COPD is started on tiotropium. The nurse practitioner should counsel
the patient to report which of the following adverse effects immediately? (Select All
That Apply)
A) Dry mouth
B) Difficulty urinating
C) Mild headache
D) Eye pain or blurred vision
Correct Answers: B, D
Rationale: Tiotropium is a LAMA that blocks muscarinic receptors. While dry mouth
(Option A) and headache (Option C) are common expected side effects, difficulty urinating
(Option B) may indicate urinary retention—particularly dangerous in patients with BPH
and requires immediate evaluation. Eye pain or blurred vision (Option D) could indicate
narrow-angle glaucoma (a contraindication) or aerosol contact with eyes, requiring
immediate assessment. Dry mouth is expected and manageable; headache is typically self-
limiting.
Question 4
A 45-year-old patient on montelukast for allergic asthma reports new-onset
nightmares, anxiety, and suicidal ideation. What is the most appropriate action?
A) Reassure the patient and continue montelukast
B) Discontinue montelukast immediately and switch to ICS
C) Add an antidepressant
D) Reduce the montelukast dose by half
Correct Answer: B
Rationale: Montelukast carries an FDA black box warning for neuropsychiatric events
including suicidal ideation, depression, agitation, and nightmares. Any neuropsychiatric
symptoms require immediate discontinuation. The patient should be switched to an
alternative controller (ICS preferred). Adding an antidepressant (Option C) does not
,address the drug-induced etiology. Dose reduction (Option D) is insufficient given the
severity of suicidal ideation.
Question 5
Which of the following best explains why theophylline has fallen out of favor as a
first-line therapy for asthma and COPD?
A) It lacks bronchodilator activity
B) It has a narrow therapeutic index and numerous drug-drug interactions
C) It is only available in IV formulation
D) It is more expensive than newer agents
Correct Answer: B
Rationale: Theophylline has a narrow therapeutic index (therapeutic range 5-15 mcg/mL)
with significant adverse effects at toxic levels including nausea, vomiting, arrhythmias, and
seizures. It has numerous CYP450 drug interactions (macrolides, fluoroquinolones increase
levels; smoking decreases levels). It is a second or third-line therapy used only when other
options are unavailable. Theophylline does have bronchodilator activity (Option A is
incorrect), is available orally (Option C is incorrect), and is inexpensive (Option D is
incorrect).
Question 6
A patient with severe eosinophilic asthma not controlled on high-dose ICS + LABA is
being considered for biologic therapy. Which biologic agent targets the IL-5 pathway?
A) Omalizumab
B) Dupilumab
C) Mepolizumab
D) Mometasone
Correct Answer: C
Rationale: Mepolizumab is an anti-IL-5 biologic that targets eosinophilic pathways in
severe asthma. Omalizumab (Option A) is anti-IgE. Dupilumab (Option B) is an anti-IL-4
receptor antagonist. Benralizumab also targets IL-5. Mometasone (Option D) is an inhaled
corticosteroid, not a biologic. Biologics are reserved for severe asthma not controlled with
standard therapy.
, NSG 533 Exam 3 Focused Study Guide
Short Acting Beta 2 Agonists (SABA)
Examples
Albuterol
Levalbuterol
Mechanism of Action
Stimulate β2-adrenergic receptors in bronchial smooth muscle
Increase cAMP, Cause rapid bronchodilation
Adverse Effects
Tremor
Tachycardia
Palpitations
Hypokalemia
Nervousness
Drug Interactions
Beta blockers may reduce bronchodilation
MAO inhibitors / TCAs increase cardiovascular effects
Contraindications / Cautions
Severe cardiac disease
EXAM 3
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 533 - EXAM 3 - Advanced Pharmacology
If you require further clarification
or in need of any study resources,
feel free to Message me.
EXAM PREVIEW STUDY GUIDE FULL PDF LINKED
,Table of Contents
NSG 533 Exam 3 ................................................................................ 2
NSG 533 Exam 3 ............................................................................. 26
NSG 533 Exam 3 Focused Study Guide .............................. 49
NSG 533 Exam 3
Question 1
A 28-year-old patient with moderate persistent asthma is prescribed an inhaled
corticosteroid (ICS). Which of the following best describes the mechanism of action
of ICS?
A) Stimulate beta-2 adrenergic receptors causing bronchodilation
B) Inhibit acetylcholine on muscarinic receptors to prevent bronchoconstriction
C) Potent anti-inflammatory agents that decrease airway inflammation, attenuate airway
hyper-responsiveness, and minimize mucus production
D) Block leukotriene receptors to reduce bronchoconstriction
Correct Answer: C
Rationale: Inhaled corticosteroids (ICS) such as fluticasone, budesonide, beclomethasone,
and ciclesonide are the most potent anti-inflammatory agents for asthma. They work by
decreasing airway inflammation, attenuating airway hyper-responsiveness, and minimizing
mucus production and secretions. They also improve the actions of beta-agonists and target
the lungs directly. Option A describes LABA mechanism, Option B describes LAMA
mechanism, and Option D describes LTRA mechanism.
Question 2
Which of the following are examples of inhaled corticosteroids? (Select All That Apply)
,A) Fluticasone
B) Salmeterol
C) Budesonide
D) Tiotropium
E) Beclomethasone
F) Ciclesonide
Correct Answers: A, C, E, F
Rationale: Fluticasone, budesonide, beclomethasone, and ciclesonide are all inhaled
corticosteroids. Salmeterol (Option B) is a long-acting beta agonist (LABA), and tiotropium
(Option D) is a long-acting muscarinic antagonist (LAMA). It is critical to distinguish
between drug classes for safe prescribing.
Question 3
A patient with asthma not adequately controlled on an inhaled corticosteroid alone
is prescribed a long-acting beta agonist (LABA) as add-on therapy. What is the
primary mechanism of action of LABA?
A) Inhibit 5-lipoxygenase to reduce leukotriene production
B) Stimulate beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation)
C) Block muscarinic receptors to prevent cholinergic bronchoconstriction
D) Stabilize mast cell membranes to prevent degranulation
Correct Answer: B
Rationale: Long-acting beta agonists (LABA) such as salmeterol and vilanterol work by
stimulating beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation). Benefits include improved pulmonary function, more
symptom-free days, and decreased need for short-acting beta agonists (SABA). LABA
should NEVER be used as monotherapy for asthma—must always be combined with
ICS. Option A describes LTRA, Option C describes LAMA, and Option D describes
cromolyn/mast cell stabilizers.
Question 4
Which of the following are benefits of adding a long-acting beta agonist (LABA) to
inhaled corticosteroid therapy in asthma? (Select All That Apply)
,A) Improved pulmonary function
B) More symptom-free days
C) Decreased need for short-acting beta agonists (SABA)
D) Reduced airway inflammation independent of ICS
E) Replacement for inhaled corticosteroids
Correct Answers: A, B, C
Rationale: LABA add-on therapy to ICS provides improved pulmonary function, more
symptom-free days, and decreased need for SABA rescue inhalers. However, LABA does
NOT reduce airway inflammation independently (Option D)—that is the role of ICS. Most
importantly, LABA should NEVER replace ICS (Option E) due to safety concerns; LABA
monotherapy increases risk of asthma-related death.
Question 5
A patient with COPD is started on tiotropium. Which mechanism of action correctly
describes this medication?
A) Stimulates beta-2 receptors to increase cAMP and cause bronchodilation
B) Inhibits effects of acetylcholine on muscarinic receptors, protecting against cholinergic-
mediated bronchoconstriction
C) Blocks leukotriene D4 receptors to reduce inflammation
D) Inhibits phosphodiesterase to increase cAMP levels
Correct Answer: B
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA). It inhibits the effects
of acetylcholine on muscarinic receptors, protecting against cholinergic-mediated
bronchoconstriction. This is particularly useful in COPD where cholinergic tone is
increased. Option A describes beta-agonists, Option C describes LTRA (montelukast), and
Option D describes phosphodiesterase inhibitors like roflumilast.
Question 6
A patient newly started on tiotropium reports dry mouth and difficulty urinating. The nurse
practitioner should recognize these as:
A) Signs of an allergic reaction requiring immediate discontinuation
B) Expected antimuscarinic side effects that may improve with continued use
C) Indications that the dose is too high
D) Symptoms unrelated to the medication
,Correct Answer: B
Rationale: Tiotropium and other LAMAs may cause dry mouth, urinary retention, and
headache due to their antimuscarinic (anticholinergic) properties. These are expected side
effects. Dry mouth is the most common and often improves over time. Urinary retention
requires monitoring, especially in patients with benign prostatic hyperplasia (BPH). These
are not typically reasons for immediate discontinuation unless severe.
Question 7
Which of the following statements about leukotriene receptor antagonists (LTRA) is
CORRECT?
A) They are bronchodilators that work by stimulating beta-2 receptors
B) They are anti-inflammatories that inhibit 5-lipoxygenase or antagonize leukotriene D4
effects
C) They block muscarinic receptors to prevent bronchoconstriction
D) They are the most potent anti-inflammatory agents for asthma
Correct Answer: B
Rationale: Leukotriene receptor antagonists (LTRA) such as montelukast are anti-
inflammatories that either inhibit 5-lipoxygenase or completely antagonize the effect of
leukotriene D4. They improve forced expiratory volume (FEV), decrease symptoms, SABA
use, and exacerbations. However, they can cause neuropsychiatric events (suicidal
ideation, depression, agitation), which requires patient counseling and monitoring. Option
A describes LABA, Option C describes LAMA, and Option D describes ICS.
Question 8
A parent reports that their 10-year-old child on montelukast has become
increasingly irritable and anxious. What is the most appropriate action?
A) Reassure the parent that these are normal childhood behaviors
B) Discontinue montelukast immediately and consider alternative asthma therapy
C) Increase the dose of montelukast
D) Add a benzodiazepine for anxiety
Correct Answer: B
Rationale: Montelukast and other LTRAs carry an FDA black box warning for
neuropsychiatric events including suicidal ideation, depression, agitation, irritability, and
, NSG 533 Exam 3
Question 1
A 32-year-old patient with asthma uses albuterol for rescue inhaler use 4 days per
week and wakes up at night twice monthly with cough and wheezing. According to
GINA guidelines, what is the most appropriate next step in therapy?
A) Continue albuterol PRN only
B) Add a leukotriene receptor antagonist
C) Initiate daily low-dose inhaled corticosteroid (ICS)
D) Start high-dose ICS + LABA combination
Correct Answer: C
Rationale: This patient has symptoms >2 days per week and night awakenings, indicating
poorly controlled asthma that requires step-up to daily controller therapy. GINA
recommends low-dose ICS as initial controller therapy for persistent asthma. SABA-only
therapy (Option A) is inappropriate for persistent symptoms. LTRA (Option B) is less
effective than ICS as first-line controller. High-dose ICS + LABA (Option D) is excessive for
initial step-up; this would be Step 3-4 therapy.
Question 2
Which of the following medications is CONTRAINDICATED as monotherapy in asthma
due to increased risk of severe exacerbations and asthma-related death?
A) Albuterol
B) Fluticasone
C) Salmeterol
D) Montelukast
Correct Answer: C
Rationale: Long-acting beta-agonists (LABA) such as salmeterol and formoterol must
NEVER be used as monotherapy in asthma. They must always be combined with an inhaled
,corticosteroid due to the increased risk of severe exacerbations and asthma-related death
when used alone. This is an FDA black box warning. Albuterol (Option A) is appropriate for
acute rescue. Fluticasone (Option B) is a safe controller. Montelukast (Option D) can be
used as monotherapy but is less effective than ICS.
Question 3
A patient with COPD is started on tiotropium. The nurse practitioner should counsel
the patient to report which of the following adverse effects immediately? (Select All
That Apply)
A) Dry mouth
B) Difficulty urinating
C) Mild headache
D) Eye pain or blurred vision
Correct Answers: B, D
Rationale: Tiotropium is a LAMA that blocks muscarinic receptors. While dry mouth
(Option A) and headache (Option C) are common expected side effects, difficulty urinating
(Option B) may indicate urinary retention—particularly dangerous in patients with BPH
and requires immediate evaluation. Eye pain or blurred vision (Option D) could indicate
narrow-angle glaucoma (a contraindication) or aerosol contact with eyes, requiring
immediate assessment. Dry mouth is expected and manageable; headache is typically self-
limiting.
Question 4
A 45-year-old patient on montelukast for allergic asthma reports new-onset
nightmares, anxiety, and suicidal ideation. What is the most appropriate action?
A) Reassure the patient and continue montelukast
B) Discontinue montelukast immediately and switch to ICS
C) Add an antidepressant
D) Reduce the montelukast dose by half
Correct Answer: B
Rationale: Montelukast carries an FDA black box warning for neuropsychiatric events
including suicidal ideation, depression, agitation, and nightmares. Any neuropsychiatric
symptoms require immediate discontinuation. The patient should be switched to an
alternative controller (ICS preferred). Adding an antidepressant (Option C) does not
,address the drug-induced etiology. Dose reduction (Option D) is insufficient given the
severity of suicidal ideation.
Question 5
Which of the following best explains why theophylline has fallen out of favor as a
first-line therapy for asthma and COPD?
A) It lacks bronchodilator activity
B) It has a narrow therapeutic index and numerous drug-drug interactions
C) It is only available in IV formulation
D) It is more expensive than newer agents
Correct Answer: B
Rationale: Theophylline has a narrow therapeutic index (therapeutic range 5-15 mcg/mL)
with significant adverse effects at toxic levels including nausea, vomiting, arrhythmias, and
seizures. It has numerous CYP450 drug interactions (macrolides, fluoroquinolones increase
levels; smoking decreases levels). It is a second or third-line therapy used only when other
options are unavailable. Theophylline does have bronchodilator activity (Option A is
incorrect), is available orally (Option C is incorrect), and is inexpensive (Option D is
incorrect).
Question 6
A patient with severe eosinophilic asthma not controlled on high-dose ICS + LABA is
being considered for biologic therapy. Which biologic agent targets the IL-5 pathway?
A) Omalizumab
B) Dupilumab
C) Mepolizumab
D) Mometasone
Correct Answer: C
Rationale: Mepolizumab is an anti-IL-5 biologic that targets eosinophilic pathways in
severe asthma. Omalizumab (Option A) is anti-IgE. Dupilumab (Option B) is an anti-IL-4
receptor antagonist. Benralizumab also targets IL-5. Mometasone (Option D) is an inhaled
corticosteroid, not a biologic. Biologics are reserved for severe asthma not controlled with
standard therapy.
, NSG 533 Exam 3 Focused Study Guide
Short Acting Beta 2 Agonists (SABA)
Examples
Albuterol
Levalbuterol
Mechanism of Action
Stimulate β2-adrenergic receptors in bronchial smooth muscle
Increase cAMP, Cause rapid bronchodilation
Adverse Effects
Tremor
Tachycardia
Palpitations
Hypokalemia
Nervousness
Drug Interactions
Beta blockers may reduce bronchodilation
MAO inhibitors / TCAs increase cardiovascular effects
Contraindications / Cautions
Severe cardiac disease
