,Maryville NURS 615 Exam 4 | Advanced
Pharmacotherapeutics (2026) Q&A
1. A patient with chronic kidney disease (CKD) is prescribed a drug that is primarily
excreted renally. If the patient's Creatinine Clearance (CrCl) decreases from 60
mL/min to 30 mL/min, how should the maintenance dose generally be adjusted?
A) The dose should be doubled to ensure efficacy.
B) No change is needed as the liver will compensate.
C) The dose should be reduced or the dosing interval lengthened.
D) The drug should be discontinued immediately.
Correct Answer: C) The dose should be reduced or the dosing interval lengthened.
Rationale: When renal clearance decreases, the half-life of renally excreted drugs
increases, leading to potential toxicity; therefore, the dose must be reduced or the
interval increased to maintain therapeutic levels. This is a fundamental principle of
pharmacokinetics in patients with renal impairment.
2. What is Tiotropium (SPIRIVA) used to treat?
A) Acute asthma attacks
B) Allergic rhinitis
C) Maintenance treatment of chronic obstructive pulmonary disease (COPD)
D) Pneumonia
Correct Answer: C) Maintenance treatment of chronic obstructive pulmonary
disease (COPD)
,Rationale: Tiotropium is used in the management and maintenance treatment of
COPD, which includes chronic bronchitis and emphysema. It is not indicated for acute
asthma attacks or allergic rhinitis.
3. What is the drug classification of Tiotropium?
A) Short-acting beta-agonist (SABA)
B) Long-acting muscarinic antagonist (LAMA)
C) Inhaled corticosteroid (ICS)
D) Leukotriene receptor antagonist (LTRA)
Correct Answer: B) Long-acting muscarinic antagonist (LAMA)
Rationale: Tiotropium is a long-acting, 24-hour anticholinergic bronchodilator. It is a
muscarinic receptor antagonist, often referred to as an antimuscarinic or
anticholinergic agent.
4. What is the mechanism of action of Tiotropium (SPIRIVA)?
A) It stimulates beta-2 adrenergic receptors to relax smooth muscle.
B) It blocks the action of leukotrienes in the airways.
C) It reduces inflammation by inhibiting mast cells.
D) It acts on M3 muscarinic receptors to reduce smooth muscle contraction and
mucus secretion.
Correct Answer: D) It acts on M3 muscarinic receptors to reduce smooth muscle
contraction and mucus secretion.
Rationale: When topically applied, Tiotropium acts mainly on M3 muscarinic
receptors located on smooth muscle cells and submucosal glands. This leads to a
, reduction in smooth muscle contraction and mucus secretion, producing a
bronchodilatory effect.
5. A patient with asthma is prescribed montelukast (Singulair). What adverse effects
should the nurse practitioner teach the patient to report?
A) Weight gain and edema
B) Anxiety, aggression, depression, and suicidal thoughts
C) Tachycardia and palpitations
D) Dry mouth and constipation
Correct Answer: B) Anxiety, aggression, depression, and suicidal thoughts
Rationale: Montelukast carries a boxed warning for neuropsychiatric events,
including anxiety, aggression, depression, and suicidal thoughts. Patients and families
should be counseled to monitor for these symptoms.
6. What patient teaching should be provided when prescribing inhaled
corticosteroids?
A) Take only when symptoms occur.
B) Rinse mouth after use to prevent oral thrush.
C) Use as a rescue medication for acute bronchospasm.
D) Avoid using daily.
Correct Answer: B) Rinse mouth after use to prevent oral thrush.
Rationale: Inhaled corticosteroids should be taken daily for the prevention of
asthma. Patients should rinse their mouth after use to prevent oral thrush
(candidiasis). They are not rescue medications.
Pharmacotherapeutics (2026) Q&A
1. A patient with chronic kidney disease (CKD) is prescribed a drug that is primarily
excreted renally. If the patient's Creatinine Clearance (CrCl) decreases from 60
mL/min to 30 mL/min, how should the maintenance dose generally be adjusted?
A) The dose should be doubled to ensure efficacy.
B) No change is needed as the liver will compensate.
C) The dose should be reduced or the dosing interval lengthened.
D) The drug should be discontinued immediately.
Correct Answer: C) The dose should be reduced or the dosing interval lengthened.
Rationale: When renal clearance decreases, the half-life of renally excreted drugs
increases, leading to potential toxicity; therefore, the dose must be reduced or the
interval increased to maintain therapeutic levels. This is a fundamental principle of
pharmacokinetics in patients with renal impairment.
2. What is Tiotropium (SPIRIVA) used to treat?
A) Acute asthma attacks
B) Allergic rhinitis
C) Maintenance treatment of chronic obstructive pulmonary disease (COPD)
D) Pneumonia
Correct Answer: C) Maintenance treatment of chronic obstructive pulmonary
disease (COPD)
,Rationale: Tiotropium is used in the management and maintenance treatment of
COPD, which includes chronic bronchitis and emphysema. It is not indicated for acute
asthma attacks or allergic rhinitis.
3. What is the drug classification of Tiotropium?
A) Short-acting beta-agonist (SABA)
B) Long-acting muscarinic antagonist (LAMA)
C) Inhaled corticosteroid (ICS)
D) Leukotriene receptor antagonist (LTRA)
Correct Answer: B) Long-acting muscarinic antagonist (LAMA)
Rationale: Tiotropium is a long-acting, 24-hour anticholinergic bronchodilator. It is a
muscarinic receptor antagonist, often referred to as an antimuscarinic or
anticholinergic agent.
4. What is the mechanism of action of Tiotropium (SPIRIVA)?
A) It stimulates beta-2 adrenergic receptors to relax smooth muscle.
B) It blocks the action of leukotrienes in the airways.
C) It reduces inflammation by inhibiting mast cells.
D) It acts on M3 muscarinic receptors to reduce smooth muscle contraction and
mucus secretion.
Correct Answer: D) It acts on M3 muscarinic receptors to reduce smooth muscle
contraction and mucus secretion.
Rationale: When topically applied, Tiotropium acts mainly on M3 muscarinic
receptors located on smooth muscle cells and submucosal glands. This leads to a
, reduction in smooth muscle contraction and mucus secretion, producing a
bronchodilatory effect.
5. A patient with asthma is prescribed montelukast (Singulair). What adverse effects
should the nurse practitioner teach the patient to report?
A) Weight gain and edema
B) Anxiety, aggression, depression, and suicidal thoughts
C) Tachycardia and palpitations
D) Dry mouth and constipation
Correct Answer: B) Anxiety, aggression, depression, and suicidal thoughts
Rationale: Montelukast carries a boxed warning for neuropsychiatric events,
including anxiety, aggression, depression, and suicidal thoughts. Patients and families
should be counseled to monitor for these symptoms.
6. What patient teaching should be provided when prescribing inhaled
corticosteroids?
A) Take only when symptoms occur.
B) Rinse mouth after use to prevent oral thrush.
C) Use as a rescue medication for acute bronchospasm.
D) Avoid using daily.
Correct Answer: B) Rinse mouth after use to prevent oral thrush.
Rationale: Inhaled corticosteroids should be taken daily for the prevention of
asthma. Patients should rinse their mouth after use to prevent oral thrush
(candidiasis). They are not rescue medications.
