NSG 533 Advanced Pharmacology Exam #3 Case Study Based Practice Questions with Rationales

Module IX: Respiratory Disorders (Asthma, COPD, Allergic Rhinitis)



✅ Question 1

A 26-year-old male presents with mild intermittent asthma exacerbations once per month. He
uses albuterol PRN. Which treatment recommendation aligns with GINA guidelines for him?
 A. Continue PRN albuterol without additional therapy
 B. Add low-dose ICS/formoterol as needed
 C. Add montelukast daily
 D. Begin daily LABA therapy
Correct Answer: B ✅

Rationale:
 ✅ B: GINA guidelines now recommend low-dose ICS/formoterol as-needed even in
mild intermittent asthma due to inflammation control.
 ❌ A: Albuterol PRN alone doesn’t address underlying inflammation.

 ❌ C: Montelukast is less effective than ICS and not first-line for intermittent asthma.

 ❌ D: LABA monotherapy is contraindicated due to increased asthma-related mortality
without ICS.


✅ Question 2

A 65-year-old patient with COPD (Group D) continues to experience exacerbations despite a
LABA/LAMA regimen. Which is the appropriate next step according to GOLD guidelines?
 A. Add roflumilast
 B. Add ICS
 C. Switch to SABA only
 D. Add theophylline
Correct Answer: B ✅

Rationale:
 ✅ B: ICS should be considered in patients who continue exacerbating despite
LABA/LAMA, especially if eosinophil counts are elevated (>100 cells/μL).

,  ❌ A: Roflumilast is considered if chronic bronchitis is prominent, but ICS is often
preferred first.
 ❌ C: SABA monotherapy is inadequate for Group D COPD.

 ❌ D: Theophylline has fallen out of favor due to narrow therapeutic range and adverse
effects.


Module X: Hypertension & Heart Failure



✅ Question 3

A 54-year-old African American male with newly diagnosed hypertension and no CKD or DM
should first start therapy with:
 A. Lisinopril
 B. Metoprolol
 C. Hydrochlorothiazide
 D. Doxazosin
Correct Answer: C ✅

Rationale:
 ✅ C: Thiazides or CCBs are first-line therapies for African American patients without
CKD or DM.
 ❌ A: ACE inhibitors are less effective initially as monotherapy in African Americans
unless CKD or proteinuria is present.
 ❌ B: Beta-blockers aren't first-line for primary hypertension without specific
indications.
 ❌ D: Alpha-blockers are second-line and not recommended as first-line monotherapy.



✅ Question 4

A 62-year-old woman has HFrEF (EF 30%) with fluid retention. She takes lisinopril and
carvedilol. Which medication should be initiated next?
 A. Hydralazine-isosorbide dinitrate

,  B. Spironolactone
 C. Furosemide
 D. Digoxin
Correct Answer: C ✅

Rationale:
 ✅ C: Loop diuretics (furosemide) are indicated for symptomatic fluid retention.

 ❌ A: Hydralazine/isosorbide is recommended if intolerant to ACE-I/ARB, especially in
African American patients.
 ❌ B: Spironolactone reduces mortality but not first for acute fluid overload.

 ❌ D: Digoxin can decrease hospitalizations but not recommended before loop diuretics.



Module XI: Ischemic Heart Disease



✅ Question 5

A patient with stable angina experiences symptoms twice weekly. She currently takes sublingual
nitroglycerin PRN. What is the next recommended chronic therapy per ACC/AHA guidelines?
 A. Diltiazem
 B. Ranolazine
 C. Metoprolol
 D. Isosorbide mononitrate
Correct Answer: C ✅

Rationale:
 ✅ C: Beta-blockers are first-line therapy to reduce angina frequency and improve
survival.
 ❌ A: Non-dihydropyridine CCBs (diltiazem) second-line if beta-blockers
contraindicated or ineffective.
 ❌ B: Ranolazine reserved for persistent symptoms despite beta-blocker and nitrate use.

 ❌ D: Long-acting nitrates are second-line after beta-blockers due to tolerance.