,NSG 533 Exam 3 | Advanced Pharmacology | Wilkes
University | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the underlying pathophysiologic mechanism of asthma?
A) Excessive mucus production and airway smooth muscle hypertrophy
B) Chronic airway inflammation with bronchial hyperresponsiveness and reversible airflow obstruction
C) Alveolar destruction and loss of elastic recoil leading to air trapping
D) Pulmonary vasoconstriction and right ventricular hypertrophy
Correct Answer: Chronic airway inflammation with bronchial hyperresponsiveness and reversible airflow
obstruction
Expert Rationale: Asthma is characterized by chronic inflammation of the airways, leading to bronchial
hyperresponsiveness, airflow obstruction, and respiratory symptoms. The inflammation involves mast
cells, eosinophils, and T-lymphocytes. Airflow obstruction is typically reversible, either spontaneously or
with treatment, distinguishing it from COPD.
---
2. According to the Global Initiative for Asthma (GINA) guidelines, which is the preferred reliever
medication for adults and adolescents with asthma?
A) Short-acting beta-2 agonist (SABA) alone
B) Low-dose inhaled corticosteroid (ICS)-formoterol
C) Long-acting beta-2 agonist (LABA) alone
D) Oral corticosteroids
Correct Answer: Low-dose inhaled corticosteroid (ICS)-formoterol
Expert Rationale: The 2023 GINA strategy recommends that for adults and adolescents, the preferred
reliever is low-dose ICS-formoterol, used as needed for symptoms. This approach reduces the risk of
severe exacerbations compared to SABA alone. SABA-only use is no longer recommended as the
preferred reliever.
,---
3. What is the primary mechanism of action of inhaled corticosteroids in the management of persistent
asthma?
A) Direct bronchodilation via beta-2 receptor activation
B) Suppression of airway inflammation through inhibition of inflammatory cells and mediators
C) Antagonism of leukotriene receptors in the airways
D) Stabilization of mast cell membranes to prevent degranulation
Correct Answer: Suppression of airway inflammation through inhibition of inflammatory cells and
mediators
Expert Rationale: Inhaled corticosteroids (e.g., fluticasone, budesonide) suppress airway inflammation
by inhibiting inflammatory cell infiltration, reducing cytokine production, and decreasing mucus
secretion. They are the most effective long-term controllers for persistent asthma. They do not provide
immediate bronchodilation and are not used as rescue therapy.
---
4. A patient with asthma is prescribed a combination inhaler containing fluticasone and salmeterol.
What is the most important counseling point regarding this medication?
A) Use the inhaler as a rescue medication for acute symptoms
B) Rinse the mouth with water after each use to prevent oral candidiasis
C) Take the medication only when symptoms are severe
D) The salmeterol component is the primary controller medication
Correct Answer: Rinse the mouth with water after each use to prevent oral candidiasis
Expert Rationale: Inhaled corticosteroids can cause oral candidiasis (thrush) and dysphonia. Rinsing the
mouth with water after each use reduces this risk. Salmeterol is a LABA and should never be used as
monotherapy or as a rescue medication; it is always used in combination with an ICS for asthma.
, ---
5. Which of the following is a hallmark of severe asthma exacerbation requiring immediate medical
attention?
A) Peak expiratory flow (PEF) greater than 80% of personal best
B) Inability to speak in full sentences
C) Respiratory rate of 16 breaths per minute
D) Mild wheezing on expiration only
Correct Answer: Inability to speak in full sentences
Expert Rationale: Inability to speak in full sentences indicates severe respiratory distress and is a sign of
a life-threatening asthma exacerbation. Other signs include PEF <50% of predicted, tachycardia,
tachypnea, and accessory muscle use. These patients require immediate high-dose inhaled
bronchodilators, systemic corticosteroids, and possibly hospitalization.
---
6. According to the GOLD guidelines, which pharmacologic agent is recommended as first-line
maintenance therapy for most patients with stable COPD?
A) Inhaled corticosteroid (ICS) alone
B) Long-acting bronchodilator (LABA or LAMA)
C) Oral corticosteroid
D) Theophylline
Correct Answer: Long-acting bronchodilator (LABA or LAMA)
Expert Rationale: GOLD guidelines recommend long-acting bronchodilators (LABA or LAMA) as first-line
maintenance therapy for most patients with stable COPD. ICS are added for patients with frequent
exacerbations or eosinophilic inflammation. Oral corticosteroids are not recommended for routine
maintenance due to significant side effects.
University | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the underlying pathophysiologic mechanism of asthma?
A) Excessive mucus production and airway smooth muscle hypertrophy
B) Chronic airway inflammation with bronchial hyperresponsiveness and reversible airflow obstruction
C) Alveolar destruction and loss of elastic recoil leading to air trapping
D) Pulmonary vasoconstriction and right ventricular hypertrophy
Correct Answer: Chronic airway inflammation with bronchial hyperresponsiveness and reversible airflow
obstruction
Expert Rationale: Asthma is characterized by chronic inflammation of the airways, leading to bronchial
hyperresponsiveness, airflow obstruction, and respiratory symptoms. The inflammation involves mast
cells, eosinophils, and T-lymphocytes. Airflow obstruction is typically reversible, either spontaneously or
with treatment, distinguishing it from COPD.
---
2. According to the Global Initiative for Asthma (GINA) guidelines, which is the preferred reliever
medication for adults and adolescents with asthma?
A) Short-acting beta-2 agonist (SABA) alone
B) Low-dose inhaled corticosteroid (ICS)-formoterol
C) Long-acting beta-2 agonist (LABA) alone
D) Oral corticosteroids
Correct Answer: Low-dose inhaled corticosteroid (ICS)-formoterol
Expert Rationale: The 2023 GINA strategy recommends that for adults and adolescents, the preferred
reliever is low-dose ICS-formoterol, used as needed for symptoms. This approach reduces the risk of
severe exacerbations compared to SABA alone. SABA-only use is no longer recommended as the
preferred reliever.
,---
3. What is the primary mechanism of action of inhaled corticosteroids in the management of persistent
asthma?
A) Direct bronchodilation via beta-2 receptor activation
B) Suppression of airway inflammation through inhibition of inflammatory cells and mediators
C) Antagonism of leukotriene receptors in the airways
D) Stabilization of mast cell membranes to prevent degranulation
Correct Answer: Suppression of airway inflammation through inhibition of inflammatory cells and
mediators
Expert Rationale: Inhaled corticosteroids (e.g., fluticasone, budesonide) suppress airway inflammation
by inhibiting inflammatory cell infiltration, reducing cytokine production, and decreasing mucus
secretion. They are the most effective long-term controllers for persistent asthma. They do not provide
immediate bronchodilation and are not used as rescue therapy.
---
4. A patient with asthma is prescribed a combination inhaler containing fluticasone and salmeterol.
What is the most important counseling point regarding this medication?
A) Use the inhaler as a rescue medication for acute symptoms
B) Rinse the mouth with water after each use to prevent oral candidiasis
C) Take the medication only when symptoms are severe
D) The salmeterol component is the primary controller medication
Correct Answer: Rinse the mouth with water after each use to prevent oral candidiasis
Expert Rationale: Inhaled corticosteroids can cause oral candidiasis (thrush) and dysphonia. Rinsing the
mouth with water after each use reduces this risk. Salmeterol is a LABA and should never be used as
monotherapy or as a rescue medication; it is always used in combination with an ICS for asthma.
, ---
5. Which of the following is a hallmark of severe asthma exacerbation requiring immediate medical
attention?
A) Peak expiratory flow (PEF) greater than 80% of personal best
B) Inability to speak in full sentences
C) Respiratory rate of 16 breaths per minute
D) Mild wheezing on expiration only
Correct Answer: Inability to speak in full sentences
Expert Rationale: Inability to speak in full sentences indicates severe respiratory distress and is a sign of
a life-threatening asthma exacerbation. Other signs include PEF <50% of predicted, tachycardia,
tachypnea, and accessory muscle use. These patients require immediate high-dose inhaled
bronchodilators, systemic corticosteroids, and possibly hospitalization.
---
6. According to the GOLD guidelines, which pharmacologic agent is recommended as first-line
maintenance therapy for most patients with stable COPD?
A) Inhaled corticosteroid (ICS) alone
B) Long-acting bronchodilator (LABA or LAMA)
C) Oral corticosteroid
D) Theophylline
Correct Answer: Long-acting bronchodilator (LABA or LAMA)
Expert Rationale: GOLD guidelines recommend long-acting bronchodilators (LABA or LAMA) as first-line
maintenance therapy for most patients with stable COPD. ICS are added for patients with frequent
exacerbations or eosinophilic inflammation. Oral corticosteroids are not recommended for routine
maintenance due to significant side effects.
