NR566 | NR566 Advanced Pharmacology for Care
of the Family Exam 4 Version 3 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. A 24-year-old patient with mild persistent asthma is currently using Albuterol PRN
and wants to start a daily controller. Which medication is the preferred first-line
maintenance therapy for this patient?
A. Salmeterol (LABA)
B. Theophylline
C. Montelukast (LTRA)
D. Fluticasone (ICS)
Correct Answer: D
Expert Explanation: Inhaled corticosteroids (ICS) like fluticasone are the gold
standard for long-term control of persistent asthma. They work by reducing airway
inflammation and hyperresponsiveness over time. Using a LABA without an ICS is
contraindicated in asthma due to increased risk of asthma-related death.
2. When prescribing Albuterol for a patient with intermittent asthma, the nurse
practitioner should instruct the patient that this medication works by:
A. Reducing mucosal edema
,B. Antagonizing muscarinic receptors
C. Stimulating beta-2 adrenergic receptors
D. Inhibiting leukotriene synthesis
Correct Answer: C
Expert Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that causes
smooth muscle relaxation in the bronchioles. This leads to rapid bronchodilation
and relief of acute symptoms such as wheezing and shortness of breath. It does not
address underlying inflammation, which is why it is used for rescue rather than
maintenance.
3. A patient with COPD is prescribed Tiotropium (Spiriva). What is the primary
mechanism of action for this medication?
A. Long-acting beta-2 agonist
B. Inhaled corticosteroid
C. Phosphodiesterase-4 inhibitor
D. Long-acting muscarinic antagonist (LAMA)
Correct Answer: D
Expert Explanation: Tiotropium is a long-acting muscarinic antagonist (LAMA)
that blocks acetylcholine at the M3 receptors in the lungs. By blocking these
,receptors, the drug prevents bronchoconstriction and reduces mucus secretion. This
is a maintenance treatment and should not be used for acute symptom relief.
4. Which of the following is a black box warning associated with the use of Long-Acting
Beta Agonists (LABA) as monotherapy in asthma patients?
A. Increased risk of severe asthma-related death
B. Increased risk of myocardial infarction
C. Increased risk of suicidal ideation
D. Increased risk of hepatotoxicity
Correct Answer: A
Expert Explanation: LABAs should never be used alone in asthma patients because
they can mask inflammation while providing symptomatic relief, potentially leading
to a fatal asthma attack. They must always be used in combination with an inhaled
corticosteroid. This warning does not apply to the use of LABAs in COPD patients.
5. A patient is started on Montelukast (Singulair) for allergic rhinitis and asthma.
Which side effect requires immediate discontinuation and reporting to the provider?
A. Headache
B. Neuropsychiatric events such as agitation or suicidal thoughts
C. Upper respiratory infection symptoms
, D. Abdominal pain
Correct Answer: B
Expert Explanation: Montelukast has a boxed warning for serious neuropsychiatric
events, including agitation, aggression, depression, and suicidal thinking. Patients
and caregivers should be advised to monitor for any changes in behavior or mood. If
these symptoms occur, the medication should be stopped immediately.
6. The nurse practitioner is teaching a patient how to use an Inhaled Corticosteroid
(ICS). Which instruction is most important to prevent a common local side effect?
A. Take a deep breath before puffing
B. Wait 10 minutes between two puffs of the same medication
C. Use the inhaler only when feeling short of breath
D. Rinse the mouth with water and spit after each use
Correct Answer: D
Expert Explanation: Rinsing the mouth and spitting after using an ICS helps
prevent the development of oropharyngeal candidiasis, also known as thrush. It also
reduces the amount of systemic absorption of the drug from the oral mucosa. This
practice is essential for all patients regardless of the specific ICS device used.
of the Family Exam 4 Version 3 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. A 24-year-old patient with mild persistent asthma is currently using Albuterol PRN
and wants to start a daily controller. Which medication is the preferred first-line
maintenance therapy for this patient?
A. Salmeterol (LABA)
B. Theophylline
C. Montelukast (LTRA)
D. Fluticasone (ICS)
Correct Answer: D
Expert Explanation: Inhaled corticosteroids (ICS) like fluticasone are the gold
standard for long-term control of persistent asthma. They work by reducing airway
inflammation and hyperresponsiveness over time. Using a LABA without an ICS is
contraindicated in asthma due to increased risk of asthma-related death.
2. When prescribing Albuterol for a patient with intermittent asthma, the nurse
practitioner should instruct the patient that this medication works by:
A. Reducing mucosal edema
,B. Antagonizing muscarinic receptors
C. Stimulating beta-2 adrenergic receptors
D. Inhibiting leukotriene synthesis
Correct Answer: C
Expert Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that causes
smooth muscle relaxation in the bronchioles. This leads to rapid bronchodilation
and relief of acute symptoms such as wheezing and shortness of breath. It does not
address underlying inflammation, which is why it is used for rescue rather than
maintenance.
3. A patient with COPD is prescribed Tiotropium (Spiriva). What is the primary
mechanism of action for this medication?
A. Long-acting beta-2 agonist
B. Inhaled corticosteroid
C. Phosphodiesterase-4 inhibitor
D. Long-acting muscarinic antagonist (LAMA)
Correct Answer: D
Expert Explanation: Tiotropium is a long-acting muscarinic antagonist (LAMA)
that blocks acetylcholine at the M3 receptors in the lungs. By blocking these
,receptors, the drug prevents bronchoconstriction and reduces mucus secretion. This
is a maintenance treatment and should not be used for acute symptom relief.
4. Which of the following is a black box warning associated with the use of Long-Acting
Beta Agonists (LABA) as monotherapy in asthma patients?
A. Increased risk of severe asthma-related death
B. Increased risk of myocardial infarction
C. Increased risk of suicidal ideation
D. Increased risk of hepatotoxicity
Correct Answer: A
Expert Explanation: LABAs should never be used alone in asthma patients because
they can mask inflammation while providing symptomatic relief, potentially leading
to a fatal asthma attack. They must always be used in combination with an inhaled
corticosteroid. This warning does not apply to the use of LABAs in COPD patients.
5. A patient is started on Montelukast (Singulair) for allergic rhinitis and asthma.
Which side effect requires immediate discontinuation and reporting to the provider?
A. Headache
B. Neuropsychiatric events such as agitation or suicidal thoughts
C. Upper respiratory infection symptoms
, D. Abdominal pain
Correct Answer: B
Expert Explanation: Montelukast has a boxed warning for serious neuropsychiatric
events, including agitation, aggression, depression, and suicidal thinking. Patients
and caregivers should be advised to monitor for any changes in behavior or mood. If
these symptoms occur, the medication should be stopped immediately.
6. The nurse practitioner is teaching a patient how to use an Inhaled Corticosteroid
(ICS). Which instruction is most important to prevent a common local side effect?
A. Take a deep breath before puffing
B. Wait 10 minutes between two puffs of the same medication
C. Use the inhaler only when feeling short of breath
D. Rinse the mouth with water and spit after each use
Correct Answer: D
Expert Explanation: Rinsing the mouth and spitting after using an ICS helps
prevent the development of oropharyngeal candidiasis, also known as thrush. It also
reduces the amount of systemic absorption of the drug from the oral mucosa. This
practice is essential for all patients regardless of the specific ICS device used.
