HESI Pharmacology Test Bank 2026 – Respiratory
Pharmacology Questions 1-35 WITH CORRECT
VERIFIED ANSWERS.
Question .1
A nurse is caring for a client with acute asthma exacerbation. Which medication should
the nurse administer first?
☐ A. Inhaled corticosteroid (budesonide)
☑ B. Short-acting beta-2 agonist (albuterol)
☐ C. Leukotriene receptor antagonist (montelukast)
☐ D. Inhaled long-acting beta-2 agonist (salmeterol)
ANSWER: B. Short-acting beta-2 agonist (albuterol)
RATIONALE: During an acute asthma exacerbation, the priority is to achieve rapid
bronchodilation to relieve airway obstruction and restore adequate ventilation. Short-
acting beta-2 agonists (SABAs) such as albuterol are the first-line rescue medications
for acute bronchospasm because they rapidly stimulate beta-2 adrenergic receptors in
bronchial smooth muscle, causing bronchodilation within 5 to 15 minutes. Inhaled
corticosteroids (ICS) such as budesonide are anti-inflammatory maintenance
medications and do not provide rapid bronchodilation during acute episodes.
Leukotriene receptor antagonists such as montelukast are oral maintenance
medications with slow onset and no role in acute management. Long-acting beta-2
agonists (LABAs) such as salmeterol are not indicated for acute rescue as they have a
slower onset and are not approved as monotherapy in asthma.
Question 2.
A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium
(Spiriva) via HandiHaler. The nurse teaches the client proper inhaler technique. Which
instruction is correct?
,☐ A. "Shake the HandiHaler vigorously before each use."
☑ B. "Pierce the capsule only once by pressing the green buttons, then inhale deeply
and hold your breath for 10 seconds."
☐ C. "Rinse the HandiHaler with water after each use and leave it wet for next time."
☐ D. "Take two inhalations from the capsule, then swallow the remaining powder with
water."
ANSWER: B. "Pierce the capsule only once by pressing the green buttons, then inhale
deeply and hold your breath for 10 seconds."
RATIONALE: Tiotropium (Spiriva) is a long-acting muscarinic antagonist (LAMA) used
for maintenance treatment of COPD. It is administered via the HandiHaler dry powder
inhaler device. The correct technique includes: placing the capsule in the chamber,
pressing the green piercing buttons once to puncture the capsule, exhaling fully before
inhaling, then inhaling deeply and rapidly through the mouthpiece, and holding the
breath for 10 seconds to allow deposition. Pressing the buttons only once prevents
tearing the capsule into pieces that could be inhaled. The HandiHaler should not be
shaken. It should be wiped clean (not washed with water and left wet, as moisture can
damage dry powder inhalers). The capsule contains dry powder only for inhalation and
should never be swallowed.
Question 3.
A nurse is caring for a client receiving theophylline for COPD. The client's serum
theophylline level is reported as 24 mcg/mL. The nurse anticipates which clinical
manifestations?
☐ A. No concerns; this is within the therapeutic range
☑ B. Nausea, vomiting, tachycardia, and potential seizures indicating toxicity
☐ C. Excessive sedation and respiratory depression
☐ D. Urinary retention and constipation
ANSWER: B. Nausea, vomiting, tachycardia, and potential seizures indicating toxicity
RATIONALE: Theophylline is a methylxanthine bronchodilator with a narrow therapeutic
index. The therapeutic serum range is 10 to 20 mcg/mL. A level of 24 mcg/mL exceeds
the therapeutic range and indicates toxicity. Early signs of theophylline toxicity include
nausea, vomiting, abdominal pain, and headache. As levels increase further,
, cardiovascular effects such as tachycardia, palpitations, and hypotension occur. Severe
toxicity (levels above 30 mcg/mL) can cause life-threatening seizures and ventricular
dysrhythmias. The nurse should hold the next dose, notify the healthcare provider, and
anticipate orders for supportive care. Many factors affect theophylline levels, including
smoking (induces metabolism, decreasing levels), caffeine consumption, liver disease
(decreases metabolism, increasing levels), and interactions with medications like
cimetidine and ciprofloxacin (increase levels).
Question 4.
A nurse is educating a client newly prescribed fluticasone/salmeterol (Advair) inhaler for
asthma. Which instruction is most important to include?
☐ A. "Use this inhaler when you feel short of breath during an asthma attack."
☑ B. "Rinse your mouth thoroughly with water and spit after each use."
☐ C. "Shake the diskus inhaler vigorously before use."
☐ D. "You do not need to use a separate rescue inhaler while taking this medication."
ANSWER: B. "Rinse your mouth thoroughly with water and spit after each use."
RATIONALE: Fluticasone/salmeterol (Advair) is a combination inhaler containing an
inhaled corticosteroid (ICS) and a long-acting beta-2 agonist (LABA). Inhaled
corticosteroids deposit in the oral cavity and oropharynx, and if not removed by rinsing,
they are absorbed and can cause local adverse effects including oropharyngeal
candidiasis (oral thrush) and dysphonia (hoarseness). Rinsing the mouth with water and
spitting after each use is essential to prevent these local complications.
Fluticasone/salmeterol is a maintenance medication and should not be used as a
rescue inhaler during acute episodes. Clients should continue to carry a separate short-
acting bronchodilator for acute symptoms. The Diskus device does not require shaking.
LABAs should not be used as monotherapy in asthma due to increased risk of asthma-
related death without concurrent ICS use.
Question 5.
A nurse is caring for a client with asthma who uses a metered-dose inhaler (MDI). The
nurse observes the client's inhaler technique. The client inhales rapidly and forcefully as
soon as the MDI is activated. What instruction should the nurse provide?
☐ A. "Your technique is correct; continue doing exactly as you are."
Pharmacology Questions 1-35 WITH CORRECT
VERIFIED ANSWERS.
Question .1
A nurse is caring for a client with acute asthma exacerbation. Which medication should
the nurse administer first?
☐ A. Inhaled corticosteroid (budesonide)
☑ B. Short-acting beta-2 agonist (albuterol)
☐ C. Leukotriene receptor antagonist (montelukast)
☐ D. Inhaled long-acting beta-2 agonist (salmeterol)
ANSWER: B. Short-acting beta-2 agonist (albuterol)
RATIONALE: During an acute asthma exacerbation, the priority is to achieve rapid
bronchodilation to relieve airway obstruction and restore adequate ventilation. Short-
acting beta-2 agonists (SABAs) such as albuterol are the first-line rescue medications
for acute bronchospasm because they rapidly stimulate beta-2 adrenergic receptors in
bronchial smooth muscle, causing bronchodilation within 5 to 15 minutes. Inhaled
corticosteroids (ICS) such as budesonide are anti-inflammatory maintenance
medications and do not provide rapid bronchodilation during acute episodes.
Leukotriene receptor antagonists such as montelukast are oral maintenance
medications with slow onset and no role in acute management. Long-acting beta-2
agonists (LABAs) such as salmeterol are not indicated for acute rescue as they have a
slower onset and are not approved as monotherapy in asthma.
Question 2.
A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium
(Spiriva) via HandiHaler. The nurse teaches the client proper inhaler technique. Which
instruction is correct?
,☐ A. "Shake the HandiHaler vigorously before each use."
☑ B. "Pierce the capsule only once by pressing the green buttons, then inhale deeply
and hold your breath for 10 seconds."
☐ C. "Rinse the HandiHaler with water after each use and leave it wet for next time."
☐ D. "Take two inhalations from the capsule, then swallow the remaining powder with
water."
ANSWER: B. "Pierce the capsule only once by pressing the green buttons, then inhale
deeply and hold your breath for 10 seconds."
RATIONALE: Tiotropium (Spiriva) is a long-acting muscarinic antagonist (LAMA) used
for maintenance treatment of COPD. It is administered via the HandiHaler dry powder
inhaler device. The correct technique includes: placing the capsule in the chamber,
pressing the green piercing buttons once to puncture the capsule, exhaling fully before
inhaling, then inhaling deeply and rapidly through the mouthpiece, and holding the
breath for 10 seconds to allow deposition. Pressing the buttons only once prevents
tearing the capsule into pieces that could be inhaled. The HandiHaler should not be
shaken. It should be wiped clean (not washed with water and left wet, as moisture can
damage dry powder inhalers). The capsule contains dry powder only for inhalation and
should never be swallowed.
Question 3.
A nurse is caring for a client receiving theophylline for COPD. The client's serum
theophylline level is reported as 24 mcg/mL. The nurse anticipates which clinical
manifestations?
☐ A. No concerns; this is within the therapeutic range
☑ B. Nausea, vomiting, tachycardia, and potential seizures indicating toxicity
☐ C. Excessive sedation and respiratory depression
☐ D. Urinary retention and constipation
ANSWER: B. Nausea, vomiting, tachycardia, and potential seizures indicating toxicity
RATIONALE: Theophylline is a methylxanthine bronchodilator with a narrow therapeutic
index. The therapeutic serum range is 10 to 20 mcg/mL. A level of 24 mcg/mL exceeds
the therapeutic range and indicates toxicity. Early signs of theophylline toxicity include
nausea, vomiting, abdominal pain, and headache. As levels increase further,
, cardiovascular effects such as tachycardia, palpitations, and hypotension occur. Severe
toxicity (levels above 30 mcg/mL) can cause life-threatening seizures and ventricular
dysrhythmias. The nurse should hold the next dose, notify the healthcare provider, and
anticipate orders for supportive care. Many factors affect theophylline levels, including
smoking (induces metabolism, decreasing levels), caffeine consumption, liver disease
(decreases metabolism, increasing levels), and interactions with medications like
cimetidine and ciprofloxacin (increase levels).
Question 4.
A nurse is educating a client newly prescribed fluticasone/salmeterol (Advair) inhaler for
asthma. Which instruction is most important to include?
☐ A. "Use this inhaler when you feel short of breath during an asthma attack."
☑ B. "Rinse your mouth thoroughly with water and spit after each use."
☐ C. "Shake the diskus inhaler vigorously before use."
☐ D. "You do not need to use a separate rescue inhaler while taking this medication."
ANSWER: B. "Rinse your mouth thoroughly with water and spit after each use."
RATIONALE: Fluticasone/salmeterol (Advair) is a combination inhaler containing an
inhaled corticosteroid (ICS) and a long-acting beta-2 agonist (LABA). Inhaled
corticosteroids deposit in the oral cavity and oropharynx, and if not removed by rinsing,
they are absorbed and can cause local adverse effects including oropharyngeal
candidiasis (oral thrush) and dysphonia (hoarseness). Rinsing the mouth with water and
spitting after each use is essential to prevent these local complications.
Fluticasone/salmeterol is a maintenance medication and should not be used as a
rescue inhaler during acute episodes. Clients should continue to carry a separate short-
acting bronchodilator for acute symptoms. The Diskus device does not require shaking.
LABAs should not be used as monotherapy in asthma due to increased risk of asthma-
related death without concurrent ICS use.
Question 5.
A nurse is caring for a client with asthma who uses a metered-dose inhaler (MDI). The
nurse observes the client's inhaler technique. The client inhales rapidly and forcefully as
soon as the MDI is activated. What instruction should the nurse provide?
☐ A. "Your technique is correct; continue doing exactly as you are."
