NCLEX-RN Pharmacology Respiratory
System Practice Questions with Detailed
Rationales
20 Original ATI & NGN-Style Nursing
MCQs
Asthma, COPD, Bronchodilators,
Corticosteroids & Medication Safety
Question 1
Clinical Scenario
A 22-year-old woman with a history of persistent asthma
presents to the emergency department with increasing
shortness of breath, wheezing, and chest tightness after
exposure to cat dander. She has been using her albuterol
inhaler every 2 hours since the previous evening without
sustained relief. Her vital signs are: temperature 37°C (98.6°F),
heart rate 118/min, respiratory rate 30/min, blood pressure
128/76 mm Hg, and oxygen saturation 91% on room air.
Bilateral expiratory wheezes are noted. The provider prescribes
,nebulized albuterol, intravenous methylprednisolone, and
supplemental oxygen.
Question Stem
Which therapeutic effect should the nurse expect first after
administering nebulized albuterol?
A. Resolution of airway inflammation
B. Relaxation of bronchial smooth muscle resulting in improved
airflow
C. Decreased mucus production by airway glands
D. Suppression of the immune response responsible for asthma
Correct Answer
Correct Answer: B. Relaxation of bronchial smooth muscle
resulting in improved airflow
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly stimulates beta₂ receptors in bronchial smooth muscle,
producing bronchodilation within approximately 5–15 minutes.
This makes it the medication of choice for rapid relief during an
acute asthma exacerbation. The nurse should expect improved
airflow, decreased wheezing, and reduced work of breathing
shortly after administration. Because albuterol primarily
,relieves bronchospasm rather than inflammation, it serves as a
rescue medication rather than a controller medication.
Option A is incorrect because airway inflammation is primarily
reduced by corticosteroids such as methylprednisolone, whose
effects begin several hours after administration.
Option C is incorrect because albuterol does not significantly
decrease mucus production.
Option D is incorrect because immune suppression is the action
of corticosteroids, not beta₂ agonists.
Nursing considerations include monitoring respiratory status,
oxygen saturation, heart rate, and signs of excessive beta
stimulation such as tachycardia and tremors. Frequent reliance
on albuterol indicates poor asthma control and should prompt
evaluation of the patient's long-term controller therapy. The
nurse should also teach the patient to seek medical attention if
rescue inhaler use becomes increasingly frequent or ineffective.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action of short-acting beta₂
agonists.
• Differentiate rescue medications from controller
medications for asthma.
, • Evaluate the expected therapeutic response following
albuterol administration.
• Monitor for common adverse effects of beta₂ agonists.
Medication Safety Focus
Expected therapeutic response and monitoring
Question 2
Clinical Scenario
A 48-year-old man with moderate persistent asthma has been
prescribed fluticasone inhalation twice daily and albuterol as
needed. During a follow-up clinic visit, he reports that his
asthma symptoms have improved. However, he complains of a
sore mouth and notices white patches inside his cheeks.
Examination confirms oral candidiasis.
Question Stem
Which nursing instruction would best help prevent this adverse
effect?
A. Use albuterol immediately after each dose of fluticasone.
B. Rinse the mouth thoroughly with water and spit after each
inhaled dose.
C. Take the medication only when experiencing wheezing.
System Practice Questions with Detailed
Rationales
20 Original ATI & NGN-Style Nursing
MCQs
Asthma, COPD, Bronchodilators,
Corticosteroids & Medication Safety
Question 1
Clinical Scenario
A 22-year-old woman with a history of persistent asthma
presents to the emergency department with increasing
shortness of breath, wheezing, and chest tightness after
exposure to cat dander. She has been using her albuterol
inhaler every 2 hours since the previous evening without
sustained relief. Her vital signs are: temperature 37°C (98.6°F),
heart rate 118/min, respiratory rate 30/min, blood pressure
128/76 mm Hg, and oxygen saturation 91% on room air.
Bilateral expiratory wheezes are noted. The provider prescribes
,nebulized albuterol, intravenous methylprednisolone, and
supplemental oxygen.
Question Stem
Which therapeutic effect should the nurse expect first after
administering nebulized albuterol?
A. Resolution of airway inflammation
B. Relaxation of bronchial smooth muscle resulting in improved
airflow
C. Decreased mucus production by airway glands
D. Suppression of the immune response responsible for asthma
Correct Answer
Correct Answer: B. Relaxation of bronchial smooth muscle
resulting in improved airflow
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly stimulates beta₂ receptors in bronchial smooth muscle,
producing bronchodilation within approximately 5–15 minutes.
This makes it the medication of choice for rapid relief during an
acute asthma exacerbation. The nurse should expect improved
airflow, decreased wheezing, and reduced work of breathing
shortly after administration. Because albuterol primarily
,relieves bronchospasm rather than inflammation, it serves as a
rescue medication rather than a controller medication.
Option A is incorrect because airway inflammation is primarily
reduced by corticosteroids such as methylprednisolone, whose
effects begin several hours after administration.
Option C is incorrect because albuterol does not significantly
decrease mucus production.
Option D is incorrect because immune suppression is the action
of corticosteroids, not beta₂ agonists.
Nursing considerations include monitoring respiratory status,
oxygen saturation, heart rate, and signs of excessive beta
stimulation such as tachycardia and tremors. Frequent reliance
on albuterol indicates poor asthma control and should prompt
evaluation of the patient's long-term controller therapy. The
nurse should also teach the patient to seek medical attention if
rescue inhaler use becomes increasingly frequent or ineffective.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action of short-acting beta₂
agonists.
• Differentiate rescue medications from controller
medications for asthma.
, • Evaluate the expected therapeutic response following
albuterol administration.
• Monitor for common adverse effects of beta₂ agonists.
Medication Safety Focus
Expected therapeutic response and monitoring
Question 2
Clinical Scenario
A 48-year-old man with moderate persistent asthma has been
prescribed fluticasone inhalation twice daily and albuterol as
needed. During a follow-up clinic visit, he reports that his
asthma symptoms have improved. However, he complains of a
sore mouth and notices white patches inside his cheeks.
Examination confirms oral candidiasis.
Question Stem
Which nursing instruction would best help prevent this adverse
effect?
A. Use albuterol immediately after each dose of fluticasone.
B. Rinse the mouth thoroughly with water and spit after each
inhaled dose.
C. Take the medication only when experiencing wheezing.
