NCLEX-RN Respiratory Pharmacology
Exam Questions & Answers
20 NGN Practice MCQs with Rationales
Question 1
Clinical Scenario
A 22-year-old woman with a history of moderate persistent
asthma arrives at the emergency department complaining of
increasing shortness of breath and wheezing after exposure to
cat dander. She is anxious and speaking in short sentences. Vital
signs: BP 126/78 mmHg, HR 118 beats/min, RR 30 breaths/min,
SpO₂ 90% on room air. The provider prescribes nebulized
albuterol.
Question Stem
Which assessment finding indicates that the prescribed
medication is producing the desired therapeutic effect?
A. Heart rate decreases to 60 beats/min.
B. Bilateral wheezing becomes louder after treatment.
C. Oxygen saturation increases to 96% and breath sounds
improve.
,D. The client becomes drowsy and less anxious.
Correct Answer
Correct Answer: C. Oxygen saturation increases to 96% and
breath sounds improve.
Detailed Rationale
Albuterol is a short-acting β₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle by stimulating β₂
receptors, increasing cyclic AMP, and producing
bronchodilation. During an acute asthma exacerbation,
improvement in oxygen saturation, decreased wheezing, easier
breathing, and improved airflow indicate that the medication is
effective. An SpO₂ increase from 90% to 96%, accompanied by
improved breath sounds, reflects successful reversal of
bronchospasm.
Option A is incorrect because albuterol commonly causes mild
tachycardia rather than significant bradycardia. A heart rate of
60 beats/min is not an expected therapeutic response.
Option B is incorrect because louder wheezing may indicate
worsening airflow obstruction rather than improvement.
Option D is incorrect because drowsiness is not a therapeutic
goal and may indicate fatigue from respiratory distress or
another complication requiring evaluation.
,The nurse should reassess respiratory status, lung sounds,
respiratory effort, oxygen saturation, and the need for
additional bronchodilator therapy. Patient teaching includes
carrying a rescue inhaler at all times, recognizing early asthma
symptoms, and seeking emergency care if symptoms do not
improve after rescue medication.
Learning Objectives
After completing this question, the learner should be able to:
• Evaluate therapeutic effects of short-acting β₂-agonists.
• Differentiate expected outcomes from adverse findings.
• Monitor respiratory improvement following bronchodilator
administration.
Medication Safety Focus
Monitoring of therapeutic response
Question 2
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium via a dry powder inhaler for
long-term maintenance therapy. During discharge teaching, the
nurse assesses the client's understanding of medication use.
, Question Stem
Which statement by the client indicates a need for additional
teaching?
A. "I will use this medication every day, even if I feel well."
B. "I should rinse my mouth after using this medication."
C. "I will use this inhaler when I suddenly become short of
breath."
D. "This medication helps keep my airways open over time."
Correct Answer
Correct Answer: C. "I will use this inhaler when I suddenly
become short of breath."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) used
for maintenance treatment of COPD and, in some patients,
asthma. It produces prolonged bronchodilation by blocking
muscarinic receptors in airway smooth muscle. Because its
onset is relatively slow, it is not appropriate for acute
bronchospasm or rescue therapy.
Option A is correct because maintenance inhalers should be
taken consistently, regardless of symptoms.
Option B is acceptable teaching. Although mouth rinsing is
particularly important with inhaled corticosteroids to reduce
Exam Questions & Answers
20 NGN Practice MCQs with Rationales
Question 1
Clinical Scenario
A 22-year-old woman with a history of moderate persistent
asthma arrives at the emergency department complaining of
increasing shortness of breath and wheezing after exposure to
cat dander. She is anxious and speaking in short sentences. Vital
signs: BP 126/78 mmHg, HR 118 beats/min, RR 30 breaths/min,
SpO₂ 90% on room air. The provider prescribes nebulized
albuterol.
Question Stem
Which assessment finding indicates that the prescribed
medication is producing the desired therapeutic effect?
A. Heart rate decreases to 60 beats/min.
B. Bilateral wheezing becomes louder after treatment.
C. Oxygen saturation increases to 96% and breath sounds
improve.
,D. The client becomes drowsy and less anxious.
Correct Answer
Correct Answer: C. Oxygen saturation increases to 96% and
breath sounds improve.
Detailed Rationale
Albuterol is a short-acting β₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle by stimulating β₂
receptors, increasing cyclic AMP, and producing
bronchodilation. During an acute asthma exacerbation,
improvement in oxygen saturation, decreased wheezing, easier
breathing, and improved airflow indicate that the medication is
effective. An SpO₂ increase from 90% to 96%, accompanied by
improved breath sounds, reflects successful reversal of
bronchospasm.
Option A is incorrect because albuterol commonly causes mild
tachycardia rather than significant bradycardia. A heart rate of
60 beats/min is not an expected therapeutic response.
Option B is incorrect because louder wheezing may indicate
worsening airflow obstruction rather than improvement.
Option D is incorrect because drowsiness is not a therapeutic
goal and may indicate fatigue from respiratory distress or
another complication requiring evaluation.
,The nurse should reassess respiratory status, lung sounds,
respiratory effort, oxygen saturation, and the need for
additional bronchodilator therapy. Patient teaching includes
carrying a rescue inhaler at all times, recognizing early asthma
symptoms, and seeking emergency care if symptoms do not
improve after rescue medication.
Learning Objectives
After completing this question, the learner should be able to:
• Evaluate therapeutic effects of short-acting β₂-agonists.
• Differentiate expected outcomes from adverse findings.
• Monitor respiratory improvement following bronchodilator
administration.
Medication Safety Focus
Monitoring of therapeutic response
Question 2
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium via a dry powder inhaler for
long-term maintenance therapy. During discharge teaching, the
nurse assesses the client's understanding of medication use.
, Question Stem
Which statement by the client indicates a need for additional
teaching?
A. "I will use this medication every day, even if I feel well."
B. "I should rinse my mouth after using this medication."
C. "I will use this inhaler when I suddenly become short of
breath."
D. "This medication helps keep my airways open over time."
Correct Answer
Correct Answer: C. "I will use this inhaler when I suddenly
become short of breath."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) used
for maintenance treatment of COPD and, in some patients,
asthma. It produces prolonged bronchodilation by blocking
muscarinic receptors in airway smooth muscle. Because its
onset is relatively slow, it is not appropriate for acute
bronchospasm or rescue therapy.
Option A is correct because maintenance inhalers should be
taken consistently, regardless of symptoms.
Option B is acceptable teaching. Although mouth rinsing is
particularly important with inhaled corticosteroids to reduce
