NCLEX RN Pharmacology Respiratory
System Test Bank
20 Original ATI-Style & NGN Practice
Questions With Rationales
Question 1
Clinical Scenario
A 24-year-old woman with a history of moderate persistent
asthma presents to the emergency department with worsening
shortness of breath and wheezing after exposure to cat dander.
She uses an albuterol metered-dose inhaler (MDI) as needed
and fluticasone inhaler twice daily but admits she has missed
several doses of her inhaled corticosteroid over the past month.
Her respiratory rate is 28/min, heart rate is 112/min, oxygen
saturation is 91% on room air, and she has diffuse expiratory
wheezes.
Question Stem
Which medication should the nurse anticipate administering
first?
A. Fluticasone inhalation
,B. Montelukast orally
C. Albuterol inhalation
D. Theophylline orally
Correct Answer
C. Albuterol inhalation
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle, making it the
medication of choice for immediate relief of acute
bronchospasm. During an asthma exacerbation, restoring
airflow takes priority before addressing long-term
inflammation. Improvement typically occurs within minutes,
making albuterol the first-line rescue medication.
Option A: Fluticasone is an inhaled corticosteroid intended for
long-term control of airway inflammation. Although poor
adherence likely contributed to this exacerbation, fluticasone
does not provide rapid bronchodilation and should not be relied
upon for acute symptom relief.
Option B: Montelukast is a leukotriene receptor antagonist
used for chronic asthma management and prevention of
,exercise-induced bronchospasm. It has no immediate role
during an acute asthma attack.
Option D: Theophylline has limited use because of its narrow
therapeutic index, significant drug interactions, and delayed
onset of action. It is not recommended as first-line therapy for
acute exacerbations.
After stabilization, the nurse should reinforce adherence to
controller medications, proper inhaler technique, trigger
avoidance, and recognition of worsening symptoms requiring
prompt treatment.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue medications from controller
medications.
• Prioritize treatment during an acute asthma exacerbation.
• Explain the role of inhaled corticosteroids in long-term
asthma management.
• Educate patients regarding adherence to maintenance
therapy.
Medication Safety Focus
Priority medication administration
, Question 2
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium by dry powder inhaler. During
discharge teaching, he demonstrates use of the inhaler.
Question Stem
Which patient statement 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 if I suddenly become very short of
breath."
D. "This medication helps keep my airways open over time."
Correct Answer
C. "I will use this inhaler if I suddenly become very short of
breath."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) used
for maintenance treatment of COPD. It produces prolonged
System Test Bank
20 Original ATI-Style & NGN Practice
Questions With Rationales
Question 1
Clinical Scenario
A 24-year-old woman with a history of moderate persistent
asthma presents to the emergency department with worsening
shortness of breath and wheezing after exposure to cat dander.
She uses an albuterol metered-dose inhaler (MDI) as needed
and fluticasone inhaler twice daily but admits she has missed
several doses of her inhaled corticosteroid over the past month.
Her respiratory rate is 28/min, heart rate is 112/min, oxygen
saturation is 91% on room air, and she has diffuse expiratory
wheezes.
Question Stem
Which medication should the nurse anticipate administering
first?
A. Fluticasone inhalation
,B. Montelukast orally
C. Albuterol inhalation
D. Theophylline orally
Correct Answer
C. Albuterol inhalation
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle, making it the
medication of choice for immediate relief of acute
bronchospasm. During an asthma exacerbation, restoring
airflow takes priority before addressing long-term
inflammation. Improvement typically occurs within minutes,
making albuterol the first-line rescue medication.
Option A: Fluticasone is an inhaled corticosteroid intended for
long-term control of airway inflammation. Although poor
adherence likely contributed to this exacerbation, fluticasone
does not provide rapid bronchodilation and should not be relied
upon for acute symptom relief.
Option B: Montelukast is a leukotriene receptor antagonist
used for chronic asthma management and prevention of
,exercise-induced bronchospasm. It has no immediate role
during an acute asthma attack.
Option D: Theophylline has limited use because of its narrow
therapeutic index, significant drug interactions, and delayed
onset of action. It is not recommended as first-line therapy for
acute exacerbations.
After stabilization, the nurse should reinforce adherence to
controller medications, proper inhaler technique, trigger
avoidance, and recognition of worsening symptoms requiring
prompt treatment.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue medications from controller
medications.
• Prioritize treatment during an acute asthma exacerbation.
• Explain the role of inhaled corticosteroids in long-term
asthma management.
• Educate patients regarding adherence to maintenance
therapy.
Medication Safety Focus
Priority medication administration
, Question 2
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium by dry powder inhaler. During
discharge teaching, he demonstrates use of the inhaler.
Question Stem
Which patient statement 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 if I suddenly become very short of
breath."
D. "This medication helps keep my airways open over time."
Correct Answer
C. "I will use this inhaler if I suddenly become very short of
breath."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) used
for maintenance treatment of COPD. It produces prolonged
