NCLEX-RN Pharmacology Respiratory
System Exam Questions & Rationales
20 NGN-Style Practice MCQs
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 22-year-old client with persistent asthma is prescribed
albuterol via metered-dose inhaler (MDI) as needed for
wheezing. During a clinic visit, the nurse observes the client
using the inhaler several times daily and reports feeling "shaky"
afterward.
Question Stem
Which adverse effect should the nurse recognize as most likely
related to albuterol therapy?
A. Bradycardia
B. Tremors
C. Constipation
D. Urinary retention
,Correct Answer
Correct Answer: B. Tremors
Detailed Rationale
Albuterol is a short-acting beta2-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle and rapidly relieves
bronchospasm. Because beta2 receptors are also found in
skeletal muscle, stimulation can cause tremors, nervousness,
and mild tachycardia. These effects are common and expected,
particularly when the medication is used frequently.
A. Bradycardia is incorrect because albuterol more commonly
causes tachycardia due to sympathetic stimulation.
C. Constipation is incorrect because gastrointestinal slowing is
not a typical adverse effect of beta2 agonists.
D. Urinary retention is incorrect because this effect is more
commonly associated with anticholinergic medications such as
ipratropium.
The nurse should assess frequency of inhaler use because
excessive reliance on albuterol may indicate poor asthma
control and the need for controller therapy. Clients should be
instructed to report increased use of rescue inhalers, worsening
symptoms, or nighttime awakenings.
Learning Objective
,After completing this question, the learner should be able to:
• Identify common adverse effects of short-acting beta2
agonists.
• Recognize signs of inadequate asthma control.
• Educate clients regarding rescue inhaler use.
• Monitor for medication-related sympathetic stimulation.
Medication Safety Focus
Adverse Effect Monitoring
Question 2
Clinical Scenario
A 68-year-old client with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium inhalation daily. The client has
a history of glaucoma and benign prostatic hyperplasia (BPH).
Question Stem
Which assessment finding should the nurse report to the
provider as a potential complication of tiotropium therapy?
A. Increased urinary retention
B. Mild headache
C. Productive cough
, D. Weight gain
Correct Answer
Correct Answer: A. Increased urinary retention
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
produces bronchodilation by blocking acetylcholine-mediated
bronchoconstriction. Because it has anticholinergic effects,
urinary retention may occur, particularly in older adults and
those with BPH.
B. Mild headache may occur but is generally not a significant
complication.
C. Productive cough may reflect the underlying COPD rather
than medication toxicity.
D. Weight gain is not a typical adverse effect of tiotropium.
The nurse should carefully monitor clients with BPH or
glaucoma because anticholinergic medications can worsen both
conditions. Prompt reporting of difficulty urinating can prevent
bladder distention and complications.
Learning Objective
After completing this question, the learner should be able to:
• Identify anticholinergic adverse effects.
System Exam Questions & Rationales
20 NGN-Style Practice MCQs
ATI Pharmacology Made Easy Review
Question 1
Clinical Scenario
A 22-year-old client with persistent asthma is prescribed
albuterol via metered-dose inhaler (MDI) as needed for
wheezing. During a clinic visit, the nurse observes the client
using the inhaler several times daily and reports feeling "shaky"
afterward.
Question Stem
Which adverse effect should the nurse recognize as most likely
related to albuterol therapy?
A. Bradycardia
B. Tremors
C. Constipation
D. Urinary retention
,Correct Answer
Correct Answer: B. Tremors
Detailed Rationale
Albuterol is a short-acting beta2-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle and rapidly relieves
bronchospasm. Because beta2 receptors are also found in
skeletal muscle, stimulation can cause tremors, nervousness,
and mild tachycardia. These effects are common and expected,
particularly when the medication is used frequently.
A. Bradycardia is incorrect because albuterol more commonly
causes tachycardia due to sympathetic stimulation.
C. Constipation is incorrect because gastrointestinal slowing is
not a typical adverse effect of beta2 agonists.
D. Urinary retention is incorrect because this effect is more
commonly associated with anticholinergic medications such as
ipratropium.
The nurse should assess frequency of inhaler use because
excessive reliance on albuterol may indicate poor asthma
control and the need for controller therapy. Clients should be
instructed to report increased use of rescue inhalers, worsening
symptoms, or nighttime awakenings.
Learning Objective
,After completing this question, the learner should be able to:
• Identify common adverse effects of short-acting beta2
agonists.
• Recognize signs of inadequate asthma control.
• Educate clients regarding rescue inhaler use.
• Monitor for medication-related sympathetic stimulation.
Medication Safety Focus
Adverse Effect Monitoring
Question 2
Clinical Scenario
A 68-year-old client with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium inhalation daily. The client has
a history of glaucoma and benign prostatic hyperplasia (BPH).
Question Stem
Which assessment finding should the nurse report to the
provider as a potential complication of tiotropium therapy?
A. Increased urinary retention
B. Mild headache
C. Productive cough
, D. Weight gain
Correct Answer
Correct Answer: A. Increased urinary retention
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
produces bronchodilation by blocking acetylcholine-mediated
bronchoconstriction. Because it has anticholinergic effects,
urinary retention may occur, particularly in older adults and
those with BPH.
B. Mild headache may occur but is generally not a significant
complication.
C. Productive cough may reflect the underlying COPD rather
than medication toxicity.
D. Weight gain is not a typical adverse effect of tiotropium.
The nurse should carefully monitor clients with BPH or
glaucoma because anticholinergic medications can worsen both
conditions. Prompt reporting of difficulty urinating can prevent
bladder distention and complications.
Learning Objective
After completing this question, the learner should be able to:
• Identify anticholinergic adverse effects.
