NCLEX-RN Respiratory Pharmacology
Exam Questions & Answers
20 ATI-Style Practice MCQs with
Detailed Rationales, Medication Safety,
Asthma & COPD Review
Question 1
Clinical Scenario
A 22-year-old woman with a history of persistent asthma
presents to the emergency department complaining of
wheezing, chest tightness, and shortness of breath after
exposure to cat dander. She is alert but anxious. Vital signs are:
BP 126/78 mm Hg, HR 112 beats/min, RR 28 breaths/min, SpO₂
89% on room air. Current medications include fluticasone
inhaler twice daily and albuterol metered-dose inhaler (MDI) as
needed. Lung assessment reveals diffuse expiratory wheezes.
Question Stem
Which medication should the nurse administer first?
,A. Fluticasone inhaler
B. Montelukast orally
C. Albuterol via metered-dose inhaler
D. Tiotropium inhalation capsule
Correct Answer
Correct Answer: C. Albuterol via metered-dose inhaler
Detailed Rationale
Albuterol is a short-acting β₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle through stimulation of
β₂ receptors, producing bronchodilation within minutes. During
an acute asthma exacerbation accompanied by hypoxemia,
tachypnea, and wheezing, immediate reversal of bronchospasm
is the priority. Prompt administration improves airflow,
oxygenation, and respiratory effort.
Option A: Fluticasone is an inhaled corticosteroid intended for
long-term control of airway inflammation. It does not provide
immediate bronchodilation and should never be used as rescue
therapy during an acute asthma attack.
Option B: Montelukast is a leukotriene receptor antagonist
used for long-term asthma control and prevention of exercise-
induced bronchospasm. It has a delayed onset and is ineffective
for acute symptom relief.
,Option D: Tiotropium is a long-acting muscarinic antagonist
(LAMA) used as maintenance therapy in chronic obstructive
pulmonary disease (COPD) and selected patients with persistent
asthma. It is not appropriate for immediate treatment of acute
bronchospasm.
The nurse should reassess breath sounds, respiratory effort,
oxygen saturation, and response to therapy after
administration. Patients should also be taught to always carry
their rescue inhaler and recognize worsening symptoms that
require emergency care.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue medications from maintenance
asthma therapies.
• Prioritize treatment during an acute asthma exacerbation.
• Evaluate clinical indicators requiring immediate
bronchodilator therapy.
• Reinforce proper rescue inhaler use.
Medication Safety Focus
Priority medication administration
Question 2
, Clinical Scenario
A 58-year-old man with moderate persistent asthma has been
prescribed fluticasone by metered-dose inhaler twice daily.
During a follow-up visit, he reports that his asthma has
improved but complains of a sore mouth and white patches on
his tongue. Assessment confirms oral candidiasis.
Question Stem
Which nursing instruction is most appropriate to prevent this
adverse effect?
A. Take the medication only during asthma attacks.
B. Drink grapefruit juice after each dose.
C. Rinse the mouth thoroughly after each inhalation.
D. Stop using the medication once symptoms improve.
Correct Answer
Correct Answer: C. Rinse the mouth thoroughly after each
inhalation.
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) that suppresses
airway inflammation and decreases asthma exacerbations.
Because a portion of the medication remains in the oropharynx
after inhalation, local immunosuppression can promote the
growth of Candida species, resulting in oral thrush. Rinsing the
Exam Questions & Answers
20 ATI-Style Practice MCQs with
Detailed Rationales, Medication Safety,
Asthma & COPD Review
Question 1
Clinical Scenario
A 22-year-old woman with a history of persistent asthma
presents to the emergency department complaining of
wheezing, chest tightness, and shortness of breath after
exposure to cat dander. She is alert but anxious. Vital signs are:
BP 126/78 mm Hg, HR 112 beats/min, RR 28 breaths/min, SpO₂
89% on room air. Current medications include fluticasone
inhaler twice daily and albuterol metered-dose inhaler (MDI) as
needed. Lung assessment reveals diffuse expiratory wheezes.
Question Stem
Which medication should the nurse administer first?
,A. Fluticasone inhaler
B. Montelukast orally
C. Albuterol via metered-dose inhaler
D. Tiotropium inhalation capsule
Correct Answer
Correct Answer: C. Albuterol via metered-dose inhaler
Detailed Rationale
Albuterol is a short-acting β₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle through stimulation of
β₂ receptors, producing bronchodilation within minutes. During
an acute asthma exacerbation accompanied by hypoxemia,
tachypnea, and wheezing, immediate reversal of bronchospasm
is the priority. Prompt administration improves airflow,
oxygenation, and respiratory effort.
Option A: Fluticasone is an inhaled corticosteroid intended for
long-term control of airway inflammation. It does not provide
immediate bronchodilation and should never be used as rescue
therapy during an acute asthma attack.
Option B: Montelukast is a leukotriene receptor antagonist
used for long-term asthma control and prevention of exercise-
induced bronchospasm. It has a delayed onset and is ineffective
for acute symptom relief.
,Option D: Tiotropium is a long-acting muscarinic antagonist
(LAMA) used as maintenance therapy in chronic obstructive
pulmonary disease (COPD) and selected patients with persistent
asthma. It is not appropriate for immediate treatment of acute
bronchospasm.
The nurse should reassess breath sounds, respiratory effort,
oxygen saturation, and response to therapy after
administration. Patients should also be taught to always carry
their rescue inhaler and recognize worsening symptoms that
require emergency care.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue medications from maintenance
asthma therapies.
• Prioritize treatment during an acute asthma exacerbation.
• Evaluate clinical indicators requiring immediate
bronchodilator therapy.
• Reinforce proper rescue inhaler use.
Medication Safety Focus
Priority medication administration
Question 2
, Clinical Scenario
A 58-year-old man with moderate persistent asthma has been
prescribed fluticasone by metered-dose inhaler twice daily.
During a follow-up visit, he reports that his asthma has
improved but complains of a sore mouth and white patches on
his tongue. Assessment confirms oral candidiasis.
Question Stem
Which nursing instruction is most appropriate to prevent this
adverse effect?
A. Take the medication only during asthma attacks.
B. Drink grapefruit juice after each dose.
C. Rinse the mouth thoroughly after each inhalation.
D. Stop using the medication once symptoms improve.
Correct Answer
Correct Answer: C. Rinse the mouth thoroughly after each
inhalation.
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) that suppresses
airway inflammation and decreases asthma exacerbations.
Because a portion of the medication remains in the oropharynx
after inhalation, local immunosuppression can promote the
growth of Candida species, resulting in oral thrush. Rinsing the
