NCLEX-RN Respiratory System
Pharmacology Practice Questions &
Rationales
20 Original NGN-Style MCQs
ATI Pharmacology Made Easy Review
Asthma, COPD, Inhalers, Respiratory
Drugs Study Guide
Question 1
Clinical Scenario
A 67-year-old man with a history of chronic obstructive
pulmonary disease (COPD) is admitted with worsening
shortness of breath and wheezing. Home medications include
tiotropium, albuterol inhaler as needed, lisinopril, and
atorvastatin. Vital signs are: BP 142/84 mm Hg, HR 104/min, RR
26/min, SpO₂ 88% on room air, temperature 37.2°C (99°F). The
provider prescribes nebulized albuterol every 4 hours as
needed.
Question Stem
,Which assessment finding requires the nurse to notify the
provider before administering the next dose of albuterol?
A. Heart rate of 148 beats/min with new palpitations
B. Respiratory rate of 24 breaths/min
C. Mild hand tremors after the previous treatment
D. Oxygen saturation of 91% while receiving 2 L/min oxygen
Correct Answer
Correct Answer: A. Heart rate of 148 beats/min with new
palpitations
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle and rapidly improves airflow
during bronchospasm. Although primarily selective for beta₂
receptors, higher doses or increased systemic absorption may
stimulate beta₁ receptors, producing tachycardia and cardiac
dysrhythmias. A heart rate of 148 beats/min accompanied by
new palpitations suggests excessive cardiovascular stimulation
or an underlying arrhythmia and requires prompt provider
notification before another dose is administered. Administering
additional albuterol could worsen the patient's condition.
Option B is incorrect because tachypnea is expected during an
acute COPD exacerbation and, by itself, is not a contraindication
,to treatment. Option C is incorrect because mild tremor is a
common, expected adverse effect of beta₂ agonists and should
be monitored but usually does not require discontinuation.
Option D is incorrect because an SpO₂ of 91% on supplemental
oxygen may represent improvement from baseline in a patient
with COPD and does not independently warrant withholding
albuterol.
The nurse should continue monitoring respiratory status, heart
rate, lung sounds, oxygen saturation, and response to therapy
while reinforcing proper inhaler technique and reporting
significant cardiovascular symptoms promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize serious adverse effects of short-acting beta₂
agonists.
• Differentiate expected from concerning medication side
effects.
• Prioritize nursing assessment before bronchodilator
administration.
Medication Safety Focus: Adverse effect monitoring
Question 2
, Clinical Scenario
A 22-year-old woman with persistent asthma is prescribed
fluticasone via a metered-dose inhaler twice daily and albuterol
as a rescue inhaler. During a clinic visit she states, "I stop using
my steroid inhaler whenever I feel better because I don't think I
need it."
Question Stem
Which response by the nurse is most appropriate?
A. "Use fluticasone only when wheezing develops."
B. "Fluticasone should be taken every day to reduce airway
inflammation."
C. "Take albuterol before bedtime instead of using fluticasone."
D. "Stop both inhalers once your peak flow improves."
Correct Answer
Correct Answer: B. Fluticasone should be taken every day to
reduce airway inflammation.
Detailed Rationale
Inhaled corticosteroids such as fluticasone are maintenance
medications that suppress chronic airway inflammation,
decrease airway hyperresponsiveness, and reduce the
frequency of asthma exacerbations. They are not designed to
relieve acute bronchospasm and must be taken consistently,
Pharmacology Practice Questions &
Rationales
20 Original NGN-Style MCQs
ATI Pharmacology Made Easy Review
Asthma, COPD, Inhalers, Respiratory
Drugs Study Guide
Question 1
Clinical Scenario
A 67-year-old man with a history of chronic obstructive
pulmonary disease (COPD) is admitted with worsening
shortness of breath and wheezing. Home medications include
tiotropium, albuterol inhaler as needed, lisinopril, and
atorvastatin. Vital signs are: BP 142/84 mm Hg, HR 104/min, RR
26/min, SpO₂ 88% on room air, temperature 37.2°C (99°F). The
provider prescribes nebulized albuterol every 4 hours as
needed.
Question Stem
,Which assessment finding requires the nurse to notify the
provider before administering the next dose of albuterol?
A. Heart rate of 148 beats/min with new palpitations
B. Respiratory rate of 24 breaths/min
C. Mild hand tremors after the previous treatment
D. Oxygen saturation of 91% while receiving 2 L/min oxygen
Correct Answer
Correct Answer: A. Heart rate of 148 beats/min with new
palpitations
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle and rapidly improves airflow
during bronchospasm. Although primarily selective for beta₂
receptors, higher doses or increased systemic absorption may
stimulate beta₁ receptors, producing tachycardia and cardiac
dysrhythmias. A heart rate of 148 beats/min accompanied by
new palpitations suggests excessive cardiovascular stimulation
or an underlying arrhythmia and requires prompt provider
notification before another dose is administered. Administering
additional albuterol could worsen the patient's condition.
Option B is incorrect because tachypnea is expected during an
acute COPD exacerbation and, by itself, is not a contraindication
,to treatment. Option C is incorrect because mild tremor is a
common, expected adverse effect of beta₂ agonists and should
be monitored but usually does not require discontinuation.
Option D is incorrect because an SpO₂ of 91% on supplemental
oxygen may represent improvement from baseline in a patient
with COPD and does not independently warrant withholding
albuterol.
The nurse should continue monitoring respiratory status, heart
rate, lung sounds, oxygen saturation, and response to therapy
while reinforcing proper inhaler technique and reporting
significant cardiovascular symptoms promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize serious adverse effects of short-acting beta₂
agonists.
• Differentiate expected from concerning medication side
effects.
• Prioritize nursing assessment before bronchodilator
administration.
Medication Safety Focus: Adverse effect monitoring
Question 2
, Clinical Scenario
A 22-year-old woman with persistent asthma is prescribed
fluticasone via a metered-dose inhaler twice daily and albuterol
as a rescue inhaler. During a clinic visit she states, "I stop using
my steroid inhaler whenever I feel better because I don't think I
need it."
Question Stem
Which response by the nurse is most appropriate?
A. "Use fluticasone only when wheezing develops."
B. "Fluticasone should be taken every day to reduce airway
inflammation."
C. "Take albuterol before bedtime instead of using fluticasone."
D. "Stop both inhalers once your peak flow improves."
Correct Answer
Correct Answer: B. Fluticasone should be taken every day to
reduce airway inflammation.
Detailed Rationale
Inhaled corticosteroids such as fluticasone are maintenance
medications that suppress chronic airway inflammation,
decrease airway hyperresponsiveness, and reduce the
frequency of asthma exacerbations. They are not designed to
relieve acute bronchospasm and must be taken consistently,
