NCLEX-RN Respiratory Pharmacology
Test Bank (2026 NGN)
20 High-Quality Questions with
Rationales & Clinical Judgment Focus
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 after exposure to cat dander. She
is anxious and speaking in short phrases. Vital signs: BP 128/76
mmHg, HR 118 beats/min, RR 30 breaths/min, SpO₂ 89% on
room air. Expiratory wheezes are heard throughout both lungs.
The provider prescribes albuterol via nebulizer.
Question Stem
Which finding indicates the albuterol treatment is having the
desired therapeutic effect?
A. Respiratory rate increases to 34 breaths/min.
B. Wheezing becomes louder after treatment.
,C. Oxygen saturation increases to 95% and breath sounds
improve.
D. Heart rate decreases to 58 beats/min.
Correct Answer
Correct Answer: C. Oxygen saturation increases to 95% 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, resulting in bronchodilation and improved airflow.
The primary indicators of effectiveness include improved
oxygenation, decreased wheezing, easier breathing, and
improved peak expiratory flow. An increase in SpO₂ from 89% to
95% accompanied by improved breath sounds demonstrates
successful reversal of bronchospasm and improved gas
exchange.
Option A is incorrect because an increased respiratory rate
suggests persistent respiratory distress rather than
improvement. Option B is incorrect because worsening
wheezing may indicate continued airway obstruction or fatigue
and requires reassessment. Option D is incorrect because
albuterol commonly causes mild tachycardia due to β-receptor
,stimulation; bradycardia is not an expected therapeutic
response.
The nurse should reassess lung sounds, respiratory effort,
oxygen saturation, and the patient's ability to speak after
administration. Patients should also be educated that rescue
inhalers provide rapid symptom relief but do not control chronic
airway inflammation. Frequent need for albuterol may indicate
inadequate asthma control and should prompt provider
evaluation for adjustment of long-term therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the expected therapeutic response to a short-
acting β₂ agonist.
• Evaluate respiratory assessment findings after
bronchodilator therapy.
• Differentiate expected medication effects from signs of
treatment failure.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
, A 56-year-old man with chronic persistent asthma is prescribed
fluticasone inhalation twice daily and albuterol inhalation as
needed. During a clinic visit, he states, "I use my steroid inhaler
whenever I feel short of breath."
Question Stem
Which nursing response is most appropriate?
A. "Use fluticasone only before strenuous exercise."
B. "Fluticasone is a rescue medication and should replace
albuterol."
C. "Use albuterol for sudden symptoms and fluticasone every
day as prescribed."
D. "Stop albuterol once you begin inhaled corticosteroid
therapy."
Correct Answer
Correct Answer: C. "Use albuterol for sudden symptoms and
fluticasone every day as prescribed."
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) that reduces
airway inflammation over time but does not provide immediate
bronchodilation. It is considered a controller medication and
must be taken consistently, even when symptoms are absent.
Albuterol is the rescue medication used to relieve acute
Test Bank (2026 NGN)
20 High-Quality Questions with
Rationales & Clinical Judgment Focus
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 after exposure to cat dander. She
is anxious and speaking in short phrases. Vital signs: BP 128/76
mmHg, HR 118 beats/min, RR 30 breaths/min, SpO₂ 89% on
room air. Expiratory wheezes are heard throughout both lungs.
The provider prescribes albuterol via nebulizer.
Question Stem
Which finding indicates the albuterol treatment is having the
desired therapeutic effect?
A. Respiratory rate increases to 34 breaths/min.
B. Wheezing becomes louder after treatment.
,C. Oxygen saturation increases to 95% and breath sounds
improve.
D. Heart rate decreases to 58 beats/min.
Correct Answer
Correct Answer: C. Oxygen saturation increases to 95% 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, resulting in bronchodilation and improved airflow.
The primary indicators of effectiveness include improved
oxygenation, decreased wheezing, easier breathing, and
improved peak expiratory flow. An increase in SpO₂ from 89% to
95% accompanied by improved breath sounds demonstrates
successful reversal of bronchospasm and improved gas
exchange.
Option A is incorrect because an increased respiratory rate
suggests persistent respiratory distress rather than
improvement. Option B is incorrect because worsening
wheezing may indicate continued airway obstruction or fatigue
and requires reassessment. Option D is incorrect because
albuterol commonly causes mild tachycardia due to β-receptor
,stimulation; bradycardia is not an expected therapeutic
response.
The nurse should reassess lung sounds, respiratory effort,
oxygen saturation, and the patient's ability to speak after
administration. Patients should also be educated that rescue
inhalers provide rapid symptom relief but do not control chronic
airway inflammation. Frequent need for albuterol may indicate
inadequate asthma control and should prompt provider
evaluation for adjustment of long-term therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the expected therapeutic response to a short-
acting β₂ agonist.
• Evaluate respiratory assessment findings after
bronchodilator therapy.
• Differentiate expected medication effects from signs of
treatment failure.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
, A 56-year-old man with chronic persistent asthma is prescribed
fluticasone inhalation twice daily and albuterol inhalation as
needed. During a clinic visit, he states, "I use my steroid inhaler
whenever I feel short of breath."
Question Stem
Which nursing response is most appropriate?
A. "Use fluticasone only before strenuous exercise."
B. "Fluticasone is a rescue medication and should replace
albuterol."
C. "Use albuterol for sudden symptoms and fluticasone every
day as prescribed."
D. "Stop albuterol once you begin inhaled corticosteroid
therapy."
Correct Answer
Correct Answer: C. "Use albuterol for sudden symptoms and
fluticasone every day as prescribed."
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) that reduces
airway inflammation over time but does not provide immediate
bronchodilation. It is considered a controller medication and
must be taken consistently, even when symptoms are absent.
Albuterol is the rescue medication used to relieve acute
