NCLEX-RN Respiratory System
Pharmacology Exam Questions &
Answers
20 Original NGN Practice MCQs with
Detailed Rationales
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with persistent asthma arrives at the
outpatient clinic for a follow-up visit. She reports using her
albuterol inhaler "about six or seven times every day" over the
past two weeks because of increasing wheezing and shortness
of breath. She also takes an inhaled fluticasone inhaler twice
daily but admits she frequently forgets the evening dose. Vital
signs are: BP 118/72 mmHg, HR 94 beats/min, RR 22
breaths/min, SpO₂ 96% on room air. Lung assessment reveals
mild expiratory wheezes bilaterally.
Question Stem
,Which nursing intervention is the highest priority?
A. Encourage the client to increase albuterol use before
exercise.
B. Assess adherence to the prescribed inhaled corticosteroid
regimen.
C. Recommend discontinuing the inhaled corticosteroid to
reduce adverse effects.
D. Teach the client to use the albuterol inhaler every morning
regardless of symptoms.
Correct Answer
Correct Answer: B. Assess adherence to the prescribed inhaled
corticosteroid regimen.
Detailed Rationale
Frequent reliance on a short-acting beta₂-agonist (SABA) such as
albuterol suggests inadequate long-term asthma control rather
than an increased need for rescue medication. The nurse should
first determine whether the patient is taking the prescribed
inhaled corticosteroid (ICS) consistently. Inhaled corticosteroids
reduce airway inflammation, decrease bronchial
hyperresponsiveness, and lower the frequency of
exacerbations. Poor adherence is a common cause of worsening
asthma symptoms and excessive rescue inhaler use.
,Option A is incorrect because increasing SABA use treats
symptoms temporarily but does not address chronic airway
inflammation. Overuse may also increase the risk of
tachycardia, tremor, and decreased effectiveness.
Option C is incorrect because discontinuing the ICS would likely
worsen asthma control and increase exacerbation risk.
Option D is incorrect because albuterol is intended for rapid
symptom relief or prevention of exercise-induced
bronchospasm, not routine daily maintenance therapy.
The nurse should also evaluate inhaler technique, identify
asthma triggers, reinforce adherence, and notify the provider if
persistent symptoms continue despite appropriate therapy, as
medication adjustment may be required.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue medications from controller
medications.
• Recognize signs of poorly controlled asthma.
• Assess medication adherence before recommending
therapy changes.
• Reinforce appropriate inhaler use.
Medication Safety Focus
, Patient education and medication adherence
Question 2
Clinical Scenario
A 68-year-old man with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium via a dry powder inhaler. His
history includes benign prostatic hyperplasia (BPH),
hypertension, and glaucoma. During discharge teaching, he asks
about possible side effects.
Question Stem
Which adverse effect should the nurse emphasize as requiring
prompt notification of the healthcare provider?
A. Mild dry mouth
B. Temporary cough after inhalation
C. Difficulty urinating
D. Mild throat irritation
Correct Answer
Correct Answer: C. Difficulty urinating.
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
produces bronchodilation by blocking acetylcholine at
Pharmacology Exam Questions &
Answers
20 Original NGN Practice MCQs with
Detailed Rationales
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 24-year-old woman with persistent asthma arrives at the
outpatient clinic for a follow-up visit. She reports using her
albuterol inhaler "about six or seven times every day" over the
past two weeks because of increasing wheezing and shortness
of breath. She also takes an inhaled fluticasone inhaler twice
daily but admits she frequently forgets the evening dose. Vital
signs are: BP 118/72 mmHg, HR 94 beats/min, RR 22
breaths/min, SpO₂ 96% on room air. Lung assessment reveals
mild expiratory wheezes bilaterally.
Question Stem
,Which nursing intervention is the highest priority?
A. Encourage the client to increase albuterol use before
exercise.
B. Assess adherence to the prescribed inhaled corticosteroid
regimen.
C. Recommend discontinuing the inhaled corticosteroid to
reduce adverse effects.
D. Teach the client to use the albuterol inhaler every morning
regardless of symptoms.
Correct Answer
Correct Answer: B. Assess adherence to the prescribed inhaled
corticosteroid regimen.
Detailed Rationale
Frequent reliance on a short-acting beta₂-agonist (SABA) such as
albuterol suggests inadequate long-term asthma control rather
than an increased need for rescue medication. The nurse should
first determine whether the patient is taking the prescribed
inhaled corticosteroid (ICS) consistently. Inhaled corticosteroids
reduce airway inflammation, decrease bronchial
hyperresponsiveness, and lower the frequency of
exacerbations. Poor adherence is a common cause of worsening
asthma symptoms and excessive rescue inhaler use.
,Option A is incorrect because increasing SABA use treats
symptoms temporarily but does not address chronic airway
inflammation. Overuse may also increase the risk of
tachycardia, tremor, and decreased effectiveness.
Option C is incorrect because discontinuing the ICS would likely
worsen asthma control and increase exacerbation risk.
Option D is incorrect because albuterol is intended for rapid
symptom relief or prevention of exercise-induced
bronchospasm, not routine daily maintenance therapy.
The nurse should also evaluate inhaler technique, identify
asthma triggers, reinforce adherence, and notify the provider if
persistent symptoms continue despite appropriate therapy, as
medication adjustment may be required.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue medications from controller
medications.
• Recognize signs of poorly controlled asthma.
• Assess medication adherence before recommending
therapy changes.
• Reinforce appropriate inhaler use.
Medication Safety Focus
, Patient education and medication adherence
Question 2
Clinical Scenario
A 68-year-old man with chronic obstructive pulmonary disease
(COPD) is prescribed tiotropium via a dry powder inhaler. His
history includes benign prostatic hyperplasia (BPH),
hypertension, and glaucoma. During discharge teaching, he asks
about possible side effects.
Question Stem
Which adverse effect should the nurse emphasize as requiring
prompt notification of the healthcare provider?
A. Mild dry mouth
B. Temporary cough after inhalation
C. Difficulty urinating
D. Mild throat irritation
Correct Answer
Correct Answer: C. Difficulty urinating.
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
produces bronchodilation by blocking acetylcholine at
