NCLEX-RN Respiratory System
Pharmacology Practice Questions with
Rationales
20 Original NGN-Style Nursing MCQs
ATI Pharmacology Made Easy Study
Guide
Question 1
Clinical Scenario
A 68-year-old man with moderate chronic obstructive
pulmonary disease (COPD) is admitted for worsening shortness
of breath and wheezing. His history includes hypertension and
benign prostatic hyperplasia (BPH). Home medications include
tiotropium, lisinopril, and tamsulosin. Vital signs are: BP 136/82
mm Hg, HR 92/min, RR 24/min, SpO₂ 91% on room air. The
provider prescribes tiotropium via dry-powder inhaler once
daily.
Question Stem
,Which assessment finding requires the nurse to notify the
provider before administering the medication?
A. Reports dry mouth each morning
B. Complains of difficulty starting urination
C. Uses the inhaler every morning after breakfast
D. Drinks two cups of coffee daily
Correct Answer
Correct Answer: B. Complains of difficulty starting urination
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
produces bronchodilation by blocking acetylcholine at
muscarinic receptors in the airways. Although effective in COPD
maintenance therapy, its anticholinergic effects can worsen
urinary retention, particularly in patients with BPH. Difficulty
initiating urination may indicate developing urinary retention
and warrants provider notification before administration
because the medication could exacerbate this condition.
Option A is incorrect because dry mouth is a common,
expected anticholinergic side effect that can usually be
managed with hydration or sugar-free lozenges.
Option C is incorrect because consistent daily administration is
appropriate for maintenance therapy.
,Option D is incorrect because moderate caffeine intake is not a
contraindication to tiotropium therapy.
The nurse should also assess for glaucoma symptoms because
anticholinergic medications may increase intraocular pressure if
medication accidentally enters the eyes. Patient education
should include correct inhaler technique and that tiotropium is
not a rescue medication for acute bronchospasm.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications and precautions for tiotropium.
• Recognize anticholinergic adverse effects requiring
intervention.
• Assess patients with BPH before medication
administration.
• Differentiate maintenance from rescue respiratory
medications.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
, A 24-year-old woman with persistent asthma uses fluticasone
by metered-dose inhaler twice daily. During her follow-up visit,
she reports increasing throat soreness and notices white
patches inside her mouth. Lung sounds are clear, and she
denies fever or increased wheezing.
Question Stem
Which nursing instruction is most appropriate?
A. Stop taking the medication immediately.
B. Rinse the mouth thoroughly after each inhalation.
C. Use the inhaler only when experiencing wheezing.
D. Double the inhaled dose during respiratory infections.
Correct Answer
Correct Answer: B. Rinse the mouth thoroughly after each
inhalation
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) used for long-term
asthma control by reducing airway inflammation and decreasing
airway hyperresponsiveness. A common adverse effect is oral
candidiasis (thrush), caused by local immunosuppression within
the oropharynx. Rinsing the mouth and spitting after each dose
significantly decreases residual medication, reducing the risk of
fungal infection without affecting therapeutic efficacy.
Pharmacology Practice Questions with
Rationales
20 Original NGN-Style Nursing MCQs
ATI Pharmacology Made Easy Study
Guide
Question 1
Clinical Scenario
A 68-year-old man with moderate chronic obstructive
pulmonary disease (COPD) is admitted for worsening shortness
of breath and wheezing. His history includes hypertension and
benign prostatic hyperplasia (BPH). Home medications include
tiotropium, lisinopril, and tamsulosin. Vital signs are: BP 136/82
mm Hg, HR 92/min, RR 24/min, SpO₂ 91% on room air. The
provider prescribes tiotropium via dry-powder inhaler once
daily.
Question Stem
,Which assessment finding requires the nurse to notify the
provider before administering the medication?
A. Reports dry mouth each morning
B. Complains of difficulty starting urination
C. Uses the inhaler every morning after breakfast
D. Drinks two cups of coffee daily
Correct Answer
Correct Answer: B. Complains of difficulty starting urination
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
produces bronchodilation by blocking acetylcholine at
muscarinic receptors in the airways. Although effective in COPD
maintenance therapy, its anticholinergic effects can worsen
urinary retention, particularly in patients with BPH. Difficulty
initiating urination may indicate developing urinary retention
and warrants provider notification before administration
because the medication could exacerbate this condition.
Option A is incorrect because dry mouth is a common,
expected anticholinergic side effect that can usually be
managed with hydration or sugar-free lozenges.
Option C is incorrect because consistent daily administration is
appropriate for maintenance therapy.
,Option D is incorrect because moderate caffeine intake is not a
contraindication to tiotropium therapy.
The nurse should also assess for glaucoma symptoms because
anticholinergic medications may increase intraocular pressure if
medication accidentally enters the eyes. Patient education
should include correct inhaler technique and that tiotropium is
not a rescue medication for acute bronchospasm.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications and precautions for tiotropium.
• Recognize anticholinergic adverse effects requiring
intervention.
• Assess patients with BPH before medication
administration.
• Differentiate maintenance from rescue respiratory
medications.
Medication Safety Focus
Contraindication
Question 2
Clinical Scenario
, A 24-year-old woman with persistent asthma uses fluticasone
by metered-dose inhaler twice daily. During her follow-up visit,
she reports increasing throat soreness and notices white
patches inside her mouth. Lung sounds are clear, and she
denies fever or increased wheezing.
Question Stem
Which nursing instruction is most appropriate?
A. Stop taking the medication immediately.
B. Rinse the mouth thoroughly after each inhalation.
C. Use the inhaler only when experiencing wheezing.
D. Double the inhaled dose during respiratory infections.
Correct Answer
Correct Answer: B. Rinse the mouth thoroughly after each
inhalation
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) used for long-term
asthma control by reducing airway inflammation and decreasing
airway hyperresponsiveness. A common adverse effect is oral
candidiasis (thrush), caused by local immunosuppression within
the oropharynx. Rinsing the mouth and spitting after each dose
significantly decreases residual medication, reducing the risk of
fungal infection without affecting therapeutic efficacy.
