NCLEX-RN Pharmacology Respiratory
System Practice Questions & Rationales
20 Original NGN-Style MCQs
ATI Pharmacology Made Easy Study
Guide
Nursing Exam Prep
Question 1
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) is admitted for worsening dyspnea and wheezing. His
oxygen saturation is 89% on room air, respiratory rate is 26/min,
heart rate is 108/min, and blood pressure is 142/84 mm Hg. The
provider prescribes albuterol via metered-dose inhaler (MDI)
every 4 hours as needed and tiotropium once daily. The nurse
prepares to administer the first medications.
Question Stem
Which nursing action is most appropriate to maximize the
therapeutic effect of both inhaled medications?
,A. Administer tiotropium first, followed immediately by
albuterol.
B. Administer albuterol first, wait several minutes, then
administer tiotropium.
C. Administer both medications simultaneously using separate
inhalers.
D. Delay albuterol until after tiotropium has reached peak
effect.
Correct Answer
Correct Answer: B. Administer albuterol first, wait several
minutes, then administer tiotropium.
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle, producing
bronchodilation within minutes. Administering albuterol before
tiotropium allows the airways to open, improving penetration
and deposition of the long-acting muscarinic antagonist (LAMA)
deeper into the lungs. This sequence optimizes therapeutic
benefit and is commonly recommended when multiple inhaled
bronchodilators are prescribed.
Option A is incorrect because administering tiotropium first
may reduce its effectiveness due to narrower airways before
bronchodilation occurs. Option C is incorrect because inhalers
,should not be used simultaneously; spacing medications
improves delivery and minimizes administration errors. Option
D is incorrect because delaying albuterol prolongs respiratory
distress and postpones rapid symptom relief.
The nurse should also assess lung sounds, respiratory effort,
oxygen saturation, and the patient's inhaler technique. Patients
should be instructed to inhale slowly and deeply when using
tiotropium and to understand that tiotropium is a maintenance
medication rather than a rescue medication. Monitoring for
tachycardia and tremor after albuterol administration is
important, particularly in older adults or patients with
cardiovascular disease.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue and maintenance inhaled
bronchodilators.
• Sequence inhaled medications appropriately.
• Evaluate therapeutic response after bronchodilator
administration.
• Reinforce proper inhaler administration techniques.
Medication Safety Focus
Medication administration
, Question 2
Clinical Scenario
A 24-year-old woman with persistent asthma has been
prescribed fluticasone via metered-dose inhaler twice daily.
During a follow-up visit, she reports that her asthma symptoms
have improved, but she has developed white patches inside her
mouth and mild throat discomfort. Her vital signs are stable,
and she denies fever.
Question Stem
Which nursing instruction is most appropriate?
A. Stop the medication immediately and notify the provider.
B. Rinse the mouth with water and spit after each inhaled dose.
C. Increase the inhaled dose until symptoms completely resolve.
D. Use the inhaler only during asthma attacks.
Correct Answer
Correct Answer: B. Rinse the mouth with water and spit after
each inhaled dose.
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) used for long-term
asthma control by reducing airway inflammation. A common
System Practice Questions & Rationales
20 Original NGN-Style MCQs
ATI Pharmacology Made Easy Study
Guide
Nursing Exam Prep
Question 1
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) is admitted for worsening dyspnea and wheezing. His
oxygen saturation is 89% on room air, respiratory rate is 26/min,
heart rate is 108/min, and blood pressure is 142/84 mm Hg. The
provider prescribes albuterol via metered-dose inhaler (MDI)
every 4 hours as needed and tiotropium once daily. The nurse
prepares to administer the first medications.
Question Stem
Which nursing action is most appropriate to maximize the
therapeutic effect of both inhaled medications?
,A. Administer tiotropium first, followed immediately by
albuterol.
B. Administer albuterol first, wait several minutes, then
administer tiotropium.
C. Administer both medications simultaneously using separate
inhalers.
D. Delay albuterol until after tiotropium has reached peak
effect.
Correct Answer
Correct Answer: B. Administer albuterol first, wait several
minutes, then administer tiotropium.
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle, producing
bronchodilation within minutes. Administering albuterol before
tiotropium allows the airways to open, improving penetration
and deposition of the long-acting muscarinic antagonist (LAMA)
deeper into the lungs. This sequence optimizes therapeutic
benefit and is commonly recommended when multiple inhaled
bronchodilators are prescribed.
Option A is incorrect because administering tiotropium first
may reduce its effectiveness due to narrower airways before
bronchodilation occurs. Option C is incorrect because inhalers
,should not be used simultaneously; spacing medications
improves delivery and minimizes administration errors. Option
D is incorrect because delaying albuterol prolongs respiratory
distress and postpones rapid symptom relief.
The nurse should also assess lung sounds, respiratory effort,
oxygen saturation, and the patient's inhaler technique. Patients
should be instructed to inhale slowly and deeply when using
tiotropium and to understand that tiotropium is a maintenance
medication rather than a rescue medication. Monitoring for
tachycardia and tremor after albuterol administration is
important, particularly in older adults or patients with
cardiovascular disease.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue and maintenance inhaled
bronchodilators.
• Sequence inhaled medications appropriately.
• Evaluate therapeutic response after bronchodilator
administration.
• Reinforce proper inhaler administration techniques.
Medication Safety Focus
Medication administration
, Question 2
Clinical Scenario
A 24-year-old woman with persistent asthma has been
prescribed fluticasone via metered-dose inhaler twice daily.
During a follow-up visit, she reports that her asthma symptoms
have improved, but she has developed white patches inside her
mouth and mild throat discomfort. Her vital signs are stable,
and she denies fever.
Question Stem
Which nursing instruction is most appropriate?
A. Stop the medication immediately and notify the provider.
B. Rinse the mouth with water and spit after each inhaled dose.
C. Increase the inhaled dose until symptoms completely resolve.
D. Use the inhaler only during asthma attacks.
Correct Answer
Correct Answer: B. Rinse the mouth with water and spit after
each inhaled dose.
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) used for long-term
asthma control by reducing airway inflammation. A common
