NCLEX Pharmacology Respiratory
System Practice Questions
20 High-Yield Nursing MCQs with
Rationales
Question 1
Clinical Scenario
A 22-year-old client with a history of persistent asthma arrives
at the emergency department complaining of chest tightness,
wheezing, and shortness of breath after exposure to cat dander.
Assessment findings include respiratory rate 30 breaths/min,
heart rate 118 beats/min, oxygen saturation 90% on room air,
and diffuse bilateral wheezing. The client reports using a
fluticasone inhaler twice daily but forgot to carry a rescue
inhaler. The provider prescribes nebulized albuterol.
Question Stem
Which assessment finding best indicates that the albuterol
treatment has been therapeutically effective?
A. Heart rate decreases to 60 beats/min.
,B. Wheezing diminishes and oxygen saturation increases to
96%.
C. The client reports a mild tremor in both hands.
D. Blood pressure increases from 118/72 mm Hg to 132/80 mm
Hg.
Correct Answer
Correct Answer: B. Wheezing diminishes and oxygen
saturation increases to 96%.
Detailed Rationale
Albuterol is a short-acting beta2-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle, producing rapid
bronchodilation during acute bronchospasm. The primary
therapeutic goal is improved airflow, demonstrated by reduced
wheezing, easier breathing, improved oxygenation, and
increased peak expiratory flow when measured. An oxygen
saturation increase to 96% with diminished wheezing indicates
that gas exchange has improved and the medication is working
as intended.
Option A is incorrect because albuterol commonly causes mild
tachycardia rather than bradycardia. A heart rate of 60
beats/min is not an expected indicator of effectiveness.
Option C is incorrect because tremor is a common adverse
effect resulting from beta2 receptor stimulation in skeletal
,muscle. Although expected, it does not indicate therapeutic
improvement.
Option D is incorrect because mild increases in blood pressure
may occur secondary to sympathetic stimulation but are not
measures of respiratory improvement.
Nurses should reassess respiratory status within minutes of
administration, including respiratory effort, lung sounds, oxygen
saturation, and, when available, peak expiratory flow. If
symptoms fail to improve after treatment, further interventions
and escalation of care may be required.
Learning Objectives
After completing this question, the learner should be able to:
• Evaluate the therapeutic response to short-acting beta2
agonists.
• Distinguish expected adverse effects from desired
therapeutic outcomes.
• Prioritize respiratory assessment following bronchodilator
administration.
Medication Safety Focus
Monitoring Therapeutic Response
Question 2
, Clinical Scenario
A 68-year-old client with moderate chronic obstructive
pulmonary disease (COPD) is prescribed tiotropium via a dry
powder inhaler. During discharge teaching, the client states, "I'll
use this inhaler whenever I suddenly become short of breath."
Question Stem
Which nursing response is most appropriate?
A. "Tiotropium works immediately to stop acute
bronchospasm."
B. "Use tiotropium before exercise to prevent bronchospasm."
C. "Tiotropium is a maintenance medication and should not be
used for sudden breathing attacks."
D. "Take two extra doses if your symptoms worsen suddenly."
Correct Answer
Correct Answer: C. "Tiotropium is a maintenance medication
and should not be used for sudden breathing attacks."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
provides prolonged bronchodilation through inhibition of
muscarinic receptors in the airways. It is designed for daily
maintenance therapy in COPD and certain patients with asthma
but does not provide rapid relief during acute respiratory
System Practice Questions
20 High-Yield Nursing MCQs with
Rationales
Question 1
Clinical Scenario
A 22-year-old client with a history of persistent asthma arrives
at the emergency department complaining of chest tightness,
wheezing, and shortness of breath after exposure to cat dander.
Assessment findings include respiratory rate 30 breaths/min,
heart rate 118 beats/min, oxygen saturation 90% on room air,
and diffuse bilateral wheezing. The client reports using a
fluticasone inhaler twice daily but forgot to carry a rescue
inhaler. The provider prescribes nebulized albuterol.
Question Stem
Which assessment finding best indicates that the albuterol
treatment has been therapeutically effective?
A. Heart rate decreases to 60 beats/min.
,B. Wheezing diminishes and oxygen saturation increases to
96%.
C. The client reports a mild tremor in both hands.
D. Blood pressure increases from 118/72 mm Hg to 132/80 mm
Hg.
Correct Answer
Correct Answer: B. Wheezing diminishes and oxygen
saturation increases to 96%.
Detailed Rationale
Albuterol is a short-acting beta2-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle, producing rapid
bronchodilation during acute bronchospasm. The primary
therapeutic goal is improved airflow, demonstrated by reduced
wheezing, easier breathing, improved oxygenation, and
increased peak expiratory flow when measured. An oxygen
saturation increase to 96% with diminished wheezing indicates
that gas exchange has improved and the medication is working
as intended.
Option A is incorrect because albuterol commonly causes mild
tachycardia rather than bradycardia. A heart rate of 60
beats/min is not an expected indicator of effectiveness.
Option C is incorrect because tremor is a common adverse
effect resulting from beta2 receptor stimulation in skeletal
,muscle. Although expected, it does not indicate therapeutic
improvement.
Option D is incorrect because mild increases in blood pressure
may occur secondary to sympathetic stimulation but are not
measures of respiratory improvement.
Nurses should reassess respiratory status within minutes of
administration, including respiratory effort, lung sounds, oxygen
saturation, and, when available, peak expiratory flow. If
symptoms fail to improve after treatment, further interventions
and escalation of care may be required.
Learning Objectives
After completing this question, the learner should be able to:
• Evaluate the therapeutic response to short-acting beta2
agonists.
• Distinguish expected adverse effects from desired
therapeutic outcomes.
• Prioritize respiratory assessment following bronchodilator
administration.
Medication Safety Focus
Monitoring Therapeutic Response
Question 2
, Clinical Scenario
A 68-year-old client with moderate chronic obstructive
pulmonary disease (COPD) is prescribed tiotropium via a dry
powder inhaler. During discharge teaching, the client states, "I'll
use this inhaler whenever I suddenly become short of breath."
Question Stem
Which nursing response is most appropriate?
A. "Tiotropium works immediately to stop acute
bronchospasm."
B. "Use tiotropium before exercise to prevent bronchospasm."
C. "Tiotropium is a maintenance medication and should not be
used for sudden breathing attacks."
D. "Take two extra doses if your symptoms worsen suddenly."
Correct Answer
Correct Answer: C. "Tiotropium is a maintenance medication
and should not be used for sudden breathing attacks."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
provides prolonged bronchodilation through inhibition of
muscarinic receptors in the airways. It is designed for daily
maintenance therapy in COPD and certain patients with asthma
but does not provide rapid relief during acute respiratory
