NCLEX-RN Respiratory System
Pharmacology Exam Questions &
Answers
20 Original NGN Practice MCQs with
Rationales
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old man with chronic obstructive pulmonary disease
(COPD) is admitted with increasing shortness of breath and
wheezing. His oxygen saturation is 88% on room air, respiratory
rate is 28/min, heart rate is 104/min, and blood pressure is
138/82 mm Hg. The provider prescribes albuterol via nebulizer
every 4 hours as needed for wheezing. The nurse prepares to
administer the first dose.
Question Stem
Which assessment finding best indicates that the medication is
producing the desired therapeutic effect?
,A. Heart rate decreases to 72/min
B. Oxygen saturation improves to 94% with decreased wheezing
C. Blood pressure decreases to 110/70 mm Hg
D. The client reports mild hand tremors
Correct Answer
Correct Answer: B. Oxygen saturation improves to 94% with
decreased wheezing
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle, producing rapid
bronchodilation. The desired therapeutic response is improved
airflow, evidenced by reduced wheezing, easier breathing, and
improved oxygenation. An increase in oxygen saturation from
88% to 94%, accompanied by decreased wheezing,
demonstrates effective bronchodilation and improved gas
exchange.
Option A is incorrect because although improved oxygenation
may reduce sympathetic stimulation, a decrease in heart rate is
not the primary indicator of effectiveness. Albuterol commonly
causes transient tachycardia rather than bradycardia.
Option C is incorrect because blood pressure changes are not
used to evaluate the therapeutic effect of albuterol.
,Option D is incorrect because fine tremors are a common
adverse effect of beta₂ agonists due to skeletal muscle
stimulation. Although expected, tremors do not indicate
therapeutic success.
The nurse should assess lung sounds, respiratory effort,
respiratory rate, oxygen saturation, and the client's subjective
report of breathing before and after treatment. Persistent
hypoxemia or worsening respiratory distress despite therapy
requires prompt provider notification and possible escalation of
respiratory support.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the expected therapeutic response to short-acting
beta₂ agonists.
• Evaluate treatment effectiveness using respiratory
assessment findings.
• Distinguish therapeutic effects from common adverse
effects.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
, A 42-year-old woman with moderate persistent asthma uses
fluticasone via a metered-dose inhaler twice daily. During a
clinic visit she states, "I usually stop using it when I feel better
because I don't like taking medicine every day."
Question Stem
Which response by the nurse is most appropriate?
A. "Use the inhaler only when wheezing becomes severe."
B. "You should continue taking it every day, even when your
symptoms improve."
C. "Double the dose if you miss your morning treatment."
D. "Take the medication only before exercise."
Correct Answer
Correct Answer: B. "You should continue taking it every day,
even when your symptoms improve."
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) used as a controller
medication for long-term management of asthma. It suppresses
airway inflammation, decreases mucus production, and reduces
airway hyperresponsiveness. Because inflammation persists
even when symptoms improve, inhaled corticosteroids must be
taken consistently as prescribed. They are not intended for
rapid symptom relief.
Pharmacology Exam Questions &
Answers
20 Original NGN Practice MCQs with
Rationales
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old man with chronic obstructive pulmonary disease
(COPD) is admitted with increasing shortness of breath and
wheezing. His oxygen saturation is 88% on room air, respiratory
rate is 28/min, heart rate is 104/min, and blood pressure is
138/82 mm Hg. The provider prescribes albuterol via nebulizer
every 4 hours as needed for wheezing. The nurse prepares to
administer the first dose.
Question Stem
Which assessment finding best indicates that the medication is
producing the desired therapeutic effect?
,A. Heart rate decreases to 72/min
B. Oxygen saturation improves to 94% with decreased wheezing
C. Blood pressure decreases to 110/70 mm Hg
D. The client reports mild hand tremors
Correct Answer
Correct Answer: B. Oxygen saturation improves to 94% with
decreased wheezing
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
relaxes bronchial smooth muscle, producing rapid
bronchodilation. The desired therapeutic response is improved
airflow, evidenced by reduced wheezing, easier breathing, and
improved oxygenation. An increase in oxygen saturation from
88% to 94%, accompanied by decreased wheezing,
demonstrates effective bronchodilation and improved gas
exchange.
Option A is incorrect because although improved oxygenation
may reduce sympathetic stimulation, a decrease in heart rate is
not the primary indicator of effectiveness. Albuterol commonly
causes transient tachycardia rather than bradycardia.
Option C is incorrect because blood pressure changes are not
used to evaluate the therapeutic effect of albuterol.
,Option D is incorrect because fine tremors are a common
adverse effect of beta₂ agonists due to skeletal muscle
stimulation. Although expected, tremors do not indicate
therapeutic success.
The nurse should assess lung sounds, respiratory effort,
respiratory rate, oxygen saturation, and the client's subjective
report of breathing before and after treatment. Persistent
hypoxemia or worsening respiratory distress despite therapy
requires prompt provider notification and possible escalation of
respiratory support.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the expected therapeutic response to short-acting
beta₂ agonists.
• Evaluate treatment effectiveness using respiratory
assessment findings.
• Distinguish therapeutic effects from common adverse
effects.
Medication Safety Focus: Monitoring
Question 2
Clinical Scenario
, A 42-year-old woman with moderate persistent asthma uses
fluticasone via a metered-dose inhaler twice daily. During a
clinic visit she states, "I usually stop using it when I feel better
because I don't like taking medicine every day."
Question Stem
Which response by the nurse is most appropriate?
A. "Use the inhaler only when wheezing becomes severe."
B. "You should continue taking it every day, even when your
symptoms improve."
C. "Double the dose if you miss your morning treatment."
D. "Take the medication only before exercise."
Correct Answer
Correct Answer: B. "You should continue taking it every day,
even when your symptoms improve."
Detailed Rationale
Fluticasone is an inhaled corticosteroid (ICS) used as a controller
medication for long-term management of asthma. It suppresses
airway inflammation, decreases mucus production, and reduces
airway hyperresponsiveness. Because inflammation persists
even when symptoms improve, inhaled corticosteroids must be
taken consistently as prescribed. They are not intended for
rapid symptom relief.
