NCLEX-RN Pharmacology Respiratory
System Practice Questions
20 Original NCLEX-Style MCQs with
Detailed Rationales
Asthma, COPD, Tuberculosis, Inhalers,
Medication Safety & Clinical Judgment
Study Guide
Question 1
Clinical Scenario
A 22-year-old woman with a history of moderate persistent
asthma presents to the emergency department with worsening
wheezing, chest tightness, and shortness of breath after
exposure to cat dander. Vital signs are: BP 124/78 mm Hg, HR
118 beats/min, RR 30 breaths/min, SpO₂ 89% on room air.
Bilateral expiratory wheezes are noted. The provider prescribes
nebulized albuterol.
Question Stem
,Which assessment finding best indicates that the medication is
having the desired therapeutic effect?
A. Heart rate decreases to 62 beats/min.
B. Breath sounds change from wheezing to clear with improved
oxygen saturation.
C. Blood glucose decreases to 70 mg/dL.
D. Respiratory rate increases to 36 breaths/min.
Correct Answer
Correct Answer: B. Breath sounds change from wheezing to
clear with improved oxygen saturation.
Detailed Rationale
Albuterol is a short-acting β₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle through stimulation of
β₂ receptors, producing bronchodilation within minutes. The
desired therapeutic response is improved airflow, demonstrated
by decreased wheezing, easier breathing, improved oxygen
saturation, and reduced work of breathing. Improvement in
lung sounds together with increasing SpO₂ indicates effective
reversal of bronchospasm.
Option A is incorrect because although severe respiratory
distress may elevate heart rate, albuterol commonly causes
mild tachycardia rather than significant bradycardia. A heart
,rate of 62 beats/min is not the expected indicator of
therapeutic success.
Option C is incorrect because albuterol does not lower blood
glucose. β₂ agonists may actually produce mild transient
hyperglycemia in susceptible patients.
Option D is incorrect because an increasing respiratory rate
suggests worsening respiratory distress rather than clinical
improvement.
Nurses should reassess respiratory status after treatment by
evaluating lung sounds, respiratory effort, oxygen saturation,
peak expiratory flow (when appropriate), and the patient's
ability to speak in full sentences. Patients should also be
educated that frequent need for rescue inhalers may indicate
inadequate asthma control and warrants provider evaluation.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the expected therapeutic effects of short-acting β₂
agonists.
• Evaluate clinical indicators of improved airway function.
• Differentiate therapeutic effects from medication adverse
effects.
Medication Safety Focus
, Monitoring
Question 2
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) receives a new prescription for tiotropium inhalation
once daily. During discharge teaching, the nurse evaluates the
client's understanding of home medication use.
Question Stem
Which statement by the client indicates a need for additional
teaching?
A. "I'll take this medicine every day even if I feel well."
B. "This inhaler helps keep my airways open over time."
C. "I'll use this inhaler whenever I suddenly become severely
short of breath."
D. "I'll notify my provider if I develop worsening urinary
retention."
Correct Answer
Correct Answer: C. "I'll use this inhaler whenever I suddenly
become severely short of breath."
Detailed Rationale
System Practice Questions
20 Original NCLEX-Style MCQs with
Detailed Rationales
Asthma, COPD, Tuberculosis, Inhalers,
Medication Safety & Clinical Judgment
Study Guide
Question 1
Clinical Scenario
A 22-year-old woman with a history of moderate persistent
asthma presents to the emergency department with worsening
wheezing, chest tightness, and shortness of breath after
exposure to cat dander. Vital signs are: BP 124/78 mm Hg, HR
118 beats/min, RR 30 breaths/min, SpO₂ 89% on room air.
Bilateral expiratory wheezes are noted. The provider prescribes
nebulized albuterol.
Question Stem
,Which assessment finding best indicates that the medication is
having the desired therapeutic effect?
A. Heart rate decreases to 62 beats/min.
B. Breath sounds change from wheezing to clear with improved
oxygen saturation.
C. Blood glucose decreases to 70 mg/dL.
D. Respiratory rate increases to 36 breaths/min.
Correct Answer
Correct Answer: B. Breath sounds change from wheezing to
clear with improved oxygen saturation.
Detailed Rationale
Albuterol is a short-acting β₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle through stimulation of
β₂ receptors, producing bronchodilation within minutes. The
desired therapeutic response is improved airflow, demonstrated
by decreased wheezing, easier breathing, improved oxygen
saturation, and reduced work of breathing. Improvement in
lung sounds together with increasing SpO₂ indicates effective
reversal of bronchospasm.
Option A is incorrect because although severe respiratory
distress may elevate heart rate, albuterol commonly causes
mild tachycardia rather than significant bradycardia. A heart
,rate of 62 beats/min is not the expected indicator of
therapeutic success.
Option C is incorrect because albuterol does not lower blood
glucose. β₂ agonists may actually produce mild transient
hyperglycemia in susceptible patients.
Option D is incorrect because an increasing respiratory rate
suggests worsening respiratory distress rather than clinical
improvement.
Nurses should reassess respiratory status after treatment by
evaluating lung sounds, respiratory effort, oxygen saturation,
peak expiratory flow (when appropriate), and the patient's
ability to speak in full sentences. Patients should also be
educated that frequent need for rescue inhalers may indicate
inadequate asthma control and warrants provider evaluation.
Learning Objectives
After completing this question, the learner should be able to:
• Identify the expected therapeutic effects of short-acting β₂
agonists.
• Evaluate clinical indicators of improved airway function.
• Differentiate therapeutic effects from medication adverse
effects.
Medication Safety Focus
, Monitoring
Question 2
Clinical Scenario
A 67-year-old man with chronic obstructive pulmonary disease
(COPD) receives a new prescription for tiotropium inhalation
once daily. During discharge teaching, the nurse evaluates the
client's understanding of home medication use.
Question Stem
Which statement by the client indicates a need for additional
teaching?
A. "I'll take this medicine every day even if I feel well."
B. "This inhaler helps keep my airways open over time."
C. "I'll use this inhaler whenever I suddenly become severely
short of breath."
D. "I'll notify my provider if I develop worsening urinary
retention."
Correct Answer
Correct Answer: C. "I'll use this inhaler whenever I suddenly
become severely short of breath."
Detailed Rationale
