NCLEX-RN Pharmacology Respiratory
System Practice Questions & Rationales
20 Original NGN/ATI-Style MCQs
Asthma, COPD, Bronchodilators,
Inhaled Corticosteroids, Nursing Exam
Study Guide
Question 1
Clinical Scenario
A 24-year-old client with persistent asthma presents to the
emergency department reporting increased wheezing, chest
tightness, and shortness of breath after exposure to pollen. The
client uses an albuterol metered-dose inhaler (MDI) as needed
and a fluticasone inhaler twice daily but admits to forgetting the
corticosteroid several times this week. Vital signs are BP 122/74
mmHg, HR 108/min, RR 24/min, SpO₂ 92% on room air. Bilateral
expiratory wheezes are noted.
Question Stem
Which medication should the nurse administer first?
,A. Fluticasone inhaler
B. Montelukast
C. Albuterol inhaler
D. Tiotropium inhaler
Correct Answer
Correct Answer: C. Albuterol inhaler
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle by stimulating beta₂
receptors, producing bronchodilation within minutes. During an
acute asthma exacerbation, restoring airway patency is the
priority because bronchospasm impairs oxygenation.
Administering albuterol first improves airflow and reduces
respiratory distress before maintenance medications are
considered.
Option A: Fluticasone is an inhaled corticosteroid used for long-
term control by reducing airway inflammation. It does not
provide immediate bronchodilation and should never be relied
upon to relieve an acute asthma attack.
Option B: Montelukast is a leukotriene receptor antagonist
used for long-term prevention and allergic asthma
,management. It has no role in immediate relief of
bronchospasm.
Option D: Tiotropium is a long-acting muscarinic antagonist
(LAMA) used as maintenance therapy in selected asthma
patients and COPD. Its onset is too slow for emergency
symptom relief.
After albuterol administration, the nurse should reassess
respiratory effort, oxygen saturation, lung sounds, and response
to therapy. Once stabilized, reinforce adherence to daily inhaled
corticosteroids to reduce future exacerbations and prevent
airway remodeling.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue from maintenance asthma
medications.
• Prioritize treatment during an acute asthma exacerbation.
• Explain the mechanism of action of short-acting beta₂
agonists.
• Reinforce adherence to controller medications.
Medication Safety Focus
Priority nursing action
, Question 2
Clinical Scenario
A 67-year-old client with moderate chronic obstructive
pulmonary disease (COPD) has been prescribed tiotropium via
dry powder inhaler once daily. During discharge teaching, the
client says, "I'll use this inhaler whenever I suddenly become
short of breath."
Question Stem
Which response by the nurse is most appropriate?
A. "Tiotropium should only be used at bedtime."
B. "Tiotropium is for daily maintenance and will not quickly
relieve sudden shortness of breath."
C. "Use tiotropium every hour until your breathing improves."
D. "Stop using albuterol now that you have tiotropium."
Correct Answer
Correct Answer: B. "Tiotropium is for daily maintenance and
will not quickly relieve sudden shortness of breath."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
blocks acetylcholine-mediated bronchoconstriction, producing
prolonged bronchodilation. It is prescribed as a maintenance
System Practice Questions & Rationales
20 Original NGN/ATI-Style MCQs
Asthma, COPD, Bronchodilators,
Inhaled Corticosteroids, Nursing Exam
Study Guide
Question 1
Clinical Scenario
A 24-year-old client with persistent asthma presents to the
emergency department reporting increased wheezing, chest
tightness, and shortness of breath after exposure to pollen. The
client uses an albuterol metered-dose inhaler (MDI) as needed
and a fluticasone inhaler twice daily but admits to forgetting the
corticosteroid several times this week. Vital signs are BP 122/74
mmHg, HR 108/min, RR 24/min, SpO₂ 92% on room air. Bilateral
expiratory wheezes are noted.
Question Stem
Which medication should the nurse administer first?
,A. Fluticasone inhaler
B. Montelukast
C. Albuterol inhaler
D. Tiotropium inhaler
Correct Answer
Correct Answer: C. Albuterol inhaler
Detailed Rationale
Albuterol is a short-acting beta₂-adrenergic agonist (SABA) that
rapidly relaxes bronchial smooth muscle by stimulating beta₂
receptors, producing bronchodilation within minutes. During an
acute asthma exacerbation, restoring airway patency is the
priority because bronchospasm impairs oxygenation.
Administering albuterol first improves airflow and reduces
respiratory distress before maintenance medications are
considered.
Option A: Fluticasone is an inhaled corticosteroid used for long-
term control by reducing airway inflammation. It does not
provide immediate bronchodilation and should never be relied
upon to relieve an acute asthma attack.
Option B: Montelukast is a leukotriene receptor antagonist
used for long-term prevention and allergic asthma
,management. It has no role in immediate relief of
bronchospasm.
Option D: Tiotropium is a long-acting muscarinic antagonist
(LAMA) used as maintenance therapy in selected asthma
patients and COPD. Its onset is too slow for emergency
symptom relief.
After albuterol administration, the nurse should reassess
respiratory effort, oxygen saturation, lung sounds, and response
to therapy. Once stabilized, reinforce adherence to daily inhaled
corticosteroids to reduce future exacerbations and prevent
airway remodeling.
Learning Objectives
After completing this question, the learner should be able to:
• Differentiate rescue from maintenance asthma
medications.
• Prioritize treatment during an acute asthma exacerbation.
• Explain the mechanism of action of short-acting beta₂
agonists.
• Reinforce adherence to controller medications.
Medication Safety Focus
Priority nursing action
, Question 2
Clinical Scenario
A 67-year-old client with moderate chronic obstructive
pulmonary disease (COPD) has been prescribed tiotropium via
dry powder inhaler once daily. During discharge teaching, the
client says, "I'll use this inhaler whenever I suddenly become
short of breath."
Question Stem
Which response by the nurse is most appropriate?
A. "Tiotropium should only be used at bedtime."
B. "Tiotropium is for daily maintenance and will not quickly
relieve sudden shortness of breath."
C. "Use tiotropium every hour until your breathing improves."
D. "Stop using albuterol now that you have tiotropium."
Correct Answer
Correct Answer: B. "Tiotropium is for daily maintenance and
will not quickly relieve sudden shortness of breath."
Detailed Rationale
Tiotropium is a long-acting muscarinic antagonist (LAMA) that
blocks acetylcholine-mediated bronchoconstriction, producing
prolonged bronchodilation. It is prescribed as a maintenance
