WorksheetsNCLEX-Style Questions (1–30)
Total questions: 100
Worksheet time: 55mins
A patient with asthma reports using their albuterol inhaler several times daily. What is the nurse’s best response?
This indicates your asthma is well controlled.
You should increase the dose of albuterol.
Frequent use suggests poor control and the need for a controller medication.
This is expected during allergy season.
A patient arrives in the emergency department with acute wheezing and shortness of breath. Which medication provides the fastest relief?
Budesonide
Montelukast
Albuterol
Tiotropium
Which finding requires immediate follow-up in a patient taking theophylline?
Mild insomnia
Serum level of 22 mcg/mL
Heart rate of 88 bpm
Decreased appetite
A nurse is teaching a patient about inhaled corticosteroids. Which statement indicates correct understanding?
I should use this medication only when I feel short of breath.
This medication works immediately.
I need to rinse my mouth after using this inhaler.
This replaces my rescue inhaler.
A patient with COPD is prescribed ipratropium. Which adverse effect should the nurse monitor for?
Hyperglycemia
Dry mouth
Bradycardia
Productive cough
A patient using an MDI without a spacer has poor symptom control. What is the most appropriate nursing intervention?
Increase medication dose
Teach spacer use
Which medication is contraindicated as monotherapy in asthma?
Albuterol
Formoterol
Budesonide
Montelukast
A patient with asthma is prescribed budesonide-formoterol for SMART therapy. Which instruction is correct?
Use only as a rescue medication
Use daily and as needed for symptoms
Discontinue albuterol immediately
Use only during exacerbations
Which patient is the best candidate for roflumilast therapy?
Mild asthma
Exercise-induced asthma
Severe COPD with chronic bronchitis
Acute asthma exacerbation
A patient taking montelukast reports new depression and sleep disturbances. What is the nurse’s priority action?
Reassure the patient
Discontinue medication immediately
Notify the healthcare provider
Suggest taking the medication in the morning
Which inhalation device requires the patient to generate sufficient inspiratory flow?
Nebulizer
MDI with spacer
DPI
Respimat inhaler
Why are inhaled medications preferred over oral therapy in asthma management?
Lower cost
Slower onset
Direct delivery to lungs with fewer systemic effects
Elimination of side effects
Which medication requires serum level monitoring due to a narrow therapeutic index?
Albuterol
Budesonide
Theophylline
Montelukast
A patient with glaucoma should use which medication with caution?
Albuterol
Ipratropium
Budesonide
Montelukast
Which action best reduces the risk of oropharyngeal candidiasis with inhaled corticosteroids?
Using a nebulizer
Taking medication with food
Rinsing the mouth after use
Reducing dose frequency
Which LABA characteristic allows formoterol to be used in SMART therapy?
Long duration
Anti-inflammatory effects
Rapid onset of action
Minimal side effects
A patient with COPD asks why antibiotics were prescribed during an exacerbation. What is the best explanation?
All COPD exacerbations require antibiotics
Asthma and COPD use identical treatment
Increased sputum purulence indicates bacterial infection
Antibiotics improve bronchodilation
Which medication is not considered a rescue medication?
Albuterol
Budesonide
Albuterol-ipratropium
ICS-formoterol (SMART)
Which patient teaching point is most important for albuterol use?
A patient using theophylline drinks multiple cups of coffee daily. What is the concern?
Reduced absorption
Increased CNS stimulation
Decreased metabolism
Reduced effectiveness
Which mechanism explains beta-2 agonist bronchodilation?
Blocking acetylcholine
Decreasing leukotrienes
Increasing cAMP
Inhibiting mast cell degranulation
A patient states, “My controller inhaler isn’t helping, so I stopped using it.” What is the best nursing response?
That’s appropriate if you feel better.
Controller medications must be taken daily.
Use it only during attacks.
Double the dose next time.
Which inhaler produces a slow-moving fine mist without propellant?
MDI
DPI
Nebulizer
Respimat
Which corticosteroid effect explains delayed onset of action?
Smooth muscle relaxation
Mast cell stabilization
Alteration of gene transcription
Immediate cytokine suppression
Which LABA safety warning must be reinforced in asthma patients?
Risk of infection
Risk of renal failure
Risk of asthma-related death without ICS
Risk of sedation
Which medication blocks leukotriene receptors?
Zileuton
Montelukast
Roflumilast
Budesonide
A patient with severe liver disease should avoid which medication?
Albuterol
Tiotropium
Roflumilast
Ipratropium
Which device is most appropriate for a patient unable to coordinate inhalation?
DPI
MDI without spacer
Nebulizer
Dry powder inhaler
Which patient teaching statement indicates understanding of SMART therapy?
I will carry two inhalers at all times.
This inhaler treats symptoms and inflammation.
I only use this during severe attacks.
This replaces vaccinations.
Which symptom indicates possible theophylline toxicity?
Mild tremor
Dry mouth
Seizures
Hoarseness
Which medication is classified as a short-acting beta-2 agonist?
Salmeterol
Albuterol
Formoterol
Tiotropium
Which medication is a long-acting muscarinic antagonist?
Ipratropium
Albuterol
What is the primary indication for roflumilast?
Acute asthma
Mild COPD
Severe COPD with chronic bronchitis
Allergic rhinitis
Which drug is a phosphodiesterase inhibitor with multiple mechanisms?
Montelukast
Budesonide
Theophylline
Ipratropium
Which corticosteroid is inhaled?
Prednisone
Methylprednisolone
Budesonide
Dexamethasone
Which medication combination includes an ICS and LABA?
DuoNeb
Stiolto
Symbicort
Spiriva
Which medication has a black box warning for neuropsychiatric effects?
Budesonide
Montelukast
Albuterol
Tiotropium
Which device delivers medication over 5–15 minutes of normal breathing?
DPI
Nebulizer
MDI
Respimat
Which adverse effect is common with beta-2 agonists?
Bradycardia
Tremor
Hypoglycemia
Sedation
Which medication blocks M3 muscarinic receptors?
Montelukast
Budesonide
Ipratropium
Roflumilast
Which medication should be used daily even when symptoms are absent?
Albuterol
Budesonide
Epinephrine
DuoNeb
Which LABA has a rapid onset suitable for SMART therapy?
Salmeterol
Indacaterol
Formoterol
Olodaterol
Which guideline recommends ICS-formoterol for all asthma patients?
GOLD
NAEPP 2020
GINA
ATS
Which vaccination is recommended annually for asthma and COPD patients?
Hepatitis B
Influenza
HPV
Varicella
Which adverse effect is associated with inhaled corticosteroids?
Seizures
Oral candidiasis
Which medication is available OTC as Primatene® Mist?
Albuterol
Epinephrine
Salmeterol
Budesonide
Which condition increases the metabolism of theophylline?
Liver disease
Smoking
Heart failure
Renal impairment
Which inhaler type does not require propellant?
MDI
DPI
Respimat
Nebulizer
Which medication is a leukotriene synthesis inhibitor?
Montelukast
Zileuton
Budesonide
Roflumilast
Which drug requires caution with grapefruit juice due to CYP3A4 interaction?
Albuterol
Budesonide
Montelukast
Ipratropium
Which inhaler improves lung deposition when used with a spacer?
DPI
MDI
Nebulizer
Respimat
Which medication is not recommended for allergic rhinitis unless alternatives fail?
A. Cetirizine
B. Fexofenadine
C. Loratadine
D. Budesonide
Which therapy reduces asthma exacerbations and simplifies treatment?
SABA only
Oral corticosteroids
SMART therapy
Antibiotics
Which medication combination includes a LABA + LAMA?
Symbicort
Advair
Stiolto
Pulmicort
Which medication is metabolized by COMT and MAO enzymes?
Budesonide
Theophylline
Albuterol
Montelukast
Which inhaler is most cost-effective but requires longer administration time?
DPI
Nebulizer
Respimat
MDI
Which medication may cause weight loss and mood changes?
Albuterol
Roflumilast
Ipratropium
Budesonide
Which class of drugs decreases mediator synthesis and inflammatory cell infiltration?
LABAs
Corticosteroids
Anticholinergics
Methylxanthines
Which condition warrants antibiotic use during exacerbation?
Asthma
Mild COPD
COPD with purulent sputum
Exercise-induced bronchospasm
Which patient education topic is essential for both asthma and COPD?
Oxygen titration
Smoking cessation
Insulin administration
Fluid restriction
A patient with asthma states, “I stopped my inhaled steroid because I felt better.” What is the nurse’s best response?
That is appropriate once symptoms improve.
Controller medications should be used only during flare-ups.
Stopping the medication may increase the risk of exacerbations.
You should replace it with albuterol.
A patient using budesonide reports hoarseness and white patches in the mouth. What is the priority nursing action?
Increase the dose
Discontinue medication
Assess inhaler technique and mouth rinsing
Switch to oral corticosteroids
Which medication is most appropriate for acute relief of bronchospasm in a patient with COPD?
Tiotropium
Budesonide
Albuterol
Roflumilast
A patient prescribed formoterol asks why they must also take an inhaled corticosteroid. What is the best explanation?
LABAs cause inflammation
LABAs reduce steroid absorption
LABAs increase asthma-related death risk when used alone
ICS improves bronchodilator onset
Which assessment finding suggests poor asthma control?
A nurse is educating a patient about proper MDI use. Which instruction is correct?
Inhale quickly and forcefully
Exhale fully before inhalation
Hold breath for 2 seconds
Take repeated puffs without waiting
Which medication should be avoided in a patient with a history of severe depression unless benefits outweigh risks?
Albuterol
Budesonide
Montelukast
Tiotropium
A patient with COPD and frequent exacerbations asks why roflumilast was added. What is the correct explanation?
It is a rescue bronchodilator
It reduces airway inflammation and exacerbations
It replaces inhaled therapy
It improves oxygen saturation immediately
Which finding requires immediate provider notification in a patient taking theophylline?
Insomnia
Nausea
Palpitations
New-onset seizures
A patient with asthma uses a DPI incorrectly. Which factor most likely contributes to poor drug delivery?
Slow inhalation
Insufficient inspiratory effort
Use of a spacer
Delayed onset of medication
A nurse is reviewing medications for a patient with asthma and COPD. Which medication is appropriate for both conditions as a rescue option?
(a)
A patient taking oral prednisone for an acute exacerbation asks why the medication is prescribed for only 5–7 days. What is the best response?
Short courses minimize adrenal suppression
The drug loses effectiveness after one week
Long-term therapy worsens asthma control
Tapering is unnecessary
Which teaching point is most important for a patient prescribed tiotropium?
Use as needed for shortness of breath
Expect immediate relief
Use once daily as maintenance therapy
Discontinue albuterol
Which patient statement indicates understanding of nebulizer therapy?
I must inhale deeply and quickly.
I can breathe normally during treatment.
It delivers lower doses than MDIs.
It works faster than all inhalers.
Which adverse effect is most concerning in a patient newly started on roflumilast?
Dry mouth
Weight loss
Tremor
Hoarseness
A patient with asthma is prescribed ICS-formoterol as both maintenance and reliever therapy. This approach is known as:
GOLD therapy
SABA monotherapy
SMART/MART
Step-down therapy
Which factor increases systemic absorption of inhaled asthma medications?
(a)
A patient taking theophylline reports increased caffeine intake. What is the nurse’s primary concern?
Reduced drug levels
Increased risk of CNS stimulation and cardiac effects
Delayed drug absorption
Decreased bronchodilation
Which inhaler device is best for a patient with severe arthritis and poor hand coordination?
DPI
MDI without spacer
Nebulizer
Breath-actuated DPI
A nurse is providing discharge teaching for a patient with COPD. Which instruction is most important to reduce future exacerbations?
Limit fluid intake
Avoid all exercise
Stop smoking
Use rescue inhaler daily
Which medication is classified as a short-acting muscarinic antagonist (SAMA)?
Tiotropium
Ipratropium
Umeclidinium
Glycopyrrolate
Which drug combination contains albuterol and ipratropium?
Symbicort
Advair
DuoNeb
Spiriva
Which medication acts by blocking leukotriene receptors?
Zileuton
Montelukast
Roflumilast
Budesonide
Which class of drugs alters gene transcription to reduce inflammation?
Beta-2 agonists
Anticholinergics
Corticosteroids
Methylxanthines
Which inhaler type delivers medication as a fine, slow-moving mist?
DPI
MDI
Nebulizer
Respimat
Which adverse effect is common with inhaled anticholinergics?
Hypoglycemia
Dry mouth
Bradycardia
Sedation
Which LABA has a rapid onset of action compared with other LABAs?
Salmeterol
Indacaterol
Formoterol
Olodaterol
Which medication is not a bronchodilator?
Albuterol
Tiotropium
Roflumilast
Formoterol
Which guideline is specific to COPD management?
GINA
NAEPP
GOLD
ATS
Which inhaled corticosteroid is metabolized via CYP3A4?
Prednisone
Budesonide
Which medication is associated with oral candidiasis as a side effect?
Albuterol
Budesonide
Montelukast
Tiotropium
Which therapy combines bronchodilation and anti-inflammatory effects in one inhaler?
SABA only
LAMA only
ICS + LABA
PDE4 inhibitor
Which medication is not recommended as monotherapy in asthma?
LABA
SABA
ICS
Leukotriene antagonist
Which patient population may benefit from SMART therapy?
Mild intermittent asthma
Moderate persistent asthma
COPD only
Acute respiratory failure
Which medication is primarily used for maintenance, not acute relief?
Albuterol
Budesonide
Epinephrine
DuoNeb
Which medication requires avoidance of grapefruit juice?
Albuterol
Montelukast
Roflumilast
Ipratropium
Which inhaler requires hand-breath coordination for effective delivery?
Nebulizer
DPI
MDI
Respimat
Which class of medications reduces eosinophil and neutrophil activity in lung tissue?
SABAs
LABAs
PDE4 inhibitors
Anticholinergics
Which medication is approved for exercise-induced asthma prophylaxis?
Montelukast
Tiotropium
Roflumilast
Budesonide
Which non-pharmacologic intervention is emphasized for both asthma and COPD management?
Fluid restriction
Smoking cessation
Bed rest
Low-protein diet
