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Worksheets

NCLEX-Style Questions (1–30)

Total questions: 100

Worksheet time: 53mins

Name
Class
Date
1.

A patient with asthma reports using their albuterol inhaler several times daily. What is the nurse’s best response?

a)

This indicates your asthma is well controlled.

b)

You should increase the dose of albuterol.

c)

Frequent use suggests poor control and the need for a controller medication.

d)

This is expected during allergy season.

2.

A patient arrives in the emergency department with acute wheezing and shortness of breath. Which medication provides the fastest relief?

a)

Budesonide

b)

Montelukast

c)

Albuterol

d)

Tiotropium

3.

Which finding requires immediate follow-up in a patient taking theophylline?

a)

Mild insomnia

b)

Serum level of 22 mcg/mL

c)

Heart rate of 88 bpm

d)

Decreased appetite

4.

A nurse is teaching a patient about inhaled corticosteroids. Which statement indicates correct understanding?

a)

I should use this medication only when I feel short of breath.

b)

This medication works immediately.

c)

I need to rinse my mouth after using this inhaler.

d)

This replaces my rescue inhaler.

5.

A patient with COPD is prescribed ipratropium. Which adverse effect should the nurse monitor for?

a)

Hyperglycemia

b)

Dry mouth

c)

Bradycardia

d)

Productive cough

6.

A patient using an MDI without a spacer has poor symptom control. What is the most appropriate nursing intervention?

a)

Increase medication dose

b)

Teach spacer use

7.

Which medication is contraindicated as monotherapy in asthma?

a)

Albuterol

b)

Formoterol

c)

Budesonide

d)

Montelukast

8.

A patient with asthma is prescribed budesonide-formoterol for SMART therapy. Which instruction is correct?

a)

Use only as a rescue medication

b)

Use daily and as needed for symptoms

c)

Discontinue albuterol immediately

d)

Use only during exacerbations

9.

Which patient is the best candidate for roflumilast therapy?

a)

Mild asthma

b)

Exercise-induced asthma

c)

Severe COPD with chronic bronchitis

d)

Acute asthma exacerbation

10.

A patient taking montelukast reports new depression and sleep disturbances. What is the nurse’s priority action?

a)

Reassure the patient

b)

Discontinue medication immediately

c)

Notify the healthcare provider

d)

Suggest taking the medication in the morning

11.

Which inhalation device requires the patient to generate sufficient inspiratory flow?

a)

Nebulizer

b)

MDI with spacer

c)

DPI

d)

Respimat inhaler

12.

Why are inhaled medications preferred over oral therapy in asthma management?

a)

Lower cost

b)

Slower onset

c)

Direct delivery to lungs with fewer systemic effects

d)

Elimination of side effects

13.

Which medication requires serum level monitoring due to a narrow therapeutic index?

a)

Albuterol

b)

Budesonide

c)

Theophylline

d)

Montelukast

14.

A patient with glaucoma should use which medication with caution?

a)

Albuterol

b)

Ipratropium

c)

Budesonide

d)

Montelukast

15.

Which action best reduces the risk of oropharyngeal candidiasis with inhaled corticosteroids?

a)

Using a nebulizer

b)

Taking medication with food

c)

Rinsing the mouth after use

d)

Reducing dose frequency

16.

Which LABA characteristic allows formoterol to be used in SMART therapy?

a)

Long duration

b)

Anti-inflammatory effects

c)

Rapid onset of action

d)

Minimal side effects

17.

A patient with COPD asks why antibiotics were prescribed during an exacerbation. What is the best explanation?

a)

All COPD exacerbations require antibiotics

b)

Asthma and COPD use identical treatment

c)

Increased sputum purulence indicates bacterial infection

d)

Antibiotics improve bronchodilation

18.

Which medication is not considered a rescue medication?

a)

Albuterol

b)

Budesonide

c)

Albuterol-ipratropium

d)

ICS-formoterol (SMART)

19.

Which patient teaching point is most important for albuterol use?

a)

Store in refrigerator

b)

Use before exercise if prescribed

c)

Take with food

d)

Rinse mouth after use

20.

A patient using theophylline drinks multiple cups of coffee daily. What is the concern?

a)

Reduced absorption

b)

Increased CNS stimulation

c)

Decreased metabolism

d)

Reduced effectiveness

21.

Which mechanism explains beta-2 agonist bronchodilation?

a)

Blocking acetylcholine

b)

Decreasing leukotrienes

c)

Increasing cAMP

d)

Inhibiting mast cell degranulation

22.

A patient states, “My controller inhaler isn’t helping, so I stopped using it.” What is the best nursing response?

a)

That’s appropriate if you feel better.

b)

Controller medications must be taken daily.

c)

Use it only during attacks.

d)

Double the dose next time.

23.

Which inhaler produces a slow-moving fine mist without propellant?

a)

MDI

b)

DPI

c)

Nebulizer

d)

Respimat

24.

Which corticosteroid effect explains delayed onset of action?

a)

Smooth muscle relaxation

b)

Mast cell stabilization

c)

Alteration of gene transcription

d)

Immediate cytokine suppression

25.

Which LABA safety warning must be reinforced in asthma patients?

a)

Risk of infection

b)

Risk of renal failure

c)

Risk of asthma-related death without ICS

d)

Risk of sedation

26.

Which medication blocks leukotriene receptors?

a)

Zileuton

b)

Montelukast

c)

Roflumilast

d)

Budesonide

27.

A patient with severe liver disease should avoid which medication?

a)

Albuterol

b)

Tiotropium

c)

Roflumilast

d)

Ipratropium

28.

Which device is most appropriate for a patient unable to coordinate inhalation?

a)

DPI

b)

MDI without spacer

c)

Nebulizer

d)

Dry powder inhaler

29.

Which patient teaching statement indicates understanding of SMART therapy?

a)

I will carry two inhalers at all times.

b)

This inhaler treats symptoms and inflammation.

c)

I only use this during severe attacks.

d)

This replaces vaccinations.

30.

Which symptom indicates possible theophylline toxicity?

a)

Mild tremor

b)

Dry mouth

c)

Seizures

d)

Hoarseness

31.

Which medication is classified as a short-acting beta-2 agonist?

a)

Salmeterol

b)

Albuterol

c)

Formoterol

d)

Tiotropium

32.

Which medication is a long-acting muscarinic antagonist?

a)

Ipratropium

b)

Albuterol

33.

What is the primary indication for roflumilast?

a)

Acute asthma

b)

Mild COPD

c)

Severe COPD with chronic bronchitis

d)

Allergic rhinitis

34.

Which drug is a phosphodiesterase inhibitor with multiple mechanisms?

a)

Montelukast

b)

Budesonide

c)

Theophylline

d)

Ipratropium

35.

Which corticosteroid is inhaled?

a)

Prednisone

b)

Methylprednisolone

c)

Budesonide

d)

Dexamethasone

36.

Which medication combination includes an ICS and LABA?

a)

DuoNeb

b)

Stiolto

c)

Symbicort

d)

Spiriva

37.

Which medication has a black box warning for neuropsychiatric effects?

a)

Budesonide

b)

Montelukast

c)

Albuterol

d)

Tiotropium

38.

Which device delivers medication over 5–15 minutes of normal breathing?

a)

DPI

b)

Nebulizer

c)

MDI

d)

Respimat

39.

Which adverse effect is common with beta-2 agonists?

a)

Bradycardia

b)

Tremor

c)

Hypoglycemia

d)

Sedation

40.

Which medication blocks M3 muscarinic receptors?

a)

Montelukast

b)

Budesonide

c)

Ipratropium

d)

Roflumilast

41.

Which medication should be used daily even when symptoms are absent?

a)

Albuterol

b)

Budesonide

c)

Epinephrine

d)

DuoNeb

42.

Which LABA has a rapid onset suitable for SMART therapy?

a)

Salmeterol

b)

Indacaterol

c)

Formoterol

d)

Olodaterol

43.

Which guideline recommends ICS-formoterol for all asthma patients?

a)

A. GOLD

b)

B. NAEPP 2020

c)

C. GINA

d)

D. ATS

44.

Which vaccination is recommended annually for asthma and COPD patients?

a)

Hepatitis B

b)

Influenza

c)

HPV

d)

Varicella

45.

Which adverse effect is associated with inhaled corticosteroids?

a)

Seizures

b)

Oral candidiasis

46.

Which medication is available OTC as Primatene® Mist?

a)

Albuterol

b)

Epinephrine

c)

Salmeterol

d)

Budesonide

47.

Which condition increases the metabolism of theophylline?

a)

Liver disease

b)

Smoking

c)

Heart failure

d)

Renal impairment

48.

Which inhaler type does not require propellant?

a)

MDI

b)

DPI

c)

Respimat

d)

Nebulizer

49.

Which medication is a leukotriene synthesis inhibitor?

a)

Montelukast

b)

Zileuton

c)

Budesonide

d)

Roflumilast

50.

Which drug requires caution with grapefruit juice due to CYP3A4 interaction?

a)

Albuterol

b)

Budesonide

c)

Montelukast

d)

Ipratropium

51.

Which inhaler improves lung deposition when used with a spacer?

a)

DPI

b)

MDI

c)

Nebulizer

d)

Respimat

52.

Which medication is not recommended for allergic rhinitis unless alternatives fail?

a)

A. Antihistamines

b)

B. Corticosteroids

c)

C. Decongestants

d)

D. Nebulizer

53.

Which therapy reduces asthma exacerbations and simplifies treatment?

a)

SABA only

b)

Oral corticosteroids

c)

SMART therapy

d)

Antibiotics

54.

Which medication combination includes a LABA + LAMA?

a)

Symbicort

b)

Advair

c)

Stiolto

d)

Pulmicort

55.

Which medication is metabolized by COMT and MAO enzymes?

a)

Budesonide

b)

Theophylline

c)

Albuterol

d)

Montelukast

56.

Which inhaler is most cost-effective but requires longer administration time?

a)

DPI

b)

Nebulizer

c)

Respimat

d)

MDI

57.

Which medication may cause weight loss and mood changes?

a)

Albuterol

b)

Roflumilast

c)

Ipratropium

d)

Budesonide

58.

Which class of drugs decreases mediator synthesis and inflammatory cell infiltration?

a)

LABAs

b)

Corticosteroids

c)

Anticholinergics

d)

Methylxanthines

59.

Which condition warrants antibiotic use during exacerbation?

a)

Asthma

b)

Mild COPD

c)

COPD with purulent sputum

d)

Exercise-induced bronchospasm

60.

Which patient education topic is essential for both asthma and COPD?

a)

Oxygen titration

b)

Smoking cessation

c)

Insulin administration

d)

Fluid restriction

61.

A patient with asthma states, “I stopped my inhaled steroid because I felt better.” What is the nurse’s best response?

a)

That is appropriate once symptoms improve.

b)

Controller medications should be used only during flare-ups.

c)

Stopping the medication may increase the risk of exacerbations.

d)

You should replace it with albuterol.

62.

A patient using budesonide reports hoarseness and white patches in the mouth. What is the priority nursing action?

a)

Increase the dose

b)

Discontinue medication

c)

Assess inhaler technique and mouth rinsing

d)

Switch to oral corticosteroids

63.

Which medication is most appropriate for acute relief of bronchospasm in a patient with COPD?

a)

Tiotropium

b)

Budesonide

c)

Albuterol

d)

Roflumilast

64.

A patient prescribed formoterol asks why they must also take an inhaled corticosteroid. What is the best explanation?

a)

LABAs cause inflammation

b)

LABAs reduce steroid absorption

c)

LABAs increase asthma-related death risk when used alone

d)

ICS improves bronchodilator onset

65.

Which assessment finding suggests poor asthma control?

4 lines
66.

A nurse is educating a patient about proper MDI use. Which instruction is correct?

a)

Inhale quickly and forcefully

b)

Exhale fully before inhalation

c)

Hold breath for 2 seconds

d)

Take repeated puffs without waiting

67.

Which medication should be avoided in a patient with a history of severe depression unless benefits outweigh risks?

a)

Albuterol

b)

Budesonide

c)

Montelukast

d)

Tiotropium

68.

A patient with COPD and frequent exacerbations asks why roflumilast was added. What is the correct explanation?

a)

It is a rescue bronchodilator

b)

It reduces airway inflammation and exacerbations

c)

It replaces inhaled therapy

d)

It improves oxygen saturation immediately

69.

Which finding requires immediate provider notification in a patient taking theophylline?

a)

Insomnia

b)

Nausea

c)

Palpitations

d)

New-onset seizures

70.

A patient with asthma uses a DPI incorrectly. Which factor most likely contributes to poor drug delivery?

a)

Slow inhalation

b)

Insufficient inspiratory effort

c)

Use of a spacer

d)

Delayed onset of medication

71.

A nurse is reviewing medications for a patient with asthma and COPD. Which medication is appropriate for both conditions as a rescue option?

(a)  

72.

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?

a)

Short courses minimize adrenal suppression

b)

The drug loses effectiveness after one week

c)

Long-term therapy worsens asthma control

d)

Tapering is unnecessary

73.

Which teaching point is most important for a patient prescribed tiotropium?

a)

Use as needed for shortness of breath

b)

Expect immediate relief

c)

Use once daily as maintenance therapy

d)

Discontinue albuterol

74.

Which patient statement indicates understanding of nebulizer therapy?

a)

I must inhale deeply and quickly.

b)

I can breathe normally during treatment.

c)

It delivers lower doses than MDIs.

d)

It works faster than all inhalers.

75.

Which adverse effect is most concerning in a patient newly started on roflumilast?

a)

Dry mouth

b)

Weight loss

c)

Tremor

d)

Hoarseness

76.

A patient with asthma is prescribed ICS-formoterol as both maintenance and reliever therapy. This approach is known as:

a)

A. GOLD therapy

b)

B. SABA monotherapy

c)

C. SMART/MART

d)

D. Step-down therapy

77.

Which factor increases systemic absorption of inhaled asthma medications?

(a)  

78.

A patient taking theophylline reports increased caffeine intake. What is the nurse’s primary concern?

a)

Reduced drug levels

b)

Increased risk of CNS stimulation and cardiac effects

c)

Delayed drug absorption

d)

Decreased bronchodilation

79.

Which inhaler device is best for a patient with severe arthritis and poor hand coordination?

a)

DPI

b)

MDI without spacer

c)

Nebulizer

d)

Breath-actuated DPI

80.

A nurse is providing discharge teaching for a patient with COPD. Which instruction is most important to reduce future exacerbations?

a)

Limit fluid intake

b)

Avoid all exercise

c)

Stop smoking

d)

Use rescue inhaler daily

81.

Which medication is classified as a short-acting muscarinic antagonist (SAMA)?

a)

Tiotropium

b)

Ipratropium

c)

Umeclidinium

d)

Glycopyrrolate

82.

Which drug combination contains albuterol and ipratropium?

a)

Symbicort

b)

Advair

c)

DuoNeb

d)

Spiriva

83.

Which medication acts by blocking leukotriene receptors?

a)

Zileuton

b)

Montelukast

c)

Roflumilast

d)

Budesonide

84.

Which class of drugs alters gene transcription to reduce inflammation?

a)

Beta-2 agonists

b)

Anticholinergics

c)

Corticosteroids

d)

Methylxanthines

85.

Which inhaler type delivers medication as a fine, slow-moving mist?

a)

DPI

b)

MDI

c)

Nebulizer

d)

Respimat

86.

Which adverse effect is common with inhaled anticholinergics?

a)

Hypoglycemia

b)

Dry mouth

c)

Bradycardia

d)

Sedation

87.

Which LABA has a rapid onset of action compared with other LABAs?

a)

Salmeterol

b)

Indacaterol

c)

Formoterol

d)

Olodaterol

88.

Which medication is not a bronchodilator?

a)

Albuterol

b)

Tiotropium

c)

Roflumilast

d)

Formoterol

89.

Which guideline is specific to COPD management?

a)

A. GINA

b)

B. NAEPP

c)

C. GOLD

d)

D. ATS

90.

Which inhaled corticosteroid is metabolized via CYP3A4?

a)

Prednisone

b)

Budesonide

91.

Which medication is associated with oral candidiasis as a side effect?

a)

Albuterol

b)

Budesonide

c)

Montelukast

d)

Tiotropium

92.

Which therapy combines bronchodilation and anti-inflammatory effects in one inhaler?

a)

SABA only

b)

LAMA only

c)

ICS + LABA

d)

PDE4 inhibitor

93.

Which medication is not recommended as monotherapy in asthma?

a)

LABA

b)

SABA

c)

ICS

d)

Leukotriene antagonist

94.

Which patient population may benefit from SMART therapy?

a)

Mild intermittent asthma

b)

Moderate persistent asthma

c)

COPD only

d)

Acute respiratory failure

95.

Which medication is primarily used for maintenance, not acute relief?

a)

Albuterol

b)

Budesonide

c)

Epinephrine

d)

DuoNeb

96.

Which medication requires avoidance of grapefruit juice?

a)

Albuterol

b)

Montelukast

c)

Roflumilast

d)

Ipratropium

97.

Which inhaler requires hand-breath coordination for effective delivery?

a)

Nebulizer

b)

DPI

c)

MDI

d)

Respimat

98.

Which class of medications reduces eosinophil and neutrophil activity in lung tissue?

a)

SABAs

b)

LABAs

c)

PDE4 inhibitors

d)

Anticholinergics

99.

Which medication is approved for exercise-induced asthma prophylaxis?

a)

Montelukast

b)

Tiotropium

c)

Roflumilast

d)

Budesonide

100.

Which non-pharmacologic intervention is emphasized for both asthma and COPD management?

a)

Fluid restriction

b)

Smoking cessation

c)

Bed rest

d)

Low-protein diet