PHARMACOLOGY NURS 251 MODULE 8 EXAM 2026/2027
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Respiratory Drugs (Questions 1-30)
Q1: A patient with acute asthma exacerbation is prescribed albuterol via metered-dose inhaler
(MDI). Which statement by the patient indicates a need for further teaching regarding proper
MDI technique?
A. "I will shake the inhaler well right before I use it."
B. "I will exhale fully and place my lips tightly around the mouthpiece."
C. "I will press the canister to release the medication and then immediately inhale." [CORRECT]
D. "I will hold my breath for about 10 seconds after inhaling the medication."
Correct Answer: C
Rationale: The correct MDI technique requires the patient to press the canister and begin a
slow, deep inhalation simultaneously or just after actuation; actuating before inhaling wastes the
medication. Shaking, exhaling fully, sealing lips, and breath-holding are all correct steps for MDI
use. Module 8 Exam Insight: Portage/ABCnursing frequently tests the exact sequencing of
inhaler maneuvers, specifically identifying the error of actuating prior to inhalation as a common
knowledge deficit.
Q2: A nurse is caring for a patient with COPD who is taking salmeterol (Serevent) twice daily.
Which finding requires immediate intervention by the nurse?
A. The patient reports a sore throat and hoarse voice.
B. The patient is using the salmeterol inhaler as the only medication for acute shortness of
breath. [CORRECT]
C. The patient's heart rate is 88 beats per minute.
D. The patient reports occasional dry mouth.
Correct Answer: B
Rationale: Salmeterol is a long-acting beta-2 agonist (LABA) and carries a black box warning
that LABA monotherapy increases asthma-related death; it must never be used as a rescue
inhaler for acute bronchospasm. Sore throat, hoarseness, mild tachycardia, and dry mouth are
,expected adverse effects that do not require immediate intervention compared to the
life-threatening risk of misusing a LABA for rescue. Module 8 Exam Insight: Geneva College
exams heavily emphasize the SMART study black box warning and the absolute
contraindication of using LABAs for acute symptom relief.
Q3: A patient with severe persistent asthma is prescribed fluticasone/salmeterol (Advair). What
is the primary pharmacologic rationale for combining these two drugs?
A. The combination prevents the development of thrush and dysphonia.
B. Salmeterol provides immediate relief while fluticasone prevents inflammation.
C. Fluticasone suppresses airway inflammation while salmeterol provides sustained
bronchodilation, mitigating the LABA monotherapy risk. [CORRECT]
D. Salmeterol enhances the systemic absorption of fluticasone, increasing its anti-inflammatory
effect.
Correct Answer: C
Rationale: Advair combines an inhaled corticosteroid (fluticasone) to reduce underlying
inflammation with a LABA (salmeterol) for prolonged bronchodilation. This combination
addresses both pathways of asthma pathophysiology and specifically fulfills the black box
requirement that LABAs must be used concurrently with an inhaled corticosteroid. Salmeterol is
not a SABA (no immediate relief), and the combination does not prevent thrush (which is
actually a risk of the ICS component). Module 8 Exam Insight: Identifying the pharmacologic
synergy and safety rationale for ICS/LABA combination products is a core NCLEX and NURS
251 testing pattern.
Q4: A nurse is teaching a patient how to use a dry powder inhaler (DPI) containing tiotropium
(Spiriva). Which instruction should the nurse include?
A. "Shake the inhaler vigorously for 5 seconds before removing the cap."
B. "Exhale forcefully into the mouthpiece to clear any moisture."
C. "Load the dose, exhale away from the device, and then inhale rapidly and deeply."
[CORRECT]
D. "Actuate the dose and inhale slowly over 3 to 5 seconds like an MDI."
Correct Answer: C
Rationale: DPIs require a rapid, deep inhalation to disaggregate the powder and carry it to the
lungs, unlike the slow inhalation needed for an MDI. Patients should never shake a DPI (this
packs the powder) or exhale into the device (moisture damages the dose). Actuation is
mechanical (loading a capsule or clicking a lever), not chemical like an MDI. Module 8 Exam
,Insight: Distinguishing between the slow inhalation of an MDI/spacer versus the forceful
inhalation required for a DPI is a classic application question on the Portage Module 8 exam.
Q5: A patient with COPD asks why they must rinse their mouth after using their fluticasone
(Flovent) inhaler. What is the nurse's best response?
A. "Rinsing prevents the medication from being absorbed systemically and causing muscle
tremors."
B. "Rinsing removes the drug residue to prevent local adverse effects like oral candidiasis and
hoarseness." [CORRECT]
C. "Rinsing enhances the bronchodilatory effect of the medication in your lungs."
D. "Rinsing prevents you from swallowing the drug, which could cause severe nausea."
Correct Answer: B
Rationale: Inhaled corticosteroids like fluticasone deposit in the oropharynx and can suppress
local immunity, leading to oropharyngeal candidiasis (thrush) and dysphonia. Rinsing the mouth
with water and spitting it out removes this residue and significantly reduces these local adverse
effects. Systemic tremors are a beta-agonist effect, not an ICS effect, and rinsing does not alter
lung deposition or cause systemic nausea. Module 8 Exam Insight: ABCnursing exams
consistently test the exact nursing intervention for ICS-induced thrush, emphasizing that the
patient must spit, not swallow, the rinse water.
Q6: A patient is receiving nebulized ipratropium (Atrovent). The nurse observes the patient
rubbing their eyes during the treatment. Which adverse effect is the patient at highest risk for
developing?
A. Tachycardia and palpitations
B. Pupillary dilation and acute angle-closure glaucoma [CORRECT]
C. Hypokalemia and muscle cramping
D. Bronchospasm and wheezing
Correct Answer: B
Rationale: Ipratropium is a muscarinic antagonist (anticholinergic). If the nebulized mist comes
into direct contact with the eyes, it can cause mydriasis (pupillary dilation) and precipitate acute
angle-closure glaucoma, especially in predisposed patients. Tachycardia and hypokalemia are
adverse effects of beta-2 agonists, not anticholinergics. Module 8 Exam Insight: Geneva College
testing patterns specifically highlight the risk of accidental ocular exposure to nebulized
anticholinergics and the resulting need for protective eyewear or proper nebulizer mask
placement.
, Q7: A patient with asthma is prescribed montelukast (Singulair). Which statement by the patient
indicates understanding of the medication's administration and safety profile?
A. "I will take this medication every morning for the best control of my daytime symptoms."
B. "I understand this is a rescue medication that will open my airways quickly during an attack."
C. "I will take this medication in the evening and report any mood changes or suicidal thoughts
to my doctor." [CORRECT]
D. "I will need regular liver function tests because this drug frequently causes hepatotoxicity."
Correct Answer: C
Rationale: Montelukast is administered once daily in the evening for allergic rhinitis and asthma
maintenance. It carries an FDA black box warning for neuropsychiatric events, including
agitation, depression, and suicidality, which patients must report immediately. It is not a rescue
bronchodilator, and while hepatotoxicity is a risk with zileuton and zafirlukast, it is rare with
montelukast and does not mandate routine LFTs. Module 8 Exam Insight: The Portage Learning
exam heavily tests the specific timing (evening) and the black box warning (suicidality) of
montelukast, differentiating it from other leukotriene modifiers.
Q8: A patient is admitted with severe acute asthma exacerbation and is prescribed intravenous
methylprednisolone (Solu-Medrol). Which adverse effect should the nurse monitor for during the
first 24 hours of therapy?
A. Bradycardia and hypotension
B. Hyperglycemia and fluid retention [CORRECT]
C. Tardive dyskinesia and dystonic reactions
D. Respiratory depression and decreased cough reflex
Correct Answer: B
Rationale: Systemic corticosteroids cause rapid metabolic effects, including hyperglycemia (due
to gluconeogenesis and insulin resistance) and fluid retention (mineralocorticoid effect).
Bradycardia and respiratory depression are not expected; in fact, systemic steroids often cause
a transient leukocytosis and slight tachycardia. Tardive dyskinesia is associated with dopamine
antagonists like metoclopramide. Module 8 Exam Insight: NURS 251 questions frequently link
acute high-dose IV corticosteroids to immediate metabolic monitoring (blood glucose, intake and
output) rather than long-term adverse effects like osteoporosis.
Q9: A nurse is reviewing the medication profile of a patient prescribed theophylline for COPD.
Which concurrent medication or condition will most significantly increase the risk of theophylline
toxicity?
A. The patient smokes a pack of cigarettes daily.
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Respiratory Drugs (Questions 1-30)
Q1: A patient with acute asthma exacerbation is prescribed albuterol via metered-dose inhaler
(MDI). Which statement by the patient indicates a need for further teaching regarding proper
MDI technique?
A. "I will shake the inhaler well right before I use it."
B. "I will exhale fully and place my lips tightly around the mouthpiece."
C. "I will press the canister to release the medication and then immediately inhale." [CORRECT]
D. "I will hold my breath for about 10 seconds after inhaling the medication."
Correct Answer: C
Rationale: The correct MDI technique requires the patient to press the canister and begin a
slow, deep inhalation simultaneously or just after actuation; actuating before inhaling wastes the
medication. Shaking, exhaling fully, sealing lips, and breath-holding are all correct steps for MDI
use. Module 8 Exam Insight: Portage/ABCnursing frequently tests the exact sequencing of
inhaler maneuvers, specifically identifying the error of actuating prior to inhalation as a common
knowledge deficit.
Q2: A nurse is caring for a patient with COPD who is taking salmeterol (Serevent) twice daily.
Which finding requires immediate intervention by the nurse?
A. The patient reports a sore throat and hoarse voice.
B. The patient is using the salmeterol inhaler as the only medication for acute shortness of
breath. [CORRECT]
C. The patient's heart rate is 88 beats per minute.
D. The patient reports occasional dry mouth.
Correct Answer: B
Rationale: Salmeterol is a long-acting beta-2 agonist (LABA) and carries a black box warning
that LABA monotherapy increases asthma-related death; it must never be used as a rescue
inhaler for acute bronchospasm. Sore throat, hoarseness, mild tachycardia, and dry mouth are
,expected adverse effects that do not require immediate intervention compared to the
life-threatening risk of misusing a LABA for rescue. Module 8 Exam Insight: Geneva College
exams heavily emphasize the SMART study black box warning and the absolute
contraindication of using LABAs for acute symptom relief.
Q3: A patient with severe persistent asthma is prescribed fluticasone/salmeterol (Advair). What
is the primary pharmacologic rationale for combining these two drugs?
A. The combination prevents the development of thrush and dysphonia.
B. Salmeterol provides immediate relief while fluticasone prevents inflammation.
C. Fluticasone suppresses airway inflammation while salmeterol provides sustained
bronchodilation, mitigating the LABA monotherapy risk. [CORRECT]
D. Salmeterol enhances the systemic absorption of fluticasone, increasing its anti-inflammatory
effect.
Correct Answer: C
Rationale: Advair combines an inhaled corticosteroid (fluticasone) to reduce underlying
inflammation with a LABA (salmeterol) for prolonged bronchodilation. This combination
addresses both pathways of asthma pathophysiology and specifically fulfills the black box
requirement that LABAs must be used concurrently with an inhaled corticosteroid. Salmeterol is
not a SABA (no immediate relief), and the combination does not prevent thrush (which is
actually a risk of the ICS component). Module 8 Exam Insight: Identifying the pharmacologic
synergy and safety rationale for ICS/LABA combination products is a core NCLEX and NURS
251 testing pattern.
Q4: A nurse is teaching a patient how to use a dry powder inhaler (DPI) containing tiotropium
(Spiriva). Which instruction should the nurse include?
A. "Shake the inhaler vigorously for 5 seconds before removing the cap."
B. "Exhale forcefully into the mouthpiece to clear any moisture."
C. "Load the dose, exhale away from the device, and then inhale rapidly and deeply."
[CORRECT]
D. "Actuate the dose and inhale slowly over 3 to 5 seconds like an MDI."
Correct Answer: C
Rationale: DPIs require a rapid, deep inhalation to disaggregate the powder and carry it to the
lungs, unlike the slow inhalation needed for an MDI. Patients should never shake a DPI (this
packs the powder) or exhale into the device (moisture damages the dose). Actuation is
mechanical (loading a capsule or clicking a lever), not chemical like an MDI. Module 8 Exam
,Insight: Distinguishing between the slow inhalation of an MDI/spacer versus the forceful
inhalation required for a DPI is a classic application question on the Portage Module 8 exam.
Q5: A patient with COPD asks why they must rinse their mouth after using their fluticasone
(Flovent) inhaler. What is the nurse's best response?
A. "Rinsing prevents the medication from being absorbed systemically and causing muscle
tremors."
B. "Rinsing removes the drug residue to prevent local adverse effects like oral candidiasis and
hoarseness." [CORRECT]
C. "Rinsing enhances the bronchodilatory effect of the medication in your lungs."
D. "Rinsing prevents you from swallowing the drug, which could cause severe nausea."
Correct Answer: B
Rationale: Inhaled corticosteroids like fluticasone deposit in the oropharynx and can suppress
local immunity, leading to oropharyngeal candidiasis (thrush) and dysphonia. Rinsing the mouth
with water and spitting it out removes this residue and significantly reduces these local adverse
effects. Systemic tremors are a beta-agonist effect, not an ICS effect, and rinsing does not alter
lung deposition or cause systemic nausea. Module 8 Exam Insight: ABCnursing exams
consistently test the exact nursing intervention for ICS-induced thrush, emphasizing that the
patient must spit, not swallow, the rinse water.
Q6: A patient is receiving nebulized ipratropium (Atrovent). The nurse observes the patient
rubbing their eyes during the treatment. Which adverse effect is the patient at highest risk for
developing?
A. Tachycardia and palpitations
B. Pupillary dilation and acute angle-closure glaucoma [CORRECT]
C. Hypokalemia and muscle cramping
D. Bronchospasm and wheezing
Correct Answer: B
Rationale: Ipratropium is a muscarinic antagonist (anticholinergic). If the nebulized mist comes
into direct contact with the eyes, it can cause mydriasis (pupillary dilation) and precipitate acute
angle-closure glaucoma, especially in predisposed patients. Tachycardia and hypokalemia are
adverse effects of beta-2 agonists, not anticholinergics. Module 8 Exam Insight: Geneva College
testing patterns specifically highlight the risk of accidental ocular exposure to nebulized
anticholinergics and the resulting need for protective eyewear or proper nebulizer mask
placement.
, Q7: A patient with asthma is prescribed montelukast (Singulair). Which statement by the patient
indicates understanding of the medication's administration and safety profile?
A. "I will take this medication every morning for the best control of my daytime symptoms."
B. "I understand this is a rescue medication that will open my airways quickly during an attack."
C. "I will take this medication in the evening and report any mood changes or suicidal thoughts
to my doctor." [CORRECT]
D. "I will need regular liver function tests because this drug frequently causes hepatotoxicity."
Correct Answer: C
Rationale: Montelukast is administered once daily in the evening for allergic rhinitis and asthma
maintenance. It carries an FDA black box warning for neuropsychiatric events, including
agitation, depression, and suicidality, which patients must report immediately. It is not a rescue
bronchodilator, and while hepatotoxicity is a risk with zileuton and zafirlukast, it is rare with
montelukast and does not mandate routine LFTs. Module 8 Exam Insight: The Portage Learning
exam heavily tests the specific timing (evening) and the black box warning (suicidality) of
montelukast, differentiating it from other leukotriene modifiers.
Q8: A patient is admitted with severe acute asthma exacerbation and is prescribed intravenous
methylprednisolone (Solu-Medrol). Which adverse effect should the nurse monitor for during the
first 24 hours of therapy?
A. Bradycardia and hypotension
B. Hyperglycemia and fluid retention [CORRECT]
C. Tardive dyskinesia and dystonic reactions
D. Respiratory depression and decreased cough reflex
Correct Answer: B
Rationale: Systemic corticosteroids cause rapid metabolic effects, including hyperglycemia (due
to gluconeogenesis and insulin resistance) and fluid retention (mineralocorticoid effect).
Bradycardia and respiratory depression are not expected; in fact, systemic steroids often cause
a transient leukocytosis and slight tachycardia. Tardive dyskinesia is associated with dopamine
antagonists like metoclopramide. Module 8 Exam Insight: NURS 251 questions frequently link
acute high-dose IV corticosteroids to immediate metabolic monitoring (blood glucose, intake and
output) rather than long-term adverse effects like osteoporosis.
Q9: A nurse is reviewing the medication profile of a patient prescribed theophylline for COPD.
Which concurrent medication or condition will most significantly increase the risk of theophylline
toxicity?
A. The patient smokes a pack of cigarettes daily.
