Report increased frequency of use or no relief (worsening control or impending respiratory failure).
Before you read
Test yourself first: 5 questions
Question 1 of 5
Which is correct teaching for a client using an albuterol metered-dose inhaler as a rescue medication?
Answer: B. Albuterol (short-acting) is the rescue inhaler used at the onset of acute symptoms for quick relief; use a long-acting controller for daily maintenance. Using albuterol only as a daily scheduled controller and skipping it during attacks is incorrect.
Question 2 of 5
A client with chronic obstructive pulmonary disease (COPD) is prescribed a combination inhaler containing a long-acting muscarinic antagonist and a long-acting beta-2 agonist. The client asks why an albuterol inhaler is still prescribed. What is the nurse's best response?
Answer: B. The combination inhaler provides long-acting maintenance bronchodilation but has a slow onset and is not for acute symptoms. Albuterol is a short-acting rescue inhaler used for sudden breathlessness. Keeping the rescue inhaler available is essential. It is not redundant, and the maintenance inhaler should not be skipped.
Question 3 of 5
A child experiencing an asthma exacerbation receives nebulized albuterol. Which finding should the nurse anticipate as an expected effect of this medication?
Answer: B. Albuterol is a short-acting beta-2 agonist; tachycardia, tremors, and jitteriness are common expected adverse effects. Bradycardia, drowsiness, and increased salivation are not associated with beta-agonist therapy.
Question 4 of 5
A nurse is teaching a client how to determine when an albuterol metered-dose inhaler is empty. Which is the most reliable method?
Answer: B. The most reliable way to track inhaler use is to count actuations or use the built-in dose counter if the device has one. Floating the canister in water is inaccurate and is no longer recommended. Relying on taste, sound, or how the canister feels can be misleading and lead to using an empty inhaler during an emergency.
Question 5 of 5
A nurse is teaching a client about the correct use of a metered-dose inhaler (MDI) with a spacer for albuterol. Which instruction is correct?
Answer: C. After actuating the MDI into the spacer, the client should breathe in slowly and deeply, then hold the breath for about 10 seconds to allow the medication to deposit in the lower airways. A spacer is used precisely because it removes the need for perfect hand-breath coordination, and a slow inhalation improves delivery. Rapid breathing and immediate exhalation reduce drug deposition.
Keep the streak going with more questions like these, each with a full rationale.
What is albuterol?
It is the rescue inhaler used first for acute wheezing and shortness of breath. Key principle: it works fast for quick relief but can cause tachycardia and tremor.
Key points to remember
- It is a fast-acting rescue medication, not a maintenance or anti-inflammatory drug.
- Common side effects include tachycardia, tremor, nervousness, and palpitations from beta stimulation.
- When used with an inhaled corticosteroid, give albuterol first to open airways.
- Overuse can cause paradoxical bronchospasm and tolerance, and signals poorly controlled disease.
- It can cause hypokalemia by shifting potassium into cells.
Signs & symptoms
- ↑HR, tremor, nervous, palpitations
- Watch ↓K+ (shifts into cells)
Nursing priorities
- Assess lung sounds, respiratory rate, and oxygen saturation before and after use.
- Monitor heart rate for tachycardia and assess for tremor.
- Teach correct metered-dose inhaler technique with a spacer.
- Give the bronchodilator before the steroid inhaler when both are ordered.
- Evaluate frequency of rescue use to assess asthma control.
Labs & values
Patient teaching
- This is your rescue inhaler; carry it at all times for sudden symptoms.
- Rinse the mouth and use a spacer for best delivery.
- Report needing it more than twice a week, which means your asthma is not controlled.
Red flags: report now
- Report increased frequency of use or no relief (worsening control or impending respiratory failure).
- Report chest pain or heart rate over 120 (excess beta stimulation).
- Report worsening wheeze after use (paradoxical bronchospasm).
References
Clinical references for this topic
