# A nurse administers a nebulized albuterol treatment to an adult with an acute asthma exacerbation. Which finding should the nurse expect as an EXPECTED short-term effect rather than an adverse reaction?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391767&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse administers a nebulized albuterol treatment to an adult with an acute asthma exacerbation. Which finding should the nurse expect as an EXPECTED short-term effect rather than an adverse reaction?

## Option

1. Oropharyngeal edema and stridor within the first 15 minutes
2. Bilateral pupillary constriction and a heart rate of 50 beats/min
3. Heart rate increase by 20 and mild fine tremor in the hands **✔ Correct answer**
4. Increased wheezing and bronchospasm within the first 5 minutes

**Correct answer: 3**

## Explanation

Correct (2): Albuterol is a beta-2 selective short-acting agonist, but at clinical doses it has beta-1 spillover causing mild tachycardia and skeletal muscle tremor — both predictable, dose-related, and not signs of toxicity at this level. (1) Paradoxical bronchospasm is rare and concerning. (3) Anaphylaxis. (4) Cholinergic/opioid signs, not beta-agonist effects.

## In-depth explanation

Memory Tip Beta-2 agonist side effects = "Tremor, Tachy, Twitchy" — also hypokalemia (K shifts into cells). CPG Check K+ if frequent dosing or with diuretics.

## Clinical scenario

Scenario 28-year-old female in acute asthma exacerbation receiving albuterol 2.5 mg nebulizer. Pre-treatment HR 92, post-treatment HR 112 with mild fine tremor.

## Key concepts

- **Beta-2 agonist** — Albuterol, levalbuterol, salmeterol, formoterol — bronchodilators via beta-2 receptor agonism.
- **Beta-1 spillover** — Higher doses recruit beta-1 receptors, causing tachycardia and palpitations.
- **Albuterol-induced hypokalemia** — K+ shift into cells with beta-2 stimulation; monitor with frequent dosing or diuretic co-use.

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