# A nurse cares for an older adult with COPD who develops palpitations and HR 130 after each albuterol nebulizer treatment. The provider switches to levalbuterol. Which client outcome is the most likely intended benefit?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391769&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse cares for an older adult with COPD who develops palpitations and HR 130 after each albuterol nebulizer treatment. The provider switches to levalbuterol. Which client outcome is the most likely intended benefit?

## Option

1. Stronger overall bronchodilation than albuterol
2. Conversion of paroxysmal atrial fibrillation to sinus rhythm
3. Reduced risk of pneumonia
4. Bronchodilation with reduced tachycardia and tremor due to delivery of only the active R-isomer **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): Albuterol is a racemic mixture of R-(active) and S-(inactive, may be pro-inflammatory) isomers. Levalbuterol is the purified R-isomer, marketed for similar bronchodilation with theoretically fewer beta-1 mediated side effects (tachycardia, tremor). Useful in clients with cardiac comorbidities. (1) Similar bronchodilation, not stronger. (3) Unrelated. (4) No antiarrhythmic effect.

## In-depth explanation

Memory Tip Levalbuterol = "Lev-er a-Better-tolerated" pure R-isomer. Beware: cost is much higher than albuterol; clinical benefit modest.

## Clinical scenario

Scenario 72-year-old male with COPD, atrial fibrillation. Albuterol nebulizer causes palpitations, HR 130. Provider switches to levalbuterol 1.25 mg nebulizer.

## Key concepts

- **Levalbuterol** — Single R-isomer beta-2 agonist; alternative to racemic albuterol for clients with tachycardia.
- **Racemic mixture** — Albuterol contains both R-(active) and S-(possibly pro-inflammatory) isomers.
- **Cardiac comorbidity** — AF, CHF, CAD; consider levalbuterol or careful albuterol monitoring.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=391769&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391769&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391769&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391769&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391769&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._