, NUR 210 Exam 2 | Principles of Pharmacology | Actual
Questions and Answers (PDF) | Galen Nursing
Q1. A patient with symptomatic bradycardia (heart rate 42 bpm) is about to
receive atropine. The nurse understands that this medication works by which
mechanism?
A. Stimulating beta-1 adrenergic receptors directly
B. Blocking muscarinic receptors in the sinoatrial node
C. Inhibiting acetylcholinesterase
D. Stimulating nicotinic receptors in the autonomic ganglia
Correct Answer: B
Rationale: Atropine is a muscarinic antagonist (anticholinergic) that competitively
blocks acetylcholine at muscarinic receptors in the sinoatrial (SA) node. This reduces
vagal tone, allowing the SA node to fire more rapidly and increase heart rate. It is first-
line for symptomatic bradycardia per ACLS guidelines .
Q2. A patient with asthma is prescribed albuterol via metered-dose inhaler. The
nurse explains that this medication works by which mechanism?
A. Blocking beta-2 adrenergic receptors in bronchial smooth muscle
B. Stimulating beta-2 adrenergic receptors to cause bronchodilation
C. Inhibiting acetylcholine release at parasympathetic nerve endings
D. Blocking histamine H1 receptors in the lungs
Correct Answer: B
Rationale: Albuterol is a selective beta-2 adrenergic agonist. Stimulation of beta-2
receptors in bronchial smooth muscle activates adenyl cyclase, increasing cAMP and
causing smooth muscle relaxation (bronchodilation). It is a rescue medication for acute
bronchospasm .
,Q3. Which neurotransmitter is primarily involved in the parasympathetic nervous
system?
A. Norepinephrine
B. Acetylcholine (ACh)
C. Dopamine
D. Serotonin
Correct Answer: B
Rationale: Acetylcholine (ACh) is the primary neurotransmitter for parasympathetic
(cholinergic) responses .
Q4. The neurotransmitter involved in the sympathetic nervous system is:
A. Acetylcholine
B. Norepinephrine
C. Dopamine
D. Serotonin
Correct Answer: B
Rationale: Norepinephrine is the primary neurotransmitter for most sympathetic
postganglionic fibers .
Q5. A patient receiving atropine before surgery reports dry mouth, blurred vision,
and difficulty urinating. What is the nurse's priority action?
A. Hold the next dose and notify the provider
B. Reassure the patient these are expected side effects
C. Administer pilocarpine to reverse the effects
D. Increase fluid intake to 3 L/day
Correct Answer: B
Rationale: Atropine causes predictable anticholinergic effects: dry mouth (decreased
secretions), blurred vision (cycloplegia and mydriasis), and urinary retention (relaxed
, detrusor muscle). These are expected therapeutic effects in preoperative use to reduce
secretions and prevent vagal responses .
Q6. A patient with glaucoma is prescribed pilocarpine, a cholinergic agonist.
Which statement best explains the therapeutic effect of this medication?
A. It causes pupil dilation (mydriasis), improving drainage of aqueous humor
B. It causes pupil constriction (miosis), improving outflow of aqueous humor
C. It decreases production of aqueous humor in the ciliary body
D. It blocks sympathetic stimulation to the eye, reducing intraocular pressure
Correct Answer: B
Rationale: Pilocarpine is a direct-acting cholinergic agonist that stimulates muscarinic
receptors, causing contraction of the sphincter pupillae muscle (miosis) and contraction
of the ciliary muscle. This opens the trabecular meshwork, improving outflow of
aqueous humor and reducing intraocular pressure .
Q7. A patient receiving neostigmine for myasthenia gravis should be monitored
for which sign of cholinergic crisis?
A. Muscle weakness, nausea, diarrhea, and bradycardia
B. Hypertension and tachycardia
C. Dry skin and constipation
D. Dilated pupils and urinary retention
Correct Answer: A
Rationale: Cholinergic crisis results from overstimulation of nicotinic and muscarinic
receptors by excess acetylcholine (from acetylcholinesterase inhibitors like neostigmine).
Symptoms include muscle weakness (nicotinic), nausea, vomiting, diarrhea, salivation,
and bradycardia (muscarinic). It can be difficult to distinguish from myasthenic crisis
(under-medication) .
Questions and Answers (PDF) | Galen Nursing
Q1. A patient with symptomatic bradycardia (heart rate 42 bpm) is about to
receive atropine. The nurse understands that this medication works by which
mechanism?
A. Stimulating beta-1 adrenergic receptors directly
B. Blocking muscarinic receptors in the sinoatrial node
C. Inhibiting acetylcholinesterase
D. Stimulating nicotinic receptors in the autonomic ganglia
Correct Answer: B
Rationale: Atropine is a muscarinic antagonist (anticholinergic) that competitively
blocks acetylcholine at muscarinic receptors in the sinoatrial (SA) node. This reduces
vagal tone, allowing the SA node to fire more rapidly and increase heart rate. It is first-
line for symptomatic bradycardia per ACLS guidelines .
Q2. A patient with asthma is prescribed albuterol via metered-dose inhaler. The
nurse explains that this medication works by which mechanism?
A. Blocking beta-2 adrenergic receptors in bronchial smooth muscle
B. Stimulating beta-2 adrenergic receptors to cause bronchodilation
C. Inhibiting acetylcholine release at parasympathetic nerve endings
D. Blocking histamine H1 receptors in the lungs
Correct Answer: B
Rationale: Albuterol is a selective beta-2 adrenergic agonist. Stimulation of beta-2
receptors in bronchial smooth muscle activates adenyl cyclase, increasing cAMP and
causing smooth muscle relaxation (bronchodilation). It is a rescue medication for acute
bronchospasm .
,Q3. Which neurotransmitter is primarily involved in the parasympathetic nervous
system?
A. Norepinephrine
B. Acetylcholine (ACh)
C. Dopamine
D. Serotonin
Correct Answer: B
Rationale: Acetylcholine (ACh) is the primary neurotransmitter for parasympathetic
(cholinergic) responses .
Q4. The neurotransmitter involved in the sympathetic nervous system is:
A. Acetylcholine
B. Norepinephrine
C. Dopamine
D. Serotonin
Correct Answer: B
Rationale: Norepinephrine is the primary neurotransmitter for most sympathetic
postganglionic fibers .
Q5. A patient receiving atropine before surgery reports dry mouth, blurred vision,
and difficulty urinating. What is the nurse's priority action?
A. Hold the next dose and notify the provider
B. Reassure the patient these are expected side effects
C. Administer pilocarpine to reverse the effects
D. Increase fluid intake to 3 L/day
Correct Answer: B
Rationale: Atropine causes predictable anticholinergic effects: dry mouth (decreased
secretions), blurred vision (cycloplegia and mydriasis), and urinary retention (relaxed
, detrusor muscle). These are expected therapeutic effects in preoperative use to reduce
secretions and prevent vagal responses .
Q6. A patient with glaucoma is prescribed pilocarpine, a cholinergic agonist.
Which statement best explains the therapeutic effect of this medication?
A. It causes pupil dilation (mydriasis), improving drainage of aqueous humor
B. It causes pupil constriction (miosis), improving outflow of aqueous humor
C. It decreases production of aqueous humor in the ciliary body
D. It blocks sympathetic stimulation to the eye, reducing intraocular pressure
Correct Answer: B
Rationale: Pilocarpine is a direct-acting cholinergic agonist that stimulates muscarinic
receptors, causing contraction of the sphincter pupillae muscle (miosis) and contraction
of the ciliary muscle. This opens the trabecular meshwork, improving outflow of
aqueous humor and reducing intraocular pressure .
Q7. A patient receiving neostigmine for myasthenia gravis should be monitored
for which sign of cholinergic crisis?
A. Muscle weakness, nausea, diarrhea, and bradycardia
B. Hypertension and tachycardia
C. Dry skin and constipation
D. Dilated pupils and urinary retention
Correct Answer: A
Rationale: Cholinergic crisis results from overstimulation of nicotinic and muscarinic
receptors by excess acetylcholine (from acetylcholinesterase inhibitors like neostigmine).
Symptoms include muscle weakness (nicotinic), nausea, vomiting, diarrhea, salivation,
and bradycardia (muscarinic). It can be difficult to distinguish from myasthenic crisis
(under-medication) .
