NUR 635 MIDTERM EXAM / ACTUAL NUR 635 MIDTERM EXAM
2026/2027 ACCURATE EXAM REAL QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES .
1. A 68-year-old patient with Parkinson disease is prescribed
levodopa/carbidopa and asks why another medication such as
bromocriptine might be added to the regimen. Which explanation by the
nurse is most accurate?
A. It blocks dopamine receptors to reduce tremors
B. It increases acetylcholine activity to improve rigidity
C. It stimulates dopamine receptors and can improve motor symptoms
D. It prevents levodopa from crossing the blood-brain barrier
Answer: C
2. A patient taking a newly prescribed medication reports that they
occasionally fall asleep while performing activities such as driving or eating.
Which medication class should cause the nurse to recognize a potentially
serious sleep-attack adverse effect?
A. Dopamine agonists
B. Anticholinergics
C. Beta blockers
D. ACE inhibitors
Answer: A
3. A patient with multiple sclerosis develops painful lower-extremity spasticity
and is prescribed baclofen. Which teaching point is most important?
A. The medication should be stopped abruptly when muscle spasms
improve
B. The medication may cause sedation and should not be discontinued
abruptly
C. The medication permanently eliminates spasticity after several doses
D. The medication should be taken only when severe pain occurs
Answer: B
pg. 1
, 4. A patient with Alzheimer disease is prescribed a transdermal cholinesterase
inhibitor. Which medication would the nurse identify as appropriate for this
purpose?
A. Memantine
B. Haloperidol
C. Bromocriptine
D. Rivastigmine
Answer: D
5. A patient taking an anticholinergic medication reports dry mouth, blurred
vision, urinary retention, and constipation. Which explanation best
describes the pharmacologic basis of these effects?
A. Excessive stimulation of muscarinic receptors
B. Increased stimulation of beta-2 receptors
C. Blockade of muscarinic cholinergic receptors
D. Increased dopamine transmission in the CNS
Answer: C
6. A patient with narrow-angle glaucoma is being evaluated before an
anticholinergic medication is prescribed. Why should the nurse question
this prescription?
A. Anticholinergic effects can increase intraocular pressure
B. Anticholinergic medications increase aqueous humor drainage
C. These medications cause profound hypoglycemia
D. These medications increase parasympathetic stimulation
Answer: A
7. A patient with symptomatic bradycardia is receiving emergency treatment.
Which medication is a parasympatholytic that may be administered to
increase heart rate?
A. Propranolol
B. Atropine
C. Pilocarpine
pg. 2
, D. Bethanechol
Answer: B
8. A patient with glaucoma is prescribed pilocarpine. Which response
demonstrates correct understanding of the medication's therapeutic
purpose?
A. “It will increase my heart rate.”
B. “It will reduce my gastric secretions.”
C. “It will decrease bladder contractions.”
D. “It will help lower pressure inside my eye.”
Answer: D
9. A patient with myasthenia gravis is prescribed pyridostigmine. Which effect
should the nurse expect from this medication?
A. Increased acetylcholine activity at the neuromuscular junction
B. Complete blockade of acetylcholine receptors
C. Reduced skeletal-muscle stimulation
D. Increased dopamine degradation
Answer: A
10. A patient develops severe muscle weakness and respiratory difficulty
related to myasthenic crisis. Which medication may be used to increase
cholinergic transmission?
A. Atropine
B. Neostigmine
C. Scopolamine
D. Benztropine
Answer: B
11. A patient receiving a cholinesterase inhibitor develops excessive salivation,
diarrhea, abdominal cramping, and bradycardia. Which finding most
strongly indicates excessive cholinergic activity?
A. Dilated pupils
B. Urinary retention
C. Tachycardia
pg. 3
, D. Increased gastrointestinal secretions
Answer: D
12. A nurse is explaining pharmacokinetics to a graduate nursing student.
Which sequence correctly describes the major pharmacokinetic processes?
A. Distribution, absorption, excretion, receptor binding
B. Absorption, distribution, metabolism, excretion
C. Metabolism, receptor binding, distribution, absorption
D. Excretion, absorption, metabolism, distribution
Answer: B
13. A patient receives an oral medication that undergoes substantial hepatic
metabolism before reaching systemic circulation. Which pharmacokinetic
concept is most relevant?
A. First-pass effect
B. Protein synthesis
C. Renal clearance
D. Receptor downregulation
Answer: A
14. A patient has severe hypoalbuminemia and is prescribed a highly protein-
bound medication. Why may this patient have an increased risk of adverse
effects?
A. Less medication will be absorbed from the gastrointestinal tract
B. More medication may remain in the bound and inactive state
C. A larger fraction of medication may remain unbound and
pharmacologically active
D. Protein binding completely prevents hepatic metabolism
Answer: C
15. An older adult with significant renal impairment receives a medication
eliminated primarily by the kidneys. Which change should the prescriber
anticipate?
A. Increased renal clearance
B. Reduced risk of accumulation
pg. 4
2026/2027 ACCURATE EXAM REAL QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES .
1. A 68-year-old patient with Parkinson disease is prescribed
levodopa/carbidopa and asks why another medication such as
bromocriptine might be added to the regimen. Which explanation by the
nurse is most accurate?
A. It blocks dopamine receptors to reduce tremors
B. It increases acetylcholine activity to improve rigidity
C. It stimulates dopamine receptors and can improve motor symptoms
D. It prevents levodopa from crossing the blood-brain barrier
Answer: C
2. A patient taking a newly prescribed medication reports that they
occasionally fall asleep while performing activities such as driving or eating.
Which medication class should cause the nurse to recognize a potentially
serious sleep-attack adverse effect?
A. Dopamine agonists
B. Anticholinergics
C. Beta blockers
D. ACE inhibitors
Answer: A
3. A patient with multiple sclerosis develops painful lower-extremity spasticity
and is prescribed baclofen. Which teaching point is most important?
A. The medication should be stopped abruptly when muscle spasms
improve
B. The medication may cause sedation and should not be discontinued
abruptly
C. The medication permanently eliminates spasticity after several doses
D. The medication should be taken only when severe pain occurs
Answer: B
pg. 1
, 4. A patient with Alzheimer disease is prescribed a transdermal cholinesterase
inhibitor. Which medication would the nurse identify as appropriate for this
purpose?
A. Memantine
B. Haloperidol
C. Bromocriptine
D. Rivastigmine
Answer: D
5. A patient taking an anticholinergic medication reports dry mouth, blurred
vision, urinary retention, and constipation. Which explanation best
describes the pharmacologic basis of these effects?
A. Excessive stimulation of muscarinic receptors
B. Increased stimulation of beta-2 receptors
C. Blockade of muscarinic cholinergic receptors
D. Increased dopamine transmission in the CNS
Answer: C
6. A patient with narrow-angle glaucoma is being evaluated before an
anticholinergic medication is prescribed. Why should the nurse question
this prescription?
A. Anticholinergic effects can increase intraocular pressure
B. Anticholinergic medications increase aqueous humor drainage
C. These medications cause profound hypoglycemia
D. These medications increase parasympathetic stimulation
Answer: A
7. A patient with symptomatic bradycardia is receiving emergency treatment.
Which medication is a parasympatholytic that may be administered to
increase heart rate?
A. Propranolol
B. Atropine
C. Pilocarpine
pg. 2
, D. Bethanechol
Answer: B
8. A patient with glaucoma is prescribed pilocarpine. Which response
demonstrates correct understanding of the medication's therapeutic
purpose?
A. “It will increase my heart rate.”
B. “It will reduce my gastric secretions.”
C. “It will decrease bladder contractions.”
D. “It will help lower pressure inside my eye.”
Answer: D
9. A patient with myasthenia gravis is prescribed pyridostigmine. Which effect
should the nurse expect from this medication?
A. Increased acetylcholine activity at the neuromuscular junction
B. Complete blockade of acetylcholine receptors
C. Reduced skeletal-muscle stimulation
D. Increased dopamine degradation
Answer: A
10. A patient develops severe muscle weakness and respiratory difficulty
related to myasthenic crisis. Which medication may be used to increase
cholinergic transmission?
A. Atropine
B. Neostigmine
C. Scopolamine
D. Benztropine
Answer: B
11. A patient receiving a cholinesterase inhibitor develops excessive salivation,
diarrhea, abdominal cramping, and bradycardia. Which finding most
strongly indicates excessive cholinergic activity?
A. Dilated pupils
B. Urinary retention
C. Tachycardia
pg. 3
, D. Increased gastrointestinal secretions
Answer: D
12. A nurse is explaining pharmacokinetics to a graduate nursing student.
Which sequence correctly describes the major pharmacokinetic processes?
A. Distribution, absorption, excretion, receptor binding
B. Absorption, distribution, metabolism, excretion
C. Metabolism, receptor binding, distribution, absorption
D. Excretion, absorption, metabolism, distribution
Answer: B
13. A patient receives an oral medication that undergoes substantial hepatic
metabolism before reaching systemic circulation. Which pharmacokinetic
concept is most relevant?
A. First-pass effect
B. Protein synthesis
C. Renal clearance
D. Receptor downregulation
Answer: A
14. A patient has severe hypoalbuminemia and is prescribed a highly protein-
bound medication. Why may this patient have an increased risk of adverse
effects?
A. Less medication will be absorbed from the gastrointestinal tract
B. More medication may remain in the bound and inactive state
C. A larger fraction of medication may remain unbound and
pharmacologically active
D. Protein binding completely prevents hepatic metabolism
Answer: C
15. An older adult with significant renal impairment receives a medication
eliminated primarily by the kidneys. Which change should the prescriber
anticipate?
A. Increased renal clearance
B. Reduced risk of accumulation
pg. 4
