NURS 5334 – Advanced Pharmacology Final Exam
(2025–2026) Comprehensive Study Guide with
Questions, Answers, and Rationales
1. Charlie is a 65-year-old male with hypertension and benign prostatic
hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
A. Increases peripheral vasoconstriction
B. Decreases detrusor muscle contractility
C. Lowers supine blood pressure more than standing pressure
D. Relaxes smooth muscle in the bladder neck
Rationale: Doxazosin is an alpha-1 adrenergic blocker. It relaxes smooth muscle
in the bladder neck and prostate, improving urinary flow while lowering peripheral
vascular resistance.
2. To reduce potential adverse effects, patients taking a peripherally acting
alpha1 antagonist should do all of the following EXCEPT:
A. Take the dose at bedtime
B. Sit up slowly and dangle their feet before standing
C. Monitor their blood pressure and skip a dose if the pressure is less than
120/80
D. Weigh daily and report weight gain of greater than 2 pounds in one day
Rationale: Skipping doses can cause uncontrolled hypertension. Patients should
monitor for hypotension and postural dizziness but continue medication as
prescribed.
3. John has clonidine, a centrally-acting adrenergic blocker, prescribed for his
hypertension. He should:
A. Not miss a dose or stop taking the drug because of potential rebound
hypertension
B. Increase fiber in the diet to treat any diarrhea that may occur
C. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
,D. Avoid sitting for long periods, as this can lead to deep vein thrombosis
Rationale: Abrupt cessation of clonidine can cause rebound hypertension due to
sudden surge in sympathetic activity.
4. Clonidine has several off-label uses, including:
A. Alcohol withdrawal
B. Post-herpetic neuralgia
C. Both 1 and 2
D. Neither 1 nor 2
Rationale: Clonidine’s central alpha-2 agonist activity helps reduce sympathetic
overactivity in alcohol/nicotine withdrawal and has analgesic effects in neuropathic
pain.
5. Jim is being treated for hypertension. Because he has a history of heart
attacks, the drug chosen is atenolol. Beta-blockers treat hypertension by:
A. Increasing heart rate to improve cardiac output
B. Reducing vascular smooth muscle tone
C. Increasing aldosterone-mediated volume activity
D. Reducing aqueous humor production
Rationale: Beta-blockers decrease sympathetic stimulation of the heart and
vasculature, reducing heart rate and vascular resistance, which lowers blood
pressure.
6. Which of the following adverse effects are less likely in a beta 1-selective
blocker?
A. Dysrhythmias
B. Impaired insulin release
C. Reflex orthostatic changes
D. Decreased triglycerides and cholesterol
Rationale: Beta-1 selective blockers primarily act on the heart, sparing pancreatic
beta-2 receptors, so the risk of impaired insulin release is lower compared to non-
selective beta-blockers.
, 7. Richard is 70 years old with cardiac dysrhythmias and CrCl of 25 ml/min.
Nadolol has been prescribed. What should be done?
A. Extend the dosage interval
B. Decrease the dose by 75%
C. Take no action because this value is expected in the older adult
D. Schedule a serum creatinine level to validate the CrCl value
Rationale: Nadolol is renally excreted. In renal impairment, extending the dosing
interval prevents drug accumulation and toxicity.
8. Beta blockers are the drugs of choice for exertional angina because they:
A. Improve myocardial oxygen supply by vasodilating the coronary arteries
B. Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
C. Both 1 and 2
D. Neither 1 nor 2
Rationale: Beta-blockers reduce oxygen demand by lowering heart rate and
contractility; they do not directly increase oxygen supply via vasodilation.
9. Adherence to beta-blocker therapy may be affected by their:
A. Short half-lives requiring twice daily dosing
B. Tendency to elevate lipid levels
C. Effects on the male genitalia, which may produce impotence
D. None of the above
Rationale: Sexual side effects, especially erectile dysfunction, are a common
reason patients stop taking beta-blockers.
10. Beta-blockers have favorable effects on survival and disease progression in
heart failure. Treatment should be initiated when:
A. Symptoms are severe
B. Patient has not responded to other therapies
C. Patient has concurrent hypertension
D. Left ventricular dysfunction is diagnosed
Rationale: Early initiation in left ventricular dysfunction improves remodeling and
survival, even before symptoms are severe.
(2025–2026) Comprehensive Study Guide with
Questions, Answers, and Rationales
1. Charlie is a 65-year-old male with hypertension and benign prostatic
hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
A. Increases peripheral vasoconstriction
B. Decreases detrusor muscle contractility
C. Lowers supine blood pressure more than standing pressure
D. Relaxes smooth muscle in the bladder neck
Rationale: Doxazosin is an alpha-1 adrenergic blocker. It relaxes smooth muscle
in the bladder neck and prostate, improving urinary flow while lowering peripheral
vascular resistance.
2. To reduce potential adverse effects, patients taking a peripherally acting
alpha1 antagonist should do all of the following EXCEPT:
A. Take the dose at bedtime
B. Sit up slowly and dangle their feet before standing
C. Monitor their blood pressure and skip a dose if the pressure is less than
120/80
D. Weigh daily and report weight gain of greater than 2 pounds in one day
Rationale: Skipping doses can cause uncontrolled hypertension. Patients should
monitor for hypotension and postural dizziness but continue medication as
prescribed.
3. John has clonidine, a centrally-acting adrenergic blocker, prescribed for his
hypertension. He should:
A. Not miss a dose or stop taking the drug because of potential rebound
hypertension
B. Increase fiber in the diet to treat any diarrhea that may occur
C. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
,D. Avoid sitting for long periods, as this can lead to deep vein thrombosis
Rationale: Abrupt cessation of clonidine can cause rebound hypertension due to
sudden surge in sympathetic activity.
4. Clonidine has several off-label uses, including:
A. Alcohol withdrawal
B. Post-herpetic neuralgia
C. Both 1 and 2
D. Neither 1 nor 2
Rationale: Clonidine’s central alpha-2 agonist activity helps reduce sympathetic
overactivity in alcohol/nicotine withdrawal and has analgesic effects in neuropathic
pain.
5. Jim is being treated for hypertension. Because he has a history of heart
attacks, the drug chosen is atenolol. Beta-blockers treat hypertension by:
A. Increasing heart rate to improve cardiac output
B. Reducing vascular smooth muscle tone
C. Increasing aldosterone-mediated volume activity
D. Reducing aqueous humor production
Rationale: Beta-blockers decrease sympathetic stimulation of the heart and
vasculature, reducing heart rate and vascular resistance, which lowers blood
pressure.
6. Which of the following adverse effects are less likely in a beta 1-selective
blocker?
A. Dysrhythmias
B. Impaired insulin release
C. Reflex orthostatic changes
D. Decreased triglycerides and cholesterol
Rationale: Beta-1 selective blockers primarily act on the heart, sparing pancreatic
beta-2 receptors, so the risk of impaired insulin release is lower compared to non-
selective beta-blockers.
, 7. Richard is 70 years old with cardiac dysrhythmias and CrCl of 25 ml/min.
Nadolol has been prescribed. What should be done?
A. Extend the dosage interval
B. Decrease the dose by 75%
C. Take no action because this value is expected in the older adult
D. Schedule a serum creatinine level to validate the CrCl value
Rationale: Nadolol is renally excreted. In renal impairment, extending the dosing
interval prevents drug accumulation and toxicity.
8. Beta blockers are the drugs of choice for exertional angina because they:
A. Improve myocardial oxygen supply by vasodilating the coronary arteries
B. Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
C. Both 1 and 2
D. Neither 1 nor 2
Rationale: Beta-blockers reduce oxygen demand by lowering heart rate and
contractility; they do not directly increase oxygen supply via vasodilation.
9. Adherence to beta-blocker therapy may be affected by their:
A. Short half-lives requiring twice daily dosing
B. Tendency to elevate lipid levels
C. Effects on the male genitalia, which may produce impotence
D. None of the above
Rationale: Sexual side effects, especially erectile dysfunction, are a common
reason patients stop taking beta-blockers.
10. Beta-blockers have favorable effects on survival and disease progression in
heart failure. Treatment should be initiated when:
A. Symptoms are severe
B. Patient has not responded to other therapies
C. Patient has concurrent hypertension
D. Left ventricular dysfunction is diagnosed
Rationale: Early initiation in left ventricular dysfunction improves remodeling and
survival, even before symptoms are severe.
