NUR 210 — PHARMACOLOGY EXAM 2: 100 NCLEX-STYLE
QUESTIONS with answers and rationales. (answers and
rationales are at end of questions)
Unit 4: Adrenergic & Cholinergic Drugs | Unit 5: Parkinson's, Alzheimer's, MG, Muscle
Relaxants | All NCLEX Test Plan | Galen-Style
DIRECTIONS: Select the ONE BEST answer (unless SELECT ALL THAT APPLY is specified).
★ ADRENERGIC AGONISTS (EPINEPHRINE)
1. A client presents to the emergency department in anaphylactic shock after a bee
sting. The nurse administers epinephrine. Which physiological effects does the nurse
expect? SELECT ALL THAT APPLY.
A. Increased heart rate (beta-1 stimulation)
B. Bronchodilation (beta-2 stimulation)
C. Decreased blood pressure from vasodilation
D. Vasoconstriction and increased blood pressure (alpha-1 stimulation)
E. Pupil constriction (miosis)
2. Aclient with diabetes mellitus receives epinephrine for anaphylaxis. Which additional
assessment is the nurse's priority?
A. Urine output
B. Blood glucose level — epinephrine activates glycogenolysis causing hyperglycemia
C. Bowel sounds
D. Skin turgor
3. Anurse is teaching a client how to use an EpiPen. Which instruction is INCORRECT and
requires the nurse to correct it?
A. "Use the EpiPen at the first sign of an allergic reaction."
B. "Inject into the outer thigh and hold in place for 5-10 seconds, then massage the site."
C. "Store the EpiPen in the refrigerator to keep it stable."
D. "Notify your provider if you need to use the EpiPen more than twice a week."
4. A client is receiving IV epinephrine. Which action by the nurse is MOST important to ensure
client safety?
A. Administer via rapid IV push for fastest effect
B. Place the client on a cardiac monitor and administer at 1 mg/minute IV
C. Administer subcutaneously only — IV is contraindicated
D. Monitor bowel sounds every 4 hours
5. Aclient taking an MAOI antidepressant requires epinephrine for anaphylaxis. What is the
nurse's priority concern?
A. MAOIs decrease the effectiveness of epinephrine — a higher dose is needed
, B. MAOIs intensify and prolong the effects of epinephrine — dangerously high BP may result
C. MAOIs cause bronchodilation, making epinephrine unnecessary
D. There is no interaction between MAOIs and epinephrine
6. Epinephrine is prescribed for a client with glaucoma who developed anaphylaxis. What
should the nurse do?
A. Give the epinephrine without concern — anaphylaxis is life-threatening and takes priority
B. Refuse to give epinephrine because glaucoma is a contraindication
C. Administer as prescribed since anaphylaxis is life-threatening, but notify the provider of
the glaucoma history
D. Give half the dose to reduce the risk of increased intraocular pressure
7. Whichdrug interaction is MOST concerning when a client receiving digoxin requires
epinephrine for cardiac arrest?
A. Epinephrine decreases digoxin levels, reducing its effectiveness
B. Epinephrine combined with digoxin increases the risk of cardiac dysrhythmias
C. Digoxin blocks the beta-2 effects of epinephrine
D. The combination causes severe hypotension
8. A
nurse is reviewing the action of epinephrine on adrenergic receptors. Which statement
CORRECTLY describes the alpha-1 receptor response?
A. Alpha-1 stimulation causes bronchodilation and decreased blood pressure
, B. Alpha-1 stimulation causes vasoconstriction, increased blood pressure, pupil dilation, and
bladder sphincter contraction
C. Alpha-1 stimulation increases heart rate and cardiac contractility
D. Alpha-1 stimulation causes relaxation of smooth muscle in the uterus
9. Aclient with asthma and cardiac arrhythmias requires epinephrine. The nurse recognizes
which combination as a priority concern?
A. Asthma is a contraindication to epinephrine — alternative treatment must be found
B. Epinephrine can cause cardiac dysrhythmias, and the client's existing arrhythmia
increases the risk — cardiac monitoring is essential
C. Epinephrine is safe in arrhythmias because it is used for cardiac arrest
D. The asthma makes epinephrine more effective due to beta-2 stimulation
10. Thenurse is caring for a client who received epinephrine 20 minutes ago for
anaphylaxis. The client now reports chest pain and palpitations. What action should the
nurse take FIRST?
A. Document the finding as expected — epinephrine commonly causes chest discomfort
B. Administer propranolol as prescribed PRN to counteract the tachycardia
C. Obtain vital signs and place the client on cardiac monitoring immediately
D. Encourage the client to take slow, deep breaths and reassess
11. Which EpiPen teaching points should the nurse include? SELECT ALL THAT APPLY.
A. Have the EpiPen available at all times
B. Store additional medication in a cool, dark place — not the refrigerator
C. Use EpiPen immediately at the first sign of reaction
D. Inject into the intradermal tissue of the arm
E. Notify provider if EpiPen is needed more than twice a week
12. Anurse explains to a nursing student why epinephrine raises blood glucose. Which
explanation is CORRECT?
A. Epinephrine stimulates alpha-1 receptors in the pancreas to release glucose
B. Epinephrine's beta-2 stimulation activates liver glycogenolysis, releasing glucose into the
bloodstream
C. Epinephrine inhibits insulin secretion, causing passive glucose elevation
D. Epinephrine causes renal glucose reabsorption, raising serum glucose
★ ADRENERGIC BLOCKERS (ATENOLOL)
13. Thenurse is preparing to administer atenolol to a client with hypertension. The client's
apical pulse is 54 beats/min. What is the nurse's PRIORITY action?
A. Administer
the medication as ordered — 54 bpm is within normal range
B. HOLD the medication and notify the provider — pulse below 60 bpm is a standard hold
, parameter for beta blockers
C. Administer half the dose and recheck the pulse in 30 minutes
D. Give the medication and document the low pulse rate
14. Adiabetic client on atenolol develops diaphoresis and confusion. Which action is the nurse's
priority?
A. Assess for hypertensive crisis — atenolol can cause sudden BP elevation
B. Check blood glucose — beta blockers MASK hypoglycemia signs (tremors, tachycardia
hidden) but diaphoresis remains
C. Assess for infection — confusion and sweating indicate fever
D. Administer atropine for suspected bradycardia
15. A
client prescribed propranolol (a non-selective beta blocker) has a history of asthma.
Why does the nurse question this prescription?
A. Propranolol begins with "P" — letters N-Z are non-selective and block beta-1 AND beta-
2, causing bronchoconstriction which can trigger a severe asthma attack
B. Propranolol is selective for beta-1, making it the safest choice for asthma
C. Non-selective beta blockers cause bronchodilation, worsening asthma
D. Propranolol is contraindicated only in COPD, not asthma
QUESTIONS with answers and rationales. (answers and
rationales are at end of questions)
Unit 4: Adrenergic & Cholinergic Drugs | Unit 5: Parkinson's, Alzheimer's, MG, Muscle
Relaxants | All NCLEX Test Plan | Galen-Style
DIRECTIONS: Select the ONE BEST answer (unless SELECT ALL THAT APPLY is specified).
★ ADRENERGIC AGONISTS (EPINEPHRINE)
1. A client presents to the emergency department in anaphylactic shock after a bee
sting. The nurse administers epinephrine. Which physiological effects does the nurse
expect? SELECT ALL THAT APPLY.
A. Increased heart rate (beta-1 stimulation)
B. Bronchodilation (beta-2 stimulation)
C. Decreased blood pressure from vasodilation
D. Vasoconstriction and increased blood pressure (alpha-1 stimulation)
E. Pupil constriction (miosis)
2. Aclient with diabetes mellitus receives epinephrine for anaphylaxis. Which additional
assessment is the nurse's priority?
A. Urine output
B. Blood glucose level — epinephrine activates glycogenolysis causing hyperglycemia
C. Bowel sounds
D. Skin turgor
3. Anurse is teaching a client how to use an EpiPen. Which instruction is INCORRECT and
requires the nurse to correct it?
A. "Use the EpiPen at the first sign of an allergic reaction."
B. "Inject into the outer thigh and hold in place for 5-10 seconds, then massage the site."
C. "Store the EpiPen in the refrigerator to keep it stable."
D. "Notify your provider if you need to use the EpiPen more than twice a week."
4. A client is receiving IV epinephrine. Which action by the nurse is MOST important to ensure
client safety?
A. Administer via rapid IV push for fastest effect
B. Place the client on a cardiac monitor and administer at 1 mg/minute IV
C. Administer subcutaneously only — IV is contraindicated
D. Monitor bowel sounds every 4 hours
5. Aclient taking an MAOI antidepressant requires epinephrine for anaphylaxis. What is the
nurse's priority concern?
A. MAOIs decrease the effectiveness of epinephrine — a higher dose is needed
, B. MAOIs intensify and prolong the effects of epinephrine — dangerously high BP may result
C. MAOIs cause bronchodilation, making epinephrine unnecessary
D. There is no interaction between MAOIs and epinephrine
6. Epinephrine is prescribed for a client with glaucoma who developed anaphylaxis. What
should the nurse do?
A. Give the epinephrine without concern — anaphylaxis is life-threatening and takes priority
B. Refuse to give epinephrine because glaucoma is a contraindication
C. Administer as prescribed since anaphylaxis is life-threatening, but notify the provider of
the glaucoma history
D. Give half the dose to reduce the risk of increased intraocular pressure
7. Whichdrug interaction is MOST concerning when a client receiving digoxin requires
epinephrine for cardiac arrest?
A. Epinephrine decreases digoxin levels, reducing its effectiveness
B. Epinephrine combined with digoxin increases the risk of cardiac dysrhythmias
C. Digoxin blocks the beta-2 effects of epinephrine
D. The combination causes severe hypotension
8. A
nurse is reviewing the action of epinephrine on adrenergic receptors. Which statement
CORRECTLY describes the alpha-1 receptor response?
A. Alpha-1 stimulation causes bronchodilation and decreased blood pressure
, B. Alpha-1 stimulation causes vasoconstriction, increased blood pressure, pupil dilation, and
bladder sphincter contraction
C. Alpha-1 stimulation increases heart rate and cardiac contractility
D. Alpha-1 stimulation causes relaxation of smooth muscle in the uterus
9. Aclient with asthma and cardiac arrhythmias requires epinephrine. The nurse recognizes
which combination as a priority concern?
A. Asthma is a contraindication to epinephrine — alternative treatment must be found
B. Epinephrine can cause cardiac dysrhythmias, and the client's existing arrhythmia
increases the risk — cardiac monitoring is essential
C. Epinephrine is safe in arrhythmias because it is used for cardiac arrest
D. The asthma makes epinephrine more effective due to beta-2 stimulation
10. Thenurse is caring for a client who received epinephrine 20 minutes ago for
anaphylaxis. The client now reports chest pain and palpitations. What action should the
nurse take FIRST?
A. Document the finding as expected — epinephrine commonly causes chest discomfort
B. Administer propranolol as prescribed PRN to counteract the tachycardia
C. Obtain vital signs and place the client on cardiac monitoring immediately
D. Encourage the client to take slow, deep breaths and reassess
11. Which EpiPen teaching points should the nurse include? SELECT ALL THAT APPLY.
A. Have the EpiPen available at all times
B. Store additional medication in a cool, dark place — not the refrigerator
C. Use EpiPen immediately at the first sign of reaction
D. Inject into the intradermal tissue of the arm
E. Notify provider if EpiPen is needed more than twice a week
12. Anurse explains to a nursing student why epinephrine raises blood glucose. Which
explanation is CORRECT?
A. Epinephrine stimulates alpha-1 receptors in the pancreas to release glucose
B. Epinephrine's beta-2 stimulation activates liver glycogenolysis, releasing glucose into the
bloodstream
C. Epinephrine inhibits insulin secretion, causing passive glucose elevation
D. Epinephrine causes renal glucose reabsorption, raising serum glucose
★ ADRENERGIC BLOCKERS (ATENOLOL)
13. Thenurse is preparing to administer atenolol to a client with hypertension. The client's
apical pulse is 54 beats/min. What is the nurse's PRIORITY action?
A. Administer
the medication as ordered — 54 bpm is within normal range
B. HOLD the medication and notify the provider — pulse below 60 bpm is a standard hold
, parameter for beta blockers
C. Administer half the dose and recheck the pulse in 30 minutes
D. Give the medication and document the low pulse rate
14. Adiabetic client on atenolol develops diaphoresis and confusion. Which action is the nurse's
priority?
A. Assess for hypertensive crisis — atenolol can cause sudden BP elevation
B. Check blood glucose — beta blockers MASK hypoglycemia signs (tremors, tachycardia
hidden) but diaphoresis remains
C. Assess for infection — confusion and sweating indicate fever
D. Administer atropine for suspected bradycardia
15. A
client prescribed propranolol (a non-selective beta blocker) has a history of asthma.
Why does the nurse question this prescription?
A. Propranolol begins with "P" — letters N-Z are non-selective and block beta-1 AND beta-
2, causing bronchoconstriction which can trigger a severe asthma attack
B. Propranolol is selective for beta-1, making it the safest choice for asthma
C. Non-selective beta blockers cause bronchodilation, worsening asthma
D. Propranolol is contraindicated only in COPD, not asthma
