ARIZONA COLLEGE OF NURSING — NUR 354 PHARMACOLOGY II EXAM 1 2026
COURSE: NUR 354 Pharmacology II | INSTITUTION: Arizona College of Nursing
TERM: Fall 2026 | EXAM TYPE: Exam 1 Comprehensive Practice Examination (50 Items)
INSTRUCTIONS: Select the best answer (A, B, C, or D) for each item. All items are strictly grounded in course
materials.
1. A patient in the ICU is in septic shock and receiving norepinephrine by IV infusion. Why is
frequent inspection of the IV insertion site a critical nursing priority?
A. Norepinephrine rapidly degrades when exposed to plastic IV tubing.
B. Frequent site checks prevent the rapid development of systemic hyperkalemia.
C. The IV site must be rotated every 2 hours to avoid severe rebound hypertension.
D. Norepinephrine can cause local tissue damage and necrosis if extravasation occurs.
✔■ Correct Answer: (D) Norepinephrine can cause local tissue damage and necrosis if extravasation occurs.
■ Rationale: Extravasation and leakage of vasopressors like norepinephrine at the IV insertion site cause
severe local tissue damage and sloughing [8, 14, 41]. Phentolamine is used as the antidote to treat tissue
damage from extravasation [7, 19, 41].
2. A nurse is caring for a patient who was administered succinylcholine during emergency intubation.
Which life-threatening adverse reaction should the nurse continuously monitor for?
A. Acute renal failure from rapid rhabdomyolysis
B. Severe hypothermia and generalized muscle flaccidity
C. Malignant hyperthermia characterized by muscle rigidity and tachycardia
D. Profound hypertension and reflex bradycardia
✔■ Correct Answer: (C) Malignant hyperthermia characterized by muscle rigidity and tachycardia
■ Rationale: Succinylcholine is a neuromuscular blocker whose major adverse effect is malignant hyperthermia,
evidenced by muscle rigidity, jaw/thigh muscle spasms, tachycardia, tachypnea, hypercarbia, and late elevated
temperature [44, 45, 52]. The antidote for malignant hyperthermia is dantrolene [37, 43, 45, 53].
3. A patient with myasthenia gravis is receiving pyridostigmine. Which assessment finding indicates to
the nurse that the patient is experiencing a cholinergic crisis from excessive medication?
A. Tachycardia, dilated pupils, and severe hypertension
B. Dry mouth, constipation, and urinary retention
C. Hypersalivation, bradycardia, sweating, and muscle weakness
D. Restlessness, insomnia, and hyperthermia
✔■ Correct Answer: (C) Hypersalivation, bradycardia, sweating, and muscle weakness
■ Rationale: A cholinergic crisis results from excessive acetylcholine and manifests with pale skin, bradycardia,
muscle weakness, hypersalivation/drooling, muscle twitching, sweating, tearing, abdominal cramps, and
bronchospasm [17, 39, 46, 51]. Atropine is the antidote used to reverse a cholinergic crisis [17, 37, 46, 49, 51].
4. Which intravenous fluid solution is classified as hypertonic and causes fluid to be drawn out of the cells
into the extracellular space?
A. 5% Dextrose in Water (D5W)
B. 0.9% Normal Saline
C. Lactated Ringer's
D. 3% Sodium Chloride
✔■ Correct Answer: (D) 3% Sodium Chloride
■ Rationale: Hypertonic solutions such as 3% Sodium Chloride (3% NS), 5% NS, and D10W contain a higher
concentration of solutes than blood plasma, drawing water out of cells into the extracellular space and causing
cells to shrink [12, 55]. Isotonic solutions include 0.9% NS, Lactated Ringer's, and Plasma-Lyte [6, 12, 46, 48,
55].
Page 1 of 50
Questions
, ARIZONA COLLEGE OF NURSING — NUR 354 PHARMACOLOGY II EXAM 1 2026
5. A patient with Parkinson's disease is prescribed benztropine. Which co-existing condition represents a
strict Black Box Warning contraindication for this drug?
A. Essential tremor
B. Narrow-angle glaucoma
C. Chronic obstructive pulmonary disease (COPD)
D. Irritable bowel syndrome (IBS)
✔■ Correct Answer: (B) Narrow-angle glaucoma
■ Rationale: Benztropine is a centrally acting anticholinergic drug used to decrease tremors and
extrapyramidal symptoms in Parkinson's disease [20, 54]. It carries a Black Box Warning contraindication for
patients with narrow-angle glaucoma [21, 54].
6. A patient in hypovolemic shock due to severe dehydration from prolonged vomiting is receiving
IV dopamine. What finding indicates to the nurse that dopamine therapy is successful?
A. Improved urine output and increased blood pressure
B. Mild peripheral vasodilation and decreased cardiac output
C. Decreased heart rate and pupil constriction
D. Resolution of skin rash and reduced core temperature
✔■ Correct Answer: (A) Improved urine output and increased blood pressure
■ Rationale: Dopamine is a nonselective adrenergic agonist and inotropic drug used in shock [40]. Successful
therapy is indicated by improved urine output and increased blood pressure, as low doses stimulate
dopaminergic receptors to increase renal perfusion ('P in dopamine makes me Pee') [8, 40, 56].
7. A nurse is preparing to administer phenytoin (Dilantin) to a female patient with a history of tonic-
clonic seizures. Which critical safety instruction must the nurse keep in mind regarding this medication?
A. It carries a strict Black Box Warning and must NOT be used in pregnancy.
B. The target therapeutic blood level range is 50 to 100 mcg/mL.
C. It increases the effectiveness of oral contraceptives.
D. It is completely safe during pregnancy but contraindicated in liver disease.
✔■ Correct Answer: (A) It carries a strict Black Box Warning and must NOT be used in pregnancy.
■ Rationale: Phenytoin (Dilantin) is a hydantoin antiseizure drug that desensitizes sodium channels [1, 30]. It
has a Black Box Warning stating it must NOT be used during pregnancy [1, 31]. Its therapeutic blood level
range is 10-20 mcg/mL, and it decreases the effectiveness of oral contraceptives [31].
8. A patient experiencing severe anaphylactic shock from a penicillin allergy is administered
epinephrine. Which nursing interventions are mandatory following administration?
A. Administer a continuous infusion of a neuromuscular blocker
B. Restrict fluid intake and place the patient in a prone position
C. Monitor blood pressure, level of consciousness, and respiratory rate
D. Assess for hyperkalemia and decreased central venous pressure
✔■ Correct Answer: (C) Monitor blood pressure, level of consciousness, and respiratory rate
■ Rationale: Anaphylactic shock is an acute allergic reaction causing severe hemodynamic and respiratory
failure [2, 13, 48]. When epinephrine is given for anaphylaxis, the nurse must closely monitor blood pressure
(BP), level of consciousness (LOC), and respiratory rate (RR) [3].
Page 2 of 50
Questions
COURSE: NUR 354 Pharmacology II | INSTITUTION: Arizona College of Nursing
TERM: Fall 2026 | EXAM TYPE: Exam 1 Comprehensive Practice Examination (50 Items)
INSTRUCTIONS: Select the best answer (A, B, C, or D) for each item. All items are strictly grounded in course
materials.
1. A patient in the ICU is in septic shock and receiving norepinephrine by IV infusion. Why is
frequent inspection of the IV insertion site a critical nursing priority?
A. Norepinephrine rapidly degrades when exposed to plastic IV tubing.
B. Frequent site checks prevent the rapid development of systemic hyperkalemia.
C. The IV site must be rotated every 2 hours to avoid severe rebound hypertension.
D. Norepinephrine can cause local tissue damage and necrosis if extravasation occurs.
✔■ Correct Answer: (D) Norepinephrine can cause local tissue damage and necrosis if extravasation occurs.
■ Rationale: Extravasation and leakage of vasopressors like norepinephrine at the IV insertion site cause
severe local tissue damage and sloughing [8, 14, 41]. Phentolamine is used as the antidote to treat tissue
damage from extravasation [7, 19, 41].
2. A nurse is caring for a patient who was administered succinylcholine during emergency intubation.
Which life-threatening adverse reaction should the nurse continuously monitor for?
A. Acute renal failure from rapid rhabdomyolysis
B. Severe hypothermia and generalized muscle flaccidity
C. Malignant hyperthermia characterized by muscle rigidity and tachycardia
D. Profound hypertension and reflex bradycardia
✔■ Correct Answer: (C) Malignant hyperthermia characterized by muscle rigidity and tachycardia
■ Rationale: Succinylcholine is a neuromuscular blocker whose major adverse effect is malignant hyperthermia,
evidenced by muscle rigidity, jaw/thigh muscle spasms, tachycardia, tachypnea, hypercarbia, and late elevated
temperature [44, 45, 52]. The antidote for malignant hyperthermia is dantrolene [37, 43, 45, 53].
3. A patient with myasthenia gravis is receiving pyridostigmine. Which assessment finding indicates to
the nurse that the patient is experiencing a cholinergic crisis from excessive medication?
A. Tachycardia, dilated pupils, and severe hypertension
B. Dry mouth, constipation, and urinary retention
C. Hypersalivation, bradycardia, sweating, and muscle weakness
D. Restlessness, insomnia, and hyperthermia
✔■ Correct Answer: (C) Hypersalivation, bradycardia, sweating, and muscle weakness
■ Rationale: A cholinergic crisis results from excessive acetylcholine and manifests with pale skin, bradycardia,
muscle weakness, hypersalivation/drooling, muscle twitching, sweating, tearing, abdominal cramps, and
bronchospasm [17, 39, 46, 51]. Atropine is the antidote used to reverse a cholinergic crisis [17, 37, 46, 49, 51].
4. Which intravenous fluid solution is classified as hypertonic and causes fluid to be drawn out of the cells
into the extracellular space?
A. 5% Dextrose in Water (D5W)
B. 0.9% Normal Saline
C. Lactated Ringer's
D. 3% Sodium Chloride
✔■ Correct Answer: (D) 3% Sodium Chloride
■ Rationale: Hypertonic solutions such as 3% Sodium Chloride (3% NS), 5% NS, and D10W contain a higher
concentration of solutes than blood plasma, drawing water out of cells into the extracellular space and causing
cells to shrink [12, 55]. Isotonic solutions include 0.9% NS, Lactated Ringer's, and Plasma-Lyte [6, 12, 46, 48,
55].
Page 1 of 50
Questions
, ARIZONA COLLEGE OF NURSING — NUR 354 PHARMACOLOGY II EXAM 1 2026
5. A patient with Parkinson's disease is prescribed benztropine. Which co-existing condition represents a
strict Black Box Warning contraindication for this drug?
A. Essential tremor
B. Narrow-angle glaucoma
C. Chronic obstructive pulmonary disease (COPD)
D. Irritable bowel syndrome (IBS)
✔■ Correct Answer: (B) Narrow-angle glaucoma
■ Rationale: Benztropine is a centrally acting anticholinergic drug used to decrease tremors and
extrapyramidal symptoms in Parkinson's disease [20, 54]. It carries a Black Box Warning contraindication for
patients with narrow-angle glaucoma [21, 54].
6. A patient in hypovolemic shock due to severe dehydration from prolonged vomiting is receiving
IV dopamine. What finding indicates to the nurse that dopamine therapy is successful?
A. Improved urine output and increased blood pressure
B. Mild peripheral vasodilation and decreased cardiac output
C. Decreased heart rate and pupil constriction
D. Resolution of skin rash and reduced core temperature
✔■ Correct Answer: (A) Improved urine output and increased blood pressure
■ Rationale: Dopamine is a nonselective adrenergic agonist and inotropic drug used in shock [40]. Successful
therapy is indicated by improved urine output and increased blood pressure, as low doses stimulate
dopaminergic receptors to increase renal perfusion ('P in dopamine makes me Pee') [8, 40, 56].
7. A nurse is preparing to administer phenytoin (Dilantin) to a female patient with a history of tonic-
clonic seizures. Which critical safety instruction must the nurse keep in mind regarding this medication?
A. It carries a strict Black Box Warning and must NOT be used in pregnancy.
B. The target therapeutic blood level range is 50 to 100 mcg/mL.
C. It increases the effectiveness of oral contraceptives.
D. It is completely safe during pregnancy but contraindicated in liver disease.
✔■ Correct Answer: (A) It carries a strict Black Box Warning and must NOT be used in pregnancy.
■ Rationale: Phenytoin (Dilantin) is a hydantoin antiseizure drug that desensitizes sodium channels [1, 30]. It
has a Black Box Warning stating it must NOT be used during pregnancy [1, 31]. Its therapeutic blood level
range is 10-20 mcg/mL, and it decreases the effectiveness of oral contraceptives [31].
8. A patient experiencing severe anaphylactic shock from a penicillin allergy is administered
epinephrine. Which nursing interventions are mandatory following administration?
A. Administer a continuous infusion of a neuromuscular blocker
B. Restrict fluid intake and place the patient in a prone position
C. Monitor blood pressure, level of consciousness, and respiratory rate
D. Assess for hyperkalemia and decreased central venous pressure
✔■ Correct Answer: (C) Monitor blood pressure, level of consciousness, and respiratory rate
■ Rationale: Anaphylactic shock is an acute allergic reaction causing severe hemodynamic and respiratory
failure [2, 13, 48]. When epinephrine is given for anaphylaxis, the nurse must closely monitor blood pressure
(BP), level of consciousness (LOC), and respiratory rate (RR) [3].
Page 2 of 50
Questions
