, NURS 1150 Exam 2 – Nurse Pharmacology I
(2026/2027) | 50 Questions & Correct Answers
with Rationales | NCLEX NGN Style | Northwest
College (NWC)
Question 1: Cholinergic Agonists — Bethanechol
A nurse is caring for a postoperative client experiencing non-obstructive urinary
retention. The provider orders Bethanechol 10 mg PO TID. Which physiological effect
should the nurse expect following administration?
• A. Relaxation of the detrusor muscle and contraction of the internal urethral
sphincter
• B. Contraction of the detrusor muscle and relaxation of the internal urethral
sphincter to promote micturition
• C. Inhibition of salivary gland secretions and dry mouth
• D. Bronchodilation and tachycardia
Correct Answer: B. Contraction of the detrusor muscle and relaxation of the
internal urethral sphincter to promote micturition
Rationale: Bethanechol is a direct-acting parasympathomimetic (cholinergic agonist)
that selectively stimulates muscarinic receptors. It contracts the detrusor muscle of the
urinary bladder and relaxes the trigone and sphincter, facilitating urine voiding. Side
effects include parasympathetic stimulation (bradycardia, hypotension, diaphoresis,
abdominal cramps, and bronchospasm).
Question 2: Cholinergic Crisis vs. Myasthenic Crisis — Edrophonium
Test
A client with Myasthenia Gravis presents to the emergency department with severe
generalized muscle weakness and acute respiratory distress. To differentiate between a
Myasthenic Crisis and a Cholinergic Crisis, an IV dose of Edrophonium (Tensilon) is
administered. What finding indicates that the client is experiencing a Cholinergic
Crisis?
• A. Immediate improvement in muscle strength and respiratory effort
• B. Sudden worsening of muscle weakness, increased lacrimation, salivation, and
bradycardia
• C. Complete resolution of ptosis and diplopia
• D. Transient rise in systolic blood pressure without cardiac changes
, Correct Answer: B. Sudden worsening of muscle weakness, increased
lacrimation, salivation, and bradycardia
Rationale: Edrophonium is an ultra-short-acting acetylcholinesterase inhibitor. If the
client improves, it is a Myasthenic Crisis (under-medicated). If muscle weakness
worsens along with parasympathetic excess (SLUDGE symptoms: Salivation,
Lacrimation, Urination, Defecation, GI distress, Emesis), it is a Cholinergic Crisis (over-
medicated). Atropine sulfate must be immediately available as the antidote for
cholinergic crisis.
Question 3: Anticholinergic Drugs — Atropine Toxicity
A client received intravenous Atropine for severe symptomatic bradycardia. The nurse
assesses the client 30 minutes later. Which clinical manifestations indicate atropine
toxicity (anticholinergic syndrome)?
• A. Profuse sweating, diarrhea, pupillary constriction, and hypersalivation
• B. Hyperthermia, dry flushed skin, mydriasis (dilated pupils), delirium, and urinary
retention
• C. Bradycardia, hypotension, and excessive tearing
• D. Muscle flaccidity, hypoglycemia, and bronchorrhea
Correct Answer: B. Hyperthermia, dry flushed skin, mydriasis (dilated pupils),
delirium, and urinary retention
Rationale: Classic anticholinergic toxicity is remembered by the mnemonic: "Hot as a
hare (hyperthermia), Mad as a hatter (delirium/confusion), Red as a beet (flushed skin),
Dry as a bone (anhidrosis/dry mouth), Blind as a bat (mydriasis/cycloplegia)." Central
nervous system excitation, tachycardia, and urinary retention are hallmark symptoms.
Question 4: Neuromuscular Blocking Agents — Succinylcholine &
Malignant Hyperthermia
A surgical client receives Succinylcholine IV for rapid sequence endotracheal intubation.
Minutes later, the anesthesia provider notes masseter muscle spasm, severe sinus
tachycardia, hypercapnia (𝐸𝑇𝐶𝑂2 > 65 mmHg), and a rapidly climbing core body
temperature. What is the nurse's priority collaborative intervention?
• A. Administer IV atropine to slow the heart rate.
• B. Discontinue succinylcholine, hyperventilate with 100% oxygen, and administer
IV Dantrolene Sodium.
• C. Place the client in Trendelenburg position and infuse warm 0.9% normal
saline.
• D. Administer neostigmine to reverse neuromuscular blockade.
(2026/2027) | 50 Questions & Correct Answers
with Rationales | NCLEX NGN Style | Northwest
College (NWC)
Question 1: Cholinergic Agonists — Bethanechol
A nurse is caring for a postoperative client experiencing non-obstructive urinary
retention. The provider orders Bethanechol 10 mg PO TID. Which physiological effect
should the nurse expect following administration?
• A. Relaxation of the detrusor muscle and contraction of the internal urethral
sphincter
• B. Contraction of the detrusor muscle and relaxation of the internal urethral
sphincter to promote micturition
• C. Inhibition of salivary gland secretions and dry mouth
• D. Bronchodilation and tachycardia
Correct Answer: B. Contraction of the detrusor muscle and relaxation of the
internal urethral sphincter to promote micturition
Rationale: Bethanechol is a direct-acting parasympathomimetic (cholinergic agonist)
that selectively stimulates muscarinic receptors. It contracts the detrusor muscle of the
urinary bladder and relaxes the trigone and sphincter, facilitating urine voiding. Side
effects include parasympathetic stimulation (bradycardia, hypotension, diaphoresis,
abdominal cramps, and bronchospasm).
Question 2: Cholinergic Crisis vs. Myasthenic Crisis — Edrophonium
Test
A client with Myasthenia Gravis presents to the emergency department with severe
generalized muscle weakness and acute respiratory distress. To differentiate between a
Myasthenic Crisis and a Cholinergic Crisis, an IV dose of Edrophonium (Tensilon) is
administered. What finding indicates that the client is experiencing a Cholinergic
Crisis?
• A. Immediate improvement in muscle strength and respiratory effort
• B. Sudden worsening of muscle weakness, increased lacrimation, salivation, and
bradycardia
• C. Complete resolution of ptosis and diplopia
• D. Transient rise in systolic blood pressure without cardiac changes
, Correct Answer: B. Sudden worsening of muscle weakness, increased
lacrimation, salivation, and bradycardia
Rationale: Edrophonium is an ultra-short-acting acetylcholinesterase inhibitor. If the
client improves, it is a Myasthenic Crisis (under-medicated). If muscle weakness
worsens along with parasympathetic excess (SLUDGE symptoms: Salivation,
Lacrimation, Urination, Defecation, GI distress, Emesis), it is a Cholinergic Crisis (over-
medicated). Atropine sulfate must be immediately available as the antidote for
cholinergic crisis.
Question 3: Anticholinergic Drugs — Atropine Toxicity
A client received intravenous Atropine for severe symptomatic bradycardia. The nurse
assesses the client 30 minutes later. Which clinical manifestations indicate atropine
toxicity (anticholinergic syndrome)?
• A. Profuse sweating, diarrhea, pupillary constriction, and hypersalivation
• B. Hyperthermia, dry flushed skin, mydriasis (dilated pupils), delirium, and urinary
retention
• C. Bradycardia, hypotension, and excessive tearing
• D. Muscle flaccidity, hypoglycemia, and bronchorrhea
Correct Answer: B. Hyperthermia, dry flushed skin, mydriasis (dilated pupils),
delirium, and urinary retention
Rationale: Classic anticholinergic toxicity is remembered by the mnemonic: "Hot as a
hare (hyperthermia), Mad as a hatter (delirium/confusion), Red as a beet (flushed skin),
Dry as a bone (anhidrosis/dry mouth), Blind as a bat (mydriasis/cycloplegia)." Central
nervous system excitation, tachycardia, and urinary retention are hallmark symptoms.
Question 4: Neuromuscular Blocking Agents — Succinylcholine &
Malignant Hyperthermia
A surgical client receives Succinylcholine IV for rapid sequence endotracheal intubation.
Minutes later, the anesthesia provider notes masseter muscle spasm, severe sinus
tachycardia, hypercapnia (𝐸𝑇𝐶𝑂2 > 65 mmHg), and a rapidly climbing core body
temperature. What is the nurse's priority collaborative intervention?
• A. Administer IV atropine to slow the heart rate.
• B. Discontinue succinylcholine, hyperventilate with 100% oxygen, and administer
IV Dantrolene Sodium.
• C. Place the client in Trendelenburg position and infuse warm 0.9% normal
saline.
• D. Administer neostigmine to reverse neuromuscular blockade.
