NR 508 Advanced Pharmacology
Midterm – 2025/2026 – Questions &
Verified A+ Answers | Chamberlain
Autonomic Nervous System Agents (Questions 1-15)
1. Question: A 55-year-old patient with hypertension is prescribed atenolol. What is the
primary mechanism of action for this beta-blocker? Options:
o A. Blocks alpha-1 receptors
o B. Inhibits beta-1 adrenergic receptors in the heart
o C. Stimulates muscarinic receptors
o D. Enhances sympathetic outflow Answer: B. Inhibits beta-1 adrenergic receptors
in the heart Rationale: Atenolol is a cardioselective beta-1 blocker that reduces
heart rate and contractility, decreasing myocardial oxygen demand; per
ACC/AHA 2022 guidelines, it is first-line for hypertension with compelling
indications like post-MI, but monitor for bradycardia in older adults.
2. Question: A patient with overactive bladder is started on oxybutynin. What common
adverse effect should the nurse monitor for in this anticholinergic agent? Options:
o A. Dry mouth and constipation
o B. Tachycardia and hypertension
o C. Hypoglycemia
o D. Hyperkalemia Answer: A. Dry mouth and constipation Rationale:
Oxybutynin blocks muscarinic receptors, leading to reduced salivary and GI
secretions; Beers Criteria 2023 flags anticholinergics as high-risk in older adults
due to delirium risk, recommending alternatives like mirabegron.
3. Question: In a patient with myasthenia gravis, pyridostigmine is prescribed. This
acetylcholinesterase inhibitor works by? Options:
o A. Increasing acetylcholine availability at neuromuscular junctions
o B. Blocking beta-2 receptors
o C. Enhancing GABA activity
o D. Inhibiting dopamine reuptake Answer: A. Increasing acetylcholine availability
at neuromuscular junctions Rationale: Pyridostigmine prolongs acetylcholine
action, improving muscle strength; per AAN 2023 guidelines, titrate to minimize
cholinergic crisis, with monitoring for bradycardia in comorbid cardiac
conditions.
4. Question: A client with orthostatic hypotension is prescribed midodrine. What is the key
counseling point regarding timing of administration? Options:
o A. Take in the morning and early afternoon to avoid supine hypertension
o B. Administer at bedtime
o C. With meals to reduce GI upset
o D. As needed for symptoms only Answer: A. Take in the morning and early
afternoon to avoid supine hypertension Rationale: Midodrine, an alpha-1 agonist,
, increases peripheral vascular resistance; AGS 2023 guidelines emphasize
avoiding evening doses to prevent nocturnal hypertension, with orthostatic BP
checks.
5. Question: For a patient with glaucoma, timolol eye drops are prescribed. What systemic
effect requires monitoring? Options:
o A. Bradycardia due to beta-blockade
o B. Hyperglycemia
o C. Constipation
o D. Urinary retention Answer: A. Bradycardia due to beta-blockade Rationale:
Timolol is a non-selective beta-blocker absorbed systemically; AAO 2024
guidelines recommend cardiac monitoring in patients with asthma or bradycardia,
as it can exacerbate conduction abnormalities.
6. Question: A 68-year-old with urinary retention is started on bethanechol. What
precaution is essential? Options:
o A. Avoid in patients with asthma
o B. Use with calcium supplements
o C. Take on empty stomach
o D. Combine with anticholinergics Answer: A. Avoid in patients with asthma
Rationale: Bethanechol, a cholinergic agonist, can cause bronchoconstriction; per
AUA 2023 guidelines, contraindicate in obstructive airway disease, opting for
intermittent catheterization instead.
7. Question: In pheochromocytoma management, phenoxybenzamine is used
preoperatively to? Options:
o A. Block alpha receptors and control BP
o B. Increase heart rate
o C. Reduce anxiety
o D. Enhance insulin release Answer: A. Block alpha receptors and control BP
Rationale: Non-selective alpha-blocker prevents catecholamine surges;
Endocrine Society 2024 guidelines recommend 7-14 days titration with beta-
blocker add-on for tachycardia.
8. Question: A patient with Raynaud's phenomenon is prescribed nifedipine. This calcium
channel blocker primarily? Options:
o A. Vasodilates peripheral arteries
o B. Increases cardiac output
o C. Blocks beta receptors
o D. Enhances platelet aggregation Answer: A. Vasodilates peripheral arteries
Rationale: Dihydropyridine relaxes smooth muscle; ACR 2023 guidelines
endorse low-dose for vasospasm, monitoring for headaches and reflex
tachycardia.
9. Question: For a client with postural orthostatic tachycardia syndrome (POTS), which
medication is first-line? Options:
o A. Fludrocortisone to expand volume
o B. Beta-agonists
o C. Diuretics
Midterm – 2025/2026 – Questions &
Verified A+ Answers | Chamberlain
Autonomic Nervous System Agents (Questions 1-15)
1. Question: A 55-year-old patient with hypertension is prescribed atenolol. What is the
primary mechanism of action for this beta-blocker? Options:
o A. Blocks alpha-1 receptors
o B. Inhibits beta-1 adrenergic receptors in the heart
o C. Stimulates muscarinic receptors
o D. Enhances sympathetic outflow Answer: B. Inhibits beta-1 adrenergic receptors
in the heart Rationale: Atenolol is a cardioselective beta-1 blocker that reduces
heart rate and contractility, decreasing myocardial oxygen demand; per
ACC/AHA 2022 guidelines, it is first-line for hypertension with compelling
indications like post-MI, but monitor for bradycardia in older adults.
2. Question: A patient with overactive bladder is started on oxybutynin. What common
adverse effect should the nurse monitor for in this anticholinergic agent? Options:
o A. Dry mouth and constipation
o B. Tachycardia and hypertension
o C. Hypoglycemia
o D. Hyperkalemia Answer: A. Dry mouth and constipation Rationale:
Oxybutynin blocks muscarinic receptors, leading to reduced salivary and GI
secretions; Beers Criteria 2023 flags anticholinergics as high-risk in older adults
due to delirium risk, recommending alternatives like mirabegron.
3. Question: In a patient with myasthenia gravis, pyridostigmine is prescribed. This
acetylcholinesterase inhibitor works by? Options:
o A. Increasing acetylcholine availability at neuromuscular junctions
o B. Blocking beta-2 receptors
o C. Enhancing GABA activity
o D. Inhibiting dopamine reuptake Answer: A. Increasing acetylcholine availability
at neuromuscular junctions Rationale: Pyridostigmine prolongs acetylcholine
action, improving muscle strength; per AAN 2023 guidelines, titrate to minimize
cholinergic crisis, with monitoring for bradycardia in comorbid cardiac
conditions.
4. Question: A client with orthostatic hypotension is prescribed midodrine. What is the key
counseling point regarding timing of administration? Options:
o A. Take in the morning and early afternoon to avoid supine hypertension
o B. Administer at bedtime
o C. With meals to reduce GI upset
o D. As needed for symptoms only Answer: A. Take in the morning and early
afternoon to avoid supine hypertension Rationale: Midodrine, an alpha-1 agonist,
, increases peripheral vascular resistance; AGS 2023 guidelines emphasize
avoiding evening doses to prevent nocturnal hypertension, with orthostatic BP
checks.
5. Question: For a patient with glaucoma, timolol eye drops are prescribed. What systemic
effect requires monitoring? Options:
o A. Bradycardia due to beta-blockade
o B. Hyperglycemia
o C. Constipation
o D. Urinary retention Answer: A. Bradycardia due to beta-blockade Rationale:
Timolol is a non-selective beta-blocker absorbed systemically; AAO 2024
guidelines recommend cardiac monitoring in patients with asthma or bradycardia,
as it can exacerbate conduction abnormalities.
6. Question: A 68-year-old with urinary retention is started on bethanechol. What
precaution is essential? Options:
o A. Avoid in patients with asthma
o B. Use with calcium supplements
o C. Take on empty stomach
o D. Combine with anticholinergics Answer: A. Avoid in patients with asthma
Rationale: Bethanechol, a cholinergic agonist, can cause bronchoconstriction; per
AUA 2023 guidelines, contraindicate in obstructive airway disease, opting for
intermittent catheterization instead.
7. Question: In pheochromocytoma management, phenoxybenzamine is used
preoperatively to? Options:
o A. Block alpha receptors and control BP
o B. Increase heart rate
o C. Reduce anxiety
o D. Enhance insulin release Answer: A. Block alpha receptors and control BP
Rationale: Non-selective alpha-blocker prevents catecholamine surges;
Endocrine Society 2024 guidelines recommend 7-14 days titration with beta-
blocker add-on for tachycardia.
8. Question: A patient with Raynaud's phenomenon is prescribed nifedipine. This calcium
channel blocker primarily? Options:
o A. Vasodilates peripheral arteries
o B. Increases cardiac output
o C. Blocks beta receptors
o D. Enhances platelet aggregation Answer: A. Vasodilates peripheral arteries
Rationale: Dihydropyridine relaxes smooth muscle; ACR 2023 guidelines
endorse low-dose for vasospasm, monitoring for headaches and reflex
tachycardia.
9. Question: For a client with postural orthostatic tachycardia syndrome (POTS), which
medication is first-line? Options:
o A. Fludrocortisone to expand volume
o B. Beta-agonists
o C. Diuretics
