NURS 251 Pharmacology Module 2 Exam
Portage Learning • ABC Nursing • Geneva College • 2026/2027
Questions and Verified Answers — 100% Guarantee
85 Questions Across 7 Domains • Cognitive Mix: 35% Recall, 45% Application, 20% Analysis • 70% Scenario-Based, 30%
Direct Recall • Verified Answers + Pharmacology-Specific Rationales
Each question is followed by four options (A–D), one verified correct answer marked [CORRECT], the correct answer letter,
and a 2–4 sentence rationale integrating receptor mechanisms, adverse effects, antidotes, nursing considerations, and
patient safety principles.
Section 1: Autonomic Nervous System Foundations (Sympathetic,
Parasympathetic, & Neurotransmitters)
Q1: Which neurotransmitter is the primary chemical messenger released at the postganglionic synapse of the
parasympathetic nervous system?
A. Norepinephrine
B. Acetylcholine [CORRECT]
C. Dopamine
D. Epinephrine
Correct Answer: B
Rationale: The parasympathetic nervous system ("rest and digest") releases acetylcholine (ACh) at both preganglionic and
postganglionic synapses, making it a cholinergic system throughout. In contrast, the sympathetic nervous system releases
ACh at the preganglionic synapse but norepinephrine at the postganglionic synapse (adrenergic). Distinguishing cholinergic
from adrenergic postganglionic fibers is foundational to understanding all autonomic drug mechanisms in NURS 251
Module 2.
Q2: Which neurotransmitter is released at the postganglionic synapse of most sympathetic fibers, and which
class of receptors does it primarily activate?
A. Acetylcholine activating nicotinic receptors
B. Norepinephrine activating adrenergic receptors (alpha and beta) [CORRECT]
C. Serotonin activating 5-HT receptors
D. Histamine activating H1 receptors
Correct Answer: B
Rationale: Most sympathetic postganglionic fibers release norepinephrine, which activates adrenergic receptors (alpha-1,
alpha-2, beta-1, beta-2) on target organs to produce the "fight-or-flight" response. The exception is sweat glands, which use
ACh. Acetylcholine at the preganglionic synapse activates nicotinic receptors in both divisions. Knowing which
neurotransmitter and receptor class is targeted at each synapse is essential for predicting drug effects.
NURS 251 Pharmacology Module 2 Exam | Portage Learning / ABC Nursing / Geneva College | 2026/2027 Page 1
, Q3: A nursing student is asked to identify the physiologic response mediated by parasympathetic (cholinergic)
stimulation. Which response is correct?
A. Pupil dilation (mydriasis) and tachycardia
B. Pupil constriction (miosis), bradycardia, increased gastrointestinal motility, and increased secretions
[CORRECT]
C. Bronchodilation and decreased GI motility
D. Vasoconstriction and increased blood pressure
Correct Answer: B
Rationale: Parasympathetic (cholinergic muscarinic) stimulation produces "rest and digest" effects: miosis (pupillary
constriction), bradycardia, increased GI motility and secretions, bladder contraction, and bronchoconstriction with increased
airway secretions. Options A, C, and D describe sympathetic (adrenergic) responses. The mnemonic "SLUDGE-MD"
(Salivation, Lacrimation, Urination, Diaphoresis, GI motility/secretions, Emesis, Miosis, Defecation) summarizes
cholinergic excess.
Q4: Activation of alpha-1 adrenergic receptors produces which physiologic effect?
A. Vasodilation and hypotension
B. Vasoconstriction, increased blood pressure, mydriasis, and contraction of the bladder sphincter
[CORRECT]
C. Bronchodilation and uterine relaxation
D. Increased heart rate and contractility
Correct Answer: B
Rationale: Alpha-1 receptor activation causes vasoconstriction (raising blood pressure), pupillary dilation (mydriasis),
contraction of the bladder sphincter (urinary retention), and ejaculation. Vasodilation (Option A) is mediated by alpha-2 or
specific beta-2 vascular beds. Bronchodilation (Option C) is beta-2. Increased heart rate and contractility (Option D) is
beta-1. Memorizing each receptor's physiologic effect allows rapid prediction of agonist and antagonist effects across all
autonomic drugs.
Q5: A patient receives a pure beta-1 adrenergic agonist. Which physiologic response should the nurse expect?
A. Bronchodilation only
B. Increased heart rate (tachycardia) and increased myocardial contractility (positive inotropy) [CORRECT]
C. Vasoconstriction and hypertension
D. Pupillary constriction
Correct Answer: B
Rationale: Beta-1 receptors are concentrated in the heart; stimulation produces increased heart rate (positive chronotropy),
increased contractility (positive inotropy), and increased AV node conduction velocity (positive dromotropy).
Bronchodilation (Option A) is beta-2. Vasoconstriction (Option C) is alpha-1. Pupillary constriction (Option D) is
parasympathetic muscarinic. Drugs such as dobutamine are beta-1 selective, useful in heart failure and shock.
NURS 251 Pharmacology Module 2 Exam | Portage Learning / ABC Nursing / Geneva College | 2026/2027 Page 2
, Q6: Which physiologic response is mediated by beta-2 adrenergic receptor activation?
A. Increased heart rate
B. Bronchodilation, uterine relaxation (tocolysis), vasodilation of skeletal muscle beds, and glycogenolysis
[CORRECT]
C. Vasoconstriction of skin and splanchnic beds
D. Increased GI motility
Correct Answer: B
Rationale: Beta-2 receptors mediate bronchodilation (albuterol, salmeterol), uterine relaxation (ritodrine, terbutaline for
preterm labor), vasodilation in skeletal muscle vascular beds, and glycogenolysis. Beta-1 (Option A) is the heart. Alpha-1
(Option C) is vasoconstriction. Increased GI motility (Option D) is parasympathetic. Beta-2 selective agonists allow
bronchodilation with minimal cardiac effects, a key principle in respiratory pharmacology.
Q7: A patient receives a nonselective beta-blocker. Which combination of effects should the nurse anticipate?
A. Tachycardia and bronchodilation
B. Decreased heart rate, decreased contractility, and potential bronchoconstriction (beta-2 blockade)
[CORRECT]
C. Increased blood pressure from vasoconstriction alone
D. Increased GI motility and miosis
Correct Answer: B
Rationale: Nonselective beta-blockers (e.g., propranolol) block both beta-1 (causing bradycardia and reduced contractility)
and beta-2 receptors (potentially causing bronchoconstriction, especially in patients with asthma/COPD). Cardioselective
beta-blockers (metoprolol, atenolol) preferentially block beta-1 at low doses. Assessing for asthma/COPD and bradycardia
before administration is a high-yield nursing safety point.
Q8: Which statement best describes the anatomic and physiologic distinction between muscarinic and
nicotinic cholinergic receptors?
A. Muscarinic receptors are located at the skeletal neuromuscular junction; nicotinic receptors are in the heart.
B. Muscarinic receptors are located on parasympathetic target organs (heart, smooth muscle, glands);
nicotinic receptors are located at the autonomic ganglia, adrenal medulla, and skeletal neuromuscular
junction. [CORRECT]
C. Both receptor types are exclusively in the central nervous system.
D. Nicotinic receptors mediate bronchoconstriction only.
Correct Answer: B
Rationale: Cholinergic receptors are subdivided into muscarinic (target organs of parasympathetic output: heart, smooth
muscle, exocrine glands) and nicotinic (autonomic ganglia, adrenal medulla, and skeletal neuromuscular junction). Most
cholinergic drugs used clinically target muscarinic receptors; nicotinic receptors are the target of neuromuscular blockers
used in anesthesia. Distinguishing these receptors is essential to understanding why a cholinergic agonist affects the bladder
but not the NMJ.
NURS 251 Pharmacology Module 2 Exam | Portage Learning / ABC Nursing / Geneva College | 2026/2027 Page 3
Portage Learning • ABC Nursing • Geneva College • 2026/2027
Questions and Verified Answers — 100% Guarantee
85 Questions Across 7 Domains • Cognitive Mix: 35% Recall, 45% Application, 20% Analysis • 70% Scenario-Based, 30%
Direct Recall • Verified Answers + Pharmacology-Specific Rationales
Each question is followed by four options (A–D), one verified correct answer marked [CORRECT], the correct answer letter,
and a 2–4 sentence rationale integrating receptor mechanisms, adverse effects, antidotes, nursing considerations, and
patient safety principles.
Section 1: Autonomic Nervous System Foundations (Sympathetic,
Parasympathetic, & Neurotransmitters)
Q1: Which neurotransmitter is the primary chemical messenger released at the postganglionic synapse of the
parasympathetic nervous system?
A. Norepinephrine
B. Acetylcholine [CORRECT]
C. Dopamine
D. Epinephrine
Correct Answer: B
Rationale: The parasympathetic nervous system ("rest and digest") releases acetylcholine (ACh) at both preganglionic and
postganglionic synapses, making it a cholinergic system throughout. In contrast, the sympathetic nervous system releases
ACh at the preganglionic synapse but norepinephrine at the postganglionic synapse (adrenergic). Distinguishing cholinergic
from adrenergic postganglionic fibers is foundational to understanding all autonomic drug mechanisms in NURS 251
Module 2.
Q2: Which neurotransmitter is released at the postganglionic synapse of most sympathetic fibers, and which
class of receptors does it primarily activate?
A. Acetylcholine activating nicotinic receptors
B. Norepinephrine activating adrenergic receptors (alpha and beta) [CORRECT]
C. Serotonin activating 5-HT receptors
D. Histamine activating H1 receptors
Correct Answer: B
Rationale: Most sympathetic postganglionic fibers release norepinephrine, which activates adrenergic receptors (alpha-1,
alpha-2, beta-1, beta-2) on target organs to produce the "fight-or-flight" response. The exception is sweat glands, which use
ACh. Acetylcholine at the preganglionic synapse activates nicotinic receptors in both divisions. Knowing which
neurotransmitter and receptor class is targeted at each synapse is essential for predicting drug effects.
NURS 251 Pharmacology Module 2 Exam | Portage Learning / ABC Nursing / Geneva College | 2026/2027 Page 1
, Q3: A nursing student is asked to identify the physiologic response mediated by parasympathetic (cholinergic)
stimulation. Which response is correct?
A. Pupil dilation (mydriasis) and tachycardia
B. Pupil constriction (miosis), bradycardia, increased gastrointestinal motility, and increased secretions
[CORRECT]
C. Bronchodilation and decreased GI motility
D. Vasoconstriction and increased blood pressure
Correct Answer: B
Rationale: Parasympathetic (cholinergic muscarinic) stimulation produces "rest and digest" effects: miosis (pupillary
constriction), bradycardia, increased GI motility and secretions, bladder contraction, and bronchoconstriction with increased
airway secretions. Options A, C, and D describe sympathetic (adrenergic) responses. The mnemonic "SLUDGE-MD"
(Salivation, Lacrimation, Urination, Diaphoresis, GI motility/secretions, Emesis, Miosis, Defecation) summarizes
cholinergic excess.
Q4: Activation of alpha-1 adrenergic receptors produces which physiologic effect?
A. Vasodilation and hypotension
B. Vasoconstriction, increased blood pressure, mydriasis, and contraction of the bladder sphincter
[CORRECT]
C. Bronchodilation and uterine relaxation
D. Increased heart rate and contractility
Correct Answer: B
Rationale: Alpha-1 receptor activation causes vasoconstriction (raising blood pressure), pupillary dilation (mydriasis),
contraction of the bladder sphincter (urinary retention), and ejaculation. Vasodilation (Option A) is mediated by alpha-2 or
specific beta-2 vascular beds. Bronchodilation (Option C) is beta-2. Increased heart rate and contractility (Option D) is
beta-1. Memorizing each receptor's physiologic effect allows rapid prediction of agonist and antagonist effects across all
autonomic drugs.
Q5: A patient receives a pure beta-1 adrenergic agonist. Which physiologic response should the nurse expect?
A. Bronchodilation only
B. Increased heart rate (tachycardia) and increased myocardial contractility (positive inotropy) [CORRECT]
C. Vasoconstriction and hypertension
D. Pupillary constriction
Correct Answer: B
Rationale: Beta-1 receptors are concentrated in the heart; stimulation produces increased heart rate (positive chronotropy),
increased contractility (positive inotropy), and increased AV node conduction velocity (positive dromotropy).
Bronchodilation (Option A) is beta-2. Vasoconstriction (Option C) is alpha-1. Pupillary constriction (Option D) is
parasympathetic muscarinic. Drugs such as dobutamine are beta-1 selective, useful in heart failure and shock.
NURS 251 Pharmacology Module 2 Exam | Portage Learning / ABC Nursing / Geneva College | 2026/2027 Page 2
, Q6: Which physiologic response is mediated by beta-2 adrenergic receptor activation?
A. Increased heart rate
B. Bronchodilation, uterine relaxation (tocolysis), vasodilation of skeletal muscle beds, and glycogenolysis
[CORRECT]
C. Vasoconstriction of skin and splanchnic beds
D. Increased GI motility
Correct Answer: B
Rationale: Beta-2 receptors mediate bronchodilation (albuterol, salmeterol), uterine relaxation (ritodrine, terbutaline for
preterm labor), vasodilation in skeletal muscle vascular beds, and glycogenolysis. Beta-1 (Option A) is the heart. Alpha-1
(Option C) is vasoconstriction. Increased GI motility (Option D) is parasympathetic. Beta-2 selective agonists allow
bronchodilation with minimal cardiac effects, a key principle in respiratory pharmacology.
Q7: A patient receives a nonselective beta-blocker. Which combination of effects should the nurse anticipate?
A. Tachycardia and bronchodilation
B. Decreased heart rate, decreased contractility, and potential bronchoconstriction (beta-2 blockade)
[CORRECT]
C. Increased blood pressure from vasoconstriction alone
D. Increased GI motility and miosis
Correct Answer: B
Rationale: Nonselective beta-blockers (e.g., propranolol) block both beta-1 (causing bradycardia and reduced contractility)
and beta-2 receptors (potentially causing bronchoconstriction, especially in patients with asthma/COPD). Cardioselective
beta-blockers (metoprolol, atenolol) preferentially block beta-1 at low doses. Assessing for asthma/COPD and bradycardia
before administration is a high-yield nursing safety point.
Q8: Which statement best describes the anatomic and physiologic distinction between muscarinic and
nicotinic cholinergic receptors?
A. Muscarinic receptors are located at the skeletal neuromuscular junction; nicotinic receptors are in the heart.
B. Muscarinic receptors are located on parasympathetic target organs (heart, smooth muscle, glands);
nicotinic receptors are located at the autonomic ganglia, adrenal medulla, and skeletal neuromuscular
junction. [CORRECT]
C. Both receptor types are exclusively in the central nervous system.
D. Nicotinic receptors mediate bronchoconstriction only.
Correct Answer: B
Rationale: Cholinergic receptors are subdivided into muscarinic (target organs of parasympathetic output: heart, smooth
muscle, exocrine glands) and nicotinic (autonomic ganglia, adrenal medulla, and skeletal neuromuscular junction). Most
cholinergic drugs used clinically target muscarinic receptors; nicotinic receptors are the target of neuromuscular blockers
used in anesthesia. Distinguishing these receptors is essential to understanding why a cholinergic agonist affects the bladder
but not the NMJ.
NURS 251 Pharmacology Module 2 Exam | Portage Learning / ABC Nursing / Geneva College | 2026/2027 Page 3
