, NURS 1150: Nurse Pharmacology I
Exam 2 – Comprehensive Examination
70 Multiple-Choice Questions with Detailed Clinical Rationales
Covering Autonomic Nervous System, Cardiovascular, Renal, Respiratory, and CNS Pharmacology.
Question 1: A patient is prescribed epinephrine for emergency treatment of severe
anaphylaxis. Which primary receptor action is responsible for reversing the life-threatening
bronchospasm and laryngeal edema associated with this reaction?
A) Alpha-1 receptor vasoconstriction
B) Beta-1 receptor positive inotropy
C) Beta-2 receptor bronchodilation
D) Muscarinic receptor antagonism
Correct Answer: C
Rationale: Beta-2 adrenergic receptor stimulation in the lungs leads to relaxation of bronchial
smooth muscle, effectively reversing bronchospasm. Alpha-1 activation causes vasoconstriction
(helping maintain blood pressure), and Beta-1 increases heart rate and contractility, but
bronchodilation is specifically mediated by Beta-2 receptors.
Question 2: A nurse is administering bethanechol to a postoperative patient experiencing
urinary retention. Which assessment finding indicates that the medication is producing a
therapeutic cholinergic response?
A) Decreased bowel sounds and abdominal distention
B) Increased bladder tone and micturition
C) Bronchodilation and decreased respiratory secretions
D) Tachycardia and elevated blood pressure
Correct Answer: B
Rationale: Bethanechol is a direct-acting muscarinic agonist used to treat nonobstructive urinary
retention by stimulating cholinergic receptors in the detrusor muscle of the bladder, promoting
contraction and urination. Other cholinergic effects include increased GI motility, miosis, and
bradycardia.
, Question 3: An emergency department nurse is preparing atropine for a patient presenting
with symptomatic bradycardia (heart rate 34 bpm). What is the primary pharmacodynamic
mechanism of action of atropine in this clinical scenario?
A) Direct stimulation of beta-1 adrenergic receptors in the SA node
B) Inhibition of acetylcholinesterase to increase synaptic acetylcholine
C) Competitive blockade of muscarinic cholinergic receptors
D) Stimulation of alpha-2 receptors in the vasomotor center
Correct Answer: C
Rationale: Atropine is an anticholinergic (antimuscarinic) agent that competitively blocks
acetylcholine at muscarinic receptors. By blocking parasympathetic (vagal) input to the sinoatrial
(SA) and atrioventricular (AV) nodes, it increases heart rate.
Question 4: A patient diagnosed with myasthenia gravis is prescribed neostigmine. Which of
the following adverse effects should the nurse monitor for as a sign of impending cholinergic
crisis?
A) Extreme muscle weakness, excessive salivation, and miosis
B) Severe constipation, mydriasis, and urinary retention
C) Hypertension, tachycardia, and dry mucous membranes
D) Hyperglycemia, peripheral edema, and sedation
Correct Answer: A
Rationale: Neostigmine is a reversible acetylcholinesterase inhibitor. Excessive accumulation of
acetylcholine leads to cholinergic crisis, characterized by the 'SLUDGE' mnemonic (Salivation,
Lacrimation, Urination, Diaphoresis/Diarrhea, Gastrointestinal cramping, Emesis) plus muscle
fasciculations transitioning to severe weakness due to receptor depolarization blockade.
Question 5: A patient receiving an intravenous infusion of dopamine for septic shock
exhibits extravasation into the dorsal aspect of the hand. Which immediate nursing
intervention is indicated to prevent tissue necrosis?
A) Apply ice packs directly to the site for 30 minutes
B) Administer subcutaneous phentolamine into the affected area
C) Elevate the extremity and apply warm compresses
Exam 2 – Comprehensive Examination
70 Multiple-Choice Questions with Detailed Clinical Rationales
Covering Autonomic Nervous System, Cardiovascular, Renal, Respiratory, and CNS Pharmacology.
Question 1: A patient is prescribed epinephrine for emergency treatment of severe
anaphylaxis. Which primary receptor action is responsible for reversing the life-threatening
bronchospasm and laryngeal edema associated with this reaction?
A) Alpha-1 receptor vasoconstriction
B) Beta-1 receptor positive inotropy
C) Beta-2 receptor bronchodilation
D) Muscarinic receptor antagonism
Correct Answer: C
Rationale: Beta-2 adrenergic receptor stimulation in the lungs leads to relaxation of bronchial
smooth muscle, effectively reversing bronchospasm. Alpha-1 activation causes vasoconstriction
(helping maintain blood pressure), and Beta-1 increases heart rate and contractility, but
bronchodilation is specifically mediated by Beta-2 receptors.
Question 2: A nurse is administering bethanechol to a postoperative patient experiencing
urinary retention. Which assessment finding indicates that the medication is producing a
therapeutic cholinergic response?
A) Decreased bowel sounds and abdominal distention
B) Increased bladder tone and micturition
C) Bronchodilation and decreased respiratory secretions
D) Tachycardia and elevated blood pressure
Correct Answer: B
Rationale: Bethanechol is a direct-acting muscarinic agonist used to treat nonobstructive urinary
retention by stimulating cholinergic receptors in the detrusor muscle of the bladder, promoting
contraction and urination. Other cholinergic effects include increased GI motility, miosis, and
bradycardia.
, Question 3: An emergency department nurse is preparing atropine for a patient presenting
with symptomatic bradycardia (heart rate 34 bpm). What is the primary pharmacodynamic
mechanism of action of atropine in this clinical scenario?
A) Direct stimulation of beta-1 adrenergic receptors in the SA node
B) Inhibition of acetylcholinesterase to increase synaptic acetylcholine
C) Competitive blockade of muscarinic cholinergic receptors
D) Stimulation of alpha-2 receptors in the vasomotor center
Correct Answer: C
Rationale: Atropine is an anticholinergic (antimuscarinic) agent that competitively blocks
acetylcholine at muscarinic receptors. By blocking parasympathetic (vagal) input to the sinoatrial
(SA) and atrioventricular (AV) nodes, it increases heart rate.
Question 4: A patient diagnosed with myasthenia gravis is prescribed neostigmine. Which of
the following adverse effects should the nurse monitor for as a sign of impending cholinergic
crisis?
A) Extreme muscle weakness, excessive salivation, and miosis
B) Severe constipation, mydriasis, and urinary retention
C) Hypertension, tachycardia, and dry mucous membranes
D) Hyperglycemia, peripheral edema, and sedation
Correct Answer: A
Rationale: Neostigmine is a reversible acetylcholinesterase inhibitor. Excessive accumulation of
acetylcholine leads to cholinergic crisis, characterized by the 'SLUDGE' mnemonic (Salivation,
Lacrimation, Urination, Diaphoresis/Diarrhea, Gastrointestinal cramping, Emesis) plus muscle
fasciculations transitioning to severe weakness due to receptor depolarization blockade.
Question 5: A patient receiving an intravenous infusion of dopamine for septic shock
exhibits extravasation into the dorsal aspect of the hand. Which immediate nursing
intervention is indicated to prevent tissue necrosis?
A) Apply ice packs directly to the site for 30 minutes
B) Administer subcutaneous phentolamine into the affected area
C) Elevate the extremity and apply warm compresses
