NURS 5338 Module 2 Pretest Actual Exam:
University of Texas at Arlington Complete
Practice & Preparation
DOMAIN 1: AUTONOMIC NERVOUS SYSTEM PHARMACOLOGY (Q1-12)
1. A patient with myasthenia gravis is prescribed pyridostigmine. The nurse practitioner
understands this medication works by:
A. Blocking muscarinic receptors to reduce parasympathetic activity
B. Inhibiting acetylcholinesterase to increase acetylcholine availability
C. Stimulating beta-2 receptors to improve neuromuscular transmission
D. Blocking nicotinic receptors to prevent excessive stimulation
Correct Answer: B
Rationale: B is correct. Pyridostigmine is an acetylcholinesterase inhibitor that
increases acetylcholine availability at neuromuscular junctions, improving muscle
strength in myasthenia gravis. It does not block muscarinic (A) or nicotinic (D)
receptors. Beta-2 agonists (C) are for asthma, not myasthenia gravis.
2. When prescribing atropine for bradycardia, the nurse practitioner should monitor for
which expected anticholinergic effect?
A. Bradycardia and hypersalivation
B. Bronchoconstriction and increased secretions
C. Tachycardia and dry mouth
D. Hypotension and diarrhea
Correct Answer: C
Rationale: C is correct. Atropine, an antimuscarinic agent, blocks parasympathetic
activity, causing tachycardia (desired for bradycardia) and dry mouth (anticholinergic
,effect). Bradycardia (A) is the condition being treated. Bronchoconstriction (B) would be
cholinergic effects. Hypotension (D) is not typical with atropine.
3. A patient with urinary incontinence is prescribed oxybutynin. The nurse practitioner
should counsel about which mechanism of action?
A. Selective beta-3 agonism to relax detrusor muscle
B. Alpha-1 antagonism to reduce urethral sphincter tone
C. Muscarinic receptor antagonism to inhibit bladder contractions
D. Calcium channel blockade to reduce smooth muscle contractility
Correct Answer: C
Rationale: C is correct. Oxybutynin is an antimuscarinic (anticholinergic) agent that
blocks M3 muscarinic receptors on the detrusor muscle, inhibiting involuntary bladder
contractions and increasing capacity. Beta-3 agonists (A—mirabegron) are newer
alternatives. Alpha-blockers (B) are for BPH. Calcium channel blockers (D) are not
first-line for incontinence.
4. When prescribing pilocarpine for a patient with glaucoma, the nurse practitioner
understands the primary mechanism is:
A. Alpha-2 agonism to decrease aqueous humor production
B. Beta-blockade to reduce aqueous humor secretion
C. Muscarinic agonism to increase aqueous humor outflow
D. Carbonic anhydrase inhibition to reduce aqueous production
Correct Answer: C
Rationale: C is correct. Pilocarpine is a direct-acting muscarinic agonist that contracts
the ciliary muscle and opens the trabecular meshwork, increasing aqueous humor
outflow to lower intraocular pressure. Alpha-2 agonists (A—brimonidine) and
beta-blockers (B—timolol) decrease production. Carbonic anhydrase inhibitors
(D—acetazolamide) also reduce production.
5. A patient on beta-blocker therapy for hypertension reports fatigue and exercise
intolerance. The nurse practitioner recognizes these as:
A. Expected therapeutic effects indicating adequate beta-blockade
, B. Unusual reactions requiring immediate discontinuation
C. Common adverse effects due to decreased heart rate and contractility
D. Signs of developing heart failure unrelated to medication
Correct Answer: C
Rationale: C is correct. Fatigue and exercise intolerance are common adverse effects of
beta-blockers resulting from reduced heart rate, contractility, and exercise capacity.
While expected, they should be monitored but don't necessarily require discontinuation.
They are not therapeutic effects (A) or immediate discontinuation criteria (B). While
heart failure (D) must be ruled out, these are typical beta-blocker effects.
6. When prescribing prazosin for a patient with PTSD-related nightmares, the nurse
practitioner should advise:
A. Take the first dose at bedtime to minimize first-dose hypotension
B. Take with food to enhance absorption
C. Avoid all activities requiring mental alertness
D. Increase salt intake to maintain blood pressure
Correct Answer: C
Rationale: C is correct. Prazosin, an alpha-1 antagonist, causes significant first-dose
hypotension and syncope. Patients must take the first dose at bedtime and titrate
slowly. While food may slightly affect absorption (B), bedtime dosing is critical. Avoiding
all activities (C) is excessive. Salt increase (D) is not recommended for hypertension
management.
7. A patient with COPD is prescribed ipratropium bromide. The nurse practitioner
understands this medication:
A. Is a short-acting beta-2 agonist for quick relief
B. Stimulates muscarinic receptors to bronchodilate
C. Blocks muscarinic receptors to reduce bronchoconstriction
D. Inhibits acetylcholinesterase at neuromuscular junctions
Correct Answer: C
University of Texas at Arlington Complete
Practice & Preparation
DOMAIN 1: AUTONOMIC NERVOUS SYSTEM PHARMACOLOGY (Q1-12)
1. A patient with myasthenia gravis is prescribed pyridostigmine. The nurse practitioner
understands this medication works by:
A. Blocking muscarinic receptors to reduce parasympathetic activity
B. Inhibiting acetylcholinesterase to increase acetylcholine availability
C. Stimulating beta-2 receptors to improve neuromuscular transmission
D. Blocking nicotinic receptors to prevent excessive stimulation
Correct Answer: B
Rationale: B is correct. Pyridostigmine is an acetylcholinesterase inhibitor that
increases acetylcholine availability at neuromuscular junctions, improving muscle
strength in myasthenia gravis. It does not block muscarinic (A) or nicotinic (D)
receptors. Beta-2 agonists (C) are for asthma, not myasthenia gravis.
2. When prescribing atropine for bradycardia, the nurse practitioner should monitor for
which expected anticholinergic effect?
A. Bradycardia and hypersalivation
B. Bronchoconstriction and increased secretions
C. Tachycardia and dry mouth
D. Hypotension and diarrhea
Correct Answer: C
Rationale: C is correct. Atropine, an antimuscarinic agent, blocks parasympathetic
activity, causing tachycardia (desired for bradycardia) and dry mouth (anticholinergic
,effect). Bradycardia (A) is the condition being treated. Bronchoconstriction (B) would be
cholinergic effects. Hypotension (D) is not typical with atropine.
3. A patient with urinary incontinence is prescribed oxybutynin. The nurse practitioner
should counsel about which mechanism of action?
A. Selective beta-3 agonism to relax detrusor muscle
B. Alpha-1 antagonism to reduce urethral sphincter tone
C. Muscarinic receptor antagonism to inhibit bladder contractions
D. Calcium channel blockade to reduce smooth muscle contractility
Correct Answer: C
Rationale: C is correct. Oxybutynin is an antimuscarinic (anticholinergic) agent that
blocks M3 muscarinic receptors on the detrusor muscle, inhibiting involuntary bladder
contractions and increasing capacity. Beta-3 agonists (A—mirabegron) are newer
alternatives. Alpha-blockers (B) are for BPH. Calcium channel blockers (D) are not
first-line for incontinence.
4. When prescribing pilocarpine for a patient with glaucoma, the nurse practitioner
understands the primary mechanism is:
A. Alpha-2 agonism to decrease aqueous humor production
B. Beta-blockade to reduce aqueous humor secretion
C. Muscarinic agonism to increase aqueous humor outflow
D. Carbonic anhydrase inhibition to reduce aqueous production
Correct Answer: C
Rationale: C is correct. Pilocarpine is a direct-acting muscarinic agonist that contracts
the ciliary muscle and opens the trabecular meshwork, increasing aqueous humor
outflow to lower intraocular pressure. Alpha-2 agonists (A—brimonidine) and
beta-blockers (B—timolol) decrease production. Carbonic anhydrase inhibitors
(D—acetazolamide) also reduce production.
5. A patient on beta-blocker therapy for hypertension reports fatigue and exercise
intolerance. The nurse practitioner recognizes these as:
A. Expected therapeutic effects indicating adequate beta-blockade
, B. Unusual reactions requiring immediate discontinuation
C. Common adverse effects due to decreased heart rate and contractility
D. Signs of developing heart failure unrelated to medication
Correct Answer: C
Rationale: C is correct. Fatigue and exercise intolerance are common adverse effects of
beta-blockers resulting from reduced heart rate, contractility, and exercise capacity.
While expected, they should be monitored but don't necessarily require discontinuation.
They are not therapeutic effects (A) or immediate discontinuation criteria (B). While
heart failure (D) must be ruled out, these are typical beta-blocker effects.
6. When prescribing prazosin for a patient with PTSD-related nightmares, the nurse
practitioner should advise:
A. Take the first dose at bedtime to minimize first-dose hypotension
B. Take with food to enhance absorption
C. Avoid all activities requiring mental alertness
D. Increase salt intake to maintain blood pressure
Correct Answer: C
Rationale: C is correct. Prazosin, an alpha-1 antagonist, causes significant first-dose
hypotension and syncope. Patients must take the first dose at bedtime and titrate
slowly. While food may slightly affect absorption (B), bedtime dosing is critical. Avoiding
all activities (C) is excessive. Salt increase (D) is not recommended for hypertension
management.
7. A patient with COPD is prescribed ipratropium bromide. The nurse practitioner
understands this medication:
A. Is a short-acting beta-2 agonist for quick relief
B. Stimulates muscarinic receptors to bronchodilate
C. Blocks muscarinic receptors to reduce bronchoconstriction
D. Inhibits acetylcholinesterase at neuromuscular junctions
Correct Answer: C
