NURS 5334 Advanced Pharmacology Final
Exam 2026| Actual Exam Questions and
Correct Answers
Question 1
Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic
hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
A) Increases peripheral vasoconstriction
B) Decreases detrusor muscle contractility
C) Lowers supine blood pressure more than standing pressure
D) Relaxes smooth muscle in the bladder neck
Correct Answer: D) Relaxes smooth muscle in the bladder neck
Explanation: Doxazosin is a selective alpha-1 adrenergic antagonist. It relaxes smooth muscle in
the prostate and bladder neck (beneficial for BPH symptoms) while also causing peripheral
vasodilation to lower blood pressure. It does not increase vasoconstriction and lowers standing
BP more than supine (risk of orthostatic hypotension).
Question 2
To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should
do all of the following EXCEPT:
A) Take the dose at bedtime
B) Sit up slowly and dangle their feet before standing
C) Monitor their blood pressure and skip a dose if the pressure is less than 120/80
D) Weigh daily and report weight gain of greater than 2 pounds in one day
Correct Answer: C) Monitor their blood pressure and skip a dose if the pressure is less than
120/80
Explanation: Alpha-1 blockers commonly cause orthostatic hypotension, especially with the first
dose. Patients should take the initial dose at bedtime, rise slowly, and monitor for dizziness.
,Daily weights help detect fluid retention. Self-adjusting or skipping doses based on BP is not
recommended; dose changes should be provider-guided.
Question 3
John has clonidine, a centrally-acting adrenergic blocker, prescribed for his hypertension. He
should:
A) Not miss a dose or stop taking the drug because of potential rebound hypertension
B) Increase fiber in the diet to treat any diarrhea that may occur
C) Reduce fluid intake to less than 2 liters per day to prevent fluid retention
D) Avoid sitting for long periods, as this can lead to deep vein thrombosis
Correct Answer: A) Not miss a dose or stop taking the drug because of potential rebound
hypertension
Explanation: Abrupt discontinuation of clonidine can cause severe rebound hypertension due to
sudden sympathetic surge. Patients must not miss doses or stop suddenly; tapering is required
under supervision. Clonidine more commonly causes constipation (not diarrhea), and it does not
increase DVT risk.
Question 4
Clonidine has several off-label uses, including:
A) Alcohol and nicotine withdrawal
B) Post-herpetic neuralgia
C) Both 1 and 2
D) Neither 1 nor 2
Correct Answer: C) Both 1 and 2
Explanation: Clonidine is used off-label for alcohol and nicotine withdrawal (reduces
sympathetic hyperactivity and craving) and for neuropathic pain such as post-herpetic neuralgia
(central alpha-2 agonism modulates pain signals).
Question 5
,Jim is being treated for hypertension. Because he has a history of heart attacks, the drug chosen
is atenolol. Beta-blockers treat hypertension by:
A) Increasing heart rate to improve cardiac output
B) Reducing vascular smooth muscle tone
C) Increasing aldosterone-mediated volume activity
D) Reducing aqueous humor production
Correct Answer: B) Reducing vascular smooth muscle tone
Explanation: Beta-blockers lower BP through reduced cardiac output, decreased renin release,
and reduced sympathetic drive leading to decreased vascular smooth muscle tone. Atenolol is
beta-1 selective and is often chosen post-MI for cardioprotection.
Question 6
Which of the following adverse effects are less likely in a beta 1-selective blocker?
A) Dysrhythmias
B) Impaired insulin release
C) Reflex orthostatic changes
D) Decreased triglycerides and cholesterol
Correct Answer: B) Impaired insulin release
Explanation: Non-selective beta-blockers block beta-2 receptors in the pancreas, impairing
insulin release and masking hypoglycemia symptoms. Beta-1 selective agents have less impact
on insulin release and are safer in diabetics.
Question 7
Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed
nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should
you take related to his nadolol?
A) Extend the dosage interval
B) Decrease the dose by 75%
C) Take no action because this value is expected in the older adult
, D) Schedule a serum creatinine level to validate the CrCl value
Correct Answer: A) Extend the dosage interval
Explanation: Nadolol is primarily renally excreted. In severe renal impairment (CrCl <30
mL/min), extend the dosing interval (e.g., every 48 hours) or reduce the dose to prevent
accumulation and bradycardia/toxicity.
Question 8
Beta blockers are the drugs of choice for exertional angina because they:
A) Improve myocardial oxygen supply by vasodilating the coronary arteries
B) Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
C) Both 1 and 2
D) Neither 1 nor 2
Correct Answer: B) Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
Explanation: Beta-blockers reduce heart rate, contractility, and afterload, lowering myocardial
oxygen demand—the primary benefit in stable exertional angina. They do not directly vasodilate
coronary arteries (nitrates do that).
Question 9
Adherence to beta-blocker therapy may be affected by their:
A) Short half-lives requiring twice daily dosing
B) Tendency to elevate lipid levels
C) Effects on the male genitalia, which may produce impotence
D) None of the above
Correct Answer: C) Effects on the male genitalia, which may produce impotence
Explanation: Beta-blockers can cause erectile dysfunction due to reduced penile blood flow and
sympathetic blockade. This is a frequent cause of non-adherence in men. Lipid effects are
variable and less commonly the main adherence issue.
Exam 2026| Actual Exam Questions and
Correct Answers
Question 1
Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic
hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
A) Increases peripheral vasoconstriction
B) Decreases detrusor muscle contractility
C) Lowers supine blood pressure more than standing pressure
D) Relaxes smooth muscle in the bladder neck
Correct Answer: D) Relaxes smooth muscle in the bladder neck
Explanation: Doxazosin is a selective alpha-1 adrenergic antagonist. It relaxes smooth muscle in
the prostate and bladder neck (beneficial for BPH symptoms) while also causing peripheral
vasodilation to lower blood pressure. It does not increase vasoconstriction and lowers standing
BP more than supine (risk of orthostatic hypotension).
Question 2
To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should
do all of the following EXCEPT:
A) Take the dose at bedtime
B) Sit up slowly and dangle their feet before standing
C) Monitor their blood pressure and skip a dose if the pressure is less than 120/80
D) Weigh daily and report weight gain of greater than 2 pounds in one day
Correct Answer: C) Monitor their blood pressure and skip a dose if the pressure is less than
120/80
Explanation: Alpha-1 blockers commonly cause orthostatic hypotension, especially with the first
dose. Patients should take the initial dose at bedtime, rise slowly, and monitor for dizziness.
,Daily weights help detect fluid retention. Self-adjusting or skipping doses based on BP is not
recommended; dose changes should be provider-guided.
Question 3
John has clonidine, a centrally-acting adrenergic blocker, prescribed for his hypertension. He
should:
A) Not miss a dose or stop taking the drug because of potential rebound hypertension
B) Increase fiber in the diet to treat any diarrhea that may occur
C) Reduce fluid intake to less than 2 liters per day to prevent fluid retention
D) Avoid sitting for long periods, as this can lead to deep vein thrombosis
Correct Answer: A) Not miss a dose or stop taking the drug because of potential rebound
hypertension
Explanation: Abrupt discontinuation of clonidine can cause severe rebound hypertension due to
sudden sympathetic surge. Patients must not miss doses or stop suddenly; tapering is required
under supervision. Clonidine more commonly causes constipation (not diarrhea), and it does not
increase DVT risk.
Question 4
Clonidine has several off-label uses, including:
A) Alcohol and nicotine withdrawal
B) Post-herpetic neuralgia
C) Both 1 and 2
D) Neither 1 nor 2
Correct Answer: C) Both 1 and 2
Explanation: Clonidine is used off-label for alcohol and nicotine withdrawal (reduces
sympathetic hyperactivity and craving) and for neuropathic pain such as post-herpetic neuralgia
(central alpha-2 agonism modulates pain signals).
Question 5
,Jim is being treated for hypertension. Because he has a history of heart attacks, the drug chosen
is atenolol. Beta-blockers treat hypertension by:
A) Increasing heart rate to improve cardiac output
B) Reducing vascular smooth muscle tone
C) Increasing aldosterone-mediated volume activity
D) Reducing aqueous humor production
Correct Answer: B) Reducing vascular smooth muscle tone
Explanation: Beta-blockers lower BP through reduced cardiac output, decreased renin release,
and reduced sympathetic drive leading to decreased vascular smooth muscle tone. Atenolol is
beta-1 selective and is often chosen post-MI for cardioprotection.
Question 6
Which of the following adverse effects are less likely in a beta 1-selective blocker?
A) Dysrhythmias
B) Impaired insulin release
C) Reflex orthostatic changes
D) Decreased triglycerides and cholesterol
Correct Answer: B) Impaired insulin release
Explanation: Non-selective beta-blockers block beta-2 receptors in the pancreas, impairing
insulin release and masking hypoglycemia symptoms. Beta-1 selective agents have less impact
on insulin release and are safer in diabetics.
Question 7
Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed
nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should
you take related to his nadolol?
A) Extend the dosage interval
B) Decrease the dose by 75%
C) Take no action because this value is expected in the older adult
, D) Schedule a serum creatinine level to validate the CrCl value
Correct Answer: A) Extend the dosage interval
Explanation: Nadolol is primarily renally excreted. In severe renal impairment (CrCl <30
mL/min), extend the dosing interval (e.g., every 48 hours) or reduce the dose to prevent
accumulation and bradycardia/toxicity.
Question 8
Beta blockers are the drugs of choice for exertional angina because they:
A) Improve myocardial oxygen supply by vasodilating the coronary arteries
B) Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
C) Both 1 and 2
D) Neither 1 nor 2
Correct Answer: B) Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
Explanation: Beta-blockers reduce heart rate, contractility, and afterload, lowering myocardial
oxygen demand—the primary benefit in stable exertional angina. They do not directly vasodilate
coronary arteries (nitrates do that).
Question 9
Adherence to beta-blocker therapy may be affected by their:
A) Short half-lives requiring twice daily dosing
B) Tendency to elevate lipid levels
C) Effects on the male genitalia, which may produce impotence
D) None of the above
Correct Answer: C) Effects on the male genitalia, which may produce impotence
Explanation: Beta-blockers can cause erectile dysfunction due to reduced penile blood flow and
sympathetic blockade. This is a frequent cause of non-adherence in men. Lipid effects are
variable and less commonly the main adherence issue.
