GALEN COLLEGE CINCINNATI PHARM EXAM 2 2026/2027 |
100% Correct Answers with Complete Solutions | Autonomic,
Cardiovascular, CNS, Anti-Infective, Endocrine, Respiratory,
GI/GU, Medication Safety | Pass Guaranteed - A+ Graded
Unit 1: Autonomic Nervous System Pharmacology (15 Questions)
Q1: A 68-year-old male patient with urinary retention secondary to benign prostatic
hyperplasia (BPH) is prescribed bethanechol (Urecholine) 25 mg PO TID. The nurse
should prioritize which assessment before administering this medication?
A. Blood pressure and heart rate to detect potential tachycardia and hypertension
B. Lung sounds and respiratory rate to assess for bronchospasm
C. Bladder scan for post-void residual and assessment for urinary obstruction
[CORRECT]
D. Pupil size and accommodation to detect miosis and ciliary muscle contraction
Correct Answer: C
Rationale: Bethanechol is a direct-acting cholinergic agonist (parasympathomimetic)
that stimulates muscarinic receptors, causing contraction of the detrusor muscle and
,relaxation of the trigone sphincter to promote bladder emptying. However, if significant
urethral obstruction exists (common in BPH), forcing bladder contraction against
obstruction can cause painful bladder spasms, upper urinary tract damage, or reflux. A
bladder scan assessing post-void residual and ensuring no complete obstruction is
essential. While bethanechol can cause hypotension and bradycardia (Option A), these
are less urgent than obstruction assessment. Bronchospasm (Option B) is possible but
rare with oral dosing. Pupil changes (Option D) occur but are not priority assessments
for this indication.
Q2: A patient receiving atropine for symptomatic bradycardia develops dry mouth,
blurred vision, and urinary retention. These effects result from atropine's action at which
receptor sites?
A. Stimulation of nicotinic receptors at the neuromuscular junction
B. Blockade of muscarinic receptors on smooth muscle and exocrine glands [CORRECT]
C. Activation of alpha-1 adrenergic receptors causing vasoconstriction
D. Inhibition of beta-2 adrenergic receptors leading to bronchoconstriction
Correct Answer: B
Rationale: Atropine is a non-selective muscarinic (M) receptor antagonist
(anticholinergic) that competitively blocks acetylcholine at muscarinic receptors. The
described effects—dry mouth (decreased salivation), blurred vision (cycloplegia and
,mydriasis from ciliary body and iris effects), urinary retention (detrusor relaxation and
trigone sphincter contraction)—are classic anticholinergic adverse effects from
muscarinic blockade in parasympathetically innervated tissues. Nicotinic receptors
(Option A) are unaffected by atropine's therapeutic doses. Alpha-1 (Option C) and beta-2
(Option D) are adrenergic receptors, not cholinergic targets.
Q3: A nurse is caring for a patient with myasthenia gravis who is prescribed
pyridostigmine (Mestinon) 60 mg PO every 4 hours while awake. The nurse understands
that this medication works by which mechanism?
A. Direct stimulation of nicotinic receptors at the neuromuscular junction
B. Irreversible inhibition of acetylcholinesterase, preventing acetylcholine breakdown
C. Reversible inhibition of acetylcholinesterase, increasing acetylcholine availability
[CORRECT]
D. Blockade of muscarinic receptors to enhance nicotinic receptor activity
Correct Answer: C
Rationale: Pyridostigmine is an indirect-acting cholinergic agonist (cholinesterase
inhibitor) that reversibly inhibits acetylcholinesterase, the enzyme that degrades
acetylcholine at synaptic clefts. This increases acetylcholine concentration and duration
of action at nicotinic receptors on skeletal muscle, improving neuromuscular
transmission in myasthenia gravis. It is reversible (unlike organophosphates), allowing
, normal acetylcholinesterase recovery between doses. Direct stimulation (Option A)
describes bethanechol or pilocarpine. Irreversible inhibition (Option B) describes
organophosphate insecticides/nerve agents. Muscarinic blockade (Option D) would
worsen myasthenia by reducing parasympathetic tone without addressing the
neuromuscular deficit.
Q4: A patient with glaucoma is prescribed pilocarpine ophthalmic drops. The nurse
should instruct the patient that the therapeutic effect of this medication occurs through
which mechanism?
A. Dilation of the pupil to improve aqueous humor outflow through the trabecular
meshwork
B. Constriction of the pupil (miosis) opening the trabecular meshwork and increasing
aqueous outflow [CORRECT]
C. Decreased production of aqueous humor by the ciliary body
D. Relaxation of the ciliary muscle to decrease intraocular pressure
Correct Answer: B
Rationale: Pilocarpine is a direct-acting muscarinic agonist (parasympathomimetic) that
causes miosis (pupil constriction) via contraction of the iris sphincter muscle. This pulls
the iris away from the trabecular meshwork, opening the drainage angle and increasing
aqueous humor outflow, thereby reducing intraocular pressure in open-angle glaucoma.
100% Correct Answers with Complete Solutions | Autonomic,
Cardiovascular, CNS, Anti-Infective, Endocrine, Respiratory,
GI/GU, Medication Safety | Pass Guaranteed - A+ Graded
Unit 1: Autonomic Nervous System Pharmacology (15 Questions)
Q1: A 68-year-old male patient with urinary retention secondary to benign prostatic
hyperplasia (BPH) is prescribed bethanechol (Urecholine) 25 mg PO TID. The nurse
should prioritize which assessment before administering this medication?
A. Blood pressure and heart rate to detect potential tachycardia and hypertension
B. Lung sounds and respiratory rate to assess for bronchospasm
C. Bladder scan for post-void residual and assessment for urinary obstruction
[CORRECT]
D. Pupil size and accommodation to detect miosis and ciliary muscle contraction
Correct Answer: C
Rationale: Bethanechol is a direct-acting cholinergic agonist (parasympathomimetic)
that stimulates muscarinic receptors, causing contraction of the detrusor muscle and
,relaxation of the trigone sphincter to promote bladder emptying. However, if significant
urethral obstruction exists (common in BPH), forcing bladder contraction against
obstruction can cause painful bladder spasms, upper urinary tract damage, or reflux. A
bladder scan assessing post-void residual and ensuring no complete obstruction is
essential. While bethanechol can cause hypotension and bradycardia (Option A), these
are less urgent than obstruction assessment. Bronchospasm (Option B) is possible but
rare with oral dosing. Pupil changes (Option D) occur but are not priority assessments
for this indication.
Q2: A patient receiving atropine for symptomatic bradycardia develops dry mouth,
blurred vision, and urinary retention. These effects result from atropine's action at which
receptor sites?
A. Stimulation of nicotinic receptors at the neuromuscular junction
B. Blockade of muscarinic receptors on smooth muscle and exocrine glands [CORRECT]
C. Activation of alpha-1 adrenergic receptors causing vasoconstriction
D. Inhibition of beta-2 adrenergic receptors leading to bronchoconstriction
Correct Answer: B
Rationale: Atropine is a non-selective muscarinic (M) receptor antagonist
(anticholinergic) that competitively blocks acetylcholine at muscarinic receptors. The
described effects—dry mouth (decreased salivation), blurred vision (cycloplegia and
,mydriasis from ciliary body and iris effects), urinary retention (detrusor relaxation and
trigone sphincter contraction)—are classic anticholinergic adverse effects from
muscarinic blockade in parasympathetically innervated tissues. Nicotinic receptors
(Option A) are unaffected by atropine's therapeutic doses. Alpha-1 (Option C) and beta-2
(Option D) are adrenergic receptors, not cholinergic targets.
Q3: A nurse is caring for a patient with myasthenia gravis who is prescribed
pyridostigmine (Mestinon) 60 mg PO every 4 hours while awake. The nurse understands
that this medication works by which mechanism?
A. Direct stimulation of nicotinic receptors at the neuromuscular junction
B. Irreversible inhibition of acetylcholinesterase, preventing acetylcholine breakdown
C. Reversible inhibition of acetylcholinesterase, increasing acetylcholine availability
[CORRECT]
D. Blockade of muscarinic receptors to enhance nicotinic receptor activity
Correct Answer: C
Rationale: Pyridostigmine is an indirect-acting cholinergic agonist (cholinesterase
inhibitor) that reversibly inhibits acetylcholinesterase, the enzyme that degrades
acetylcholine at synaptic clefts. This increases acetylcholine concentration and duration
of action at nicotinic receptors on skeletal muscle, improving neuromuscular
transmission in myasthenia gravis. It is reversible (unlike organophosphates), allowing
, normal acetylcholinesterase recovery between doses. Direct stimulation (Option A)
describes bethanechol or pilocarpine. Irreversible inhibition (Option B) describes
organophosphate insecticides/nerve agents. Muscarinic blockade (Option D) would
worsen myasthenia by reducing parasympathetic tone without addressing the
neuromuscular deficit.
Q4: A patient with glaucoma is prescribed pilocarpine ophthalmic drops. The nurse
should instruct the patient that the therapeutic effect of this medication occurs through
which mechanism?
A. Dilation of the pupil to improve aqueous humor outflow through the trabecular
meshwork
B. Constriction of the pupil (miosis) opening the trabecular meshwork and increasing
aqueous outflow [CORRECT]
C. Decreased production of aqueous humor by the ciliary body
D. Relaxation of the ciliary muscle to decrease intraocular pressure
Correct Answer: B
Rationale: Pilocarpine is a direct-acting muscarinic agonist (parasympathomimetic) that
causes miosis (pupil constriction) via contraction of the iris sphincter muscle. This pulls
the iris away from the trabecular meshwork, opening the drainage angle and increasing
aqueous humor outflow, thereby reducing intraocular pressure in open-angle glaucoma.
