PHARMACOLOGY NURS 251 MODULE 2 EXAM 2026/2027
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Graded
Section 1: Autonomic Nervous System - Cholinergic Drugs (Questions 1-25)
Q1: A nurse is teaching a patient about bethanechol (Urecholine) for the treatment of
urinary retention post-surgery. Which statement by the patient indicates a need for
further teaching?
A. "This medication helps my bladder muscles contract to empty my bladder."
B. "I should take this medication on an empty stomach to decrease nausea."
C. "I may experience sweating and salivation as side effects."
D. "If I feel dizzy or faint, I should take an extra dose immediately."
Correct Answer: D
Rationale: Bethanechol is a direct-acting cholinergic agonist that stimulates muscarinic
receptors to induce bladder contraction. It can cause hypotension and bradycardia as
adverse effects; dizziness suggests hypotension, and taking an extra dose could
exacerbate this to dangerous levels (severe hypotension, circulatory collapse).
Distractor A is correct regarding the mechanism. Distractor B is correct as taking it on
an empty stomach reduces GI upset. Distractor C describes expected cholinergic
(SLUDGE) side effects.
Module 2 Exam Insight: Portage exams frequently test patient safety regarding "extra
dosing" for drugs with narrow safety profiles like cholinergics. Always identify the
statement that indicates unsafe behavior.
Q2: A patient presents to the emergency department with signs of organophosphate
poisoning (insecticide ingestion). The nurse anticipates the administration of which two
agents?
A. Atropine and Pralidoxime (2-PAM)
B. Physostigmine and Atropine
C. Neostigmine and Glycopyrrolate
D. Bethanechol and Flumazenil
Correct Answer: A
Rationale: Organophosphates cause irreversible inhibition of acetylcholinesterase,
leading to cholinergic crisis (SLUDGE, seizures, respiratory paralysis). Atropine is a
muscarinic antagonist that blocks the excessive ACh effects at muscarinic receptors.
Pralidoxime (2-PAM) reactivates acetylcholinesterase if given early, before the aging of
the enzyme-pesticide complex occurs. Distractor B is incorrect because Physostigmine
,is a cholinesterase inhibitor (antidote for anticholinergic toxicity). Distractor C includes
Neostigmine, which would worsen the poisoning.
Module 2 Exam Insight: A high-yield "antidote" question. Remember: Atropine dries
secretions and increases heart rate (antidote for cholinergic toxicity), while
Physostigmine is the antidote for anticholinergic toxicity.
Q3: A nurse is administering pilocarpine eye drops to a patient with glaucoma. The
nurse understands that this medication lowers intraocular pressure by which
mechanism?
A. Dilating the pupil to improve aqueous humor outflow.
B. Constricting the pupil and contracting the ciliary muscle to improve outflow.
C. Decreasing the production of aqueous humor.
D. Blocking alpha-adrenergic receptors in the eye.
Correct Answer: B
Rationale: Pilocarpine is a direct-acting cholinergic agonist (muscarinic agonist). It
causes miosis (pupil constriction) and contraction of the ciliary muscle, which opens the
trabecular meshwork and Schlemm's canal, facilitating the outflow of aqueous humor.
Distractor A describes mydriasis (incorrect mechanism). Distractor C describes the
mechanism of beta-blockers or carbonic anhydrase inhibitors. Distractor D describes
alpha-blockers.
Module 2 Exam Insight: Differentiate drug classes for glaucoma. Cholinergics
(pilocarpine) = "Pupil constricts" (Miosis). Anticholinergics/Antihistamines are
contraindicated in Narrow-Angle Glaucoma.
Q4: Which assessment finding would the nurse recognize as a contraindication for
administering a cholinergic agonist like bethanechol?
A. Urinary retention
B. Bradycardia
C. Post-operative abdominal distention
D. Neurogenic bladder
Correct Answer: B
Rationale: Cholinergic agonists stimulate the parasympathetic nervous system, causing
bradycardia. Administering them to a patient who is already bradycardic could lead to
severe cardiac depression, heart block, or cardiac arrest. Distractors A, C, and D are
indications for bethanechol, as the drug increases smooth muscle tone and peristalsis.
Module 2 Exam Insight: "Simulate the Parasympathetic" = Slow heart, Secretions,
Stomach/Gut activity. If the patient already has these "Slow" symptoms (Bradycardia,
Block), do not give the drug.
Q5: A patient with Myasthenia Gravis is taking pyridostigmine (Mestinon). The nurse
educates the patient to be alert for symptoms of cholinergic crisis, which includes:
,A. Muscle weakness and dry mouth.
B. Increased muscle strength and tachycardia.
C. Muscle fasciculations, excessive salivation, and muscle weakness.
D. Dilated pupils and urinary retention.
Correct Answer: C
Rationale: Cholinergic crisis results from overtreatment/excessive acetylcholine.
Symptoms include SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI upset,
Emesis) and muscle weakness/fasciculations due to persistent depolarization at the
neuromuscular junction. Distractors A, B, and D describe anticholinergic effects or
opposite physiological responses.
Module 2 Exam Insight: Distinguish Myasthenic Crisis (too little medication) from
Cholinergic Crisis (too much medication). Both cause muscle weakness, but Cholinergic
Crisis has SLUDGE symptoms.
Q6: The nurse is caring for a patient receiving neostigmine for myasthenia gravis.
Which medication should be readily available at the bedside to treat potential
cholinergic crisis?
A. Epinephrine
B. Atropine
C. Naloxone
D. Flumazenil
Correct Answer: B
Rationale: Atropine is a muscarinic antagonist and is the specific antidote for cholinergic
toxicity (caused by cholinesterase inhibitors like neostigmine). It blocks the muscarinic
effects (SLUDGE, bradycardia) to stabilize the patient. Distractor A is for anaphylaxis.
Distractor C is for opioids. Distractor D is for benzodiazepines.
Module 2 Exam Insight: Antidote pairings are heavily tested. Cholinergic toxicity
→ Atropine.
Q7: A nurse is preparing to administer edrophonium (Tensilon) for a diagnostic test.
What is the primary purpose of this test?
A. To confirm the diagnosis of Myasthenia Gravis.
B. To determine if the patient is experiencing cholinergic crisis or myasthenic crisis.
C. To reverse the effects of non-depolarizing neuromuscular blockers.
D. To treat symptoms of Alzheimer's disease.
Correct Answer: A
Rationale: The Tensilon test uses edrophonium (a short-acting cholinesterase inhibitor)
to diagnose Myasthenia Gravis. If muscle strength improves temporarily (due to
increased ACh), the test is positive for MG. Distractor B describes a differentiation test,
but the primary diagnostic utility described in standard texts for edrophonium is the
, diagnosis of MG itself, though it can differentiate crisis types. However, standard
curriculum (Portage/Geneva) emphasizes the diagnostic confirmation of MG.
Module 2 Exam Insight: Edrophonium = Diagnosis. Pyridostigmine = Maintenance.
Know the difference in duration (Edrophonium is very short acting).
Q8: A patient is prescribed oxybutynin (Ditropan) for overactive bladder. The nurse
instructs the patient that this medication works by:
A. Stimulating muscarinic receptors to increase bladder capacity.
B. Relaxing the detrusor muscle by blocking muscarinic receptors.
C. Increasing the tone of the urinary sphincter via alpha-adrenergic stimulation.
D. Promoting diuresis to reduce bladder volume.
Correct Answer: B
Rationale: Oxybutynin is an anticholinergic (muscarinic antagonist). It relaxes the
smooth muscle of the detrusor muscle in the bladder, decreasing spasms and
increasing bladder capacity. Distractor A describes a cholinergic agonist. Distractor C
describes an alpha agonist mechanism (not the primary mechanism here).
Module 2 Exam Insight: "Anti-cholinergic" = "Anti-spasm" for the bladder. It prevents the
"Go" signal for urination.
Q9: A nurse is reviewing the medical history of a patient prescribed scopolamine
(Transderm-Scop) for motion sickness. Which condition in the patient's history requires
caution or contraindicates the use of this drug?
A. Hypertension
B. Narrow-angle glaucoma
C. Type 2 Diabetes Mellitus
D. Migraine headaches
Correct Answer: B
Rationale: Scopolamine is an anticholinergic. It causes mydriasis (pupil dilation), which
can obstruct the drainage of aqueous humor in patients with narrow-angle glaucoma,
leading to a rapid increase in intraocular pressure and potential blindness. Distractors A,
C, and D are not primary contraindications, though anticholinergics can worsen heat
stroke risk or urinary retention.
Module 2 Exam Insight: NCLEX "Red Flag" for Anticholinergics: Glaucoma (Narrow
Angle), BPH (Urinary Retention), and Bowel Obstruction.
Q10: Which clinical manifestation is described by the mnemonic "Hot as a hare"
associated with anticholinergic toxicity?
A. Hypothermia
B. Hyperthermia
C. Hypotension
D. Hallucinations
| Portage Learning ABCnursing Geneva College | Verified
Edition Questions & Answers | Pass Guaranteed - A+
Graded
Section 1: Autonomic Nervous System - Cholinergic Drugs (Questions 1-25)
Q1: A nurse is teaching a patient about bethanechol (Urecholine) for the treatment of
urinary retention post-surgery. Which statement by the patient indicates a need for
further teaching?
A. "This medication helps my bladder muscles contract to empty my bladder."
B. "I should take this medication on an empty stomach to decrease nausea."
C. "I may experience sweating and salivation as side effects."
D. "If I feel dizzy or faint, I should take an extra dose immediately."
Correct Answer: D
Rationale: Bethanechol is a direct-acting cholinergic agonist that stimulates muscarinic
receptors to induce bladder contraction. It can cause hypotension and bradycardia as
adverse effects; dizziness suggests hypotension, and taking an extra dose could
exacerbate this to dangerous levels (severe hypotension, circulatory collapse).
Distractor A is correct regarding the mechanism. Distractor B is correct as taking it on
an empty stomach reduces GI upset. Distractor C describes expected cholinergic
(SLUDGE) side effects.
Module 2 Exam Insight: Portage exams frequently test patient safety regarding "extra
dosing" for drugs with narrow safety profiles like cholinergics. Always identify the
statement that indicates unsafe behavior.
Q2: A patient presents to the emergency department with signs of organophosphate
poisoning (insecticide ingestion). The nurse anticipates the administration of which two
agents?
A. Atropine and Pralidoxime (2-PAM)
B. Physostigmine and Atropine
C. Neostigmine and Glycopyrrolate
D. Bethanechol and Flumazenil
Correct Answer: A
Rationale: Organophosphates cause irreversible inhibition of acetylcholinesterase,
leading to cholinergic crisis (SLUDGE, seizures, respiratory paralysis). Atropine is a
muscarinic antagonist that blocks the excessive ACh effects at muscarinic receptors.
Pralidoxime (2-PAM) reactivates acetylcholinesterase if given early, before the aging of
the enzyme-pesticide complex occurs. Distractor B is incorrect because Physostigmine
,is a cholinesterase inhibitor (antidote for anticholinergic toxicity). Distractor C includes
Neostigmine, which would worsen the poisoning.
Module 2 Exam Insight: A high-yield "antidote" question. Remember: Atropine dries
secretions and increases heart rate (antidote for cholinergic toxicity), while
Physostigmine is the antidote for anticholinergic toxicity.
Q3: A nurse is administering pilocarpine eye drops to a patient with glaucoma. The
nurse understands that this medication lowers intraocular pressure by which
mechanism?
A. Dilating the pupil to improve aqueous humor outflow.
B. Constricting the pupil and contracting the ciliary muscle to improve outflow.
C. Decreasing the production of aqueous humor.
D. Blocking alpha-adrenergic receptors in the eye.
Correct Answer: B
Rationale: Pilocarpine is a direct-acting cholinergic agonist (muscarinic agonist). It
causes miosis (pupil constriction) and contraction of the ciliary muscle, which opens the
trabecular meshwork and Schlemm's canal, facilitating the outflow of aqueous humor.
Distractor A describes mydriasis (incorrect mechanism). Distractor C describes the
mechanism of beta-blockers or carbonic anhydrase inhibitors. Distractor D describes
alpha-blockers.
Module 2 Exam Insight: Differentiate drug classes for glaucoma. Cholinergics
(pilocarpine) = "Pupil constricts" (Miosis). Anticholinergics/Antihistamines are
contraindicated in Narrow-Angle Glaucoma.
Q4: Which assessment finding would the nurse recognize as a contraindication for
administering a cholinergic agonist like bethanechol?
A. Urinary retention
B. Bradycardia
C. Post-operative abdominal distention
D. Neurogenic bladder
Correct Answer: B
Rationale: Cholinergic agonists stimulate the parasympathetic nervous system, causing
bradycardia. Administering them to a patient who is already bradycardic could lead to
severe cardiac depression, heart block, or cardiac arrest. Distractors A, C, and D are
indications for bethanechol, as the drug increases smooth muscle tone and peristalsis.
Module 2 Exam Insight: "Simulate the Parasympathetic" = Slow heart, Secretions,
Stomach/Gut activity. If the patient already has these "Slow" symptoms (Bradycardia,
Block), do not give the drug.
Q5: A patient with Myasthenia Gravis is taking pyridostigmine (Mestinon). The nurse
educates the patient to be alert for symptoms of cholinergic crisis, which includes:
,A. Muscle weakness and dry mouth.
B. Increased muscle strength and tachycardia.
C. Muscle fasciculations, excessive salivation, and muscle weakness.
D. Dilated pupils and urinary retention.
Correct Answer: C
Rationale: Cholinergic crisis results from overtreatment/excessive acetylcholine.
Symptoms include SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI upset,
Emesis) and muscle weakness/fasciculations due to persistent depolarization at the
neuromuscular junction. Distractors A, B, and D describe anticholinergic effects or
opposite physiological responses.
Module 2 Exam Insight: Distinguish Myasthenic Crisis (too little medication) from
Cholinergic Crisis (too much medication). Both cause muscle weakness, but Cholinergic
Crisis has SLUDGE symptoms.
Q6: The nurse is caring for a patient receiving neostigmine for myasthenia gravis.
Which medication should be readily available at the bedside to treat potential
cholinergic crisis?
A. Epinephrine
B. Atropine
C. Naloxone
D. Flumazenil
Correct Answer: B
Rationale: Atropine is a muscarinic antagonist and is the specific antidote for cholinergic
toxicity (caused by cholinesterase inhibitors like neostigmine). It blocks the muscarinic
effects (SLUDGE, bradycardia) to stabilize the patient. Distractor A is for anaphylaxis.
Distractor C is for opioids. Distractor D is for benzodiazepines.
Module 2 Exam Insight: Antidote pairings are heavily tested. Cholinergic toxicity
→ Atropine.
Q7: A nurse is preparing to administer edrophonium (Tensilon) for a diagnostic test.
What is the primary purpose of this test?
A. To confirm the diagnosis of Myasthenia Gravis.
B. To determine if the patient is experiencing cholinergic crisis or myasthenic crisis.
C. To reverse the effects of non-depolarizing neuromuscular blockers.
D. To treat symptoms of Alzheimer's disease.
Correct Answer: A
Rationale: The Tensilon test uses edrophonium (a short-acting cholinesterase inhibitor)
to diagnose Myasthenia Gravis. If muscle strength improves temporarily (due to
increased ACh), the test is positive for MG. Distractor B describes a differentiation test,
but the primary diagnostic utility described in standard texts for edrophonium is the
, diagnosis of MG itself, though it can differentiate crisis types. However, standard
curriculum (Portage/Geneva) emphasizes the diagnostic confirmation of MG.
Module 2 Exam Insight: Edrophonium = Diagnosis. Pyridostigmine = Maintenance.
Know the difference in duration (Edrophonium is very short acting).
Q8: A patient is prescribed oxybutynin (Ditropan) for overactive bladder. The nurse
instructs the patient that this medication works by:
A. Stimulating muscarinic receptors to increase bladder capacity.
B. Relaxing the detrusor muscle by blocking muscarinic receptors.
C. Increasing the tone of the urinary sphincter via alpha-adrenergic stimulation.
D. Promoting diuresis to reduce bladder volume.
Correct Answer: B
Rationale: Oxybutynin is an anticholinergic (muscarinic antagonist). It relaxes the
smooth muscle of the detrusor muscle in the bladder, decreasing spasms and
increasing bladder capacity. Distractor A describes a cholinergic agonist. Distractor C
describes an alpha agonist mechanism (not the primary mechanism here).
Module 2 Exam Insight: "Anti-cholinergic" = "Anti-spasm" for the bladder. It prevents the
"Go" signal for urination.
Q9: A nurse is reviewing the medical history of a patient prescribed scopolamine
(Transderm-Scop) for motion sickness. Which condition in the patient's history requires
caution or contraindicates the use of this drug?
A. Hypertension
B. Narrow-angle glaucoma
C. Type 2 Diabetes Mellitus
D. Migraine headaches
Correct Answer: B
Rationale: Scopolamine is an anticholinergic. It causes mydriasis (pupil dilation), which
can obstruct the drainage of aqueous humor in patients with narrow-angle glaucoma,
leading to a rapid increase in intraocular pressure and potential blindness. Distractors A,
C, and D are not primary contraindications, though anticholinergics can worsen heat
stroke risk or urinary retention.
Module 2 Exam Insight: NCLEX "Red Flag" for Anticholinergics: Glaucoma (Narrow
Angle), BPH (Urinary Retention), and Bowel Obstruction.
Q10: Which clinical manifestation is described by the mnemonic "Hot as a hare"
associated with anticholinergic toxicity?
A. Hypothermia
B. Hyperthermia
C. Hypotension
D. Hallucinations
