Question 1

The nurse is teaching a patient about the use of an anticholinergic medication. What information will the nurse include when teaching this patient about this medication?

Accepted Answer

D

Question 2

The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patient's blood pressure is 110/70 mm Hg. The nurse will perform which action?

Accepted Answer

The patient's urinary retention has been resolved and the loose stool is a common side effect of bethanechol. The patient's blood pressure is within the normal range. Recording the urine output and blood pressure and continuing to monitor is appropriate. There is no need to notify the provider of adverse effects or request atropine sulfate, as the patient's symptoms are mild and expected with this medication. Suggesting another dose of bethanechol is not necessary as the current dose has already been effective in resolving the urinary retention.

Question 3

A patient who is intubated develops sinus bradycardia. Which medication will the nurse anticipate administering to treat this symptom?

Accepted Answer

Sinus bradycardia is a slowing of the heart rate, which can lead to decreased cardiac output and blood pressure. Atropine sulfate is a medication commonly used to treat bradycardia by blocking the parasympathetic nervous system and increasing the heart rate. It is the first-line medication used for this condition. Benztropine is used to treat extrapyramidal side effects of antipsychotic medications, Bethanechol chloride is used to increase urinary bladder tone, and Metoclopramide is a prokinetic medication used to treat gastrointestinal issues. None of these medications are indicated for the treatment of sinus bradycardia.

Question 4

The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform?

Accepted Answer

Atropine can cause urinary retention, so palpating the bladder will help assess if the patient is retaining urine despite the output.

Question 5

The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug:

Accepted Answer

Indirect-acting cholinergic agonists such as neostigmine, pyridostigmine, and edrophonium inhibit the action of cholinesterase, which is responsible for breaking down acetylcholine at the synapse. By inhibiting cholinesterase, these drugs increase the concentration of acetylcholine at the synapse, thus enhancing its action on both muscarinic and nicotinic receptors.

Question 6

Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimer disease?

Accepted Answer

Donepezil HCl (Aricept) is a cholinesterase inhibitor that is specifically indicated for the treatment of Alzheimer's disease. The other options are not typically used for this condition.

Question 7

The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching?

Accepted Answer

Bethanechol can cause excessive sweating as a side effect, but it is not considered a normal reaction. This indicates a need for further teaching.

Question 8

The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinson disease. When performing an assessment, which aspect of the patient's history would cause the nurse to hold the medication and notify the provider?

Accepted Answer

Benztropine can cause increased intraocular pressure, which can worsen glaucoma. The nurse should hold the medication and notify the provider if the patient has a history of glaucoma. Asthma, irritable bowel syndrome, and motion sickness are not contraindications for benztropine.

Question 9

The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider?

Accepted Answer

Atropine sulfate is given to decrease secretions and prevent bradycardia during anesthesia. It can also cause decreased bowel motility, leading to absent bowel sounds. This could be a sign of postoperative ileus, which can be a serious complication and requires notification of the provider. Drowsiness, dry mouth, and a heart rate of 78 beats per minute are expected findings after receiving atropine sulfate.

Question 10

The nurse is teaching a patient who is going on a cruise about the use of transdermal scopolamine. What information will the nurse include when teaching this patient?

Accepted Answer

The nurse should teach the patient to change the transdermal scopolamine patch every 3 days, as this is the recommended frequency for changing the patch. Option A is incorrect because the patch should be applied as prescribed and not "as needed" for nausea and vomiting. Option B is incorrect because the patch can be applied to several areas of the body, not just the upper arm. Option D is incorrect because fluid restriction is not a necessary precaution when using transdermal scopolamine.

Question 11

A nursing student asks why a direct-acting cholinergic agonist drug that is selective to muscarinic receptors is described as being non-specific. The nurse will explain that this is because:

Accepted Answer

Muscarinic receptors are present in multiple different tissues and organs throughout the body, so drugs that are selective to these receptors can have non-specific effects on various systems.

Question 12

The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg. The nurse will perform which action?

Accepted Answer

Bethanechol can cause a decrease in blood pressure and a reflex tachycardia. Therefore, since the patient's blood pressure is already low, the medication should be held and the provider notified of the decreased blood pressure.

Question 13

A patient who has Parkinson disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinson disease would be a contraindication for this drug?

Accepted Answer

Myasthenia gravis is a neuromuscular disorder characterized by muscle weakness and is a contraindication for the use of benztropine. This medication can exacerbate muscle weakness and worsen symptoms of myasthenia gravis. Drooling and muscle rigidity are common symptoms of Parkinson disease and can be treated with benztropine. Muscle weakness can also occur in Parkinson disease, but if it is due to myasthenia gravis, benztropine should not be used.

Question 14

The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinson disease. The nurse understands that this drug is used primarily for which purpose?

Accepted Answer

Benztropine is primarily used to suppress tremors and lessen muscle rigidity in patients with Parkinson disease by blocking the action of acetylcholine, which can contribute to these symptoms. It is not typically used for decreasing drooling, improving mobility and muscle strength, or preventing urinary retention.

Question 15

The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would warrant holding administration of the drug?

Accepted Answer

Decreased bowel sounds can indicate a gastrointestinal obstruction, which is a contraindication for using tolterodine tartrate (Detrol LA) as it can exacerbate the condition.

Question 16

A patient who has irritable bowel syndrome would most likely receive which type of drug to treat this condition?

Accepted Answer

Patients with irritable bowel syndrome often experience excessive bowel contractions, leading to abdominal pain and discomfort. Anticholinergics can help reduce these contractions and relieve symptoms in patients with irritable bowel syndrome. Cholinergic esterase inhibitors, muscarinic agents, and nicotinic agents are not typically used to treat irritable bowel syndrome.

Question 17

The nurse is caring for a male patient with myasthenia gravis who will begin taking neostigmine. When performing a health history, the nurse will be concerned about a history of which condition in this patient?

Accepted Answer

Neostigmine is a cholinesterase inhibitor used to treat myasthenia gravis. It can cause urinary retention in patients with benign prostatic hypertrophy, so the nurse should be concerned about this condition in the patient's health history. Chronic constipation and erectile dysfunction are not contraindications for neostigmine. An upper respiratory infection may affect the patient's ability to breathe, but it is not related to neostigmine administration.

Quiz 16: Cholinergic Agonists and Antagonists