Deck 13: Cholinergic Agonists

Question 1

A client is prescribed bethanechol (Urecholine)10 mg PO tid.What will the nurse determine as an adverse effect of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Nausea and vomiting
B)Blurred vision
C)Orthostatic hypotension
D)Increased peristalsis
E)Slow respiratory rate

Answer 1

Nausea and vomiting
Blurred vision
Orthostatic hypotension

Question 2

The nurse is preparing to administer a prototype drug to a client with myasthenia gravis.What will the nurse identify as characteristics of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)It affects nicotinic acetylcholine synapses in skeletal muscle.
B)It is the prototype drug.
C)It does not cross the placenta.
D)It decreases peristalsis and causes bronchodilation.
E)It must be used with caution in heart failure.

Answer 2

It affects nicotinic acetylcholine synapses in skeletal muscle.
It is the prototype drug.
It must be used with caution in heart failure.

Question 3

A client with myasthenia gravis is demonstrating weakness 4 hours after taking the last dose of pyridostigmine (Mestinon).What may be the cause of the client's weakness? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The client needs a higher dose of the medication.
B)The client is developing drug resistance.
C)The client needs a lower dose of the medication.
D)The client's autonomic nervous system is rejecting the medication.
E)The client should have received the medication with atropine.

Answer 3

The client needs a higher dose of the medication.
The client is developing drug resistance.

Question 4

What do common side effects of bethanechol include?

A)Abdominal cramping
B)Hypertension
C)Constipation
D)Tachycardia

Question 5

Prior to administering a prescribed muscarinic agonist,the nurse reviews the client's medical history and decides to withhold the medication until contacting the health care provider.Which findings in the medical history support withholding the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The client's bowel sounds are absent.
B)The client is currently being treated for asthma.
C)The client has ventricular dysrhythmia.
D)The client has a diagnosis of arthritis.
E)The client has spinal stenosis.

Question 6

The nurse is administering Habitrol to a client.What effects will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Increased alertness
B)Increased heart rate
C)Increased blood pressure
D)Nausea
E)Muscle pain

Question 7

A client with myasthenia gravis is prescribed neostigmine.The client telephones to report severe abdominal pain for the last 4 hours.Which response by the nurse is the most appropriate?

A)"Increase your evening dose of medication.This should resolve your pain."
B)"This is a common side effect that should resolve when you have a bowel movement."
C)"You need to be evaluated immediately for a bowel obstruction."
D)"You are probably constipated.Take a laxative and return to the office in the morning."

Question 8

A client entering the hospital for a prostatectomy questions whether he should take his normal medications for myasthenia gravis prior to coming to the hospital.In particular,he needs to know when to take his ambenonium (Mytelase).Which action by the nurse is the most appropriate?

A)Advise him to hold the medication.
B)Advise him to take his medication as scheduled.
C)Ask if he is able to empty his bladder prior to taking his medication.
D)Consult with the urologist performing the case.

Question 9

A client has received a dose of atropine to counteract the effects of a cholinergic medication prior to having surgery.On the way to the operating room (OR),the client complains of a sudden feeling of warmth.The client's skin is flushed,warm,and dry.Which nursing action is the most appropriate?

A)Assessing the vital signs and advising the OR that surgery must be delayed for 1 hour.
B)Assessing the client's mental status and vital signs.If normal,document finding and proceed to operating room.
C)Notifying the surgeon of the client's vital signs.
D)Explaining the side effects of atropine to the client.

Question 10

A client who is suspected to have myasthenia gravis is given a small dose of postoperative medication.The client subsequently develops increased muscle weakness.Which medication should the nurse anticipate administering immediately?

A)A dopamine agonist
B)A calcium channel blocker
C)A cholinesterase inhibitor
D)A sympathetic stimulant

Question 11

A client with myasthenia gravis is receiving pyridostigmine (Mestinon).Which medications should the nurse to administering to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Decadron
B)Ibuprofen
C)Warfarin
D)NPH insulin
E)Lidocaine

Question 12

Which side effect from an anticholinergic agent such as atropine is unexpected?

A)Dry mouth
B)Diarrhea
C)Urinary retention
D)Dilated pupils

Question 13

Which action is the most appropriate description for cholinesterase inhibitors?

A)Intensify transmission at neuromuscular junctions only.
B)Prevent transmission at neuromuscular junctions only.
C)Prevent transmission at muscarinic,ganglionic,and neuromuscular junctions.
D)Intensify transmission at muscarinic,ganglionic,and neuromuscular junctions.

Question 14

A client is prescribed donepezil (Aricept)for treatment of Alzheimer disease.What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)This medication will improve memory.
B)This medication will improve thinking.
C)This medication slows the progression of the disease.
D)This medication will cure the disease.
E)This medication causes a long-term improvement in the progression of the disease.

Question 15

A client with Alzheimer disease is admitted for an overdose of donepezil (Aricept).What will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Tachycardia
B)Vomiting
C)Muscle twitching
D)Abdominal cramping
E)Urinary retention

Question 16

What is the most significant difference between neostigmine and pyridostigmine?

A)Neostigmine has no adverse effects.
B)Neostigmine has a longer duration of action.
C)Neostigmine has a shorter duration of action.
D)Neostigmine cannot counteract neuromuscular blocking effect.

Question 17

While assessing a client before administering neostigmine for myasthenia gravis management,the nurse documents that the client has increased muscle strength compared with the last assessment over an hour ago.Which interpretation of this data by the nurse is the most accurate?

A)Toxicity from the medication is imminent.
B)The client's dose should be increased.
C)The medication appears to be effective.
D)The next dose of the medication should not be given.

Question 18

In the postoperative client,the nurse recognizes that bethanechol (Urecholine)might be given to treat which condition?

A)Respiratory atelectasis
B)Postoperative hypotension
C)Ischemic colitis
D)Urinary atony

Question 19

The nurse differentiates between a cholinergic crisis and a myasthenic crisis by taking which action?

A)Assessing the neuromuscular status of the client
B)Asking the client about family and occupational history
C)Assessing serum levels of the cholinesterase inhibitor
D)Administering edrophonium and monitoring the client's response

Question 20

Cholinergic drugs are most often indicated in which situation?

A)Preventing excess salivation and sweating
B)Treating a client with bradycardia
C)Lowering intraocular pressure in clients with glaucoma
D)Inhibiting muscular contractions in the bladder

Question 21

The nurse is concerned that a client receiving pyridostigmine (Mestinon)is experiencing adverse effects.Which assessment findings indicate an adverse effect? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Muscle twitching
B)Nausea
C)Drooling
D)Increased peristalsis
E)Low blood pressure

Question 22

What is a priority nursing diagnosis for the client receiving anticholinergic drugs?

A)Injury,Risk for related to CNS changes related to medications
B)Knowledge,Deficient related to new medications
C)Gas Exchange,Impaired related to respiratory secretions
D)Urinary Retention related to loss of bladder tone

Question 23

A migrant worker presents to the emergency department with signs of an acute,recent organophosphate poisoning exposure.Which treatment plan should the nurse expect?

A)Treat the symptoms with echothiophate.
B)Keep the client relaxed and quiet; administer no medications.
C)Administer a stat dose of pralidoxime as an immediate antidote.
D)Give neostigmine as the antidote.

Question 24

The nurse is preparing discharge instructions for a client who is prescribed neostigmine (Prostigmin).What should be included in this client's discharge teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Practice home safety measures.
B)Take the medication with food,milk,or a small snack.
C)Notify the health care provider if experiencing tremors,dizziness,or urinary retention.
D)Report to the health care provider any changes in muscle weakness that occur 1 or 3 hours after taking.
E)Stop taking the medication if shortness of breath occurs.

Question 25

Caution should be used in administering cholinergic drugs to clients with a history of which condition?

A)Leg cramps
B)Glaucoma
C)Benign prostatic hypertrophy
D)Heartburn

Question 26

The nurse is evaluating instruction provided to a client who is prescribed pyridostigmine (Mestinon).Which client statements indicate teaching has been effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I am taking this medication for muscle weakness."
B)"I am to take a total of ten 60-mg tablets spaced throughout the day."
C)"I should use nightlights at home for safety when walking."
D)"I should keep all appointments with my health care provider because I will need blood work."
E)"Black tarry stools are an expected effect of this medication."

Question 27

A client is prescribed cevimeline (Evoxac)for treatment of xerostomia.What potential side effects should the nurse discuss with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Excessive sweating
B)Diarrhea
C)Rhinorrhea
D)Muscle pain
E)Respiratory infections