Deck 17: Cholinergic Agonists

Question 1

Identify a way to differentiate between a cholinergic crisis and a myasthenic crisis from among the following:
1)Ask the patient about his family and occupational history.
2)Administer edrophonium and monitor the client's response.
3)Assess serum levels of the cholinesterase inhibitor.
4)Assess the neuromuscular status of the client.

Answer 1

2

Question 2

In the postoperative client, the nurse recognizes that bethanecol (Urecholine)might be given to treat:
1)Urinary atony.
2)Ischemic colitis.
3)Postoperative hypotension.
4)Respiratory atelectasis.

Answer 2

1

Question 3

Cholinesterase inhibitors can:
1)Prevent transmission at muscarinic, ganglionic, and neuromuscular junctions.
2)Intensify transmission at neuromuscular junctions only.
3)Intensify transmission at muscarinic, ganglionic, and neuromuscular junctions.
4)Prevent transmission at neuromuscular junctions only.

Answer 3

1

Question 4

A patient who is suspected to have myasthenia gravis is given a small dose of postoperative medication.The patient subsequently develops increased muscle weakness.Which medication should the nurse anticipate administering immediately?
1)A cholinesterase inhibitor
2)A dopamine agonist
3)A sympathetic stimulant
4)A calcium channel blocker

Question 5

While assessing a patient before administering neostigmine for myasthenia gravis management, the nurse documents that the patient has increased muscle strength compared with the last assessment over an hour ago.Your interpretation of this data should be:
1)The patient's dose should be increased.
2)The medication appears to be effective.
3)The next dose of the medication should not be given.
4)Toxicity from the medication is imminent.

Question 6

A side effect to expect from an anticholinergic agent, like atropine, does not include:
1)Dilated pupils.
2)Urinary retention.
3)Dry mouth.
4)Diarrhea.

Question 7

Common side effects of bethanecol include:
1)Hypertension.
2)Constipation.
3)Tachycardia.
4)Abdominal cramping.

Question 8

The nurse recognizes that neuromuscular blocking agents do not alter perceptions of pain during medical procedures.Prior to receiving the medication, the nurse asks the client to communicate pain by blinking.Is this method of communication appropriate given the medication's action?
1)Yes, during the procedure only
2)Yes, for the first 24 hours postoperatively
3)Yes, for 72 hours postoperatively
4)No, the medication would prohibit this type of communication.

Question 9

A client has received a dose of atropine in the preoperative area.On the way to the operating room, the client complains of a sudden feeling of warmth.The client's skin is flushed, warm, and dry.The nurse's actions should include:
1)Notifying the surgeon of the client's vital signs.
2)Assessing the vital signs and advising the OR that surgery must be delayed for one hour.
3)Assessing the client's mental status and vital signs.If normal, document finding and proceed to operating room.
4)Explaining the side effects of atropine to the client.

Question 10

Stimulation of the cholinergic receptors can cause which of the following conditions?
1)Constipation
2)Vomiting
3)Muscle strength
4)Muscle weakness

Question 11

Common side effects from anticholinergic drugs include all of the following, except:
1)Diarrhea.
2)Dilated pupils.
3)Blurred vision.
4)Dry mouth.

Question 12

A priority nursing diagnosis in the patient receiving anticholinergic drugs would be:
1)Impaired Gas Exchange related to respiratory secretions.
2)Injury Risk related to CNS changes related to medications.
3)Urinary Retention related to loss of bladder tone.
4)Knowledge Deficit related to new medications.

Question 13

Cholinergic drugs are most often indicated in which situation?
1)Inhibiting muscular contractions in the bladder
2)Preventing excess salivation and sweating
3)Lowering intraocular pressure in patients with glaucoma
4)Treating a patient with bradycardia

Question 14

A patient 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).You:
1)Advise him to take his medication as scheduled.
2)Advise him to hold the medication.
3)Ask if he is able to empty his bladder prior to taking his medication.
4)Consult with the urologist performing the case.

Question 15

Clients who receive which of the following medications can be expected to have neuromuscular pain the first postoperative day?
1)Succinylcholine (Anectine)
2)Atracurium (Tracrium)
3)Pancuronium
4)Tubocurarine

Question 16

Why would physostigmine be preferred over neostigmine to reverse muscarinic toxicity?
1)Pharmacodynamics
2)Pharmacokinetics
3)No adverse effects
4)Cost efficiency

Question 17

A client with myasthenia gravis is receiving therapy with neostigmine.The client telephones to report severe abdominal pain for the last four hours.The nurse's most appropriate response would be:
1)"This is a common side effect, and should resolve when you have a bowel movement."
2)"You are probably constipated.Take a laxative and return to the office in the morning."
3)"Increase your evening dose of medication.This should resolve your pain."
4)"You need to be evaluated immediately for a bowel obstruction."

Question 18

Caution should be used in administering cholinergic drugs to patients with a history of:
1)Glaucoma.
2)Benign prostatic hypertrophy.
3)Leg cramps.
4)Heartburn.

Question 19

A migrant worker presents to the Emergency Department with signs of an acute, recent organophosphate poisoning exposure.Which treatment plan should the nurse expect?
1)Give neostigmine as the antidote.
2)Keep the patient relaxed and quiet; administer no medications.
3)Treat the symptoms with echothiophate.
4)Administer a stat dose of pralidoxime as an immediate antidote.

Question 20

The most significant difference between neostigmine versus physostigmine is that physostigmine:
1)Cannot counteract neuromuscular blocking effect.
2)Is less effective for treating overdoses of muscarinic-blocking drugs.
3)Has no adverse effects.
4)Does not cross the blood-brain barrier.