Question 1

Identify a way to differentiate between a cholinergic crisis and a myasthenic crisis from among the following:

Accepted Answer

Administering edrophonium and monitoring the client's response is a method to differentiate between a cholinergic crisis and a myasthenic crisis. Edrophonium is a short-acting cholinesterase inhibitor. In a myasthenic crisis, which is due to insufficient acetylcholine at the neuromuscular junction, administration of edrophonium will temporarily improve muscle strength. In contrast, in a cholinergic crisis, caused by excessive acetylcholine due to overmedication with cholinesterase inhibitors, symptoms will worsen after edrophonium administration.

Question 2

In the postoperative client, the nurse recognizes that bethanecol (Urecholine)might be given to treat:

Accepted Answer

Bethanechol (Urecholine) is a cholinergic agonist that stimulates the bladder to contract, which can help treat urinary retention or urinary atony by promoting urination.

Question 3

Cholinesterase inhibitors can:

Accepted Answer

Cholinesterase inhibitors prevent the breakdown of acetylcholine, which leads to increased acetylcholine levels at muscarinic, ganglionic, and neuromuscular junctions. This results in increased transmission at these junctions.

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?

Accepted Answer

A cholinesterase inhibitor is used in the treatment of myasthenia gravis because it increases the amount of acetylcholine at the neuromuscular junction, thereby improving muscle strength.

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:

Accepted Answer

Neostigmine is used in the treatment of myasthenia gravis to improve muscle strength by inhibiting the breakdown of acetylcholine. Increased muscle strength compared with the last assessment indicates that the medication is having its intended effect, thus showing its effectiveness.

Question 6

A side effect to expect from an anticholinergic agent, like atropine, does not include:

Accepted Answer

Anticholinergic agents, such as atropine, block the action of the neurotransmitter acetylcholine, leading to effects such as dilated pupils (mydriasis), urinary retention, and dry mouth (xerostomia). Diarrhea is not expected as anticholinergics typically reduce bowel movements, opposite to causing diarrhea.

Question 7

Common side effects of bethanecol include:

Accepted Answer

Bethanechol is a muscarinic agonist that stimulates the muscarinic receptors in the parasympathetic nervous system, leading to increased gastrointestinal motility and secretions, which can cause abdominal cramping. It does not cause hypertension, constipation, or tachycardia; in fact, it would more likely cause opposite effects like hypotension, diarrhea, and bradycardia due to its parasympathomimetic action.

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?

Accepted Answer

Neuromuscular blocking agents paralyze skeletal muscles, including those controlling blinking, making it impossible for the patient to communicate pain by blinking once the medication takes effect.

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:

Accepted Answer

Atropine can cause flushing, warmth, and dryness of the skin. These are common side effects of atropine and do not require delaying surgery.

Question 10

Stimulation of the cholinergic receptors can cause which of the following conditions?

Accepted Answer

The answer of Stimulation of the cholinergic receptors can cause...

Question 11

Common side effects from anticholinergic drugs include all of the following, except:

Accepted Answer

Anticholinergic drugs typically cause side effects such as dry mouth, blurred vision, and dilated pupils due to their action on the muscarinic receptors, which leads to decreased secretions and various other effects. Diarrhea is not a common side effect of anticholinergic drugs; in fact, these drugs are more likely to cause constipation.

Question 12

A priority nursing diagnosis in the patient receiving anticholinergic drugs would be:

Accepted Answer

The answer of A priority nursing diagnosis in the patient...

Question 13

Cholinergic drugs are most often indicated in which situation?

Accepted Answer

Cholinergic drugs are often used to lower intraocular pressure in patients with glaucoma by increasing the outflow of aqueous humor from the eye.

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:

Accepted Answer

The answer of A patient entering the hospital for a...

Question 15

Clients who receive which of the following medications can be expected to have neuromuscular pain the first postoperative day?

Accepted Answer

Succinylcholine (Anectine) is known to cause muscle pain (myalgia) after administration, particularly following the first postoperative day. This is due to its mechanism of action as a depolarizing muscle relaxant, which can lead to muscle fasciculations and subsequent soreness.

Question 16

Why would physostigmine be preferred over neostigmine to reverse muscarinic toxicity?

Accepted Answer

Physostigmine can cross the blood-brain barrier due to its tertiary amine structure, making it effective in reversing central nervous system effects of muscarinic toxicity, unlike neostigmine which is a quaternary amine and does not cross the blood-brain barrier.

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:

Accepted Answer

Neostigmine is a medication used to treat myasthenia gravis by increasing muscle strength. Severe abdominal pain could indicate a serious side effect such as a bowel obstruction, which requires immediate medical evaluation. The other options underestimate the potential severity of the symptom.

Question 18

Caution should be used in administering cholinergic drugs to patients with a history of:

Accepted Answer

Cholinergic drugs can exacerbate symptoms of benign prostatic hypertrophy by increasing bladder contraction and urinary retention.

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?

Accepted Answer

Pralidoxime is used as an immediate antidote for organophosphate poisoning, as it reactivates the acetylcholinesterase enzyme inhibited by organophosphates, thereby alleviating the symptoms of poisoning.

Question 20

The most significant difference between neostigmine versus physostigmine is that physostigmine:

Accepted Answer

Physostigmine can cross the blood-brain barrier, unlike neostigmine, which cannot. This allows physostigmine to be used for central nervous system effects, such as treating anticholinergic toxicity.

Quiz 17: Cholinergic Agonists