Chapter 47: Drug Therapy for Myasthenia Gravis, Alzheimer's Disease, and Urinary Retention

The nurse is reviewing the medication history of a client who is receiving drug therapy for Alzheimer's disease. What medication should the nurse question? a. atropine b. donepezil c. memantine d. rivastigmine

a. atropine Medications that may be beneficial in slowing the progression of Alzheimer's disease include rivastigmine, donepezil, and memantine. Atropine is not used for this purpose.

The nurse is providing education to a client who has been prescribed donepezil. The nurse should instruct the client to take the medication according to what schedule? a. once daily at bedtime b. each morning with food c. three times a day with meals d. every 2nd day on an empty stomach

a. once daily at bedtime Administration of donepezil should occur at bedtime each day.

A female client is taking cholinergic medication to control bladder retention. She presents to the emergency department with confusion, shortness of breath, and an apical pulse of 42 beats per minute and irregular. What action would the nurse expect the health care provider to take? a. Increase the cholinergic medication to increase cardiac contractility. b. Increase the cholinergic medication to increase oxygenation to the heart through vasodilation. c. Decrease the cholinergic medication to alleviate the symptom of confusion. d. Discontinue the cholinergic medication secondary to the diagnosis of bradycardia.

d. Discontinue the cholinergic medication secondary to the diagnosis of bradycardia. People with coronary artery disease should not take cholinergics because they can result in bradycardia, vasodilation, and hypotension.

Which agent would be most appropriate to administer to a client with Alzheimer's disease? a. Pyridostigmine b. Neostigmine c. Ambenonium d. Donepezil

d. Donepezil Donepezil is an indirect-acting cholinergic agent used to treat Alzheimer's disease. Pyridostigmine, neostigmine, and ambenonium would be used to treat myasthenia gravis.

The nurse is providing information about how to care for clients during a bioterrorism attack. The nurse knows that which drug will be administered in the case of a sarin attack? a. Atropine b. Neostigmine c. Donepezil d. Bethanechol

a. Atropine In the case of a nerve gas attack, atropine is the antidote.

The pharmacology instructor is discussing age-related susceptibility to adverse effects of cholinergic drugs. Which statement could the instructor make to accurately describe the influence of age? a. "Physiologic changes resulting from the normal aging process place older adults at higher risk for adverse effects." b. "Older adults are at higher risk for adverse effects because they receive higher doses." c. "All age groups are equally susceptible to adverse effects." d. "Children are more susceptible to adverse effects because they receive more potent drugs than adults."

a. "Physiologic changes resulting from the normal aging process place older adults at higher risk for adverse effects." Age-related physiologic changes (e.g., to metabolism and excretion) and a higher likelihood of superimposed pathologic conditions (e.g., renal dysfunction) place older adults at increased risk for adverse effects of cholinergic drugs.

An 82-year-old client is newly diagnosed with Alzheimer disease. The client's adult child asks the nurse how the medication is going to help. What should the nurse explain in layman's terms? a. "The drugs work by increasing acetylcholine (ACh) levels in the brain and slowing the progression of the disease." b. "The drugs work by crossing the blood-brain barrier and cure the disease in the brain." c. "The drugs work by increasing ACh levels in the brain and reverse the progression of the disease." d. "The drugs work by crossing the blood-brain barrier and decreasing ACh levels in the neuromuscular junctions."

a. "The drugs work by increasing acetylcholine (ACh) levels in the brain and slowing the progression of the disease." Acetylcholinesterase inhibitors that cross the blood-brain barrier are used to manage Alzheimer disease by increasing ACh levels in the brain and slowing the progression of the disease. Decreasing ACh levels in the brain does not slow the progression, reverse the progression, or cure the disease. Decreasing ACh levels at the neuromuscular junctions has no effect on Alzheimer disease.

A nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral administration? a. 30 to 90 minutes b. 5 to 15 minutes c. 2 to 4 hours d. 12 to 24 hours

a. 30 to 90 minutes A nurse caring for a client receiving bethanechol (Urecholine) for urinary retention should advise the client that voiding usually occurs 30 to 90 minutes after an oral dose is administered. The time frame of 5 to 15 minutes does not allow enough time for the medication to be absorbed and distributed. The time frame of 2 to 4 hours indicates that the medication will not work and the time frame of 12 to 24 hours indicates that the client will have bladder distention and that an insertion of a catheter may need to be placed to relieve the pressure exerted on the bladder.

A nurse has administered a drug that will have a therapeutic effect on the client's parasympathetic nervous system. The nurse understands the drug will primarily affect what neurotransmitter? a. Acetylcholine b. Norepinephrine c. Dopamine d. Serotonin

a. Acetylcholine Acetylcholine (ACh) is the neurotransmitter that produces parasympathetic effects. Serotonin, dopamine and norepinephrine do not.

A nursing student is conducting a class presentation about cholinesterase inhibitors. Which would the student identify as the primary indication for use? a. Alzheimer disease b. Myasthenia gravis c. Glaucoma d. Urinary retention

a. Alzheimer disease Cholinesterase inhibitors strengthen neurotransmission and are used for the treatment of Alzheimer disease primarily, and at times for dementia of Parkinson disease. Myasthenia gravis is a chronic autoimmune neuromuscular disorder characterized by weakness and muscle fatigue while glaucoma is a group of diseases that damage the eye's optic nerve leading to vision loss and blindness, neither are treated with cholinesterase inhibitors. Urinary retention is a common side effect of some drugs but with the use of cholinesterase inhibitors the most common side effects are anorexia, nausea and vomiting, diarrhea, dizziness, and headache.

The nurse is providing education to a client who has been prescribed an anticholinesterase drug. What caution would the nurse include in the teaching? a. Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. b. Anticholinesterase drugs should be taken on an empty stomach to decrease the risk of gastric distress and ulceration. c. Anticholinesterase drugs should be taken at bedtime to prevent nausea. d. Anticholinesterase drugs need to be started at a very high dose and titrated to effect.

a. Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. All anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. These drugs are taken at bedtime to avoid the risks associated with dizziness and vertigo, not to prevent nausea. These drugs are not started at very high doses, though doses may be increased after several weeks if initial dosing doesn't achieve the desired effect.

A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent? a. Atropine b. Dopamine c. Epinephrine d. Norepinephrine

a. Atropine Atropine is considered an antidote for a cholinergic drug overdose. Dopamine is a catecholamine neurotransmitter that is given to increase the contraction of the heart in shock. Epinephrine is a hormone released in the presence of stress and is given in the case of allergic reaction and norepinephrine is a neurotransmitter from the autonomic nervous system, that constricts blood vessels, raising blood pressure.

A nurse is reviewing the medication history of several clients. One of the clients is receiving a direct-acting cholinergic drug. The nurse would most likely identify which drug? a. Bethanechol b. Pyridostigmine c. Guanidine d. Ambenonium

a. Bethanechol Bethanechol is an example of a direct-acting cholinergic that acts like the neurotransmitter acetylcholine. Pyridostigmine, guanidine, and ambenonium are indirect-acting muscle stimulants.

A nurse is caring for a patient with urinary retention. Which of the following conditions should the nurse notify the primary healthcare provider as part of the ongoing assessment? a. Failure to void after drug administration b. Frequent vomiting after drug administration c. Increase in abdominal pain after drug administration d. Occurrence of blood in urine after drug administration

a. Failure to void after drug administration The nurse should notify the primary healthcare provider that the patient has failed to void after drug administration. Frequent vomiting, increase in abdominal pain and occurrence of blood in urine are not usually observed for urinary retention treatment by cholinergic therapy.

After teaching a group of students about direct acting cholinergic agonists, the instructor determines that additional teaching is necessary when the students identify what as an adverse effect? a. Hypertension b. Bradycardia c. Diarrhea d. Urinary urgency

a. Hypertension Direct acting cholinergic agonists can cause bradycardia, hypotension, diarrhea, and urinary urgency.

The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms? a. Improve cholinergic neurotransmission to the brain b. Improve anticholinergic neurotransmission to the brain c. Improve medication absorption through the blood-brain barrier d. Cause vasodilation of the cerebral arteries

a. Improve cholinergic neurotransmission to the brain Indirect-acting cholinergic medications for Alzheimer's disease are widely distributed, including to the central nervous system. Thus, indirect-acting cholinergic drugs are able to improve cholinergic neurotransmission in the brain.

A patient with dementia of Alzheimer's disease is administered donepezil HCL. What are the actions associated with cholinesterase inhibitors? a. Increase in the level of acetylcholine in CNS b. Decrease in the level of neurotoxins in the brain c. Increase in the level of cholinesterase in the blood d. Increase in the level of adenosine tri-phosphate in the blood

a. Increase in the level of acetylcholine in CNS Administration of cholinesterase inhibitors results in an increase in the level of acetylcholine in CNS. Administration of cholinesterase inhibitors does not decrease the neurotoxins in the brain or increase the level of adenosine tri-phosphate in the blood. Cholinesterase inhibitors do not increase the level of cholinesterase in the blood.

The nurse is caring for a client with Alzheimer's disease who has been prescribed a cholinesterase inhibitor. What symptom of the disorder does the nurse expect the medication is intended to treat? a. Mild to moderate dementia b. Severe dementia c. Wandering and aggression d. Irritability

a. Mild to moderate dementia Cholinesterase inhibitors are used to treat mild to moderate dementia, not other symptoms of AD such as wandering, irritability, or aggression. The anticipated therapeutic effects are improved memory and reduction of dementia.

When describing the action of direct-acting cholinergic agonists, which receptors would the nurse identify as being stimulated? a. Muscarinic b. Nicotinic c. Alpha d. Beta

a. Muscarinic Direct-acting cholinergic agonists usually stimulate muscarinic receptors within the parasympathetic nervous system. Alpha and beta receptors are found in the sympathetic nervous system and are affected by adrenergic agents.

After teaching a group of students about indirect acting cholinergic agonists used to treat myasthenia gravis, the instructor determines that the teaching was effective when the students identify which agent? a. Neostigmine b. Galantamine c. Rivastigmine d. Tacrine

a. Neostigmine Neostigmine is used to treat myasthenia gravis. Galantamine is used to treat Alzheimer's disease. Rivastigmine is used to treat Alzheimer's disease. Tacrine is used to treat myasthenia gravis.

The stimulation of which receptors in the parasympathetic nervous system stimulates skeletal muscle? a. Nicotinic receptors b. Muscarinic receptors c. Alpha receptors d. Beta receptors

a. Nicotinic receptors The stimulation of nicotinic receptors in the parasympathetic nervous system stimulates skeletal muscle. The stimulation of muscarinic receptors stimulates smooth muscle. Alpha receptors are part of the sympathetic nervous system. Beta receptors are part of the sympathetic nervous system.

A client is prescribed donepezil. The nurse would expect to administer this drug at which frequency? a. Once a day b. Twice a day c. Three times a day d. Four times a day

a. Once a day Donepezil has a 70-hour half-life and is usually given in a once-a-day dosing. Galantamine and rivastigmine are usually taken twice a day. Tacrine must be taken four times a day.

What drug is prescribed for mushroom poisoning? a. atropine b. pralidoxime c. bethanechol d. neostigmine

a. atropine Accidental or intentional ingestion of these mushrooms results in intense cholinergic stimulation and is potentially fatal. Atropine is the specific antidote for mushroom poisoning.

The nurse is caring for a client who is receiving neostigmine for the treatment of myasthenia gravis. The nurse is aware that a potential complication of the treatment is cholinergic crisis, which is characterized by which event? a. excessive stimulation of the parasympathetic nervous system b. excessive stimulation of the sympathetic nervous system c. hypertension and respiratory failure d. stronger skeletal muscle contractions

a. excessive stimulation of the parasympathetic nervous system A cholinergic crisis is characterized by excessive stimulation of the parasympathetic nervous system. If early symptoms are not treated, hypotension and respiratory failure may occur. At high doses, anticholinesterase drugs weaken, rather than strengthen, skeletal muscle contraction because excessive amounts of acetylcholine accumulate at motor endplates and reduce nerve impulse transmission to muscle tissue.

The nurse is caring for a postoperative client who is experiencing abdominal distension related to a paralytic ileus. What drug would the nurse expect to be prescribed? a. neostigmine b. pyridostigmine c. edrophonium d. bethanechol

a. neostigmine Bethanechol is used to treat urinary retention due to urinary bladder atony and postoperative abdominal distention due to paralytic ileus. Neostigmine is the prototype anticholinesterase agent. It is used for long-term treatment of myasthenia gravis and as an antidote for tubocurarine and other nondepolarizing skeletal muscle relaxants used in surgery as well as paralytic ileus. Pyridostigmine is similar to neostigmine in actions, uses, and adverse effects. Edrophonium is a short-acting cholinergic drug used to diagnose myasthenia gravis, to differentiate between myasthenic crisis and cholinergic crisis, and to reverse the neuromuscular blockade produced by nondepolarizing skeletal muscle relaxants.

The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as which? a. osteoarthritis. b. Alzheimer's c. rheumatoid arthritis. d. dementia.

b. Alzheimer's Alzheimer's disease is a progressive deterioration of emotional, physical, and cognitive abilities. Osteoarthritis and rheumatoid arthritis do not normally affect the cognitive function of a client. Dementia is a group of symptoms affecting social and intellectual abilities but not physical abilities.

The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered? a. Pyridostigmine b. Atropine c. Neostigmine d. Rivastigmine

b. Atropine Edrophonium is a cholinergic agonist administered by a provider to diagnose myasthenia gravis. Use of this drug requires that an antidote, typically atropine, be on hand in case of cholinergic overdose.

The client is to receive an IV cholinergic medication. When the nurse administers the drug what reaction will the nurse anticipate? a. Increase in heart rate b. Decrease in heart rate c. Increase in anxiety d. Decrease in anxiety

b. Decrease in heart rate Cholinergic drugs decrease, not increase, heart rate. They do not usually have any effect on anxiety.

The nurse is caring for a client in the emergency department who has a history of myasthenia gravis. The client has symptoms that could be interpreted as either myasthenic crisis or cholinergic crisis. The nurse is aware that the health care provider will order what medication to help determine the type of crisis the client is experiencing? a. Donepezil b. Edrophonium c. Galantamine hydrobromide d. Memantine hydrochloride

b. Edrophonium Edrophonium is the drug that is used to help determine if a client is experiencing a myasthenic or a cholinergic crisis.

Which physiologic effect would be related to the use of cholinergic agents? a. Pupil dilation b. Increased salivation c. Increased heart rate d. Decreased bladder muscle tone

b. Increased salivation Cholinergic agents cause increased salivation, pupil constriction, decreased heart rate, and increased bladder muscle tone.

A nurse is caring for a patient with urinary retention. The patient has been prescribed Urecholine. For which category of patients should the nurse take precautions when administrating Urecholine? a. Patients with Raynaud's disease b. Patients with bradycardia c. Patients with recent myocardial infarction d. Patients with hyperthyroidism

b. Patients with bradycardia The nurse should administer Urecholine cautiously in patients with bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, and megacolon. The nurse need not take precautions for the patients with Raynaud's disease, recent myocardial infarction, and hyperthyroidism when administrating Urecholine.

The nursing instructor is teaching a student about the drugs used for Alzheimer's disease. Even though cholinesterase inhibitors do not cure the disease, the instructor informs the student that they do help to slow the progression. The instructor then asks the student, "When a drug is stopped due to side effects, what happens to the client?" The student's best response would be: a. The side effects will worsen. b. The client loses any benefit they have received from the drug. c. The client will deteriorate at a faster rate. d. The client will show no changes.

b. The client loses any benefit they have received from the drug. When a cholinesterase inhibitor has to be stopped due to adverse effects then within 6 weeks of the discontinuation of the therapy, the client will lose any benefit they have received from the drugs.

A client has benign prostatic hypertrophy and has been prescribed neostigmine. The nurse is aware that this client must be monitored for what adverse effect of this medication? a. Pain with urination b. Urinary retention c. Hematuria d. Pyuria

b. Urinary retention A client with benign prostatic hypertrophy may develop urinary retention, which is an adverse effect of neostigmine.

The nursing student correctly identifies the transmitter in the cholinergic neuropathways that appears insufficient in clients with Alzheimer's disease is which? a. epinephrine. b. acetylcholine. c. norepinephrine. d. memantine.

b. acetylcholine. Acetylcholine is the transmitter in the cholinergic neuropathways. Clients with early-stage Alzheimer's disease demonstrate a degeneration of these pathways. Epinephrine is a hormone and neurotransmitter; it acts on all body tissues and is responsible for such things as contraction of smooth muscles in the airways and that line the arterioles. Norepinephrine is also both a hormone and neurotransmitter; it works with epinephrine to give the body energy in times of stress. Memantine is a drug used to treat clients in late-stage Alzheimer's disease.

The nurse is caring for a client who has been diagnosed with myasthenia gravis. To ensure client safety, the nurse reviews treatment for myasthenic crisis, which requires what intervention? a. a decrease in glucocorticoid therapy b. additional anticholinesterase inhibitors c. withdrawal of anticholinesterase drugs d. withdrawal of immunoglobulin drugs

b. additional anticholinesterase inhibitors Myasthenic crisis is an exacerbation of the disease process and its clinical manifestations, requiring more anticholinesterase drug. Cholinergic crisis is a drug-induced overstimulation of the parasympathetic nervous system, requiring discontinuation of any anticholinesterase drug that the client has been receiving. Glucocorticoids and immunoglobulins are considered part of the required therapy.

A client in the emergency department has been diagnosed with mushroom poisoning. What drug does the nurse expect the health care provider to prescribe? a. pralidoxime b. atropine c. bethanechol d. neostigmine

b. atropine Accidental or intentional ingestion of certain mushrooms results in intense cholinergic stimulation and is potentially fatal. Atropine is the specific antidote for mushroom poisoning. Pralidoxime is used in the treatment of nerve gas exposure. Bethanechol is administered during the acute postoperative and postpartum periods for the treatment of nonobstructed urinary retention and neurogenic atony of the bladder muscle. Neostigmine is used in the diagnosis and treatment of myasthenia gravis

The emergency department has been alerted to the impending arrival of several clients following possible exposure to sarin gas. The nurse knows that sarin causes harm through what process? a. distortion of the chemical structure of acetylcholine b. excessive cholinergic stimulation c. elimination of anticholinesterase d. excessive dopamine stimulation

b. excessive cholinergic stimulation Sarin is a toxic nerve gas that produces a cholinergic crisis characterized by excessive cholinergic (muscarinic) stimulation and neuromuscular blockade. This cholinergic crisis occurs because the irreversible anticholinesterase poison binds to the enzyme anticholinesterase and inactivates it. Consequently, acetylcholine remains in cholinergic synapses and causes excessive stimulation of muscarinic and nicotinic receptors. Sarin does not eliminate or distort acetylcholine nor does it cause excessive dopamine stimulation.

The client in the final stage of Alzheimer's disease tends to suffer from weight loss and eating problems. This is primarily due to: a. loss of appetite. b. inability to swallow. c. fatigue. d. inability to make food choices.

b. inability to swallow. Weight loss and eating problems related to the inability to swallow are two major problems in the late stage of AD. The other choices are factors but the inability to swallow accounts for most eating problems seen in clients with late-stage Alzheimer's disease and for most of the accompanying weight loss.

A middle-aged client is being treated for myasthenia gravis with neostigmine. What change in the client's health status would warrant immediate medical follow-up? a. significant changes in mood and affect b. sudden muscle weakness c. migraine-type symptoms d. jaundice

b. sudden muscle weakness Sudden muscle weakness may be a sign of cholinergic crisis, which requires that the health care provider be notified immediately. The other listed changes in health also warrant assessment but are less likely to be as time dependent.

The caregiver of client describes the client as having Alzheimer's disease (AD) for 10 years and is currently in the late stage of the disease. The caregiver asks the nurse if the client can go back on the medication donepezil. Which response by the nurse is appropriate? a. "Let me discuss your concerns with the prescriber." b. "A newer drug that has recently been developed is galantamine." c. "The drugs are best used early as they slow the progression of AD." d. "Donepezil has had research studies findings suggesting it cures AD."

c. "The drugs are best used early as they slow the progression of AD." Drugs used in AD early slow the mental and physical degeneration associated with the disease. The drugs must be taken routinely to slow the progression. Donepezil and galantamine are cholinesterase inhibitors. Should cholinesterase inhibitor therapy be discontinued, individuals lose any benefit they have received from the drugs within 6 weeks.

A nurse is preparing to administer a cholinergic medication. To prepare to administer the medication, the nurses is assessing the client for anticholinergic effects. Cholinergic medications act like which neurotransmitter? a. Serotonin b. Dopamine c. Acetylcholine d. Norepinephrine

c. Acetylcholine Cholinergic drugs act like the neurotransmitter acetylcholine. Serotonin, dopamine, and norepinephrine are the neurotransmitters which affect mood.

The nurse is caring for a client who is receiving an indirect-acting cholinergic medication and knows it is indicated as a treatment for myasthenia gravis as well as which other condition? a. Muscular dystrophy b. Musculoskeletal cancer c. Alzheimer's disease d. Cerebrovascular dementia

c. Alzheimer's disease Indirect-acting cholinergic or anticholinesterase drugs are indicated to treat myasthenia gravis and Alzheimer's disease.

Decreased acetylcholine levels are characteristic of what disorder? a. multiple sclerosis. b. Huntington's disease. c. Alzheimer's disease. d. Parkinson's disease.

c. Alzheimer's disease. In normal brain function, acetylcholine is an essential neurotransmitter and plays an important role in cognitive functions, including memory storage and retrieval. Alzheimer's disease, the most common type of dementia in adults, is characterized by acetylcholine abnormalities. Multiple sclerosis (MS) is a disease of the central nervous system. Protecting the nerve fibers of the central nervous system is a fatty tissue called myelin, which helps nerve fibers conduct electrical impulses. In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. Huntington's disease is a genetic neurologic disorder characterized by abnormal body movements called chorea and a lack of coordination; it also affects a number of mental abilities and some aspects of behavior. There is no specific test or marker for Parkinson's disease (PD); diagnosis is by a health care provider and depends on the presence of at least two of the three major signs: tremor at rest, rigidity, and bradykinesia, as well as the absence of a secondary cause, such as antipsychotic medications or multiple small strokes in the regions of the brain controlling movement.

A new resident has just been admitted to the long-term care facility. When reviewing the client's medication record, the nurse observes that the client is currently taking donepezil. What should the nurse include in the resident's plan of care? a. Apply restraints when necessary during times of agitation. b. Assess the client's muscles strength and active range of motion daily. c. Assess the client's orientation each shift. d. Assess the client's respiratory status once per shift.

c. Assess the client's orientation each shift. Donepezil is used to treat Alzheimer disease. Consequently, it would be necessary to monitor the client's cognition. Respiratory and musculoskeletal status would be less affected. Restraints are only used as an absolute last resort.

A student asks the pharmacology instructor to describe the function of a cholinergic agonist. What would the instructor reply? a. Cholinergic agonists increase the activity of dopamine receptor sites throughout the brain and spinal cord. b. Cholinergic agonists decrease the activity of GABA receptor sites throughout the body. c. Cholinergic agonists increase the activity of acetylcholine receptor sites throughout the body. d. Cholinergic agonists decrease the activity of norepinephrine receptor sites throughout the brain and spinal cord.

c. Cholinergic agonists increase the activity of acetylcholine receptor sites throughout the body. Cholinergic agonists are drugs that increase the activity of acetylcholine receptor sites throughout the body. Dopamine, GABA, and norepinephrine are not associated with cholinergic agonist function.

Which medication would the nurse expect to administer orally once a day to a client with AD? a. Rivastigmine b. Memantine c. Donepezil d. Galantamine

c. Donepezil Donepezil is given once a day. While rivastigmine, galantamine, and memantine are given twice a day.

A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient? a. Decreased effectiveness of anticholinergics b. Increased risk of theophylline toxicity c. Increased risk of GI bleeding d. Decrease GI absorption of the drug

c. Increased risk of GI bleeding The interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors causes increased risk of GI bleeding, which should be monitored for. Interaction of anticholinergics with cholinesterase inhibitors causes decreased effectiveness of anticholinergics. Interaction of theophylline with cholinesterase inhibitors causes increased risk of theophylline toxicity. Interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors does not decrease the GI absorption of the drug.

A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem? a. Alzheimer disease b. Parkinson disease c. Myasthenia gravis d. Multiple sclerosis

c. Myasthenia gravis The most significant indication for neostigmine therapy is myasthenia gravis. Other clinical indications include urinary retention and paralytic ileus, but the drug is not used to treat Parkinson disease, Alzheimer disease, or multiple sclerosis.

A patient with postoperative abdominal distention is given neostigmine for abdominal distention. What outcome will the nurse assess for? a. Absence of flatus through the rectum b. Increased urination c. Presence of bowel sounds d. Absence of bowel movements

c. Presence of bowel sounds Presence of bowel sounds would indicate increased GI muscle tone and motility and result in a therapeutic effect of the drug. Absence of flatus and a bowel movement would indicate that the medication is not producing a therapeutic effect. This drug would not cause increased urination, but could cause a decrease in urination, which would be a positive effect for neurogenic bladder.

The nurse is developing a teaching plan for an outpatient receiving cholinergic drugs. What should be the role of the nurse when developing a teaching plan? a. Suggest the patient avoid fiber-rich food during therapy. b. Suggest the patient adapt a self blood pressure measurement habit. c. Review the purpose of the drug therapy with the patient and family. d. Review the patient's previous history of disorders.

c. Review the purpose of the drug therapy with the patient and family. The nurse should review the purpose of the drug therapy with the patient and family when developing a teaching plan for an outpatient receiving cholinergic drugs. Suggesting that the patient avoid fiber-rich food during therapy, suggesting the patient adapt a self blood pressure measurement habit, and reviewing the patient's previous history of disorders are not related roles of the nurse when developing a teaching plan for an outpatient receiving cholinergic drugs.

The nurse is caring for a client with asthmatic bronchitis and understands that cholinergic medications are contraindicated because this classification of medication may cause which effect? a. Bronchodilation b. Decreased secretions c. Thickened secretions d. Bronchoconstriction

d. Bronchoconstriction Cholinergic drugs are contraindicated in people with asthma because they may cause bronchoconstriction and increased respiratory secretions.

A patient has been prescribed edrophonium for myasthenia gravis. Which of the following can the nurse monitor as a general adverse reaction in the patient? a. Seizure disorder b. Reduction of visual acuity c. Abdominal discomfort d. Cardiac arrhythmias

d. Cardiac arrhythmias The nurse should monitor for cardiac arrhythmias as a general adverse reaction in the patient. Seizure disorder, reduction of visual acuity, and abdominal discomfort are not edrophonium-related adverse reactions. Reduction of visual acuity is related to topical ophthalmics, and edrophonium is a muscle stimulant. When the patient is being administered bethanechol chloride for urinary retention, the nurse needs to examine abdominal discomfort as an adverse reaction of bethanechol chloride and not edrophonium.

When assessing a client for possible adverse effects of direct-acting cholinergic agents, what might the nurse find? a. Tachycardia b. Hypertension c. Constipation d. Urinary urgency

d. Urinary urgency Adverse effects associated with direct-acting cholinergic agents include urinary urgency, bradycardia, hypotension, and diarrhea.