Karch: Ch. 33 - Anticholinergic Agents

The nurse is educating a client who has been prescribed atropine, an anticholinergic drug. Which instructions should the nurse provide to the client? "Do not drive or operate machinery." "If you experience eye pain, contact the health care provider about increasing the dosage." "Increase your fluid intake and activity level." "Take long, hot showers frequently to relieve uncomfortable side effects."

"Do not drive or operate machinery."

A client with asthma will soon begin treatment with atropine as an adjunct to a normal drug regimen. What teaching point should the nurse include in client education related to this new aspect of drug treatment? "You might find that you have to urinate more often for the first few days that you take the drug." "It's possible that your eyes will take longer to adjust to bright lights." "If you develop diarrhea, it might be related to atropine and you should visit your health care provider." "You'll probably find that you are producing more saliva than normal; this is a normal side effect of atropine."

"It's possible that your eyes will take longer to adjust to bright lights."

The nurse administers atropine intramuscularly at 9:00 AM. At which time would the nurse expect the drug's peak effects to occur? 9:15 AM 9:30 AM 9:45 AM 10:00 AM

9:30 AM

A patient arrives in the emergency department (ED) with bradycardia. Atropine is the drug of choice to treat this bradycardia. What dosage would you expect the physician to order? <0.2 mg <0.3 mg <0.4 mg <0.5 mg

<0.5 mg

The nurse is preparing a client scheduled for abdominal surgery to begin at 0730. The client is to receive a preoperative medication of meperidine and scopolamine. The client also has an antibiotic to be administered prior to surgery. The nurse's first action should be Raise the side rails. Administer the preoperative medication intramuscular (IM) as ordered. Administer the antibiotic over 30 minutes intravenous as ordered. Give report to the perioperative nurse.

Administer the preoperative medication intramuscular (IM) as ordered.

Some anticholinergic drugs have the same clinical indications in the pediatric population as in the adult population. Which statement accurately describes a difference between the populations related to the use of anticholinergics? Anticholinergic drugs create different adverse effects in children. Adverse effects tend to be more severe in children. Anticholinergic drugs are more effective in the pediatric population. Adverse effects tend to be less severe in children.

Adverse effects tend to be more severe in children.

A 78-year-old client is about to begin home care and has been prescribed an anticholinergic. What should the home care nurse explain to the client and her family about this medication? The client may benefit from additional fiber and fluids in her diet. The client may need assistance with ambulation. The client may be at increased risk of heat stroke. All the above

All the above

A 75-year-old male client is experiencing extrapyramidal symptoms secondary to an antipsychotic drug. Which drug would the nurse expect the health care provider to order to relieve these symptoms? Beta-blockers Anticholinergics ACE inhibitors Physostigmine salicylate

Anticholinergics

Which would the nurse include in a teaching plan for a client who is prescribed an anticholinergic agent? Avoiding activities that require alertness Encouraging outside activity in the warm weather Limiting fluid intake during the day Decreasing fiber intake

Avoiding activities that require alertness

A male client asks the nurse why he needs the preoperative anticholinergic medication ordered by the anesthesiologist. The nurse explains that anticholinergic drugs are given preoperatively to prevent which anesthesia associated complication? Tachycardia Bradycardia Hypertension Dehydration

Bradycardia

The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client? Opioid Antiemetic Cholinergic blocking Antianxiety

Cholinergic blocking

Administration of which classes of medications can decrease secretions of the upper respiratory tract? Cholinergic blocking drug Opioids Antianxiolytic Antiemetics

Cholinergic blocking drug

A nursing mother is being prepared for an eye condition which requires a prescription for atropine. What nursing intervention should the nurse implement to assure safe and effective atropine therapy? Discuss an alternative feeding method until the atropine is no longer prescribed Discuss pumping and then warming the breast milk before bottle feeding the baby Discuss feeding the baby prior to taking the prescribed atropine Discuss the mother's need to be well hydrated to minimize the amount to atropine in the breastmilk

Discuss an alternative feeding method until the atropine is no longer prescribed

A client is using a scopolamine patch for treatment of motion sickness. The nurse would instruct the client to change the patch at which frequency? Every day Every 3 days Every 5 days Every 7 days

Every 3 days

A 57-year-old female client has a history of two myocardial infarctions in the past 3 years. She presents to the health care provider's office with symptoms of an overactive bladder. She requests an anticholinergic medication that she saw advertised on television. What does the nurse expect the provider to do for this client? Order the anticholinergic medication Order blood work to rule out a urinary tract infection and order the medication Order a urinalysis to rule out a urinary tract infection and order the medication Explain to the client that the medication is contraindicated because of her medical history

Explain to the client that the medication is contraindicated because of her medical history

Anticholinergics do not block the effects of acetylcholine in the central nervous system. True False

False Anticholinergics are thought to block the effects of acetylcholine in the CNS, which may account for their effectiveness in treating motion sickness.

The nurse is aware that cholinergic blocking agents will be used preoperatively for what type of anesthesia? Topical Local Regional General

General

The client is scheduled for surgery in two hours. The physician orders preoperative administration of glycopyrrolate and meperidine. These drugs might be contraindicated for the client if the client had what disorder? Asthma Glaucoma Diverticulitis Diabetes mellitus

Glaucoma

A male client is diagnosed with IBS, and the health care provider orders an antispasmodic. Which drug should the nurse be prepared to administer to this client? Atropine Hyoscyamine Glycopyrrolate Ipratropium

Glycopyrrolate

Which drugs are used to decrease secretions prior to surgery and are classified as cholinergic blocking drugs? Select all that apply. Fentanyl (Sublimaze) Lorazepam (Ativan) Glycopyrrolate (Robinul) Hydroxyzine (Vistaril) Atropine

Glycopyrrolate (Robinul) Atropine

A client with symptomatic bradycardia has been receiving atropine for the past 4 days and the client reports constipation. What is the most important suggestion the nurse could give the client? Avoid driving at night. Increase bulk in the diet. Suck on hard candies. Promote oral care.

Increase bulk in the diet.

A 70-year-old client is taking a cholinergic blocking drug. The family has noticed the client is a confused, excited, and not voiding normally. What would be the appropriate action by the nurse in this situation? Instruct the client's family to continue the medication and ignore the symptoms. Instruct the client's family to increase the dose of the medication to combat these symptoms. Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider. Instruct the client's family to take the client to the emergency department immediately.

Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider.

Which cholinergic-blocking drugs are used in the treatment of chronic obstructive pulmonary disease (COPD)? (Select all that apply.) Darifenacin (Enablex) Ipratropium (Atrovent) Benztropine (Cogentin) Biperiden (Akineton) Tiotropium (Spiriva)

Ipratropium (Atrovent) Tiotropium (Spiriva)

A client is administered atropine to increase the heart rate. What is the action of atropine? It blocks the parasympathetic vagal stimulation. It exacerbates the parasympathetic vagal stimulation. It provides long-acting antihistamine blockage. It blocks cell wall synthesis of gram-negative bacilli.

It blocks the parasympathetic vagal stimulation.

Which statements best reflects the action of scopolamine? It blocks the nicotinic receptors in the parasympathetic nervous system. It exerts a major effect on the neuromuscular junction. It competes with acetylcholine at muscarinic effector sites. It acts specifically on the smooth muscles of the urinary tract.

It competes with acetylcholine at muscarinic effector sites.

A client has been prescribed an anticholinergic medication. What instructions should the nurse provide related to safety when outside in hot weather? Wear a hat to protect the head Wear sunglasses to protect the eyes Keep well hydrated Keep arms and legs covered

Keep well hydrated

The nurse is describing how oxybutynin exerts its effect to a client receiving it as treatment for overactive bladder. An understanding of which receptor would the nurse integrate into the description? Muscarinic receptors Nicotinic receptors Alpha-adrenergic receptors Beta-adrenergic receptors

Muscarinic receptors

After administering a cholinergic blocking drug to a client, the client reports some blurred vision. The nurse observes that the client's pupils are dilated. The nurse documents this finding as which adverse effects? Mydriasis Cycloplegia Idiosyncrasy Photophobia

Mydriasis Mydriasis refers to dilation of the pupil. Cycloplegia refers to the paralysis of the ciliary muscles of the eye, resulting in an inability to focus. Idiosyncrasy refers to an unusual or abnormal response that differs from the response normally expected to a specific drug or dosage. Photophobia refers to an increased sensitivity to light.

An elderly woman is given scopolamine while on a cruise. She becomes very agitated and confused and is taken to the sick-bay of the ship. The nurse knows that which is a likely reason for these symptoms? Most elderly clients have dementia, which would prevent them from having normal, visual adverse reactions to cholinergic blocking drugs. Urinary retention often causes agitation. Older clients have a greater chance of adverse reactions to cholinergic blocking drugs. Elderly clients have more difficulty sleeping than regular clients, so the drowsiness that is a common side effect does not occur.

Older clients have a greater chance of adverse reactions to cholinergic blocking drugs.

A nurse administering a cholinergic-blocking medication to a client should monitor the client for which visual adverse reactions? (Select all that apply.) Miosis Photophobia Mydriasis Dipolpia Cycloplegia

Photophobia Mydriasis Cycloplegia

A male client is prescribed an anticholinergic drug by his health care provider. He likes to hike with his grandchildren. The home care nurse instructs the client that anticholinergic medications have which effect? Increased sweating and the risk for heat stroke and dehydration Postural hypotension and increased risk for falls and from exposure to the elements Bradycardia in older adults, which increases the risk for falls and from exposure to the elements Prevents sweating and heat loss and increasing the risk of heat stroke

Prevents sweating and heat loss and increasing the risk of heat stroke

A nurse is administering a cholinergic-blocking drug preoperatively to a patient. What intervention should the nurse perform after administering the drug to the patient? Provide cold milk to the patient. Raise the side rails of the bed. Tell the patient to void after drug administration. Provide frequent sips of water.

Raise the side rails of the bed.

Which agent would a nurse expect to administer transdermally? Atropine Scopolamine Dicyclomine Propantheline

Scopolamine

Which anticholinergic agent is sometimes used to manage motion sickness when delivered by transdermal patch? Scopolamine Hyoscyamine Atropine Toliterodine

Scopolamine

The nurse is preparing a client for pacemaker surgery. The health care provider orders atropine to be given 30 minutes before the client is taken to the operating room. The nurse knows this medication is ordered for what reason? To increase the heart rate to prevent complication prior to the pacemaker being inserted To dry up respiratory secretions to prevent aspiration during surgery To cause bladder relaxation during surgery so that the client will not have the urge to void during surgery To relax the bowel to prevent the client from having a bowel movement during surgery

To dry up respiratory secretions to prevent aspiration during surgery

The nurse is preparing a male client for pacemaker surgery. The physician orders atropine to be given 30 minutes before the patient leaves for the operating room. The nurse knows that the physician ordered this medication for what reason? To increase the heart rate to prevent complication prior to the pacemaker being inserted To dry up respiratory secretions to prevent aspiration during surgery To cause bladder relaxation during surgery so that the patient will not have the urge to void during surgery To relax the bowel to prevent the patient from having a bowel movement during surgery

To dry up respiratory secretions to prevent aspiration during surgery Explanation: Atropine is an anticholinergic agent. The principal actions of atropine are a reduction in salivary, bronchial, and sweat gland secretions; mydriasis; cycloplegia; changes in heart rate; contraction of the bladder detrusor muscle and of the gastrointestinal smooth muscle; decreased gastric secretion; and decreased gastrointestinal motility. The reason this patient is given the medication preoperatively is to dry up secretions to prevent aspiration during surgery.

A male client has been a paraplegic for 5 years. He reports increased incontinence, and the physician orders anticholinergic medication. What is the reason for this decision? To increase bladder capacity To strengthen the detrusor muscles To decrease bladder capacity To decrease irritation to the wall of the bladder

To increase bladder capacity

What information should the nurse provide a client prescribed an anticholinergic medication? This classification of medications is widely used today to decreased gastrointestinal activity. The primary use of anticholinergic medications today is to decrease secretions in the treatment of GI ulcers Today, atropine is the most widely prescribed anticholinergic drug. This classification of medications has few toxic effects

Today, atropine is the most widely prescribed anticholinergic drug.

A 4 year old has been prescribed an anticholinergic medication. The nurse should instruction the parents to monitor and report changes in basic function Sleep patterns Level of activity Appetite Urinary output

Urinary output

An anticholinergic drug is given to a 73-year-old man to treat his Parkinson disease. The man also has benign prostatic hyperplasia (BPH). The most important instruction the nurse can give to the patient with regard to his medication and medical diagnosis is to avoid a warm environment. avoid driving his car while taking the drug. call his doctor if he cannot urinate. take the drug with food to avoid gastrointestinal (GI) upset.

call his doctor if he cannot urinate.

Unwanted anticholinergic effects include: wakefulness, mental alertness, and decreased fatigue. drowsiness or sleep; decreased muscle tone; and decreased ability to move. increasing hyperactivity, excessive talking, nervousness, and insomnia. constipation and dry mouth.

constipation and dry mouth.

What is the primary goal for prescribing an anticholinergic agent for a preoperative client? prevent tachycardia decrease respiratory secretions decrease gastric motility relaxation of the detrusor muscle

decrease respiratory secretions

Anticholinergic drugs are used in ophthalmology to sedate the patient. dilate the pupils. constrict the pupils. decrease lacrimal secretions.

dilate the pupils.

While preparing a client for an eye examination, the nurse explains that the eye drops, an ophthalmic anticholinergic preparation, will cause the pupil to: constrict. respond briskly. dilate. spasm.

dilate. Anticholinergic drugs are applied topically for mydriatic and cycloplegic effects to aid examination or surgery.

A client who is going on a cruise is concerned about motion sickness and sees the health care provider, who prescribes scopolamine. The nurse informs the client that using scopolamine may cause the client to experience: pupil constriction. drowsiness. diarrhea. urinary incontinence.

drowsiness.

A 75-year-old male client is started on flavoxate, an anticholinergic drug used in the treatment of overactive bladder. When teaching the client about the medication, the nurse should explain that the client may be at increased risk of: infection. hypothermia related to effects on body temperature regulation. diarrhea related to GI effects. falls related to visual effects.

falls related to visual effects.

Which symptom should the nurse monitor for when caring for a client whose sinus bradycardia has been treated with large doses of atropine? pallor flushing edema incontinence

flushing

Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to: heat stroke related to decreased perspiration. diarrhea related to increased peristalsis. urinary frequency related to CNS effects. hypotension related to increased sympathetic response.

heat stroke related to decreased perspiration.

A client diagnosed with myasthenia gravis is experiencing rhinorrhea. Which medication should not be administered to the client? azelastine hydrochloride ipratropium fexofenadine nedocromil sodium

ipratropium Ipratropium is administered for rhinorrhea but is contraindicated in clients who have been diagnosed with myasthenia gravis because of its anticholinergic effects. Azelastine hydrochloride, fexofenadine, and nedocromil sodium are not contraindicated for clients with myasthenia gravis.

What disease process would cause a nurse to question a client's new prescription for benztropine? diabetes mellitus myocardial infarction narrow-angle glaucoma hyperparathyroidism

narrow-angle glaucoma