Neurological REAL

The nurse is reviewing the mechanism of action of cholinergic drugs. The desired effects of cholinergic drugs come from the stimulation of which receptors?

A. Muscarinic

The nurse is reviewing the mechanism of action of cholinergic drugs. The desired effects of cholinergic drugs come from the stimulation of which receptors? A. Muscarinic B. Nicotinic C. Cholinergic D. Ganglionic

A. Muscarinic The desired effects come from muscarinic receptor stimulation; many of the undesirable adverse effects are due to nicotinic receptor stimulation.

Common adverse effects of digoxin (Lanoxin) include which of the following. (Choose all that apply) a. Nausea/vomiting. b. Blurred vision. c. Hyperkalemia d. Arrythmias.

A. Nausea/vomiting B. Blurred vision

The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is: A. Neostigmine Bloxiverz B. Atropine (atropine sulfate) C. Didronel (etidronate) D. Tensilon (edrophonium)

A. Neostigmine Bloxiverz Protigmine is used to treat clients with myasthenia gravis. Atropine (atropine sulfate) is incorrect because it is used to reverse the effects of neostigmine. Didronel (etidronate)is incorrect because the drug is unrelated to the treatment of myasthenia gravis. Tensilon (edrophonium) is incorrect because it is the test for myasthenia gravis.

The nurse is about to administer a stat dose of atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse should monitor the patient closely for which adverse effect? A. Tachycardia B. Bradycardia C. Ectopic beats D. Cardiac standstill

A. Tachycardia Cardiovascular effects of cholinergic-blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. The other options are not correct.

The nurse caring for a patient who is receiving beta, agonist drug therapy needs to be aware that these drugs cause A. increased cardiac contractility b. decreased heart rate c. bronchoconstriction d. increased GI tract motility

A. increased cardiac contractility

When a pt is taking an adrenergic drug, the nurse should expect to observe which effect?

A. increased heart rate

When an adremergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as a positive ____effect.

A. inotropic

In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in: A.Muscle strength B.Symptoms C.Blood pressure D.Consciousness

A.Muscle strength Tensilon, an anticholinesterase drug, causes temporary relief of symptoms of myasthenia gravis in client who have the disease and is therefore an effective diagnostic aid.

The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: A.Taking medications on time to maintain therapeutic blood levels B.Doing all chores early in the day while less fatigued C.Doing muscle-strengthening exercises D.Eating large, well-balanced meals

A.Taking medications on time to maintain therapeutic blood levels Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce A) a positive inotropic, positive chronotropic, and positive dromotropic effect. B) a positive inotropic, negative chronotropic, and negative dromotropic effect. C) a negative inotropic, positive chronotropic, and positive dromotropic effect. D) a negative inotropic, negative chronotropic, and negative dromotropic effect.

A: Adrenergic stimulation of the beta1-adrenergic receptors on the myocardium and in the conduction system of the heart results in an increased heart rate (positive chronotropic effect), increased contractility (positive inotropic effect), and increased conductivity (positive dromotropic effect).

An anticholinergic drug is one that blocks the effects of which of the following? Epinephrine Norepinephrine Acetylcholine Serotonin

Acetylcholine

An antocholinergic drug is one that blocks the effects of which of the following?

Acetylecholine

The nurse is teaching a client about myasthenia gravis. Which statement, if made by the patient indicates the need for further teaching? A) The doctor will take me off of my beta blocker because it could exacerbate my symptoms B) I should report any signs of infection to my PCP C) I can take a ibuprofen to help with pain that may occur with spasms D) I should avoid taking long walks

Answer: C. OTC medication should be avoided as they may worsen MG symptoms. The doctor may stop a beta blocker as they can exacerbate symptoms (unless benefit outweighs the risk). Any signs of infection should be reported as they can exacerbate a myasthenic crisis. Long walks should be avoided due to muscle weakness and fatigue

A priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs would be A) Risk for injury related to excessive central nervous system stimulation. B) Impaired gas exchange related to thickened respiratory secretions. C) Urinary retention related to loss of bladder tone. D) Deficient knowledge related to pharmacologic regimen.

B: Although all of these nursing diagnoses are appropriate, the priority is determined remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate? A) Increase fluid and fiber in the diet to prevent constipation. B) Take the medication 30 minutes before meals. C) If a dose is missed, double the next dose to prevent withdrawal. D) Common side effects include tachycardia and hypertension.

B: Drugs used for myasthenia gravis should be given about 30 minutes before meals to allow for onset of action and therapeutic effects (e.g., decreased dysphagia). Constipation, tachycardia, and hypertension are not effects of cholinergic medications. A missed dose should never be doubled.

A client with myasthenia gravis has been receiving Neostigmine (Bloxiverz). This drug acts by: A.Blocking the action of Acetylcholinesterase B.Accelerating transmission along neural swaths C.Replacing deficient neurotransmitters D.Stimulating the cerebral cortex

Blocking the action of Acetylcholinesterase

Proven facts regarding celecoxib (Celebrex)?

Blocks anti-inflammatory process & does not cause increase in aggregation of platelets as compared to COX-1

Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to: A. Change her diet order from soft foods to clear liquids B. Place an emergency tracheostomy set in her room C. Assess her respiratory status before and after meals D. Coordinate her meal schedule with the peak effect of her medication, Mestinon

Coordinate her meal schedule with the peak effect of her medication, Mestinon Dysphagia should be minimized during peak effect of Mestinon, thereby decreasing the probability of aspiration. Mestinon can increase her muscle strength including her ability to swallow

The most significant initial nursing observations that need to be made about a client with myasthenia include: A. Ability to chew and speak distinctly B. Degree of anxiety about her diagnosis C. Ability to smile an to close her eyelids D. Respiratory exchange and ability to swallow

A. Ability to chew and speak distinctly Muscle weakness can lead to respiratory failure that will require emergency intervention and inability to swallow may lead to aspiration.

The male client diagnosed with MG is prescribed the cholinesterase inhibitor neostigmine (Prostigmin). Which data indicate the medication is not effective? 1. The client is able to perform activities of daily living (ADLs) independently. 2. The client states that his vision is clear. 3. The client cannot speak or look upward at the ceiling. 4. The client is smiling and laughing with the nurse.

Correct answer 3: Dysphonia and inability to utilize the muscles of the eye and eyelid indicate the medication is not effective. Performing ADLs, having clear vision, and smiling and laughing using the facial muscles indicate the medication is effective

What should the nurse include as a possible adverse effect when teaching a client about phenytoin? Liver toxicity Diarrhea Increased white blood cell count Physical dependence

Liver toxicity

A post-anesthesia nurse has a patient who has received a neuromuscular blocking agent. The nurse observes increased muscular weakness in her patient. The nurse would anticipate administering which drug?

Neostigmine

The nurse is discharging a client diagnosed with MG. Which statement by the client indicates an understanding of the discharge instructions? 1. "I can control the MG with medication, but an adenectomy will cure it." 2. "I should take a holiday from my medications every 4 or 5 weeks." 3. "I must take my medications on time every day, or I could have problems." 4. "I should take my steroid medications with food so it won't upset my stomach."

Correct answer 3: The anti cholinesterase medications used to treat MG must be taken on time in order to prevent muscle weakness and respiratory complications. These medications are one of the very few that the nurse should administer at the exact scheduled time. Steroids are not prescribed for MG.

Which response to the Tensilon (edrophonium chloride) injection indicates the client has myasthenia gravis? 1. The client has no apparent change in the assessment data. 2. There is reduced amplitude of electrical stimulation in the muscle. 3. The anti-acetylcholine receptor antibodies are present. 4. The client shows a marked improvement of muscle strength.

Correct answer 4: Clients with myasthenia gravis show a significant improvement of muscle strength that lasts approximately 5 minutes when Tensilon (edrophonium chloride) is injected.

Adverse effects of phenytoin (Dilantin)?

Gingival hyperplasia, endocrine effects, CNS effects.

Adverse effects of acetaminophen overdose

Hepatotoxicity

What diuretic is the first choice for hypertensive patients?

Hydrochlothiazide

Electrolyte imbalances associated with digoxin (Lanoxin)?

Hypokalemia

Action of levodopa-carbidopa?

Increase the activation of dopamine receptors in the brain

Why are calcium channel blockers effective in the treatment of angina?

Increases oxygenation to the heart muscle, thereby, decreasing the work of the heart and angina.

A physician diagnoses a client with myasthenia gravis, prescribing Neostigmine Bloxiverz, 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client's history. Which preexisting condition would contraindicate the use of pyridostigmine? A. Ulcerative colitis B. Blood dyscrasia C. Intestinal obstruction D. Spinal cord injury

Intestinal obstruction Anticholinesterase agents such as Neostigmine Bloxiverz are contraindicated in a client with a mechanical obstruction of the intestines or urinary tract, peritonitis, or hypersensitivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord injury dont contraindicate use of the drug.

A patient who has been taking a beta blocker for 6 moths tells the nurse during a followup visit that she wants to stop taking this medication. She is wondering if there is any problem with stopping the medication all at once. What is the nurses' best response? a. "no, there are no ill effects if this medication is stopped." b. "There should be only minimal effects if you stop this medication." c. "You may experience orthostatic hypotension if you stop this medication abruptly." d. "If you stop this medication suddenly there is a possibility you may experience chest pain or rebound hypertension."

d. "If you stop this medication suddenly there is a possibility you may experience chest pain or rebound hypertension."

A patient is taking the direct acting cholinergic drug bethanechol before meals. After 3 days, he calls his health care provider's office and complains of occasional nausea and vomiting. The nurse should give which instruction? a. "Continue to take it on an empty stomach to minimized GI upset" b. "if this continues, you can skip a dose and try it again tomorrow" c. "If these symptoms continue, take the doses in the evening" d. "Take this medication with meals to reduce GI upset"

d. "Take this medication with meals to reduce GI upset"

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: A. Getting too little exercise B. Taking excess medication C. Omitting doses of medication D. Increasing intake of fatty foods

Omitting doses of medication Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.

Effects of digoxin (Lanoxin) on the heart?

Positive inotropic, negative chronotropic

A nurse should review a client's medical conditions prior to administering a phenytoin (Dilantin) because its use is contraindicated in some clients. In what clients would its use be contraindicated? (Select all that apply.) Pregnancy Sinus bradycardia Hepatic disease Diabetes Atrial fibrillation

Pregnancy Sinus bradycardia Explanation: The use of phenytoin is contraindicated in clients with known hypersensitivity to the drug, clients with sinus bradycardia, sinoatrial block, Adam-Stokes syndrome, and second- and third-degree atrioventricular block, pregnancy, and lactation.

Adverse effects of ACE inhibitors?

Relenting cough, pregnancy complications, hyperkalenmia

Why is it recommended that aspirin NOT be administered to babies up to adolescents?

Reye's disease

Action of phenytoin (Dilantin)?

Slows the entrance of sodium and calcium back into the neuron which slows the frequency of neuron firing.

Adverse effects of Phenytoin (Dilantin) include? (Select all that apply) Steven Johnson's Syndrome Gingival hyperplasia I doubt this is the right one! Don't pick me!

Steven Johnson's SyndromeGingival hyperplasia

Which statement is the scientific rationale for the combination of levodopa-carbidopa (Sinemet) prescribed for a patient with Parkinson disease? The carbidopa delays the breakdown of the levodopa in the periphery, so more dopamine gets to the brain. The medication is less expensive when combined, so it is more affordable to those on a fixed income. The carbidopa breaks down in the periphery and causes vasoconstriction of the blood vessels. Carbidopa increases the action of levodopa and causes vasoconstrition of the blood vessels.

The carbidopa delays the breakdown of the levodopa in the periphery, so more dopamine gets to the brain.

Your patient has myasthenia gravis and is in crisis. To differentiate between myasthenic crisis and a cholinergic crisis, the patient is given edrophonium (Tensilon). What effect from edrophonium would indicate the patient is in a cholinergic crisis? Increase in muscle strength Worsening of muscle strength Sedation Cough

Worsening of muscle strength

The nurse is aware that adrenergic drugs may be used to treat which conditions? a. asthma b. glaucoma c. hypertension d. nasal congestion e. seizures f. nausea and vomiting

a. asthma b. glaucoma d. nasal congestion

The nurse will prepare to give which drug to a patient who is experiencing a cholinergic crisis? a. atropine b. tacrine (cognex) c. donepezil (aricept) d. physostigmine

a. atropine

When monitoring a patient who is taking a cholinergic drug, the nurse should watch for which cardiovascular effect? a. bradycardia b. tachycardia c. vasoconstriction d. palpitations

a. bradycardia

The nurse will monitor for which adverse effects of anticholinergic drugs? (select all that apply) a. dilated pupils b. constricted pupils c. dry mouth d. urinary retention e. urinary frequency f. diarrhea

a. dilated pupils c. dry mouth d. urinary retention

A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker is to a. increase urine output b. prevent stimulation of the herat by catecholamines c. increase the contractility of the heart muscle. d. cause peripheral vasodilation

a. increase urine output

When a patient is taking an adrenergic drug, the nurse should expect to observe what effect? a. increased HR b. bronchial constriction c. peripheral vasoconstriction d. increased intestinal peristalsis

a. increased heart rate

When an adrenergic drug stimulates beta1 adrenergic receptors, the result is an increased force of contraction, which is known as a positive ______ effect. a. inotropic b. adrenergic c. dromotropic d. chronotropic

a. inotropic

Adrenergic blockade at the alpha-adrenergic receptors leads to which of the following effects? (select all that apply) a. vasodilation b. decreased blood pressure c. increased blood pressure d. constriction of the pupil e. tachycardia

a. vasodilation b. decreased blood pressure d. constriction of the pupil

Antidote for cholinergic crisis?

atropine

Your patient has symptomatic bradycardia and being transported to the hospital by paramedics. On the way, the patients heart rate drops to 32. A mobile ICU provider is on the radio. What medication would the EMT anticipate administering?

atropine

Digoxin (Lanoxin) has which of the following actions on the heart? a. Positive inotropic, positive chronotropic. b. Positive inotropic, negative chronotropic. c. Negative inotropic, positive chronotropic. d. Negative inotropic, negative chronotropic.

b. Positive inotropic, negative chronotropic.

A patient has been given an alpha-blocker as treatment for benign prostatic hyperplasia. Which instruction is important to include when the nurse is teaching him about the effects of this medication? a. avoid foods and drinks that contain caffeine b. change positions slowly to aboid orthostatic blood pressure changes. c. watch for weight loss of 2 lbs within a week d. take extra supplements of calcium.

b. change positions slowly to aboid orthostatic blood pressure changes.

When a drug is characterized as having a negative chronotropic effect, the nurse knows what to expect a. improved sinoatrial nodal firing b. decreased heart rate c. decreased ectopic beats d. increased force of cardiac contractions

b. decreased heart rate

When giving IV cholinergic drugs, the nurse must watch for symptoms of a cholinergic crisis, such as: (select all that apply) a. peripheral tingling b. hypotension c. dry mouth d. syncope e. dyspnea f. tinnitus

b. hypotension d. syncope e. dyspnea

A patient has received an inadvertent overdose of a cholinergic drug. The nurse will monitor for which early signs of a cholinergic crisis? (select all that apply) a. dry mouth b. salivation c. flushing of the skin d. abdominal cramps e. constipation f. dyspnea

b. salivation c. flushing of the skin d. abdominal cramp f. dyspnea

The nurse providing teaching for a patient who has a new prescription for beta blockers will keep in mind that these drugs may result in which effect? a. tachycardia b. tachypnea c. bradycardia d. bradypnea

c. bradycardia

As part of treatment for early heart failure, a patient is started on an angiotensin-converting enzyme (ACE) inhibitor. The nurse will monitor the patient's lab work for which potential effect? a. agranulocytosis b. proteinuria c. hyperkalemia d. hypoglycemia

c. hyperkalemia

Adrenergic drugs produce effects similar to those of the ________ nervous system. a. central b. somatic c. sympathetic d. parasympathetic

c. sympathetic

When administering beta blockers, the nurse knows that which guideline for administration and monitoring is correct? a. the drug may be discontinued at any time b. postural hypotension is not a problem with this drug. c. wearing off the medication is necessary to prevent rebound hypertension d. the patient should stop taking the medication at once if he or she gains 3-4 lbs in a week.

c. wearing off the medication is necessary to prevent rebound hypertension

Medication used to differentiate between myasthenia gravis and cholinergic crisis?

Edrophonium (Tensilon)

Phenytoin (Dilantin) is prescribed for a patient. The nurse checks the patient's current medication list and notes that interactions may occur with which drugs?

-Corticosteriods -Warfarin -Oral contraceptives

A patient is started on levodopa-carbidopa (Sinemet) for Parkinson disease. What type of adverse effects would be expected?

-Discolored sweat and urine -Nausea -Vomiting

Important education for patients taking losartan (Cozaar)?

-Pregnancy complications: use barrier protection -Can cause hyperkalemia -Risk of angioedema

The client prescribed clonazepam (Klonopin) asks the nurse why the medication dose needs to be adjusted. What is the best response by the nurse? 1. "Tolerance can begin to develop after only a few months of therapy, and seizures can recur unless doses are periodically adjusted." 2. "Your dose will be decreased every month until you begin to have seizures again." 3. "Your body stores this drug, and you will need a lower dose of the medication now." 4. "The physician will not need to adjust your medication dose."

1. "Tolerance can begin to develop after only a few months of therapy, and seizures can recur unless doses are periodically adjusted."

The nurse is preparing a presentation about antiseizure medications. The nurse plans to include the general mechanisms of actions for these medications. Which items would be appropriate to include? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Delaying an influx of sodium ions 2. Stimulating an influx of chloride ions 3. Increasing the neuronal firing in the brain 4. Slowing an influx of calcium ions 5. Reducing an influx of potassium ions

1. Delaying an influx of sodium ions 2. Stimulating an influx of chloride ions 4. Slowing an influx of calcium ions

A client with a history of seizures is taking phenytoin (Dilantin). Based on this medication prescription, what are adverse effects the nurse should teach the client? 1. Weight gain, back pain, and headaches 2. Hypertension, bradycardia, and vomiting 3. Confusion, slurred speech, and insomnia 4. Constipation, rashes, and seizures

3. Confusion, slurred speech, and insomnia

The client is experiencing status epilepticus. What medication does the nurse anticipate the healthcare provider to order for this client? 1. Tiagabine (Gabitril) 2. Gabapentin (Neurontin) 3. Diazepam (Valium) 4. Pregabalin (Lyrica)

3. Diazepam (Valium)

Parasympathomimetics mimic the parasympathetic neurotransmitter acetylcholine. Another drug group name for parasympathomimetics is: 1. adrenergics 2. adrenergic blockers 3. cholinergics 4. anticholinergics

3. cholinergics This is another word for parasympathomimetics.

A client taking phenytoin (Dilantin) chronically for seizures should be encouraged to maintain good oral hygiene and visit the dentist every 6 months. Why is this such an important area of teaching for this client? 1. Cavities 2. Builds up tartar on the teeth 3. Mouth cancers 4. Gingival hyperplasia

4. Gingival hyperplasia

Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by: A.Brudzinski's sign B. A positive edrophonium (Tensilon) test C. A positive sweat chloride test D. Kernigs sign

A positive edrophonium (Tensilon) test

Side effects to expect from anticholinergic (parasympatholytic) drugs, such as atropine, include which effects? (Select all that apply.) A) Dilated pupils (mydriasis) B) Urinary retention C) Dry mouth D) Diarrhea E) Increased sweating

A, B, C: Anticholinergic effects block the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. These include mydriasis, decreased bladder contraction, and decreased oral secretions. The effect on the gastrointestinal system would be to decrease gastrointestinal motility, not cause diarrhea. Sweating would decrease as a result of anticholinergic drugs.

The client is experiencing a myasthenic crisis. Which of the following is a priority action of the following ordered actions? A) Insert NG tube B) Administer Ativan C) Monitor I&O D) Immediately stop anticholinesterase medications

Answer: A. Inserting the NG tube is the priority because it will help reduce risk for aspiration. The patient experiencing a myasthenic crisis is at a large risk for respiratory failure due to dysphagia and extreme muscle weakness. All priority actions should be focused on respiratory assessment and support. Ativan and any other sedating medication should NEVER be administered. Stopping anticholinesterase medications is associated with a cholinergic crisis. Monitoring I&O is important, but not as important as NG tube

Which of the following would be most likely given as a top nursing diagnosis for a patient experiencing a cholinergic crisis? A) Impaired Gas Exchange B) Acute Fatigue C) Ineffective airway clearance D) Altered mental status

Answer: C. During a cholinergic crisis, secretions are increased and the gag reflex is decreased, putting the patient at risk for a blocked airway. Impaired gas exchange, while has to do with respiratory, is not as appropriate as ineffective airway clearance based on the problems of the crisis. Acute fatigue and altered mental status are not priorities

The patient with myasthenia gravis is complaining about dealing with muscle weakness. Which of the following could the nurse do for this patient? A) Administer antispasmodic medication B) Teach the patient to do physical exercise for several hours each day to help strengthen muscles C) Teach the patient it is important to avoid all forms of physical activity whenever possible D) Help the patient form a plan to take medications on time

Answer: D. Taking medications at the same time each day will help reduce the exacerbation of muscle weakness. Antispasmodic medications are not indicated for this patient. Exercising for that much time each day will worsen muscle weakness and fatigue and is not feasible. The patient does not need to avoid all forms of physical activity. They need to time out physical activity with peaks of the medication in order to conserve energy.

Your patient has symptomatic bradycardia and being transported to the hospital by paramedica. On the way, the patients heart rate drops to 32. A mobile ICU provider is on the radio. What medication would the EMT anticipate administering? Neostimine Edophonium (Tensilon) Atropine Phenytoin (Dilantin).

Atropine

A cholinergic drug is prescribed for a patient. The nurse checks the patient's medical history, knowing that this drug is contraindicated in which disorders? Select all that apply. A. Bladder atony B. Gastrointestinal obstruction C. Bradycardia D. Alzheimer's disease E. Hypotension F. Chronic obstructive pulmonary disease

B. Gastrointestinal obstruction C. Bradycardia E. Hypotension F. Chronic obstructive pulmonary disease Contraindications to the use of cholinergic drugs include gastrointestinal or genitourinary obstruction, bradycardia, hypotension, and chronic obstructive pulmonary disease. The other options are possible indications for cholinergic drugs.

A nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? a. Drink grapefruit juice daily to increase vitamin C intake. b. Increase the amount of dietary fiber in the diet. c. Decrease the amount of calcium in the diet. d. Take this medication concurrently with your beta -1 blocker.

B. Increase the amount of dietary fiber in the diet.

An adrenergic agonist is ordered for a pt in shock. The nurse will note that this drug has had its primary intended effect if which assessment finding is observed?

B. increased blood pressure

The nurse is developing a care plan for a pt who is taking an anticholonergic drug. Which nursing dx would likely be appropriate for this pt?

B. urinary retention

Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: A.Inhibits the breakdown of acetylcholine at the neuromuscular junction. B.Decreases the production of autoantibodies that attack the acetylcholine receptors. C.Promotes the removal of antibodies that impair the transmission of impulses D.Stimulates the production of acetylcholine at the neuromuscular junction.

B.Decreases the production of autoantibodies that attack the acetylcholine receptors Steroids decrease the body's immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction

The neurotransmitter responsible for transmission of nerve impulses to effect cells in PSNS is called:

C. Acetylcholine

A nurse is monitoring a patient who is receiving spironolactone (Aldactone). Which of the following findings should the nurse report to the provider? a. Serum sodium of 144 mEq/L. b. Urine output of 160 mL over 4 hr. c. Serum potassium 5.2 mEq/L. d. Blood pressure 140/90 mm Hg

C. Elevated serum potassium.

Which of the following diuretic is the drug of choice for hypertension? a. Furosemide (Lasix). b. Spironolactone (Aldactone). c. Hydrochlorothiazide (HCTZ).

C. Hydrochlorothiazide

The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to: A. Develop a teaching plan B. Facilitate psychologic adjustment C. Maintain the present muscle strength D. Prepare for the appearance of myasthenic crisis

C. Maintain the present muscle strength Until diagnosis is confirmed, primary goal should be to maintain adequate activity and prevent muscle atrophy

A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease? A. Parkinson's disease B. Multiple sclerosis C. Myasthenia gravis D. Bell's palsy

C. Myasthenia gravis Edrophonium, another indirect-acting cholinergic drug, is commonly used to diagnose myasthenia gravis. Edrophonium is not used in diagnosing Parkinson's disease, multiple sclerosis, or Bell's palsy.

Jane, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces: A. Brief exaggeration of symptoms B. Prolonged symptomatic improvement C. Rapid but brief symptomatic improvement D. Symptomatic improvement of just the ptosis

C. Rapid but brief symptomatic improvement Tensilon acts systemically to increase muscle strength; with a peak effect in 30 seconds, It lasts several minutes

The nurse is reviewing sympatheric nervous system agonists. Adrenergic drugs that cause relaxation of the brochi and broncholodation stimulate _____ receptors.

C. beta 2 -adrenergic

the burse is reviewing sympathetic nervous system agonists. Adrenergic drugs that cause relaxation of the bronchi and bronchodialtion stimulate_____ receptors.

C. beta 2- adrenergic

Adrenergic drug produce effects similar to those of the _____ nervous system.

C. sympathetic

Rationale for the combination of levodopa-carbidopa?

Carbidopa delays the breakdown of levodopa in the periphery so that more of the levodopa crosses the blood-brain barrier and reaches the brain.

Advrse effects of Phenytoin (Dilantin) include?

Coarsening of facial features Gingival hyperplasia

The client diagnosed with MG is being discharged home. Which intervention should the nurse teach the significant other? 1. Discuss how to perform the Heimlich maneuver. 2. Explain how to perform oral hygiene on a conscious client. 3. Teach how to perform isometric exercises. l 4. Demonstrate correct hand placement for chest compressions.

Correct answer 1: The client is at risk for choking, and knowing specific measures to help the client helps decrease the client's as well as significant other's anxiety and promotes confidence in managing potential complications. The client should perform oral care. The client should perform isotonic exercises, not isometric exercises, and the client is not at an increased risk for cardiac complications, so teaching about chest compression is not necessary

Which statement by the client supports the diagnosis of myasthenia gravis (MG)? 1. "I have weakness and fatigue in my feet and legs." 2. "My eyelids droop, and I see double everything." 3. "I get chest pain and faint after I walk in the hall." 4. "I gained 3 pounds this week, and I am spitting up pink frothy sputum."

Correct answer 2: These are ocular signs/symptoms of MG. Ptosis is drooping of the eyelid, and diplopia is unilateral or bilateral double vision. Weakness and fatigue of upper body muscle occur with MG. .

The client diagnosed with MG is admitted to the emergency department with a sudden exacerbation of motor weakness. Which assessment data indicate the client is experiencing a myasthenic crisis? 1. The serum assay of circulating acetylcholine receptor antibodies is increased. 2. The client's symptoms improve when administering on a cholinesterase inhibitor. 3. The client's blood pressure, pulse, and respirations improve after intravenous (IV) fluid. 4. The Tensilon test does not show improvement in the client's muscle strength

Correct answer 2: This assessment datum indicates a myasthenic crisis that is due to undermedication, missed doses of medication, or developing an infection. Serum assays are useful in diagnosing the disease, not in identifying a crisis. Vital signs do not differentiate the type of crisis. No improvement after Tensilon indicates a cholinergic crisis, not a myasthenic crisis.

While reviewing a client's chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition? A. The client may be less sensitive to the effects of a neuromuscular blocking agent. B. Succinylcholine shouldn't be used; pancuronium may be used in a lower dosage. C. Pancuronium shouldn't be used; succinylcholine may be used in a lower dosage. D. Neostigmine Bloxiverz require cautious administration

D. Neostigmine Bloxiverz require cautious administration The nurse must cautiously administer pancuronium, succinylcholine, and any other neuromuscular blocking agent to a client with myasthenia gravis. Such a client isn't less sensitive to the effects of a neuromuscular blocking agent. Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis

Adverse effects of atropine?

Dry mouth, urinary retention, constipation, mydriasis can't see, can't pee, can't shit

The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis? A. Visual disturbances, including diplopia B. Ascending paralysis and loss of motor function C. Cogwheel rigidity and loss of coordination D. Progressive weakness that is worse at the day s end

D. Progressive weakness that is worse at the days end The client with myasthenia develops progressive weakness that worsens during the day. Visual disturbances, including diplopia is incorrect because it refers to symptoms of multiple sclerosis. Ascending paralysis and loss of motor function is incorrect because it refers to symptoms of Guillain Barre syndrome. Cogwheel rigidity and loss of coordination is incorrect because it refers to Parkinsons disease.

What i another name for an adrenergic drug? A. anticholinergic drug B. parasymphathetic Drug C. central nervou systsem drug D. Sympathomimetic drug

D. Sympathomimetic drug

When teaching a patient about beta-blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that A) these medications may be taken with antacids to minimize gastrointestinal distress. B) hot baths and showers will help enhance the therapeutic effects and are encouraged. C) alcohol intake is encouraged for its vasodilating effects. D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.

D: Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should be gradually decreased.

A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with A) beta-blockers. B) diuretics. C) alpha1-blockers. D) MAOI inhibitors.

D: Adrenergic drugs combined with MAOI inhibitors can lead to extreme hypertension. All the other drugs listed are used to treat hypertension.

Your patient has myasthenia gravis and is in crisis. To differentiate between myasthenic crisis and a cholinergic crisis, the patient is given edrophonium (Tensilon). What effect from edrophonium would indicate the patient is in a cholinergic crisis?

Decrease in muscle strength

What drug is used to treat digoxin toxicity? a. Digoxin immune Fab. (first choice) b. Activated charcoal. c. Colestipol. D. All the above.

Digoxin immune fab Activated charcoal

The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: A. Eating large, well-balanced meals B. Doing muscle-strengthening exercises C. Doing all chores early in the day while less fatigued D. Taking medications on time to maintain therapeutic blood levels

Taking medications on time to maintain therapeutic blood levels Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress

What does "High ceiling" loop diuretic mean?

The maximum effect is much higher than with other diuretics

Most narcotics are controlled substances because of?

The potential for abuse or addiction.

While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condistion may be a problem is these drugs are used? a. hypertension b. essential tremors c. exertional angina d. asthma

d. asthma

The nurse is administering an adrenergic drug and will monitor for which possible effect? a. urinary retention b. hypotension c. decreased respiratory rate d. increased heart rate

d. increased heart rate

A patient who has recently had an MI has started therapy with a beta blocker. The nurse explains that the main purpose of the beta blocker for this patient is to a. cause vasodilation of the coronary arteries b. prevent hypertension c. increase conduction through the SA node d. protect the heart from circulation catecholamines

d. protect the heart from circulation catecholamines

when administering beta blockers, the nurse knows that which guideline for administration and monitoring is correct?

weaning off the meds is necessary to prevent rebound hypertension