PHARM 33 PU

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

"Do not drive or operate machinery." Effects of anticholinergic drugs such as atropine include blurred vision and impaired ability to sweat. Clients should be cautioned to avoid activities that may be made dangerous by blurred vision; this may include driving and operating machinery. To avoid overheating, clients should avoid strenuous activity and take other measures to stay cool (e.g., frequent cool baths). Clients experiencing eye pain may have undiagnosed glaucoma; they should stop taking the medications and contact their health care providers.

An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching? "I need to exercise frequently outside in the warm weather." "I should make sure that I drink plenty of fluids." "I should eat plenty of fiber to prevent constipation." "I should avoid driving if I feel light-headed or dizzy."

"I need to exercise frequently outside in the warm weather." The client should avoid temperature extremes and exertion in warm temperatures because of possible heat intolerance, which could be more severe in older clients. Drinking fluids is important to maintain hydration and prevent heat intolerance. Avoiding driving is an appropriate safety measure. Constipation may occur with an anticholinergic; therefore, increased fiber intake would be appropriate.

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'll probably find that you are producing more saliva than normal; this is a normal side effect of atropine." "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."

"It's possible that your eyes will take longer to adjust to bright lights." As an anticholinergic drug, atropine has the potential to cause visual disturbances, dry mouth, constipation, and urinary retention.

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. Adverse effects tend to be less severe in children. Anticholinergic drugs are more effective in the pediatric population.

Adverse effects tend to be more severe in children. Anticholinergic drugs have essentially the same intended effects and adverse effects in the pediatric population as in the adult population. However, children are especially sensitive to these drugs, so the adverse effects may be more severe in that population.

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 be at increased risk of heat stroke. The client may benefit from additional fiber and fluids in her diet. The client may need assistance with ambulation. All the above

All the above The effects of anticholinergic drugs include decreased gastrointestinal motility, decreased sweat production, and blurred vision. These effects put the older adult at increased risk of constipation, heat stroke, and falls. The risk of constipation can be reduced by increasing fiber and fluids in the diet. The risk of falls can be reduced by assisting the client during ambulation.

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

Avoiding activities that require alertness Safety measures are important because of the possible CNS effects. Avoiding temperature extremes and exertion in warm temperatures is important because of possible heat intolerance. Drinking fluids is important to maintain hydration and combat dry mouth. Constipation may occur with an anticholinergic; therefore increased fiber intake would be appropriate.

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 Dehydration Hypertension Bradycardia

Bradycardia Anticholinergic drugs are given preoperatively to prevent anesthesia-associated complications such as bradycardia, excessive respiratory secretions, and hypotension.

Which symptoms will warrant the administration of atropine? Bradycardia Urinary retention Blurred vision Paralytic ileus

Bradycardia Atropine is the drug of choice to treat sinus bradycardia. Blurred vision, paralytic ileus, and urinary retention are not treated with atropine.

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

Cholinergic blocking drug Cholinergic antagonists are the class of medications used to decrease secretions of the upper respiratory tract. Antianxiolytics decrease preoperative anxiety. Opioids decrease both anxiety and pain preoperatively. Antiemetics are used to decrease nausea after surgery.

Which would a nurse least likely expect to assess in a client experiencing mild atropine toxicity? Increasing of heart rate Profuse sweating Dry mouth Cough

Cough Cough is not associated with mild atropine toxicity. Dry mouth is associated with mild atropine toxicity. Inhibition of sweating is associated with mild atropine toxicity not profuse sweating. Slight cardiac slowing is associated with mild atropine toxicity not increased heart rate.

Anticholinergic drugs are used to treat a variety of disease processes. What should the nurse instruct a client about newly prescribed anticholinergic drugs? Decrease fluid intake and increase salt intake. Take cool baths early in the morning and late at night. Wear dark, warm clothing. Do not drive or operate machinery until you know how the medication affects you.

Do not drive or operate machinery until you know how the medication affects you. The client should be urged not to drive or perform tasks that require concentration and coordination.

The nurse should monitor a client prescribed an anticholinergic medication for which results? Select all that apply. Constipation Dysphagia Tachycardia Blurred vision Urinary frequency

Dysphagia Tachycardia Constipation Blurred vision Clients receiving anticholinergic medications must be monitored for difficulty swallowing (dysphagia), constipation, tachycardia, blurred vision and urinary retention.

Which symptom should the nurse monitor for when caring for a client whose sinus bradycardia has been treated with large doses of atropine? Flushing Pallor Edema Incontinence

Flushing Large doses cause facial flushing because of dilation of blood vessels in the neck. Pallor, edema, and incontinence are not caused by dilation of blood vessels in the neck.

Clients with what disorder should not be given anticholinergic drugs? Glaucoma Epilepsy Attention deficit disorder Severe anxiety or hyperactivity

Glaucoma Anticholinergic drugs are contraindicated for patients with benign prostatic hypertrophy, myasthenia gravis, hyperthyroidism, glaucoma, tachyarrhythmia, myocardial infarction, heart failure, or conditions associated with esophageal reflux.

The nurse understands that older clients taking anticholinergic drugs are more likely to have all of the following symptoms EXCEPT: Confusion. Blurred vision. Hypertension. Constipation.

Hypertension. Older adults are especially likely to have significant adverse reactions because of slowed drug metabolism and the frequent presence of several disease processes. Some common adverse effects are blurred vision, confusion, constipation, and confusion or other psychotic symptoms. These are most likely to occur with the centrally active anticholinergics given for Parkinson's disease or drug-induced extrapyramidal effects, such as trihexyphenidyl or benztropine. They are not typically the causative agent for hypertension in routine medication treatment.

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? Increase bulk in the diet. Suck on hard candies. Avoid driving at night. Promote oral care.

Increase bulk in the diet. Constipation is a troubling adverse effect that may be managed by adding fiber to the diet, increasing hydration, and exercising moderately. Sucking on hard candies may help prevent a dry mouth but would not prevent constipation; the suggestions of avoiding driving at night or being attentive to oral care will help the client prevent other adverse effects of the therapy.

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 withhold the next dose and the nurse will contact the prescribing provider. Instruct the client's family to continue the medication and ignore the symptoms. Instruct the client's family to take the client to the emergency department immediately. 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. Older clients taking cholinergic blocking medications may exhibit symptoms such as excitement, mental confusion, and urinary retention. If a client is exhibiting these symptoms, the medication should be withheld for the next dose and the nurse should contact the prescribing provider. Ignoring symptoms is not advised because they could become worse. Increasing the dose would probably increase the symptoms and it is not appropriate for the nurse to change medication dosage without a provider order. It is not a medical emergency, so going to the emergency department is not necessary. The family is given the instruction due to the fact the client is confused.

The nurse is caring for an 8-year-old child who is experiencing an exacerbation of asthma. The nurse expects to administer which medication because of its bronchodilation effects in the treatment of asthma and chronic bronchitis? Hyoscyamine Ipratropium Scopolamine Atropine

Ipratropium

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

Ipratropium (Atrovent) Tiotropium (Spiriva) Ipratropium (Atrovent) and tiotropium (Spiriva) are inhaled cholinergic-blocking drugs used in the treatment of chronic obstructive pulmonary disease (COPD).

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

It blocks the parasympathetic vagal stimulation. Moderate to large doses of atropine increase the heart rate by blocking parasympathetic vagal stimulation. The exacerbation of the parasympathetic vagal stimulation is opposite to the effect of atropine. The blockage of histamine is seen with the antihistamine medications, not anticholinergic agents. Atropine does not block cell wall synthesis.

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

Keep well hydrated Adults taking an anticholinergic medication should be encouraged to drink plenty of fluids and to avoid hot temperatures because heat intolerance can occur and it will be important to maintain hydration should this happen. While the other options are appropriate suggestions, none are directly related to the safety issue of heat intolerance caused by the medication.

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? Cycloplegia Mydriasis 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.

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? Postural hypotension and increased risk for falls and from exposure to the elements Increased sweating and the risk for heat stroke and dehydration Prevents sweating and heat loss and increasing the risk of heat stroke 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 Anticholinergic drugs are commonly used in home care with children and adults. The home care nurse may need to teach older clients or caregivers that the drugs prevent sweating and heat loss and increase risks of heat stroke if precautions to avoid overheating are not taken.

Anticholinergic drugs are used in ophthalmology because they produce which effect? Sedation Pupil constriction Pupil dilation Decreased lacrimal secretions

Pupil dilation Patients receiving anticholinergic drugs must be monitored for dry mouth, difficulty swallowing, constipation, urinary retention, tachycardia, pupil dilation and photophobia, cycloplegia and blurring of vision, and heat intolerance caused by a decrease in sweating.

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

Scopolamine 1.5 mg of scopolamine is delivered via transdermal patch. This description does not relate to any of the other options.

A patient calls the clinic and talks to the nurse. The patient tells the nurse that the patient is going on a cruise and is concerned about motion sickness. The patient says that a friend got a prescription for scopolamine. What adverse effect would the nurse inform the patient that using scopolamine may result in? Urinary incontinence Diarrhea Pupil constriction Tachycardia

Tachycardia

A 27-year-old male is taking an anticholinergic drug as adjunctive therapy to treat his peptic ulcer disease. The client comes to the clinic and tells the nurse that he "feels his heart beating." What adverse effect is the client experiencing from the anticholinergic medication? Urinary frequency Hypotension Tachypnea Tachycardia

Tachycardia Tachycardia and palpitations are possible effects related to blocking of the parasympathetic effects on the heart. Tachypnea, hypotension, and urinary frequency are not generally adverse effects of anticholinergic medications.

A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response? They compete with serotonin for muscarinic acetylcholine receptor sites. They increase norepinephrine at the neuromuscular junction. They act to block the effects of the parasympathetic nervous system. They block nicotinic receptors.

They act to block the effects of the parasympathetic nervous system. Anticholinergic drugs block the effects of the parasympathetic nervous system. Atropine is the only widely used anticholinergic drug. The drug works by blocking only the muscarinic effectors in the parasympathetic nervous system. They compete with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction.

A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response? They increase norepinephrine at the neuromuscular junction. They compete with serotonin for muscarinic acetylcholine receptor sites. They block nicotinic receptors. They act to block the effects of the parasympathetic nervous system.

They act to block the effects of the parasympathetic nervous system. Anticholinergic drugs block the effects of the parasympathetic nervous system. Atropine is the only widely used anticholinergic drug. The drug works by blocking only the muscarinic effectors in the parasympathetic nervous system. They compete with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction.

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 cause bladder relaxation during surgery so that the client will not have the urge to void during surgery To increase the heart rate to prevent complication prior to the pacemaker being inserted 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

To dry up respiratory secretions to prevent aspiration during surgery 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 client is given the medication preoperatively is to dry up secretions to prevent aspiration during surgery.

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

Today, atropine is the most widely prescribed anticholinergic drug. This class of medications was once widely used to decrease GI activity and secretions in the treatment of ulcers. Today, more specific and less systemically toxic drugs are available for many of the conditions that would benefit from these effects. Therefore, this class of drugs is less commonly used. Atropine is the only widely used 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 Level of activity Urinary output Sleep patterns Appetite

Urinary output Children are often more sensitive to the adverse effects of anticholinergic medications including constipation and urinary retention. This classification of medication is not typically associated with any of the other options.

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 driving his car while taking the drug. call his doctor if he cannot urinate. avoid a warm environment. take the drug with food to avoid gastrointestinal (GI) upset.

call his doctor if he cannot urinate. Due to the patient's diagnosis and drug therapy, calling the doctor if he cannot urinate would be the most important instruction. Older men with BPH have difficulty urinating, and if an anticholinergic drug is taken, this can lead to urinary retention and bladder sphincter spasm. The patient should be encouraged to void or empty his bladder before taking the drug. Because this is an anticholinergic drug, avoiding hot environmental temperatures and driving or operating machinery should also be encouraged as well as taking the medication with food to help with GI upset.

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

constipation and dry mouth. Unwanted anticholinergic effects include dry mouth, constipation, and mydriasis.

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: drowsiness. diarrhea. urinary incontinence. pupil constriction.

drowsiness. Scopolamine at therapeutic doses produces CNS depression characterized by drowsiness, euphoria, amnesia, fatigue, and dreamless sleep resulting from decreased periods of rapid eye movement.

The nurse prepares to administer a preoperative anticholinergic to a client. What is a desired effect based upon the characteristics of the prescribed medication? wheezing heart rate 50 bilateral constricted dry mucous membranes

dry mucous membranes Anticholinergic medications block the actions of the endogenous neurotransmitters of the parasympathetic stimulation. The medication would lead to drying of mucous membranes, a desired effect for a preoperative drug. The other listed responses of wheezing, which is because of bronchoconstriction; heart rate of 50, which is bradycardia; and pupils' constriction and increase in mucous secretions would be present when a client receives a cholinergic medication resulting from the activation of the parasympathetic nervous system.

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: hypothermia related to effects on body temperature regulation. falls related to visual effects. diarrhea related to GI effects. infection.

falls related to visual effects. Among the effects of anticholinergic drugs such as flavoxate are mydriasis and blurred vision. These effects can increase the risk of falls, particularly in older clients.

A client with hypertension is to receive an anticholinergic agent. The nurse would be especially alert for: paralytic ileus. increased intraocular pressure. bladder obstruction. increased blood pressure.

increased blood pressure. A client with hypertension who receives an anticholinergic is at risk for additive hypertensive effects due to the dominance of the sympathetic system with parasympathetic blockage. Bladder obstruction, paralytic ileus, and increased intraocular pressure are contraindications for the use of an anticholinergic agent.

Which agent would the nurse expect to be prescribed for a client with seasonal rhinitis?

ipratropium