Chapter 12 Cholinergic Drugs Affecting the Autonomic Nervous System

A client has been prescribed an oral drug containing atropine. The nurse would hold the drug and contact the prescriber if the client states which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I would like to wait a few minutes to take this as I just drank some aloe juice." 2. "Can I take this at the same time as my procainamide?" 3. "I have had a headache this morning." 4. "I am allergic to penicillin." 5. "My gallbladder surgery is scheduled for next week."

1. "I would like to wait a few minutes to take this as I just drank some aloe juice." 2. "Can I take this at the same time as my procainamide?"

A preoperative client will be receiving glycopyrrolate (Robinul), which is an anticholinergic drug. The client asks the nurse, "Why do I need to take that medication?" What is the best response by the nurse? 1. "It will decrease your respiratory secretions during surgery." 2. "It will increase your urinary output during surgery." 3. "It will help you breathe better during surgery." 4. "It will help maintain your blood pressure during surgery."

1. "It will decrease your respiratory secretions during surgery."

The nursing instructor teaches the student nurses about the nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The central nervous system includes the brain and spinal cord." 2. "The peripheral nervous system has mainly sensory functions." 3. "The somatic nervous system gives us voluntary control over our gastrointestinal (GI) tract." 4. "The nervous system helps us react to environmental changes." 5. "The somatic nervous system gives us voluntary control over moving."

1. "The central nervous system includes the brain and spinal cord." 4. "The nervous system helps us react to environmental changes." 5. "The somatic nervous system gives us voluntary control over moving."

The nursing instructor teaches the student nurses about the autonomic nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The sympathetic and parasympathetic systems are not always opposite in their effects." 2. "The parasympathetic nervous system is the 'fight-or-flight' response." 3. "Sympathetic stimulation causes dilation of arterioles." 4. "The parasympathetic nervous system causes bronchial constriction." 5. "The sympathetic nervous system is activated under stress."

1. "The sympathetic and parasympathetic systems are not always opposite in their effects." 4. "The parasympathetic nervous system causes bronchial constriction." 5. "The sympathetic nervous system is activated under stress."

A nursing instructor is planning to teach nursing students about exogenous acetylcholine. The instructor should include which information? 1. Acetylcholine has almost no therapeutic effects because it is rapidly destroyed once given. 2. Acetylcholine is broken down rapidly within the body, preventing it from producing adverse effects. 3. Acetylcholine will cause the heart rate to increase and blood pressure to drop. 4. When given in small amounts, acetylcholine will produce profound parasympathetic effects.

1. Acetylcholine has almost no therapeutic effects because it is rapidly destroyed once given.

A nurse is reading about the development of drugs that inhibit the parasympathetic nervous system. The nurse would look for articles about which drug classes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anticholinergics 2. Parasympathomimetics 3. Parasympatholytics 4. Cholinergics 5. Muscarinic blockers

1. Anticholinergics 3. Parasympatholytics 5. Muscarinic blockers

Which is an adrenergic receptor associated with the sympathetic nervous system? 1. Beta 2. Dopamine 3. Muscarinic 4. Norepinephrine

1. Beta

The nurse is caring for a client with multisystem organ failure. Which client assessment findings are under the control of the sympathetic nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood glucose level 210 mg/dL 2. Blood pressure 180/90 mmHg 3. Extremities are cool 4. Respiratory rate 14 and regular 5. Hyperactive bowel sounds

1. Blood glucose level 210 mg/dL 2. Blood pressure 180/90 mmHg 3. Extremities are cool

A client is prescribed a medication that will block muscarinic receptors. The nurse realizes that this medication has implications for which body systems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Eyes 2. Respiratory 3. Cardiac 4. Endocrine 5. Metabolic

1. Eyes 2. Respiratory 3. Cardiac

A nurse is working with a student nurse. The nurse explains what a client would experience if the adrenergic receptors are activated. Which of the following comments by the student nurse indicates that the education was effective? 1. Fight-or-flight effects 2. Rest-and-digest effects 3. Increased blood volume 4. Bronchial constriction

1. Fight-or-flight effects

A client has sustained a large blood loss. During the assessment, the nurse realizes that which findings are under the control of the nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heart rate 2. Blood pressure 3. Pupil size 4. Bowel sounds 5. Fluid volume

1. Heart rate 2. Blood pressure 3. Pupil size 4. Bowel sounds

A student nurse asks a nursing instructor which part of the nervous system primarily regulates the ability of a person to use his arm muscles to lift a weight. What is the instructor's best response? 1. Somatic nervous system 2. Sympathetic nervous system 3. Autonomic nervous system 4. Parasympathetic nervous system

1. Somatic nervous system

A student nurse asks a nurse which client situations are considered involuntary responses to autonomic nervous system control? What is the nurse's best response(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sweating when hot 2. Stepping over a chair to prevent falling 3. Complaining of nausea 4. Salivating at the smell of food 5. Breathing deeper when running

1. Sweating when hot 4. Salivating at the smell of food 5. Breathing deeper when running

The nurse is preparing to administer medications to a group of clients. One of the medications is atropine, an anticholinergic drug. This drug is contraindicated in which client? 1. The client with glaucoma 2. The client with hyperthyroidism 3. The client with a hiatal hernia 4. The client with lung cancer

1. The client with glaucoma

A student nurse is learning about a medication that affects the autonomic nervous system. When instructing the student about the effects of this medication, the nurse will begin by explaining the basic structures of this system. What does this include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The preganglionic neuron 2. The postganglionic neuron 3. The synaptic cleft 4. Norepinephrine 5. Dopamine

1. The preganglionic neuron 2. The postganglionic neuron 3. The synaptic cleft

A client is prescribed an anticholinergic drug. What discharge instructions should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Wear sunglasses in bright light. 2. Limit fluid intake. 3. Increase fiber intake. 4. Avoid hot showers. 5. Avoid milk and dairy products.

1. Wear sunglasses in bright light. 3. Increase fiber intake. 4. Avoid hot showers.

A client has been prescribed scopolamine (Transderm-Scop) for the prevention of motion sickness. The nurse should teach the client to immediately report which adverse effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Slow heart rate 2. Cardiac palpitations 3. Decreased urinary output 4. Development of tremors 5. Diarrhea

2. Cardiac palpitations 3. Decreased urinary output 4. Development of tremors

The client is quadriplegic and receives the anticholinergic drug oxybutynin (Ditropan) to increase his bladder capacity. What is an important assessment of this client by the nurse? 1. Is he irritable? 2. Is he constipated? 3. Is he gaining weight? 4. Is he lethargic?

2. Is he constipated?

The healthcare provider orders dicyclomine (Bentyl), an anticholinergic drug, for a client. What is the nurse's priority assessment prior to administering this drug? 1. Does the client have light sensitivity? 2. Is the client able to urinate? 3. Does the client have a history of alcoholism? 4. Is the client dizzy upon standing?

2. Is the client able to urinate?

The nurse is preparing to administer benztropine (Cogentin), which is an anticholinergic drug. The nurse understands this drug is contraindicated in which client? 1. The client with a fractured femur 2. The client with tachycardia 3. The client with an irritable colon 4. The client with diarrhea

2. The client with tachycardia

A client's heart rate is 72 beats per minute with a regular rhythm. How does the nurse interpret this data in relation to the client's peripheral nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The sympathetic system is in control. 2. The parasympathetic system is dominating. 3. Both parasympathetic and sympathetic systems are influencing cardiac status. 4. The autonomic nervous system is affecting cardiac status. 5. The somatic nervous system is affecting cardiac status.

2. The parasympathetic system is dominating. 3. Both parasympathetic and sympathetic systems are influencing cardiac status. 4. The autonomic nervous system is affecting cardiac status.

The nurse educator is reviewing the process of synaptic transmission following the sympathetic pathway. In which order will the nurse explain the steps of synaptic transmission? 1. Action potential encounters adrenergic receptors 2. Action potential encounters cholinergic receptors 3. Action potential travels across the preganglionic neuron 4. Action potential travels across the postganglionic neuron 5. Target tissue is reached.

3. Action potential travels across the preganglionic neuron 2. Action potential encounters cholinergic receptors 4. Action potential travels across the postganglionic neuron 1. Action potential encounters adrenergic receptors 5. Target tissue is reached.

A nursing instructor is reviewing receptor types with a nursing student. The instructor identifies that learning has occurred when the student responds that which type of receptor is found at the ganglionic synapse of both the sympathetic and parasympathetic nervous systems? 1. Alpha receptors 2. Muscarinic 3. Nicotinic 4. Beta receptors

3. Nicotinic

The nurse has completed medication education about pyridostigmine (Mestinon), an indirect cholinergic drug, for a client with myasthenia gravis. The nurse determines that learning has occurred when the client makes which statement? 1. "My heart may beat slower while I am on this drug." 2. "I will need to increase my fluid intake with this medication." 3. "I must take this medication immediately before eating a full meal." 4. "It is really important to take my medication on time."

4. "It is really important to take my medication on time."

The student nurse asks the nursing instructor, "Do medications actually make more neurotransmitters?" What is the best response by the nursing instructor? 1. "No, but medications can heal diseases of the autonomic nervous system." 2. "Yes, some of the newer medications are very good at doing this." 3. "Yes, but the newer drugs that do this have some serious side effects." 4. "No, medications can only increase or decrease the action of neurotransmitters

4. "No, medications can only increase or decrease the action of neurotransmitters

A student nurse asks a nurse how atropine (Atropair) increases heart rate. What is the nurse's best response? 1. Blocking the beta receptors of the parasympathetic nervous system 2. Directly stimulating the sympathetic nervous system 3. Potentiating the effects of acetylcholine on nicotinic receptors 4. Blocking the effects of acetylcholine by occupying muscarinic receptors

4. Blocking the effects of acetylcholine by occupying muscarinic receptors

A student nurse is reviewing the autonomic nervous system. The student understands that which substance would inhibit the function of the autonomic nervous system? 1. Drugs that bind and then stimulate the postsynaptic neuron 2. Drugs that prohibit neurotransmitter reuptake 3. Drugs that increase neurotransmitter synthesis 4. Drugs that prevent the storage of neurotransmitter in vesicles

4. Drugs that prevent the storage of neurotransmitter in vesicles

A client who has myasthenia gravis (MG) presents to the emergency department with abrupt onset of increased muscle weakness and difficulty swallowing. An attempt to distinguish worsening of the MG symptoms from overdose of the client's prescribed anticholinergic is planned. What medications should the nurse obtain for use in this procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Donepezil (Aricept) 2. Pyridostigmine (Mestinon) 3. Neostigmine (Prostigmin) 4. Edrophonium (Edrophonium Injectable) 5. Atropine (Atropine Injectable)

4. Edrophonium (Edrophonium Injectable) 5. Atropine (Atropine Injectable)

The healthcare provider has ordered bethanechol (Urecholine), a cholinergic drug, for the client with urinary retention. The client also has an enlarged prostate gland. What is the priority action by the nurse? 1. Hold the drug and prepare to catheterize the client. 2. Administer the drug and measure urinary output. 3. Administer the drug and push fluids. 4. Hold the drug and contact the healthcare provider.

4. Hold the drug and contact the healthcare provider.

A nursing instructor is teaching student nurses about the sympathetic nervous system. The instructor recognizes that learning has occurred when the students say which of the following responses are regulated by the sympathetic nervous system? 1. Bronchial constriction 2. Stimulates salivation 3. Sex organ stimulation 4. Pupil dilation

4. Pupil dilation