chapter 33 pharm prepu
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? Suck on hard candies. Promote oral care. Avoid driving at night. Increase bulk in the diet.
Increase bulk in diet.
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 should eat plenty of fiber to prevent constipation." "I need to exercise frequently outside in the warm weather." "I should make sure that I drink plenty of fluids." "I should avoid driving if I feel light-headed or dizzy."
"I need to exercise frequently outside in the warm weather."
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? "It's possible that your eyes will take longer to adjust to bright lights." "You might find that you have to urinate more often for the first few days that you take the drug." "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 pharmacology instructor is discussing age-related susceptibility to adverse effects of cholinergic drugs. Which statement could the instructor make to accurately describe the influence of age? "All age groups are equally susceptible to adverse effects." "Children are more susceptible to adverse effects because they receive more potent drugs than adults." "Older adults are at higher risk for adverse effects because they receive higher doses." "Physiologic changes resulting from the normal aging process place older adults at higher risk for adverse effects.
"Physiologic changes resulting from the normal aging process place older adults at higher risk for adverse effects."
A client is receiving propantheline as adjunctive therapy for peptic ulcers. The nurse instructs the client to take the medication at which time? 30 minutes before meals 1 hour after meals Only as needed for symptom relief During a meal
30 minutes before meals
A patient receives atropine intravenously. The nurse would expect the drug to be effective for how long? 6 hours 2 hours 4 hours 8 hours
4 hours
The nurse administers atropine intramuscularly at 9:00 AM. At which time would the nurse expect the drug's peak effects to occur? 10:00 AM 9:15 AM 9:45 AM 9:30 AM
9:30 AM
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 membrane
dry mucous membranes
What disease process would cause a nurse to question a client's new prescription for benztropine? Narrow-angle glaucoma Myocardial infarction Diabetes mellitus Hyperparathyroidism
Narrow-angle glaucoma
Which would the nurse include in a teaching plan for a client who is prescribed an anticholinergic agent? Limiting fluid intake during the day Decreasing fiber intake Avoiding activities that require alertness Encouraging outside activity in the warm weather
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? Hypertension Dehydration Tachycardia Bradycardia
Bradycardia
Which symptoms will warrant the administration of atropine? Paralytic ileus Urinary retention Bradycardia Blurred vision
Bradycardia
The nurse is teaching a client about some of the cholinergic blocking drugs that are available over the counter without a prescription. Which medication would the nurse include as being available without a prescription? Select all that apply. Scopolamine Oxybutynin Belladonna Dicyclomine Diphenhydramine
Diphenhydramine Scopolamine
The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client? Antianxiety Opioid Antiemetic Cholinergic blocking
Cholinergic blocking
Administration of which classes of medications can decrease secretions of the upper respiratory tract? Antiemetics Cholinergic blocking drug Opioids Antianxiolytic
Cholinergic blocking drug
A client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal cramps, and nausea. The nurse prepares to intervene for what condition? Cholinergic overdose Anaphylactic reaction Pulmonary edema Myasthenic crisis
Cholinergic overdose
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 feeding the baby prior to taking the prescribed atropine Discuss pumping and then warming the breast milk before bottle feeding the baby 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 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? Explain to the client that the medication is contraindicated because of her medical history 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
Which symptom should the nurse monitor for when caring for a client whose sinus bradycardia has been treated with large doses of atropine? Edema Incontinence Pallor Flushing
Flushing
A client is diagnosed with atropine toxicity that resulted from the ingestion of herbal therapies. What would be done first? Administration of physostigmine Cool sponge baths Gastric lavage Administration of diazepam
Gastric lavage
The nurse is aware that cholinergic blocking agents will be used preoperatively for what type of anesthesia? Regional Topical General Local
General
Clients with what disorder should not be given anticholinergic drugs? Attention deficit disorder Glaucoma Epilepsy Severe anxiety or hyperactivity
Glaucoma
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? Diverticulitis Diabetes mellitus Glaucoma Asthma
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 Ipratropium Hyoscyamine Glycopyrrolate
Glycopyrrolate
When describing the various anticholinergic agents to a group of students, the instructor would identify which agent as being available in sublingual form? Tiotropium Scopolamine Hyoscyamine Propantheline
Hyoscyamine
The nurse understands that older clients taking anticholinergic drugs are more likely to have all of the following symptoms EXCEPT: Constipation. Confusion. Hypertension. Blurred vision
Hypertension.
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.
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? Scopolamine Hyoscyamine Atropine Ipratropium
Ipratropium
Which agent would the nurse expect to be prescribed for a client with seasonal rhinitis? Trospium Atropine Propantheline Ipratropium
Ipratropium
A client with myasthenia gravis is experiencing rhinorrhea. Which of medication should not be administered to the client? Nedocromil sodium (Tilade) Azelastine hydrochloride (Astelin) Ipratropium (Atrovent) Fexofenadine (Allegra)
Ipratropium (Atrovent)
Which cholinergic-blocking drugs are used in the treatment of chronic obstructive pulmonary disease (COPD)? (Select all that apply.) Benztropine (Cogentin) Ipratropium (Atrovent) Darifenacin (Enablex) Tiotropium (Spiriva) Biperiden (Akineton)
Ipratropium (Atrovent) Tiotropium (Spiriva)
A client is administered atropine to increase the heart rate. What is the action of atropine? It exacerbates the parasympathetic vagal stimulation. It blocks cell wall synthesis of gram-negative bacilli. It provides long-acting antihistamine blockage. It blocks the parasympathetic vagal stimulation.
It blocks the parasympathetic vagal stimulation.
Which statements best reflects the action of scopolamine? It exerts a major effect on the neuromuscular junction. It blocks the nicotinic receptors in the parasympathetic nervous system. 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.
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? Alpha-adrenergic receptors Muscarinic receptors Beta-adrenergic receptors Nicotinic receptors
Muscarinic receptors
A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem? Multiple sclerosis Parkinson disease Myasthenia gravis Alzheimer disease
Myasthenia gravis
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 Photophobi
Mydriasis
The pharmacology instructor is discussing the adverse effects of anticholinergic drugs. What drug would the instructor indicate is administered to counteract the effects of atropine poisoning? Edrophonium Neostigmine Bethanechol Physostigmine
Physostigmine
Anticholinergics have varied effects on the body. What is one of those effects? Preventing vagal stimulation Increasing secretion of sweat glands Increasing respiratory tract secretions Stimulating the release of acetylcholine
Preventing vagal stimulation
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? 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 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
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. Tell the patient to void after drug administration. Raise the side rails of the bed. Provide frequent sips of water.
Raise the side rails of the bed.
A client is prescribed glycopyrrolate preoperatively. The nurse integrates understanding of the drug's action, explaining that this drug will help achieve which effect? Relaxation Reduction of oral secretions Increase muscle rigidity Prolongation of anesthesia
Reduction of oral secretions
Which anticholinergic agent is sometimes used to manage motion sickness when delivered by transdermal patch? Scopolamine Atropine Tolterodine Hyoscyamine
Scopolamine
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 call his doctor if he cannot urinate. take the drug with food to avoid gastrointestinal (GI) upset. avoid driving his car while taking the drug. avoid a warm environment.
call his doctor if he cannot urinate.
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? Pupil constriction Urinary incontinence Tachycardia Diarrhea
Tachycardia
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 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.
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 relax the bowel to prevent the client from having a bowel movement during surgery 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 dry up respiratory secretions to prevent aspiration during surgery
To dry up respiratory secretions to prevent aspiration during surgery
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
A client is reporting diarrhea, rigidity and spasm after receiving pyridostigmine. Which medication is appropriate to suggest to the prescriber? alprazolam loperamide morphine sulfate atropine
atropine
The client is taking digitalis and has not been monitoring pulse rate. The client presents to the emergency department via ambulance experiencing digitalis toxicity and symptomatic bradycardia. The nurse knows that which medication may be administered to treat bradycardia? Milrinone Lasix Norvasc Atropine
atropine
A male client, age 75, is started on flavoxate . What adverse effect should the client be made aware of? Skin rash Headache Blurred vision Weight gain
blurred vision
What is the primary goal for prescribing an anticholinergic agent for a preoperative client? relaxation of the detrusor muscle decrease gastric motility prevent tachycardia decrease respiratory secretions
decrease respiratory secretions
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: falls related to visual effects. infection. hypothermia related to effects on body temperature regulation. diarrhea related to GI effects.
falls related to visual effects. infection.
Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to: diarrhea related to increased peristalsis. hypotension related to increased sympathetic response. urinary frequency related to CNS effects. heat stroke related to decreased perspiration.
heat stroke related to decreased perspiration.
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 Keep well hydrated Wear sunglasses to protect the eyes Keep arms and legs covered
keep well hydrated
A client is prescribed propantheline. The nurse would administer this drug by which route? Intramuscular Oral Subcutaneous Intravenous
oral
Which anticholinergic agent is sometimes used to manage motion sickness when delivered by transdermal patch? Hyoscyamine Tolterodine Atropine Scopolamine
scopolamine
Cholinergic drugs are contraindicated in all situations except in clients with:
urinary retention or postoperative abdominal distention due to paralytic ileus.
