Chapter 46

Decreased acetylcholine levels are characteristic of: multiple sclerosis. Alzheimer's disease. Huntington's disease. Parkinson's disease.

Alzheimer's disease.

The nursing instructor is teaching a student about the drugs used for Alzheimer's disease. Even though cholinesterase inhibitors do not cure the disease, the instructor informs the student that they do help to slow the progression. The instructor then asks the student, "When a drug is stopped due to side effects, what happens to the client?" The student's best response would be: The side effects will worsen. The client loses any benefit they have received from the drug. The client will show no changes. The client will deteriorate at a faster rate.

The client loses any benefit they have received from the drug.

A client has benign prostatic hypertrophy and has been prescribed neostigmine. The nurse is aware that this client must be monitored for what adverse effect of this medication? Urinary retention Pain with urination Hematuria Pyuria

Urinary retention

The client in the final stage of Alzheimer's disease tends to suffer from weight loss and eating problems. This is primarily due to: inability to swallow. inability to make food choices. fatigue. loss of appetite.

inability to swallow.

A middle-aged client is being treated for myasthenia gravis with neostigmine. What change in the client's health status would warrant immediate medical follow-up? significant changes in mood and affect sudden muscle weakness jaundice migraine-type symptoms

sudden muscle weakness

A client is taking rivastigmine for Alzheimer disease. The nurse will evaluate the client regularly for: decreased blood pressure. weight gain. increased blood pressure. weight loss.

weight loss.

Which agent would be most appropriate to administer to a client with Alzheimer's disease? Neostigmine Donepezil Pyridostigmine Ambenonium

Donepezil

A patient is administered edrophonium (Tensilon) to confirm the diagnosis of myasthenia gravis. What effect will the edrophonium (Tensilon) have 30 minutes after the medication administration, which will confirm the diagnosis?

A

A patient who is being treated for myasthenia gravis is receiving neostigmine, and her pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia? A) Atropine B) Pseudoephedrine C) Propranolol (Inderal) D) Bethanechol (Urecholine)

A

A patient with myasthenia gravis is administered pyridostigmine (Mestinon) for the first time. She asks the nurse the reason why she has been changed to this medication. Which of the following is the nurse's best response? A) "Pyridostigmine (Mestinon) will allow you to awaken with the ability to swallow." B) "Pyridostigmine (Mestinon) can be taken every other day." C) "Pyridostigmine (Mestinon) is a faster-release form of cholinergic agent." D) "Pyridostigmine (Mestinon) is taken one time per day for better control."

A

An accidental overdose of neostigmine has prompted the emergency administration of atropine. When assessing the patient, the emergency department nurse should take into account that this intervention will not relieve the effects of neostigmine on A) skeletal muscle. B) smooth muscle. C) the heart. D)

A

A nurse is assessing a client prior to giving a cholinergic drug for treatment of urinary retention. Which nursing assessments should be completed prior to administration of a cholinergic? Select all that apply. Scan the bladder to determine if urine retention present. Assess blood pressure and pulse rate. Document pain assessment. Administer antiemetic medication. Palpate the abdomen in the pelvic area.

Assess blood pressure and pulse rate. Palpate the abdomen in the pelvic area. Scan the bladder to determine if urine retention present.

A 33-year-old female patient with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this patient's health problem is ultimately attributable to what pathophysiological process? A) Idiopathic overproduction of anticholinesterase B) Autoimmune destruction of acetylcholine receptors C) Demyelination of parasympathetic nerve pathways D) Deficient synthesis of dopamine by the substantia nigra

B

A nurse is conducting health education with a man who has Alzheimer's disease and his daughter, who is his primary caregiver. The man has been deemed to be a good candidate for treatment with donepezil (Aricept) and will soon begin taking this medication. What teaching point should the nurse convey? A) "Aricept should be taken 1 hour before or 2 hours after any dairy products." B) "It's important to take this medication at bedtime." C) "Aricept should be taken with food to reduce the chance of stomach upset." D) "If you don't notice any cognitive improvement within 2 weeks, the drug should be discontinued.

B

A patient has been receiving bethanechol (Urecholine) for 1 week. One hour after the dose is administered, he develops sweating, flushing, abdominal cramps, and nausea. What is the rationale for the development of these symptoms? A) Myasthenic crisis B) Cholinergic overdose C) Anaphylactic reaction D) Pulmonary edema

B

A patient with myasthenia gravis is administered neostigmine (Prostigmin). How does this drug produce its therapeutic effect? A) It stimulates the sympathetic nervous system. B) It stimulates the parasympathetic nervous system. C) It stimulates the cardiac smooth muscle. D) It stimulates the respiratory system

B

patient has atony of the smooth muscle of the gastrointestinal tract. Which type of medication may be administered to increase smooth muscle strength? A) Anticholinergic drugs B) Cholinergic drugs C) Muscle relaxants D) Selective serotonin reuptake inhibitors

B

A nurse is reviewing the medication history of several clients. One of the clients is receiving a direct-acting cholinergic drug. The nurse would most likely identify which drug? Pyridostigmine Bethanechol Guanidine Ambenonium

Bethanechol

The nurse is caring for a client with asthmatic bronchitis and understands that cholinergic medications are contraindicated because this classification of medication may cause which effect? Decreased secretions Bronchoconstriction Bronchodilation Thickened secretions

Bronchoconstriction

40-year-old woman has received a diagnosis of myasthenia gravis (MG) and is scheduled to begin treatment with oral neostigmine in her home. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on A) matching each dose of neostigmine to the severity of symptoms at that time. B) making lifestyle modifications to prioritize a healthy diet and regular activity. C) adhering strictly to the prescribed administration schedule. D) developing acceptance of the functional deficits that result from MG.

C

A patient is diagnosed with Alzheimer's disease. The nurse should anticipate administering which of the following medications? A) Bethanechol (Urecholine) B) Neostigmine (Prostigmin) C) Donepezil (Aricept) D) Physostigmine salicylate (Antilirium

C

A patient is diagnosed with a paralytic ileus. Which of the following medications will be administered to treat a paralytic ileus? A) Neostigmine (Prostigmin) B) Donepezil (Aricept) C) Bethanechol (Urecholine) D) Ambenonium (Mytelase)

C

An 80-year-old man has been diagnosed with early-stage Alzheimer's disease and has begun treatment with donepezil (Aricept). When providing health education to the patient and his wife, the nurse should identify what goal of treatment? A) Remission of Alzheimer's disease B) Cure of Alzheimer's disease C) Improvement of cognition and function D) Resolution of memory and cognitive deficits

C

Following recent changes in memory and personality, a 72-year-old man is undergoing neurological testing to rule out Alzheimer's disease. The nurse is aware that this disease is characterized by what pathophysiological phenomena? Select all that apply. A) Meningiomas B) Neuritic plaques C) Neurofibrillary tangles D) Arteriovenous malformations (AVMs) E) Gliomas

C,D

A middle-aged female patient has been admitted to the outpatient treatment unit of the hospital for an edrophonium (Tensilon) test. Shortly after the administration of the medication, the patient reports that her muscle strength is significantly weaker than before the test. The nurse who is participating in the test should recognize that this finding is suggestive of what diagnosis? A) Alzheimer's disease B) Anticholinergic crisis C) Myasthenia gravis D) Cholinergic crisis

D

An older adult patient with a diagnosis of moderate Alzheimer's disease will soon return home with her husband. How can the nurse best facilitate the safe and effective administration of donepezil in the home setting? A) Have the patient explain the rationale for drug therapy repeatedly before discharge. B) Provide a detailed drug monograph to the patient and her husband and offer to answer any questions. C) Assess the patient's need for home care. D) Teach the patient's husband to administer the medication in a timely and safe manner.

D

When administering anticholinesterase drugs, what assessment finding would indicate the patient is experiencing a toxic effect of the medication? A) Loss of consciousness B) Abdominal distention C) Hypertension D) Muscle weakness

D

Which of the following medications is administered for ingestion of clitocybe mushrooms? A) Pyridostigmine (Mestinon) B) Donepezil (Aricept) C) Rivastigmine (Exelon) D) Atropine sulfate

D

The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms? Improve medication absorption through the blood-brain barrier Cause vasodilation of the cerebral arteries Improve anticholinergic neurotransmission to the brain Improve cholinergic neurotransmission to the brain

Improve cholinergic neurotransmission to the brain