Prep U CH 32 Questions
A client is prescribed donepezil. The nurse would expect to administer this drug at which frequency?
Once a day
What drug is prescribed for mushroom poisoning?
atropine Accidental or intentional ingestion of these mushrooms results in intense cholinergic stimulation and is potentially fatal. Atropine is the specific antidote for mushroom poisoning.
A client who has been prescribed bethanechol asks a nurse to explain how the drug works. What would be a correct response? a. bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of uring b. bethanechol is an indirect acting cholinergic drug c. bethanechol is a diuretic d. bethanechol increases water production in the kidneys
"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine." Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine. Bethanechol is not an indirect acting cholinergic drug nor is it a diuretic. It does not increase water production in the kidneys; kidneys do not produce water.
A patient has just received carbachol (Miostat). Which statement indicates the patient understands the nurse's teaching about this medication? a. I will be careful and not go around people who have infections b. I should expect medication to decrease pressure in my eye c. I should expect med to lower my blood pressure d. I should expect med to give me headaches
"I should expect the medication to decrease pressure in my eye." The medication is for glaucoma and should decrease pressure in the eye. The medication does not work on headaches and does not suppress the immune system, nor is it given by injection.
The caregiver of client describes the client as having Alzheimer's disease (AD) for 10 years and is currently in the late stage of the disease. The caregiver asks the nurse if the client can go back on the medication donepezil. Which response by the nurse is appropriate?
"The drugs are best used early as they slow the progression of AD." Drugs used in AD early slow the mental and physical degeneration associated with the disease. The drugs must be taken routinely to slow the progression. Donepezil and galantamine are cholinesterase inhibitors. Should cholinesterase inhibitor therapy be discontinued, individuals lose any benefit they have received from the drugs within 6 weeks.
A nurse is monitoring a patient with Alzheimer's disease for initiation of therapy. In which patient is the administration of donepezil contraindicated? a. bronchitis b. beriberi c. amnesia d. asthma
A patient with asthma The administration of cholinesterase inhibitors is contraindicated in patients with asthma. Use is not contraindicated in patients with bronchitis, beriberi, or amnesia.
A 40-year-old, diagnosed with myasthenia gravis (MG), is scheduled to begin treatment with oral neostigmine. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on what personal behavior?
Adhering strictly to the prescribed administration schedule Strict adherence to timely medication administration promotes optimal blood levels of neostigmine and optimal symptom control. Doses are not typically matched to short-term symptom severity, except in emergencies. Lifestyle modifications and acceptance may be of benefit, but pharmacologic therapy is of paramount importance in the treatment of MG.
The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as which? a. osteoarthritis b.rheumatoid arthritis c. alzheimers d. dementia
Alzheimer's Alzheimer's disease is a progressive deterioration of emotional, physical, and cognitive abilities. Osteoarthritis and rheumatoid arthritis do not normally affect the cognitive function of a client. Dementia is a group of symptoms affecting social and intellectual abilities but not physical abilities.
The nurse is providing education to a client who has been prescribed an anticholinesterase drug. What caution would the nurse include in the teaching? a. should be taken with food or milk to decrease the risk of gastric distress and ulceration b. taken at bed time c. started at very high doses
Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. All anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. These drugs are taken at bedtime to avoid the risks associated with dizziness and vertigo, not to prevent nausea. These drugs are not started at very high doses, though doses may be increased after several weeks if initial dosing doesn't achieve the desired effect.
A 4-year-old girl is brought to the emergency department by her mother. The mother reports the child has been vomiting, The nurse notes the child's face is flushed and is diaphoretic. The mother thinks the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which drug would be administered? a. actylcholine b.cevimeline c.atropine d. nicotine
Atropine Acetylcholine and cevimeline are both cholinergic agonists, and, like carbachol, would be contraindicated in this client. Administration of either of these drugs could be fatal. Nicotine is a direct-acting nicotinic agonist and is not indicated in cholinergic poisoning. Atropine is considered the antidote for cholinergic poisoning. The 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 client has been diagnosed with urinary retention. The nurse expects the client to receive which medication for this condition? a. benadryl b. bethanechol c. ambenonium d. guanidine
Bethanechol Bethanechol is the only medication listed that is used to treat urinary retention. Ambenonium and guanidine are used to treat myasthenia gravis. Benadryl is an antihistamine.
A client with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. When the nurse finds the client anxious, diaphoretic, and visibly flushed, what action should the nurse take to best assure the client's safety?
Contact the health care provider as the client may be experiencing a cholinergic crisis. The presence of sweating and skin flushing in a client taking bethanechol is suggestive of a cholinergic crisis. This is a medical emergency that warrants prompt intervention by the care team. This problem is not treated with epinephrine. Assessing the client's bladder or inserting a Foley catheter is not sufficient.
A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following? a. cholinergic crisis b. acetylcholinesterase crisis c. hypertensive emergency d. status epilepticus
Cholinergic crisis Symptoms of cholinergic crisis include severe abdominal cramping, diarrhea, excessive salivation, muscle weakness, rigidity and spasm, and clenching of the jaw. In acetylcholinesterase crisis a pronounced muscular weakness and respiratory paralysis caused by excessive acetylcholine, often a result of overmedication with anticholinesterase drugs. Hypertensive emergency includes retinal hemorrhage, increased intracranial pressure resulting in headache and/or vomiting, and kidney organ failure. Status epilepticus is a medical emergency and can be of different types and caused by brain trauma, infection, or stroke.
A client has atony of the smooth muscle of the gastrointestinal tract. Which type of medication will be administered to increase smooth muscle strength? a. anticholinergic drugs b. SSRIs c. cholinergic drugs
Cholinergic drugs are used to treat atony of the smooth muscle of the gastrointestinal tract and urinary systems. Anticholinergic agents and muscle relaxants will decrease muscle strength. Selective serotonin reuptake inhibitors have no effect on atony of the smooth muscle of the gastrointestinal tract.
A 32-year-old breast-feeding mother has been diagnosed with closed-angle glaucoma and is receiving cholinergic therapy. She does not have a history of asthma, cardiovascular disease, or biliary disorder. What is the most important factor that the nurse would consider during ongoing assessment of the therapy? a. stimulation of sphincters b. airway resistance c. bronchial secretions d. cholinergic stimulation
Cholinergic stimulation in her infant The therapy for closed-angle glaucoma should be continuously assessed for cholinergic stimulation in the patient's infant. If such stimulation occurs, the drug should be discontinued immediately. The assessment for cholinergic stimulation would include assessing for an increase in the airway resistance, bronchial secretions, and stimulation of sphincters; these are all cholinergic effects. It would not be advisable to assess only one of these factors. Therefore, assessing for cholinergic stimulation is the best answer.
Which adverse effects might a nurse assess in a patient receiving bethanechol? (Select all that apply.) a. diarrhea b. dehydration c. diaphoresis d.
Diarrhea is a possible adverse effect of bethanechol. Dehydration is possible due to the adverse effect of diarrhea. Increased sweating is a possible adverse effect of bethanechol. Bradycardia would occur with bethanechol. Flushing is a possible adverse effect of bethanechol. Flushing is a possible adverse effect of bethanechol. Bradycardia would occur with bethanechol.
A client is diagnosed with Alzheimer's disease. The nurse should anticipate administering which medication? a. bethanechol b.neostigmine c. physostigmine d. donepezil
Donepezil Donepezil is used to treat mild to moderate Alzheimer's disease. Bethanechol produces smooth muscle contractions and is not used to treat Alzheimer's disease. Neostigmine is not used to treat Alzheimer's disease; it is used to treat myasthenia gravis. Physostigmine is not used to treat Alzheimer's disease; it is an antidote for overdose of anticholinergic drugs.
A 70-year-old female patient has just been diagnosed with Alzheimer's disease. What cholinergic drug is used for the treatment of Alzheimer's disease? a. donepezil b.tensilon c. prostigmine d.duvoid
Donepezil (Aricept) Currently, there are four reversible indirect-acting cholinergic agonists available to slow the progression of this disease. These include tacrin (Cognex), galantamine (Razadyne), rivastigmine (Exelon), and donepezil (Aricept). Tensilon is used to diagnose myasthenia gravis; Prostigmine is used for the diagnosis and management of myasthenia gravis; and Duvoid is used infrequently today because of its widespread parasympathetic activity.
The nurse is preparing a teaching plan for a client who is taking rivastigmine. What precaution should the nurse teach the client and family to minimize the risk of adverse GI effects? a. momitoring weight b. eating nutrient and calorie rich foods c. help establish appropriate sleep and rest patterns d. having small frequent meals
Having small, frequent meals Having small, frequent meals or taking the drug with food helps offset GI effects of nausea and vomiting. Monitoring weight throughout therapy and, if weight loss occurs, eating nutrient- and calorie-rich foods are also methods of reducing adverse effects but do not help offset GI effects. Helping the client establish appropriate sleep and rest patterns helps reduce the risk for injury related to the adverse effect of sedation.
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 cholinergic neurotransmission to the brain Indirect-acting cholinergic medications for Alzheimer's disease are widely distributed, including to the central nervous system. Thus, indirect-acting cholinergic drugs are able to improve cholinergic neurotransmission in the brain.
The nurse is providing education to a client who has been recently diagnosed with myasthenia gravis. During teaching, the nurse would describe it as what type of disorder?
Myasthenia gravis is a neuromuscular disease leading to fluctuating muscle weakness and fatigability. It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the stimulative effect of the neurotransmitter acetylcholine. None of the other options describe the disorder.
A client with advanced-stage Alzheimer's disease is seen by a health care provider who prescribes a newer drug that is not a cholinesterase inhibitor. This drug is a N-methyl-D-asparate (NMDA) receptor antagonist. This drug is better known as:
Namenda. Cholinesterase inhibitors are not used in late-stage Alzheimer's disease. A newer group of drugs, NMDA receptor antagonists, is available. Namenda is thought to work by decreasing the excitability of neurotransmission caused by an excess of the amino acid glutamate in the CNS.c
The nurse administered cevimeline (Evoxac) 30 mg to a patient. What should the nurse assess to determine if the medication is having the desired effect?
Oral Mucous membranes This medication is given to patients with Sjogren's syndrome to increase secretions. This medication is considered as having a therapeutic effect if mucous membranes are moist and the patient is not having symptoms of dry mouth.
A nursing student is preparing a care plan and is choosing a nursing diagnosis for her client with Alzheimer's disease. The client is taking Exelon. Which would be an appropriate nursing diagnosis for this client? a. being confined to an Alzheimers unit d. risk of gaining weight c. being deaf or hard of hearing d. risk for injury related to dizziness or fatigue
Risk for Injury related to dizziness and fatigue Exelon has the side effects of dizziness and fatigue, which can contribute to falls and injuries. Being confined to an Alzheimer's unit is done to prevent injuries that might happen as a result of being confused. Most clients taking Exelon are at risk of losing, not gaining, weight. Nothing was said about the client being deaf or hard of hearing.
A group of students are reviewing the drugs that are available for treating Alzheimer's disease. The students demonstrate understanding of the information when they identify which drug as appropriate for treatment? a. cevimeline b. edrophonium c. pyridostigmine d. rivastigmine
Rivastigmine Rivastigmine is used to treat Alzheimer's disease. Cevimeline is used to treat dry mouth associated with Sjogren syndrome. Edrophonium is used to diagnose myasthenia gravis. Pyridostigmine is used to manage myasthenia gravis.
The client has been prescribed a cholinergic agonist. Which statement is true concerning the administration of cholinergic agonists?
The parasympathetic nervous system is stimulated by these medications. The parasympathetic nervous system is stimulated by these medications. Acetylcholine is the substance that transmits nervous impulses across the parasympathetic branch of the autonomic nervous system. The sympathetic nervous system is not stimulated by these medications and they are administered frequently.
A female client has been taking Aricept for several months. The family feels that she is better and wants to stop the medication. What would be an important teaching point? a. stop if n/v b. med is a treatment not a cure, if you stop she'll lose any benefits she's gained c. this is a placebo, give her pills anyways d. the cost of the medication is really high, stop if its too expensive
This medication is a treatment, not a cure. If you stop it, she will lose any benefits that she has gained. Cholinesterase inhibitors treat AD, they do not cure it. If the medication is stopped, the benefits seen previously will be lost. Nausea and vomiting are common side effects but not a reason to stop the medication. The cost of a medication should not determine if a client receives it or not. Cholinesterase inhibitors are not placebos; much research has been done on their effectiveness.
The client is ordered bethanechol subcutaneously. After giving the client the injection of bethanechol, the nurse should make sure that what is available? a . magazines, books, computers b. vomit bags c. sunglasses and eye mask d. urinal, bed pan, call light
Urinal, bed pan, and call light Bethanechol subcutaneous injections are used to relax the bladder so a client with urinary retention can void. After giving a client a subcutaneous injection, the client will usually need to void within about 15 minutes, so it is important the client has a way to easily void. Magazines, books, computers, sunglasses, eye mask, and vomit bags are not needed after administration of subcutaneous bethanechol.
When assessing a client for possible adverse effects of direct-acting cholinergic agents, what might the nurse find?
Urinary urgency Adverse effects associated with direct-acting cholinergic agents include urinary urgency, bradycardia, hypotension, and diarrhea.
A client is reporting diarrhea, rigidity and spasm after receiving pyridostigmine. Which medication is appropriate to suggest to the prescriber?
atropine The client is exhibiting a cholinergic crisis. An antidote of atropine 0.4 to 0.6 mg intravenously should be administered. Alprazolam is a benzodiazepine and it is not indicated. Morphine is an opioid and the client is not having pain. Loperamide is an antidiarrheal but the reported adverse effects identify a cholinergic crisis and not a medication to just treat the diarrhea.
A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent? a. dopamine b. atropine c. epinephrine d. norepinephrine
atropine Atropine is considered an antidote for a cholinergic drug overdose. Dopamine is a catecholamine neurotransmitter that is given to increase the contraction of the heart in shock. Epinephrine is a hormone released in the presence of stress and is given in the case of allergic reaction and norepinephrine is a neurotransmitter from the autonomic nervous system, that constricts blood vessels, raising blood pressure.
The health care provider is preparing to write a prescription for a client diagnosed with urinary retention. Which medication does the nurse expect to be prescribed?
bethanechol Bethanechol is a sympathomimetic agent that acts at the cholinergic receptors in the urinary and GI tracts to increase muscle tone. The increased tone of the detrusor muscle in the urinary bladder allows for bladder emptying. Neostigmine and ambenonium are used to treat myasthenia gravis. Donepezil is used to treat Alzheimer's disease.
A patient receiving neostigmine uses naproxen for relief of low back pain. The nurse would caution the patient to report: a. blood in stool b. increased bruising c. blurry vision d. muscle weakness
blood in stool. The combination of naproxen, a nonsteroidal anti-inflammatory agent, with neostigmine increases the patient's risk for GI bleeding, which would be manifested by blood in the stool or emesis. Increased bruising is not associated with the combined use of neostigmine and naproxen. Muscle weakness is not associated with the combined use of neostigmine and naproxen. Blurred vision is not associated with the combined use of neostigmine and naproxen.
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 A client who suffers cholinergic overdose will experience sweating, flushing, abdominal cramps, and nausea. An accurate diagnosis may be determined from timing in relation to medication. Signs and symptoms having an onset within approximately 1 hour after a dose of anticholinesterase drug are likely to be caused by cholinergic crisis. Signs and symptoms beginning 3 hours or more after a drug dose are more likely to be caused by myasthenic crisis. These symptoms are not generally associated with anaphylaxis or pulmonary edema since there is no respiratory dysfunction.
A client is diagnosed with Alzheimer's disease. The nurse should anticipate administering which medication?
donepezil
The nurse is caring for a client who is receiving neostigmine for the treatment of myasthenia gravis. The nurse is aware that a potential complication of the treatment is cholinergic crisis, which is characterized by which event?
excessive stimulation of the parasympathetic nervous system A cholinergic crisis is characterized by excessive stimulation of the parasympathetic nervous system. If early symptoms are not treated, hypotension and respiratory failure may occur. At high doses, anticholinesterase drugs weaken, rather than strengthen, skeletal muscle contraction because excessive amounts of acetylcholine accumulate at motor endplates and reduce nerve impulse transmission to muscle tissue.
The nurse administers a drug that will increase micturition. What should the nurse assess for a therapeutic effect?
increased voiding Micturition is another term for urination; therefore, medications given to increase micturition should increase voiding.
After teaching a group of students about indirect acting cholinergic agonists used to treat myasthenia gravis, the instructor determines that the teaching was effective when the students identify which agent? a. rivastigmine b.neostigmine c. tacrine d. galantamine
neostigmine Neostigmine is used to treat myasthenia gravis. Galantamine is used to treat Alzheimer's disease. Rivastigmine is used to treat Alzheimer's disease. Tacrine is used to treat myasthenia gravis.
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? a. parkinson disease b. myasthenia gravis c. alzheimer disease d. multiple sclerosis
the most significant indication for neostigmine therapy is myasthenia gravis. Other clinical indications include urinary retention and paralytic ileus, but the drug is not used to treat Parkinson disease, Alzheimer disease, or multiple sclerosis.
A client is taking rivastigmine for Alzheimer disease. The nurse will evaluate the client regularly for : a. decrease in BP b. monitor weight loss c. monitor urinary output d.
weight loss A client taking rivastigmine is at risk for substantial gastrointestinal adverse reactions, including nausea and vomiting, anorexia, and weight loss. It would be important for the nurse to monitor the client's weight and plan accordingly. An increase or decrease in blood pressure is not a concern with this drug.
