PrepU Practice Ch 48
Anticholinergics do not block the effects of acetylcholine in the central nervous system
False Anticholinergics are thought to block the effects of acetylcholine in the CNS, which may account for their effectiveness in treating motion sickness.
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.
Anticholinergic drugs are used in ophthalmology because they produce which effect?
Pupil dilation
52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms? a. There is an imbalance between dopamine and acetylcholine. b. There is a decrease in stimulation of the nigrostriatal neural tracts. c. There is an increase in dopamine in the terminal nerve endings. d. There is an increased level of GABA at the striatum.
a
A nurse has been invited to speak to a support group for Parkinson's disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies? a. "Persons of all cultures are treated similarly and respond in similar ways to treatment." b. "Drugs do not cure these disorders; they instead enhance quality of life." c. "Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases." d. "Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction
b
An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching? a. "I should eat plenty of fiber to prevent constipation." b. "I need to exercise frequently outside in the warm weather." c. "I should make sure that I drink plenty of fluids." d. "I should avoid driving if I feel light-headed or dizzy."
b
One of the neurotransmitters can become decreased in the area of the corpus striatum. This results in the manifestations of Parkinson's disease. Which neurotransmitter will cause this? a. Gamma-aminobutyric acid (GABA) b. Dopamine c. Serotonin d. Acetylcholine
b
While preparing a client for an eye examination, the nurse explains that the eyedrops, an ophthalmic anticholinergic preparation, will cause what pupil reaction? a. dilatation b. constriction c. brisk response d. temporary fixation
a
A pediatric client with a complex health history has developed early signs of drug-induced parkinsonism. The client's provider has prescribed diphenhydramine 25 mg PO tid. The medication is available as an oral solution with a concentration of 12.5 mg/ 5mL. How many mL should the nurse administer for each dose?
10
A client is prescribed benztropine. The nurse would anticipate administering this drug by which route? a. Oral b. Intravenous c. Subcutaneous d. Intramuscular
a
A female client is prescribed centrally acting anticholinergics for her Parkinson's disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter's request? a. Evaluate the client for adverse reactions from the centrally acting anticholinergics b. Increase the centrally active anticholinergics to decrease the client's symptoms c. Admit the client to the hospital for a psychological evaluation d. Immediately discontinue the centrally acting anticholinergic medication
a
A nurse is caring for a client who has been diagnosed with Parkinson's disease. The client does not understand how the medication, carbidopa-levodopa, is going to help the condition. What is the correct response by the nurse? a. "Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms." b. "Carbidopa-levodopa will delay the loss of muscle strength and limb function for several months." c. "This drug will change the immune processes in your body to help decrease the tissue damage." d. "Your drug therapy will reduce excessive reflex activity causing your muscle spasms and will allow for muscle relaxation.
a
A nursing instructor is describing Parkinsonism to a group of nursing students. When discussing the underlying cause of the symptoms, the instructor explains the depletion of dopamine in which of the following? a. Central nervous system b. Smooth muscle c. Skeletal muscle d. Peripheral nervous system
a
Anticholinergics block acetylcholine at the muscarinic receptors. a. True b. False
a
Levodopa is used as treatment for Parkinson's disease primarily acting as a replacement neurotransmitter. a. true b. False
a
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? a. Atropine b. Lasix c. Norvasc d. Milrinone
a
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? a. To dry up respiratory secretions to prevent aspiration during surgery b. To cause bladder relaxation during surgery so that the client will not have the urge to void during surgery c. To increase the heart rate to prevent complication prior to the pacemaker being inserted d. To relax the bowel to prevent the client from having a bowel movement during surgery
a
A nurse is reviewing a client's history for conditions that would contraindicate the use of anticholinergics for Parkinson's disease. Which would cause the nurse to be concerned? a. Myasthenia gravis b. Cardiac arrhythmia c. Hypertension d. Hepatic dysfunction
a Anticholinergics are contraindicated for clients with myasthenia gravis, which could be exacerbated by the blocking of acetylcholine receptor sites at the neuromuscular synapses. Hypertension, hepatic dysfunction, and cardiac arrhythmia would require cautious use.
A nurse administering a cholinergic-blocking medication to a client should monitor the client for which visual adverse reactions? (Select all that apply.) a. Mydriasis b. Cycloplegia c. Miosis d. Photophobia e. Dipolpia
abd
A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action? a. Contact the provider to question the route b. Administer the medication as prescribed and monitor for therapeutic and adverse effects c. Contact the provider to question the dose d. Contact the provider to question the frequency
b
A client with Parkinson's disease began treatment with dopaminergics two weeks ago and has now presented for a follow-up assessment. What finding best suggests to the nurse that the treatment is having a therapeutic effect? a. The client describes an increase in appetite compared with two weeks ago b. The client is able to walk more briskly and stably than two weeks ago c. The client denies shortness of breath and adventitious lung sounds are absent on auscultation d. The client is oriented to person, place and time
b
A male client has been a paraplegic for 5 years. He reports increased incontinence, and the health care provider orders anticholinergic medication. What is the reason for this decision? a. To decrease irritation to the wall of the bladder b. To decrease bladder capacity c. To strengthen the detrusor muscles d. To increase bladder capacity
b
The nurse would closely monitor a client for signs and symptoms of toxicity of which medication if the client is also prescribed a cholinergic blocking drug? a. Phenytoin b. Digoxin c. Lithium d. Clozapine
b
A client with advanced Parkinson's disease has undergone diagnostic testing and diagnostic imaging. What are the results most likely to reveal? a. Increased gamma-aminobutyric acid (GABA) b. Decreased enzyme dopa decarboxylase levels c. Degeneration of dopamine-producing nerve cells d. Brain infarcts
c
A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect? a. mobility. b. perspiration. c. involuntary movements. d. appetite or thirst.
c
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? a. Cycloplegia b. Idiosyncrasy c. Mydriasis d. Photophobia
c
Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to: a. diarrhea related to increased peristalsis. b. hypotension related to increased sympathetic response. c. heat stroke related to decreased perspiration. d. urinary frequency related to CNS effects.
c
A nurse is caring for 70-year-old patient who is undergoing anticholinergic drug therapy. The nurse should assess for which condition when caring for this elderly patient? a. Psychotic episodes b. Choreiform movements c. Confusion and disorientation d. Suicidal tendencies
c Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.
A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa? a. Phylloquinone (vitamin K1) b. Cyanocobalamin (vitamin B12) c. Ascorbic acid (vitamin C) d. Pyridoxine (vitamin B6)
d
A client taking anticholinergic drugs should be taught to minimize the risks of heat exhaustion and heat stroke. What would be one way to meet this goal? a. Wear dark, warm clothing during the summer months b. Routinely exercise indoors c. Take frequent, cold showers in the evenings and early mornings d. Avoid extremes of temperature
d
A group of nursing students are preparing for a class presentation to discuss drugs used to treat Parkinson disease. Which drug would the group include when discussing dopaminergic agents? a. Biperiden b. Benztropine c. Procyclidine d. Carbidopa
d
Common side effects of anticholinergics include: a. skin rashes, decreased urinary output, constipation, and increased WBCs. b. blurred vision, decreased liver enzymes, increased B/P, and papillary constriction. c. decreased GI absorption, nausea, heartburn, and hypotension. d. dry mouth, urinary retention, constipation, and increased pulse rate.
d
What is typically the first observable symptom of Parkinson's disease? a. frequent falls and signs of early dementia b. the inability to either support the head or control its movement c. the inability to either stand erect or to rise easily from a seated position d. a resting tremor that begins in one hand, involving the fingers and thumb of one hand.
d
Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:
decrease salivation, spasticity, and tremors.
A client is prescribed dicyclomine. The nurse would expect to administer this drug by which route?
oral