Chapter 19 Cholinergic Agonists and Anticholinergics

A patient is ordered to receive bethanechol chloride (Urecholine) for urinary retention. Which health condition would serve as a contraindication for this medication? a.Asthma b.Hypertension c.Diabetes mellitus d.Chronic allergies

Answer: A Rationale: Before administering bethanechol chloride (Urecholine), the nurse should obtain a history of health problems such as peptic ulcer, urinary obstruction, or asthma. Cholinergic agonists can aggravate symptoms of these conditions.

A nurse has just administered atropine to a patient. It is most important for the nurse to assess the patient for the development of which effect? a.Nausea b.Tachycardia c.Rales d.Hypotension

Answer: B Rationale: It is most important to monitor the heart rate for tachycardia after atropine is given. Atropine may be given without regard to meals. Rales would not be expected because atropine dries secretions rather than increases them. Hypertension is a more likely response than orthostatic hypotension.

A patient has received atropine. It is most important for the nurse to assess the patient for which effect? A. Anxiety B. Constipation C. Urinary retention D. Impaired oral mucous membrane

Answer: C Rationale: Urinary retention is the highest priority because it is more serious to systemic homeostasis than anxiety, constipation, or a dry mouth.

The nurse is taking care of five patients in the emergency department. which patients would be candidates to receive atropine? (select all) a. a 25-year old having surgery for appendicitis b.a 42-year old with a heart rate of 38 bpm and dizziness c. a 50-year old with diarrhea d. a 61-year old with urinary retention e. a 68- year old with gastric ulcers

a. a 25-year old having surgery for appendicitis b.a 42-year old with a heart rate of 38 bpm and dizziness

The pediatric patient had urinary retention. which cholinergic drug does the nurse anticipate will be prescribed to increase urination? a. bethanechol (urecholine) b. edrophonium chloride (tensilon) c. metoclopramide (reglan) d. neostigmine bromide (prostigmin)

a. bethanechol (urecholine)

Anticholinergic drugs are contraindiacted in patients with which other diease processes? (select all) a. coronary artery disease b. diabetes mellitus c. gastrointesinal obstruction d. supraventricular tachycardia

a. coronary artery disease c. gastrointesinal obstruction d. supraventricular tachycardia

How does the body respond to large does of cholenrgic drugs? (select all) a. decreased blood pressure b. decreases salivation c. increased bronchial secretions d. mydriasis e. urinary retention

a. decreased blood pressure c. increased bronchial secretions

Which teaching point will the nurse include for a 30-year old patient who is taking hyoscyamine (cystospaz) for irritable bowel syndrome (IBS)? (select all) a. ensure adequate fluid intake b. do not drive until you are aware of how this medication will affect your vision c. sucking on hard candy may help with dry mouth d. increased sweating is a common side effect e. report a rapid heart rate to your healthcare provider.

a. ensure adequate fluid intake b. do not drive until you are aware of how this medication will affect your vision c. sucking on hard candy may help with dry mouth e. report a rapid heart rate to your healthcare provider.

When benztropine (Cogentin) is ordered for a patient, the nurse acknowledges that this drug is an effective treatment for which condition? a.Parkinsonism b.Paralytic ileus c.Motion sickness d.Urinary retention

a.Parkinsonism

When a patient has a cholinergic overdose from excessive dosing of bethanechol (Urecholine), the nurse anticipates administration of which drug as the antidote? a.atropine b.tolterodine c.benztropine d.metoclopramide

a.atropine

Which type of medication is bethanecol (urecholine) ? a.anticholinergic b. cholinergic agonist c. cholinesterase inhibitor d. sympatholytic

b. cholinergic agonist

The patient has been scheduled for a comprehensive eye examination. anticholinergic eyedrops are used for which purpose? a. constrict the pupils b. dilate the pupils c. decrease the intraocular pressure d. detect astigmatism.

b. dilate the pupils

The older adult patient is taking benztropin(Cogentin) for symptoms associated with parkinsonism. the nurse will instruct the patient to report which clinical manifestations to the healthcare provider? (select all) a. diarrhea b. dizziness c. hallucinations d. hyperthermia e. palpitations

b. dizziness c. hallucinations d. hyperthermia e. palpitations

A patient is receiving bethanechol (Urecholine). The nurse realizes that the action of this drug is to treat which condition? a.Glaucoma b.Urinary retention c.Delayed gastric emptying d.Gastroesophageal reflux disease

b.Urinary retention

The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter? a.dopamine b.acetylcholine c.cholinesterase d.monoamine oxidase

b.acetylcholine

anticholinergic

blocks the action of acetylcholine

Anticholinesterase

blocks the breakdown of acetylcholine

The patient is admitted for evaluation of peptic ulcers. she is taking propantheline (Pro-banthine) three times a day. the nurse is teaching this patient about nutrition while taking this medication. the priority nutrition teaching point is that the patient should eat foods that are high in which component? a. calcium b.fat c. fiber d. protein

c. fiber

The 80-year old patient has glaucoma and is prescribed an anticholinergic drug. what is the nurses priority action? a. administer the medication as order after verifying the patients's identity b.give only one-half the prescribed dose. c. hold the dose and contact the health care provider. d. wait until after the patient has taken glaucoma medication and then give the medication.

c. hold the dose and contact the health care provider.

Which medication treats myasthenia gravis by increasing muscle strength? a. bethanechol (urecholine) b. edrophonium chlorise (tensilon) c. neostigmine bromide (prostigmin) d. pilocarpine (pilocar)

c. neostigmine bromide (prostigmin)

How does betahnechol (urecholine) work in the body? a.inhibits muscarinic receptors b. inhibits nicotinic receptors c. stimultes muscarinic receptors d. stimulates nicotinic receptors

c. stimultes muscarinic receptors

The patient has been prescribed bethanechol and asks the nurse how it works. what is the nurse's best response? a. this drug decreases bladder tone b. this drug inhibits bladder contraction c. this drug promotoes contraction of the bladder d. this drug stimulates urine production

c. this drug promotoes contraction of the bladder

The nurse teaches the patient receiving atropine (Atreza) to expect which side effect? a.Diarrhea b.Bradycardia c.Blurred vision d.Frequent urination

c.Blurred vision

cholinesterase

causes the breakdown of acetylcholine

The nurse would question an order for atropine for which patient? a. a 35-year old with peptic ulcer b. a 50-year old with parkinsonism c. a 55-year old with cirrhosis d. a 60-year old with glaucoma

d. a 60-year old with glaucoma

The patient has been prescribed bethanechol and is experiencing decreased urinary output. what is the nurse's priority action? a. catheterize the patient to drain the bladder and measure output. b. encourage the patient to increase fluid intake to increase urinary output c. encourage the patient to relax when urinating d. notify the health care provider with current intake and output values

d. notify the health care provider with current intake and output values

The patient has ingested organophosphate poison in a suicide attempt. what medication does the nurse anticipate the health care provider will order to treat this patient? a. bethanechol (urecholine) b. edrophonium chloride (tensilon) c. metoclopramide (reglan) d. pralidoxime cl (protopam)

d. pralidoxime cl (protopam)

The patient has been taking bethanechol and is experiencing flushing, sweating, nausea, and abdominal cramps. what is the nurses best action? a. document thepatients manifestations. b. give the patient a laxative c. increase the patients fluid intake d. prepare to administer atropine

d. prepare to administer atropine

The nurse is administering bethanechol (Urecholine), a cholinergic agonist, and should know that the expected cholinergic effects include which of the following? a.Increased heart rate b.Decreased peristalsis c.Decreased salivation d.Increased pupil constriction

d.Increased pupil constriction

Dicyclomine (Bentyl) is an anticholinergic, which the nurse realizes is given to treat which condition? a.Mydriasis b.Constipation c.Urinary retention d.Irritable bowel syndrome

d.Irritable bowel syndrome

A specific group of anticholinergics may be prescribed in the early reatment of which neuromuscular disorder? a.multiple sclerosis b.muscular dystrophy c. myasthenia gravis d.parkinsonism

d.parkinsonism

Nicotinic receptor

impacts skeletal muscle

Parasympathomimetic

mimics cholinergic actions

Acetylcholine

stimulates muscarinic receptors

Muscarinic receptor

stimulates smooth muscle and slows heart rate

cholinergic

types of drugs that stimulate the parasympathetic system