Practice Questions- Module 10

A patient with myasthenia gravis is admitted to the emergency department with cholinergic crisis. Which medication should be administered per protocol? A. atropine sulfate. B. baclofen C. edrophonium D. neostigmine

A. Atropine sulfate

A patient with myasthenia gravis is prescribed pyridostigmine. The nurse identifies that the medication is effective when the patient experiences? A. Increased muscle strength B. Decrease in sweating and salivation C. Changes in vital signs to within normal limits D. Decrease in generalized pain

A. Increased muscle strength

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

B. Tachycardia

You are caring for a client post-operatively. The indwelling urinary catheter was removed in the post-anesthesia care unit per the surgeon's orders. The client is unable to urinate, and a bladder scan reveals 500 mL in in the bladder. What prescribed medication should you administer? Bethanechol Metoclopramide Atropine Tolterodine

Bethanechol Notes: When a patient has urinary retention post-operatively, one method of correcting this problem is to administer bethanechol. Bethanechol is a cholinergic medication used to stimulate the bladder contract, which will help with post-operative urinary retention. Tolterodine is an anticholinergic used to treat overactive bladder. Atropine is an anticholinergic medication and is known to cause urinary retention. Metoclopramide is a cholinergic medication that stimulated peristalsis in the gastrointestinal tract and is used for post-operative nausea and vomiting.

A patient received atropine as a preoperative medication 30 minutes ago. The nurse evaluates the medication as effective if the patient states, A. "I feel like I need to throw up." B. "I need to urinate." C. "My mouth feels dry." D. "I have a headache."

C. "My mouth feels dry."

A client was brought into the emergency department with symptomatic bradycardia and has received multiple doses of atropine. What clinical manifestations would the nurse identify as being potential symptoms of atropine toxicity? SELECT ALL THAT APPLY Confusion Flushing of the face and neck Diaphoresis Miosis Excessive salivation Urinary frequency

Confusion Flushing of the face and neck Notes: When a patient has symptoms of atropine toxicity, the clinical manifestations can be remembered by using the mnemonic "Mad as hatter, hot as a hair, red as a beet, dry as a bone, and blind as a bat." Confusion, flushed skin, dry skin and mouth, elevated temperature and blurred vision(related to pupil dilation) are the symptoms to look for. Miosis is pupil constriction, mydriasis is pupil dilation

A client is prescribed an anticholinergic medication. What information in the past medical history would be of most concern to the nurse? Glaucoma Asthma Diabetes Bradycardia

Glaucoma Notes: Anticholinergics are blocking the responses of the parasympathetic nervous system. By blocking the response, the patient would have pupil dilation, increased heart rate, bronchodilation, urinary retention and constipation (to name a few). The most concerning thing in the patient's history is Glaucoma because of the risk of increased intraocular pressure which could cause blindness in narrow-angle or closed-angle glaucoma.

A client has been diagnosed with myasthenia gravis and is placed on pyridostigmine. Thirty minutes after taking the first dose of medication, the nurse suspects cholinergic crisis. What clinical manifestations would the nurse identify as being potential symptoms of cholinergic crisis? SELECT ALL THAT APPLY Confusion Miosis Diaphoresis Mydriasis Excessive salivation Lacrimation

Miosis Diaphoresis Excessive salivation Lacrimation Notes: When a patient is experiencing cholinergic crisis, the mnemonic to remember is "DUMBELLS": Diarrhea, urination, miosis (pupil constriction), bradycardia, emesis, lethargy, lacrimation, and salivation.

A client has been placed on high-dose therapy of selegiline. What foods should the nurse educate the client to avoid or limit while on this treatment regimen? SELECT ALL THAT APPLY Sharp cheddar cheese Summer sausage Red wine Hamburger and french fries Fish and chips

Sharp cheddar cheese Summer sausage Red wine Notes: MAO-B inhibitors are normally well tolerated and may not require the patient to avoid the tyramine- containing foods; however, in high doses, tyramine foods should be limited or avoided in order to prevent hypertensive crisis.

A client is prescribed scopolamine transdermal patch to help with motion sickness while on a cruise. What education should the nurse provide the client to alleviate the common side effects of the medication? SELECT ALL THAT APPLY Wear sunglasses when going outside Chew sugar free gum Increase fluid and fiber Urinary incontinence may occur, use caution Avoid exercise to avoid fatigue

Wear sunglasses when going outside Chew sugar free gum Increase fluid and fiber Notes: Side adverse effects of anticholinergic medications are as follows: -Pupil dilation - wear sunglasses to help prevent photophobia -Dry mouth- chew sugar free gum, suck on sugar free hard candy, suck on ice chips, perform frequent oral care- to help alleviate dry mouth -Constipation-increase fluid, fiber, and ambulation to help prevent constipation -Urinary retention- scheduled voiding will help prevent urinary retention

The family of a client diagnosed with Alzheimer's disease asks how the newly prescribed donepezil works. What is the best response by the nurse? "It prevents the breakdown of the neurotransmitter responsible for memory recall." "It stimulates the receptor sites in the brain responsible for memory recall." "By allowing more acetylcholine in the brain, this medication cures Alzheimer's disease." "It blocks the cholinergic receptor sites in the brain which allows for memory recall."

"It prevents the breakdown of the neurotransmitter responsible for memory recall." Notes: Donepezil is a cholinesterase inhibitor- it blocks the breakdown of acetylcholine in the central nervous system. By preventing the breakdown of the acetylcholine, it is thought to aid in memory recall. No medications currently available today can cure Alzheimer's disease.

A client is to have a major in-patient surgery and the nurse administered scopolamine transdermal patch behind the ear. The client asks, "What is that for? Why do I need a band aid behind my ear?" What is the best response by the nurse? "This medication is used to help dry up secretions to prevent aspiration during surgery." "The patch behind your ear will help decrease motion sickness on your ride home." "This medication helps with pain control after your surgery is completed." "The patch behind your ear will help prevent complications of glaucoma."

"This medication is used to help dry up secretions to prevent aspiration during surgery." Notes: Scopolamine is an anticholinergic medication used to prevent motion sickness, to dry up secretions during surgery to help prevent aspiration, and to help treat "death rattle" in hospice patients at end of life. Since the nurse is administering this medication pre-operatively, the reason is to prevent aspiration during surgery.

A client is prescribed a cholinergic medication. What assessment finding would be of most concern to the nurse? Heart rate of 50 beats per minute Urinary frequency Increased tear production Blood pressure 104/64

Heart rate of 50 beats per minute Notes: Cholinergic medications stimulate the parasympathetic nervous system response. Think "Rest and Digest". Remember that this will cause lowering of the heart rate and the blood pressure. While the blood pressure is a little low, it is not considered low enough to be the priority in this situation. A heart rate of 50 is low and the nurse should worry the patient may be going into a heart block, which is a serious adverse effect of cholinergic medications. While urinary frequency and increased tear production are adverse effects of cholinergic medications, they are not life-threatening.

A client is prescribed carbidopa-levodopa and the nurse is providing education on this new medication. What information should the nurse provide to help prevent injury? Rise slowly, in stages Drink 3 liters of fluid each day Increase intake of foods high in protein Decrease intake of dietary fiber

Rise slowly, in stages Notes: Carbidopa-levodopa is known to cause syncope and orthostatic hypotension, which can result in the patient falling and causing harm. Rising in stages will help prevent orthostatic hypotension and falls. While increasing fluid is important to help prevent constipation, it will not help prevent injury. Increasing fiber intake would be important to help prevent constipation as well. High protein foods can decrease absorption of the carbidopa-levodopa.