26 Cholinergic Drugs

A nurse is caring for a client with urinary retention who is receiving a cholinergic drug as part of the treatment plan. After administering the drug, the nurse would notify the primary health care provider if the assessment reveals which of the following? A) Failure to void after drug administration B) Frequent vomiting after drug administration C) Increase in abdominal pain after drug administration D) Occurrence of blood in urine after drug administration

Ans: A Feedback: The nurse should notify the primary health care provider if the client fails to void after drug administration. Frequent vomiting, increase in abdominal pain, and occurrence of blood in urine are not usually observed when urinary retention is treated with cholinergic therapy.

The nurse identifies a nursing diagnosis of Diarrhea for a client being started on cholinergic drug therapy. Which of the following would the nurse most likely include in the client's plan of care? Select all that apply. A) Ensure that the client has readily available access to the bathroom. B) Evaluate the number, frequency, and consistency of the stools. C) Contact the primary health care provider for an order to switch to another cholinergic drug. D) Limit the client's fluid intake to 1000 mL per day. E) Maintain the client on strict bed rest.

Ans: A, B Feedback: When a cholinergic drug is administered, the client may experience diarrhea. This reaction will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse needs to ensure that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist in the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse should document fluid intake and output and track the number, consistency, and frequency of stools if diarrhea is present. Since diarrhea occurs with any cholinergic drug, switching to another would be of no help. The client needs to replace fluids lost with diarrhea, so limiting fluid intake would be inappropriate. Ambulating to assist with the passage of flatus would be appropriate, while strict bed rest would not be necessary.

When conducting client teaching with a client and his family about the prescribed cholinergic therapy for myasthenia gravis, which of the following would be most important to include? Select all that apply. A) How to adjust dosage B) Indications of drug underdosage C) The need to monitor blood glucose levels D) How to keep a record of response to therapy E) The need to wear medical identification

Ans: A, B, D, E Feedback: Client and family teaching should include signs and symptoms associated with under- and overdosage, instructions on how to adjust the dosage up or down, how to keep a record of the response to therapy, and the importance of wearing medical identification. There is no need for the client and family to monitor blood glucose levels.

The nurse is preparing to administer a cholinergic drug. The nurse understands that the drug would be appropriate for which condition? Select all that apply. A) Urinary retention B) Overactive bladder C) Myasthenia gravis D) Parkinson's disease E) Graves' disease

Ans: A, C Feedback: Cholinergic drugs can be used to treat urinary retention, myasthenia gravis, and glaucoma.

A nurse would be alert for an increase in cholinergic effects if a client who is prescribed a cholinergic drug is also receiving which medication? Select all that apply. A) Prednisone B) Oxycodone C) Diclofenac D) Dexamethasone E) Ibuprofen

Ans: A, D Feedback: Cholinergic drugs administered concomitantly with corticosteroids, like prednisone and dexamethasone, can result in increased adverse effects of the cholinergic drug.

Prior to administering bethanechol to a client, the nurse would assess which of the following? Select all that apply. A) Palpation of the bladder B) Palpation of the thyroid C) Blood glucose D) Blood pressure E) Pulse rate

Ans: A, D, E Feedback: Bethanechol is used to treat urinary retentions. The nurse's preadministration assessment should include palpation of the bladder, blood pressure, and pulse rate prior to its administration to a client.

1. A nursing instructor is planning a class for a group of nursing students about cholinergic drugs. When describing the enzyme acetylcholinesterase, which of the following would the instructor most likely include about this enzyme? Select all that apply. A) Makes the parasympathetic nervous system function differently B) Inactivates the neurotransmitter serotonin C) Activates the neurotransmitter acetylcholine D) Inactivates the neurotransmitter norepinephrine E) Results in the prevention of nerve synapses to continue nerve impulses

Ans: A, E Feedback: Acetylcholinesterase makes the parasympathetic nervous system function differently by inactivating the neurotransmitter acetylcholine, thereby preventing the nerve synapse from continuing the nerve impulse.

A nurse is caring for a client with urinary retention who is prescribed bethanechol. The nurse would administer this drug cautiously if the client has which of the following? A) Raynaud's disease B) Bradycardia C) Coronary artery disease D) Hyperthyroidism

Ans: B Feedback: The nurse should administer bethanechol cautiously if a client has bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, or megacolon. Cautious use is not necessary if the client has Raynaud's disease, coronary artery disease, or hyperthyroidism.

A group of nursing students are reviewing information about the parasympathetic nervous system. The students demonstrate understanding of the information when they identify that which type of receptor is involved with stimulating smooth muscle in the parasympathetic nervous system? A) Nicotinic B) Muscarinic C) Alpha D) Beta

Ans: B Feedback: There are two types of receptors in the parasympathetic nervous branch: muscarinic receptors (which stimulate smooth muscle) and nicotinic receptors (which stimulate skeletal muscle). Alpha and beta receptors are found in the sympathetic nervous system.

A nurse should notify the physician immediately if a client taking a cholinergic drug develops which of the following? Select all that apply. A) Hypoglycemia B) Excessive salivation C) Severe abdominal cramping D) Muscle rigidity E) Muscle spasms

Ans: B, C, D, E Feedback: A client receiving a cholinergic drug is at risk for a cholinergic crisis. The signs of cholinergic crisis include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Any of these symptoms should be reported to the physician immediately.

Based on the nurse's understanding of which body systems are affected by cholinergic drug adverse reactions, the nurse would be alert for adverse reactions involving which body system? Select all that apply. A) Endocrine B) Circulatory C) Respiratory D) Gastrointestinal E) Central nervous

Ans: B, C, D, E Feedback: Cholinergic drug adverse reactions affect the circulatory, respiratory, gastrointestinal, and central nervous systems.

After teaching a group of nursing students about the parasympathetic nervous system, the instructor determines that the teaching was successful when the students identify which of the following as an action? Select all that apply. A) Decreased salivary gland production B) Vasodilation C) Increased peristalsis D) Bronchodilation E) Pupillary constriction

Ans: B, C, E Feedback: Stimulation of the parasympathetic nervous system results in the opposite reactions to those triggered by the adrenergic system: blood vessels dilate, sending blood to the gastrointestinal (GI) tract; secretions and peristalsis are activated and salivary glands increase production; the heart slows and pulmonary bronchioles constrict; the smooth muscle of the bladder contracts; and the pupils of the eyes constrict.

When assessing a client receiving a cholinergic drug, the nurse would assess the client for increased neuromuscular blocking effects if the client is also receiving which of the following? Select all that apply. A) Amoxicillin B) Tobramycin C) Cephalexin D) Neomycin E) Clarithromycin

Ans: B, D Feedback: Cholinergic drugs administered concomitantly with aminoglycoside antibiotics, like tobramycin and neomycin, can result in increased neuromuscular blocking effects.

A client is prescribed ambenonium. The nurse would assess the client closely if the client has a history of which of the following? Select all that apply. A) Diabetes B) Hypertension C) Tachycardia D) Epilepsy E) Megacolon

Ans: B, D Feedback: Cholinergic drugs, like ambenonium, are used cautiously in clients with hypertension, epilepsy, cardiac arrhythmias, bradycardia, recent coronary occlusion, and megacolon.

A nurse is administering cholinergic eye drops to a client. The nurse would be alert for which of the following as a possible adverse reaction? Select all that apply. A) Nausea B) Headache C) Nasal congestion D) Decreased visual acuity E) Decreased auditory acuity

Ans: B, D Feedback: Cholinergic eye drops are used to treat glaucoma. Topical administration usually produces few adverse reactions, but a temporary reduction of visual acuity and headache may occur.

A client is prescribed pyridostigmine. When teaching the client about this drug, which of the following would the nurse include as a possible adverse reaction? Select all that apply. A) Constipation B) Nausea C) Dry mouth D) Skin flushing E) Muscle rigidity

Ans: B, D Feedback: Pyridostigmine is an oral cholinergic medication used in the treatment of myasthenia gravis. General adverse reactions associated with oral administration include nausea, diarrhea, abdominal cramping, salivation, skin flushing, cardiac arrhythmias, and muscle weakness.

A client with myasthenia gravis who is prescribed pyridostigmine comes to the emergency department complaining of abdominal cramping, excessive diarrhea, and severe muscle weakness. The nurse would suspect which of the following? A) Underdosage of the drug B) Tolerance to the drug C) Cholinergic crisis D) Underlying infection

Ans: C Feedback: Cholinergic crisis (cholinergic drug toxicity) symptoms include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Signs of drug underdosage are signs of the disease itself, namely, rapid fatigability of the muscles, drooping of the eyelids, and difficulty breathing. Tolerance would be indicated by a reduction in the adverse reactions to the drug that the client was experiencing. There is no information to suggest that the client has an underlying infection.

A nurse is caring for a client with myasthenia gravis at a health care facility. The client is receiving ambenonium. The nurse suspects that the dosage is insufficient based on assessment of which of the following? A) Clenching of the jaw B) Muscle spasms C) Difficulty breathing D) Abdominal cramping

Ans: C Feedback: The nurse should monitor for difficulty breathing as a symptom of drug underdosage. Clenching of the jaw and muscle spasms are symptoms of drug overdosage. Abdominal cramping may occur in the client who is receiving guanidine.

The nurse is developing a teaching plan for a client who is receiving outpatient therapy with a cholinergic drug. Which of the following would be appropriate for the nurse to include? A) Instructions to avoid fiber-rich food during therapy B) Importance of adopting a self-monitoring blood pressure program C) Review of the purpose of the drug therapy with the client and family D) Evaluation of the client's previous history of disorders

Ans: C Feedback: The nurse should review the purpose of the drug therapy with the client and family when developing a teaching plan for a client receiving outpatient therapy with a cholinergic drug. Instructing the client to avoid fiber-rich food during therapy, suggesting the client adapt a self-monitoring blood pressure program, and evaluating the client's previous history of disorders would be inappropriate to include in the teaching plan.

Which of the following would the nurse assess before administering ambenonium to a client? Select all that apply. A) Palpation of the bladder B) Palpation of the thyroid C) Evidence of muscle weakness D) Signs of difficulty breathing E) Drooping of eyelids

Ans: C, D, E Feedback: Ambenonium is used to treat myasthenia gravis. The nurse's preadministration assessment should include assessment for signs of muscle weakness, such as drooling, inability to chew and swallow, drooping eyelids, inability to perform repetitive movements, difficulty breathing, and extreme fatigue.

A nurse is reviewing the medical record of a client who is to be prescribed a cholinergic drug. Which condition, if found, would alert the nurse to a possible contraindication to the prescribed therapy? Select all that apply. A) Pancreatitis B) Diabetes C) Asthma D) Hyperthyroidism E) Peptic ulcer disease

Ans: C, D, E Feedback: The use of cholinergic drugs is contraindicated in clients with known hypersensitivity to the drugs, asthma, peptic ulcer disease, coronary artery disease, and hyperthyroidism.

After teaching a group of nursing students about cholinergic drugs, the instructor determines a need for additional teaching when the students identify which drug as being administered orally? A) Ambenonium B) Bethanechol C) Pyridostigmine D) Edrophonium

Ans: D Feedback: Edrophonium is a cholinergic drug that is administered intravenously. Ambenonium, bethanechol, and pyridostigmine are administered orally.

A nurse is providing care to a client who is receiving an ophthalmic cholinergic drug. When reviewing the client's medical history, which of the following, if found, would the nurse identify as a contraindication? A) Cataracts B) Diabetic retinopathy C) Megacolon D) Corneal abrasion

Ans: D Feedback: The nurse should know that ophthalmic cholinergic drugs are contraindicated in clients with corneal abrasions. The use of ophthalmic cholinergic drugs is not contraindicated in clients with cataracts, diabetic retinopathy, or megacolon. Cholinergic drugs are used cautiously in clients with megacolon.

A client has been prescribed pyridostigmine for myasthenia gravis. The nurse would be alert for the development of which of the following? A) Seizure disorder B) Reduction of visual acuity C) Abdominal discomfort D) Cardiac arrhythmias

Ans: D Feedback: The nurse should monitor for cardiac arrhythmias as a general adverse reaction in the client. Seizure disorder, reduction of visual acuity, and abdominal discomfort are not pyridostigmine-related adverse reactions. Reduction of visual acuity is related to topical ophthalmics. When the client is receiving bethanechol chloride for urinary retention, the nurse needs to examine for abdominal discomfort, which is an adverse reaction of bethanechol chloride and not pyridostigmine.

The nurse administers a prescribed oral dose of bethanechol to a client with urinary retention at 9:30 a.m. The nurse would notify the primary health care provider if the client has not voided by which time? A) 9:45 a.m. B) 10 a.m. C) 10:30 a.m. D) 11 a.m.

Ans: D Feedback: When bethanechol is administered orally, the client should void within 30 to 90 minutes. Therefore, if the client has not yet voided by 11 a.m., the nurse should notify the primary health care provider.