Chapter 16: Cholinergic Agonists and Antagonists

A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication? A) asthma B) hypertension C) diabetes mellitus D) chronic allergies

A) asthma Contraindications for bethanechol chloride include: intestinal or urinary tract obstruction, IBS, bradycardia, hypotension, COPD, asthma, peptic ulcer, hyperthyroidism, seizures, and parkinsonsim

When a patient has a cholinergic overdose from excessive dosing of bethanechol, the nurse anticipates administration of which drug as the antidote? A) atropine B) tolterodine C) benztropine D) metoclopramide

A) atropine Atropine is the drug of choice used to treat cholinergic overdose (cholinergic crisis).

The nurse monitors a patient prescribed dicyclomine for which therapeutic effect? A) decrease in GI motility B) decrease in urinary frequency C) increase in heart rate D) increase in blood pressure

A) decrease in GI motility Dicyclomine is an antispasmodic cholinergic blocker used to decrease GI motility in patients with functional GI disorders such as irritable bowel syndrome (IBS).

Which is a priority nursing diagnosis for a patient receiving an anticholinergic (parasympatholytic) medication? A) impaired gas exchange related to thickened respiratory secretions B) knowledge deficit related to pharmacologic regimen C) risk for injury related to excessive CNS stimulation D) urinary retention related to loss of bladder tone

A) impaired gas exchange related to thickened respiratory secretions Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

The nurse is caring for a patient who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect? A) increased gastrointestinal (GI) motility B) mydriasis C) urinary retention D) vasoconstriction

A) increased gastrointestinal (GI) motility Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process.

When benztropine 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 Look at orange chart on pg. 219 in the textbook.

A patient comes to the emergency department with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously? A) 0.3 mg B) 0.5 mg C) 1.25 mg D) 2 mg

B) 0.5 mg The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

In which patient(s) would the nurse question the use of bethanechol? (Select all that apply) A) a patient with urinary retention B) a patient with asthma C) a patient with peptic ulcer disease D) a patient with bradycardia E) a patient with an enlarged prostate

B) a patient with asthma C) a patient with peptic ulcer disease D) a patient with bradycardia E) a patient with an enlarged prostate The principal use of bethanechol is to promote urination by stimulating the muscarinic cholinergic receptors in the detrusor muscle to contract the bladder and produce urine output. This group of agents should be prescribed cautiously for patients with low blood pressure and low heart rates. Muscarinic agonists are contraindicated for patients with intestinal or urinary tract obstruction, severe bradycardia, or active asthma.

The nurse realizes that cholinergic agonists mimic which parasympathetic neurotransmitter? A) dopamine B) acetylcholine C) cholinesterase D) monoamine oxidase

B) acetylcholine

Given each of the following actions, the nurse would recognize which action has the highest priority for a patient admitted with glaucoma? A) teach the patient to wear glasses at all times B) administer pilocarpine as prescribed C) teach patient to avoid bending at the waist D) administer atropine as prescribed

B) administer pilocarpine as prescribed Pilocarpine is a direct-acting cholinergic drug that constricts the pupils of the eyes, thus opening the canal of Schlemm to promote drainage of aqueous humor (fluid). This drug is used to treat glaucoma by relieving fluid (intraocular) pressure in the eye.

Which agent would the nurse expect to be ordered to facilitate the diagnosis of myasthenia gravis? A) ambenonium chloride B) edrophonium chloride C) neostigmine methylsulfate D) physostigmine salicylate

B) edrophonium chloride Edrophonium is the drug of choice to assist in the diagnosis of myasthenia gravis.

A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition? A) diabetes mellitus B) glaucoma C) allergy to penicillin D) gastric ulcer

B) glaucoma Scopolamine is an anticholinergic used to treat motion sickness. Most anticholinergics are contraindicated in patients with glaucoma.

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

The nurse administered donepezil to a patient. Which finding indicates that the medication is therapeutic? A) the patient is relaxed B) the patient has increased cognition C) the patient is awake D) the patient has urinated

B) the patient has increased cognition Donepezil is used to treat Alzheimer disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.

A patient is receiving bethanechol. 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

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" Atropine, an anticholinergic, is used preoperatively to reduce salivary secretions and to reduce the risk of aspiration. (Remember: anticholinergics dry up the body)

A nurse is monitoring a patient receiving atropine. Which finding requires nursing action? A) heart rate of 60 beats/min B) nasal congestion C) blood pressure of 90/40 mm Hg D) dilated pupils

C) blood pressure of 90/40 mm Hg Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required.

The nurse teaches the patient receiving atropine to expect which side effect? A) diarrhea B) bradycardia C) blurred vision D) frequent urination

C) blurred vision Look at orange chart on pg. 217 in the textbook.

Which adverse reaction will the nurse monitor for in a patient taking bethanechol for treatment of urinary retention? A) constipation B) hypertension C) muscle weakness D) tachycardia

C) muscle weakness Adverse reactions to bethanechol include abdominal cramps, diarrhea, orthostatic hypotension, bradycardia, and muscle weakness.

Which assessment most assists the nurse in determining if bethanechol has had a therapeutic effect? A) neurological assessment B) muscular assessment C) urinary assessment D) gastric assessment

C) urinary assessment This medication increases the tone of the detrusor muscle (promotes contraction of the bladder) and causes the patient to void.

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

C) urinary retention Urinary retention is more serious to systemic homeostasis than the other answer choices.

A patient is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse's primary action? A) monitor urinary output B) insert a large-bore IV catheter C) attach patient to telemetry monitor D) administer ordered anticholinergic medication

D) administer ordered anticholinergic medication An anticholinergic can act as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion.

The nurse is administering bethanechol, 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 Look at purple chart on pg. 213 in the textbook.

Dicyclomine 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

Atropine is most useful in the treatment of which cardiovascular condition? A) ventricular fibrillation B) first-degree heart block C) premature atrial contraction D) sinus bradycardia

D) sinus bradycardia