Chapter 33 Anticholinergic Agents PrepU
The nurse is educating a patient who has been prescribed atropine, an anticholinergic drug. Which of the following instructions should the nurse provide to the patient?
"Do not drive or operate machinery."
Which patient statement indicates to the nurse that the patient is experiencing an adverse effect of hyoscyamine?
"I feel like my heart is going to jump out of my chest."
An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching?
"I need to exercise frequently outside in the warm weather."
An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching?
"I need to exercise frequently outside in the warm weather." The client should avoid temperature extremes and exertion in warm temperatures because of possible heat intolerance, which could be more severe in older clients. Drinking fluids is important to maintain hydration and prevent heat intolerance. Avoiding driving is an appropriate safety measure. Constipation may occur with an anticholinergic; therefore, increased fiber intake would be appropriate. (less)
The health care provider has ordered scopolamine transdermally for motion sickness. Which statement by the client, prescribed transdermal scopolamine, indicates an understanding of the medication's administration guideline?
"I will change the patch every 3 days."
A patient with asthma will soon begin treatment with atropine as an adjunct to his normal drug regimen. What teaching point should the nurse include in patient education related to this new aspect of drug treatment?
"It's possible that your eyes will take longer to adjust to bright lights."
A client is using a transdermal application of scopolamine. Which of the following instructions would the nurse include when teaching the client how to use this drug?
"Make sure the area you are using is clean, dry, and free from cuts."
A client, prescribed atropine as a therapy for parkinson's disease, shared that he ingests either the herbs rosemary or turmeric on a daily basis. What instructions should the nurse provide the client regarding this herbal therapy? Select all that apply.
* The combination of turmeric and atropine can result in an increase in the medication's expected reaction. * Rosemary should not be combined with atropine since it can result in a toxic level reaction
Which would be important to perform for a client who has received an anticholinergic agent? (Select all that apply.)
-Auscultating bowel sounds -Monitoring urine output -Monitoring heart rate
The nurse should monitor a client prescribed an anticholinergic medication for which results? Select all that apply.
-Dysphagia -Tachycardia -Constipation -Blurred vision
Which drugs are classified as cholinergic blocking drugs and are used to decrease respiratory secretions prior to surgery? (Select all that apply.)
-Glycopyrrolate (Robinul) -Atropine
Which cholinergic-blocking drugs are used in the treatment of chronic obstructive pulmonary disease (COPD)? (Select all that apply.)
-Ipratropium (Atrovent) -Tiotropium (Spiriva)
A client is treated in the emergency department for suspected atropine toxicity. Which nursing assessment data support the suspicion that the client's signs and symptoms are suggestive of a 2.0 mg atropine dose? Select all that apply.
-Tachycardia -Dilated pupils -Blurred vision
What is the recommended dosage for atropine for a client with a bradyarrhythmia?
0.4-0.6 mg
A client is receiving propantheline as adjunctive therapy for peptic ulcers. The nurse instructs the client to take the medication at which time?
30 minutes before meals
When should a patient receiving propantheline (Pro-Banthine) as an adjunctive therapy for peptic ulcers be advised to take the medication?
30 minutes before meals
When should a patient receiving propantheline (Pro-Banthine) as an adjunctive therapy for peptic ulcers be advised to take the medication? (Choose one)
30 minutes before meals
When should a patient receiving propantheline (Pro-Banthine) as an adjunctive therapy for peptic ulcers be advised to take the medication?
30 minutes before meals A patient receiving propantheline (Pro-Banthine) as an adjunctive therapy for peptic ulcers be advised to take the medication 30 minutes before meals.
A patient receives atropine intravenously. The nurse would expect the drug to be effective for how long?
4 hours
The nurse administers atropine intramuscularly at 9:00 AM. At which time would the nurse expect the drug's peak effects to occur?
9:30AM
A patient arrives in the emergency department (ED) with bradycardia. Atropine is the drug of choice to treat this bradycardia. What dosage would you expect the physician to order?
<0.5 mg
Some anticholinergic drugs have the same clinical indications in the pediatric population as in the adult population. Which of the following statements accurately describes a difference between the populations related to the use of anticholinergics?
Adverse effects tend to be more severe in children.
A 78-year-old female patient who is about to begin home care has been prescribed anticholinergic drugs. Which of the following should the home care nurse explain to the patient and her family?
All the above
A 75-year-old male client is experiencing extrapyramidal symptoms secondary to an antipsychotic drug. Which drug would the nurse expect the physician to order to relieve these symptoms?
Anticholinergics
A nurse is caring for a client with peptic ulcer disease who has been prescribed a cholinergic blocking drug. Which nursing interventions should the nurse prioritize before administering the drug if the client has been experiencing prolonged diarrhea?
Assess weight of the client
The client is experiencing digitalis toxicity and presents with symptomatic bradycardia. The nurse knows that which medication may be administered to treat bradycardia?
Atropine
The client is experiencing digitalis toxicity and presents with symptomatic bradycardia. The nurse knows that which of the following medications may be administered to treat bradycardia?
Atropine Atropine is used to treat symptomatic bradycardia. Milrinone is an inotropic medication. Lasix is a diurectic and Norvac is a calcium channel blocker.
The nursing instructor is explaining the use of atropine with morphine in patients with renal colic. What role does atropine play in this indication?
Atropine acts mainly to decrease the spasm-producing effect of morphine.
Your client has a preoperative order to administer atropine. You know that the rationale for this order is:
Atropine is given preoperatively to prevent complications such as bradycardia and hypotension.
Which of the following would the nurse include in a teaching plan for a patient who is prescribed an anticholinergic agent?
Avoiding activities that require alertness
A 27-year-old male patient taking antipsychotic drugs exhibits extrapyramidal reactions. What drug might the physician order for this patient?
Benztropine (an anticholinergic drug)
A male client, age 75, is started on flavoxate . What adverse effect should the client be made aware of?
Blurred vision
A male client asks the nurse why he needs the preoperative anticholinergic medication ordered by the anesthesiologist. The nurse explains that anticholinergic drugs are given preoperatively to prevent which anesthesia associated complication?
Bradycardia
Which symptoms will warrant the administration of atropine?
Bradycardia
An anticholinergic drug is given to a 73-year-old man to treat his Parkinson disease. The man also has benign prostatic hyperplasia (BPH). The most important instruction the nurse can give to the patient with regard to his medication and medical diagnosis is to
Call his doctor if he cannot urinate
The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client?
Cholinergic blocking
Administration of which of the following classes of medications can decrease secretions of the upper respiratory tract?
Cholinergic blocking drug
Which would a nurse least likely expect to assess in a patient experiencing mild atropine toxicity?
Cough
A patient is experiencing symptoms of a hyperactive bowel. Which agent would the nurse expect to be ordered?
Dicyclomine
While preparing your client for an eye examination, you explain that the eye drops, an ophthalmic anticholinergic preparation, will cause the pupil to:
Dilate.
A patient is to receive atropine prior to surgery. The nurse would teach the patient about what as possible adverse effects? (Select all that apply.)
Dry mouth Blurred vision Dizziness Sensitivity to light
After teaching a female client who is prescribed a scopolamine patch, the nurse determines that the teaching was successful when the client states that she will change the patch in which time frame?
Every 3 days
A 57-year-old female client has a history of two myocardial infarctions in the past 3 years. She presents to the physician's office with symptoms of an overactive bladder. She requests an anticholinergic medication that she saw advertised on television. What does the nurse expect the physician to do for this client?
Explain to the client that the medication is contraindicated because of her medical history
An 80-year-old male client who lives in a long-term care facility is prescribed anticholinergic medications by his physician. Recently, he has reported blurred vision. The nurse calls the physician regarding these symptoms. The nurse expects to add which intervention to this client's plan of care?
Falls prevention Older adults are especially likely to have significant adverse reactions because of slowed drug metabolism and the frequent presence of several disease processes. A client who reports blurred vision may need help with ambulation, especially with stairs or in other potentially hazardous environments. Obstacles and hazards should be removed if possible. (less)
Anticholinergics do not block the effects of acetylcholine in the central nervous system.
False
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 nurse is caring for a patient who has been prescribed scopolamine hydrobromide for pre-anesthetic sedation. The drug is known to cause heat prostration during the hot summer months. What signs of heat prostration should the nurse monitor for when caring for this patient?
Fever
A client is experiencing urgency, nocturia, and frequency secondary to cystitis. What might the health care provider prescribe?
Flavoxate
A patient has been administered atropine for sinus bradycardia. Which of the following symptoms is noted with large doses of atropine?
Flushing
The nurse is aware that cholinergic blocking agents will be used preoperatively for what type of anesthesia?
General
A client is scheduled for surgery in 2 hours. The health care provider orders preoperative medications glycopyrrolate 1 mg and meperidine (Demerol) 50 mg IM. Before administering these medications, the nurse should assess the client for what disorder?
Glaucoma
Clients with what disorder should not be given anticholinergic drugs?
Glaucoma
Clients with the following disorder should not be given anticholinergic drugs:
Glaucoma. Anticholinergic drugs are contraindicated for patients with benign prostatic hypertrophy, myasthenia gravis, hyperthyroidism, glaucoma, tachydysrhythmia, myocardial infarction, heart failure, or conditions associated with esophageal reflux. (less)
A male client is diagnosed with IBS, and the health care provider orders an antispasmodic. Which drug should the nurse be prepared to administer to this client?
Glycopyrrolate
A male client is diagnosed with IBS, and the physician orders an antispasmodic. Which drug should the nurse be prepared to administer to this client?
Glycopyrrolate
A male client is diagnosed with IBS, and the physician orders an antispasmodic. Which drug should the nurse be prepared to administer to this client?
Glycopyrrolate Anticholinergic drugs (e.g., dicyclomine, glycopyrrolate) are indicated for antispasmodic effects in GI disorders. Historically, they have also been used to treat peptic ulcer disease; however, they are weak inhibitors of gastric acid secretion and have been largely replaced other, more effective medications (e.g., proton pump inhibitors). (less)
The nurse should observe patients receiving a cholinergic blocking drug during the hot summer months because these patients are at increased risk of which of the following? (Choose one)
Heat prostration The nurse should observe patients receiving a cholinergic blocking drug during the hot summer months because these patients are at increased risk of heat prostration.
When describing the various anticholinergic agents to a group of students, the instructor would identify which agent as being available in sublingual form?
Hyoscyamine
Which agent would the nurse identify as acting specifically on the receptors in the GI tract?
Hyoscyamine
A patient is suffering from urinary urgency and frequency. Which of the following medications will assist in treating the patient's symptoms of urinary frequency?
Hyoscyamine (Anaspaz)
After teaching a group of students about anticholinergic agents, the instructor determines the need for additional teaching when the student's identify which of the following as a contraindication for use?
Hypertension
The nurse understands that older clients taking anticholinergic drugs are more likely to have all of the following symptoms EXCEPT:
Hypertension
You understand that older clients taking anticholinergic drugs are more likely to have all of the following symptoms EXCEPT:
Hypertension.
The physician has ordered scopolamine transdermally for motion sickness. Which of the following statements by the patient indicates an understanding of the medication's administration guideline?
I will change the patch every 3 days."
James has symptomatic bradycardia. He has been receiving atropine for the past 4 days. He now complains about constipation, a common adverse effect of the drug. What is the most important suggestion the nurse could give James?
Increase bulk in the diet
A client with symptomatic bradycardia has been receiving atropine for the past 4 days and the client reports constipation. What is the most important suggestion the nurse could give the client?
Increase bulk in the diet.
A client with symptomatic bradycardia has been receiving atropine for the past 4 days. The client reports constipation, a common adverse effect of the drug. What is the most important suggestion the nurse could give the client?
Increase bulk in the diet.
A client with symptomatic bradycardia has been receiving atropine for the past 4 days. The client reports constipation, a common adverse effect of the drug. What is the most important suggestion the nurse could give the client?
Increase bulk in the diet. Constipation is a troubling adverse effect that may be managed by adding fiber to the diet, increasing hydration, and exercising moderately. Sucking on hard candies may help prevent a dry mouth but would not prevent constipation; the suggestions of avoiding driving at night or being attentive to oral care will help the patient prevent other adverse effects of the therapy. (less)
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 to withhold the next dose and contact the prescribing provider.
The nurse is caring for an 8-year-old child who is experiencing an exacerbation of asthma. The nurse expects to administer which medication because of its bronchodilation effects in the treatment of asthma and chronic bronchitis?
Ipratropium
Which agent would the nurse expect to be prescribed for a client with seasonal rhinitis?
Ipratropium
A client with myasthenia gravis is experiencing rhinorrhea. Which of medication should not be administered to the client?
Ipratropium (Atrovent)
Which of the following is a cholinergic blocking drug which is available in an inhaler form for the treatment of COPD? (Choose one)
Ipratropium (Atrovent)
A patient is administered atropine to increase the heart rate. What is the action of atropine?
It blocks the parasympathetic vagal stimulation.
Which statements best reflects the action of scopolamine?
It competes with acetylcholine at muscarinic effector sites.
A female patient is scheduled for an exploratory laparoscopy. She has been prescribed an anticholinergic agent. Why is it important to administer the anticholinergic agent in the preoperative phase?
It will decrease respiratory secretions.
A client has been prescribed an anticholinergic medication. What instructions should the nurse provide related to safety when outside in hot weather?
Keep well hydrated
A client develops labyrinthitis. What would the nurse expect the health care provider to order?
Meclizine
The nurse is describing how oxybutynin exerts its effect to a client receiving it as treatment for overactive bladder. An understanding of which receptor would the nurse integrate into the description?
Muscarinic receptors
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?
Mydriasis
The physician orders glycopyrrolate (Robinul) 1 mg and morphine sulfate 10 mg IM. What disease process would contraindicate the administration of glycopyrrolate (Robinul)?
Narrow-angle glaucoma
Which of the following agents would be least likely to cause increased adverse effects if given with an anticholinergic agent?
Nonsteroidal anti-inflammatory drugs
An elderly woman is given scopolamine while on a cruise. She becomes very agitated and confused. The nurse knows that which of the following is a likely reason for these symptoms?
Older clients have a greater chance of adverse reactions to cholinergic blocking drugs.
A client is prescribed dicyclomine. The nurse would expect to administer this drug by which route?
Oral
A client is prescribed propantheline. The nurse would administer this drug by which route?
Oral
A patient is prescribed dicyclomine. The nurse would expect to administer this drug by which route?
Oral
The pharmacology instructor is discussing the adverse effects of anticholinergic drugs. What drug would the instructor indicate is administered to counteract the effects of atropine poisoning?
Physostigmine
A male client is prescribed an anticholinergic drug by his physician. He likes to hike with his grandchildren. The home care nurse instructs the client that anticholinergic medications have which effect?
Prevents sweating and heat loss and increasing the risk of heat stroke
Anticholinergic drugs are used in ophthalmology because they produce which effect?
Pupil dilation
A nurse is administering a cholinergic-blocking drug preoperatively to a patient. What intervention should the nurse perform after administering the drug to the patient?
Raise the side rails of the bed.
A client is prescribed glycopyrrolate preoperatively. The nurse integrates understanding of the drug's action, explaining that this drug will help achieve which effect?
Reduction of oral secretions
The cholinergic blocking drug glycopyrrolate (Robinul) is used in conjunction with anesthesia for which of the following reasons?
Reduction of oral secretions
The nursing instructor is talking with the nursing students about the use of anticholinergic drugs in clients with ureteral colic. What should the instructor tell the students about the use of anticholinergic drugs in this group of clients?
Relaxes ureteral colic
A female client is going on a cruise to Nova Scotia with her husband to celebrate their 15th wedding anniversary. She is concerned because she has experienced severe, debilitating seasickness in the past. What would the nurse expect the health care provider to order?
Scopolamine
Which agent would a nurse expect to administer transdermally?
Scopolamine
Which anticholinergic agent is sometimes used to manage motion sickness when delivered by transdermal patch?
Scopolamine
Which would the nurse anticipate to be used for the prevention of nausea from motion sickness?
Scopolamine (Transderm Scop)
A nurse suspects that a client may be experiencing atropine toxicity. Which would the nurse assess?
Slight cardiac slowing
A 27-year-old male is taking an anticholinergic drug as adjunctive therapy to treat his peptic ulcer disease. The client comes to the clinic and tells the nurse that he "feels his heart beating." What adverse effect is the client experiencing from the anticholinergic medication?
Tachycardia
A patient with peptic ulcer has been prescribed mepenzolate bromide. Which of the following adverse reactions of the drug administration should a nurse monitor for in the patient?
Tachycardia The nurse should monitor for signs of tachycardia in the patient as it is one of the adverse reactions that may occur due to the administration of mepenzolate bromide. The other adverse reactions include drowsiness, blurred vision, dry mouth, and urinary hesitancy. Dysphagia and altered taste perception are the adverse reactions associated with the administration of glycopyrrolate. Constipation is an adverse reaction associated with the use of propantheline bromide and not mepenzolate bromide. (less)
A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response?
They act to block the effects of the parasympathetic nervous system.
While caring for a home bound client, the nurse provides client education relative to a prescription for trospium chloride (Sanctura). Included in your teaching is:
This drug prevents sweating and heat loss and increases the risk of heat stroke if precautions to avoid overheating are not taken.
The nurse is preparing a male client for pacemaker surgery. The physician orders atropine to be given 30 minutes before the patient leaves for the operating room. The nurse knows that the physician ordered this medication for what reason?
To dry up respiratory secretions to prevent aspiration during surgery
A client tells the nurse, "I feel like I'm constantly running to the bathroom. It's like my bladder is working overtime." The client is diagnosed with an overactive bladder. Which agent might the nurse identify as being appropriate?
Trospium
Anticholinergic agents are also called parasympatholytic agents
True
Anticholinergic agents are also called parasympatholytic agents.
True
Anticholinergics block acetylcholine at the muscarinic receptors.
True
Atropine is derived from the belladonna plant.
True
Atropine is the most widely used anticholinergic agent.
True
Anticholinergics block acetylcholine at the muscarinic receptors.
True The anticholinergic drugs competitively block the acetylcholine receptors at the muscarinic cholinergic receptor sites that are responsible for mediating the effects of parasympathetic postganglionic impulses. (less)
Unwanted anticholinergic effects include:
constipation and dry mouth
What is the primary goal for prescribing an anticholinergic agent for a preoperative client?
decrease respiratory secretions
While preparing a client for an eye examination, the nurse explains that the eyedrops, an ophthalmic anticholinergic preparation, will cause what pupil reaction?
dilatation
While preparing a client for an eye examination, the nurse explains that the eyedrops, an ophthalmic anticholinergic preparation, will cause what pupil reaction?
dilation
A patient who is going on a cruise is concerned about motion sickness and sees his physician, who prescribes scopolamine. The nurse informs the patient that using scopolamine may cause him to experience
drowsiness
A client, with a creatinine level of 25 (1906.25 µmol/L), has been diagnosed with chronic obstructive pulmonary disease. Being prescribed tiotropium bromide, the client is at risk for developing which adverse condition?
drug toxicity
The nurse prepares to administer a preoperative anticholinergic to a client. What is a desired effect based upon the characteristics of the prescribed medication?
dry mucous membranes
A 75-year-old male client is started on flavoxate, an anticholinergic drug used in the treatment of overactive bladder. When teaching the client about the medication, the nurse should explain that the client may be at increased risk of:
falls related to visual effects.
Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to
heat stroke related to decreased perspiration.
Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to:
heat stroke related to decreased perspiration.
A client with hypertension is to receive an anticholinergic agent. The nurse would be especially alert for:
increased blood pressure
How does bethanechol affect bladder emptying?
increasing the muscle tone of the detrusor muscle
The nurse would contact the health care provider prior to administering atropine preoperatively to which client?
male age 79 years
The nurse would contact the health care provider prior to administering atropine preoperatively to which client?
male age 79 years Atropine is a cholinergic blocking drug that is used to decrease secretions of the upper respiratory tract. It is contraindicated in older adults who have prostatic hypertrophy, which is common in older men. It is not contraindicated in persons under 60 unless they have glaucoma, or myocardial ischemia. (less)
What disease process would cause a nurse to question a client's new prescription for benztropine?
narrow-angle glaucoma
A 4 year old has been prescribed an anticholinergic medication. The nurse should instruction the parents to monitor and report changes in basic function
urinary output
The nurse is caring for a homebound client who is taking trospium chloride. This client likely has a history of what health problem?
urinary urgency
What should the nurse monitor for when an elderly patient is receiving cholinergic blocking drugs?
• Drowsiness • Mental confusion • Urinary retention The nurse should observe for mental confusion, drowsiness, and urinary retention when an elderly patient is receiving cholinergic blocking drugs. Parotid swelling and abdominal pain are adverse reactions associated with the administration of expectorants, namely potassium iodide and terpin hydrate respectively. (less)
If a cholinergic-blocking drug is administered prior to surgery, the nurse instructs the client of which of the following? Select all that apply:
• Dry mouth is to be expected. • Remain in bed after drug administration.
A nurse administering a cholinergic-blocking medication to a client should monitor the client for which of the following visual adverse reactions? Select all that apply:
• Photophobia • Mydriasis • Cycloplegia