Chapter 32

Cholinergic stimulation in her infant

A 32-year-old breast-feeding mother has been diagnosed with closed-angle glaucoma and is receiving cholinergic therapy. She does not have a history of asthma, cardiovascular disease, or biliary disorder. What is the most important factor that the nurse would consider during ongoing assessment of the therapy?

Atropine

A 4-year-old girl is brought to the emergency department by her mother. The mother reports the child has been vomiting, The nurse notes the child's face is flushed and is diaphoretic. The mother thinks the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which drug would be administered?

Donepezil (Aricept)

A 70-year-old female patient has just been diagnosed with Alzheimer's disease. What cholinergic drug is used for the treatment of Alzheimer's disease?

Once a day

A client is prescribed donepezil. The nurse would expect to administer this drug at which frequency?

Direct-acting cholinergic drug

A female client had surgery 24 hours ago to repair a hernia. The nurse finds that the client has not had a bowel movement since the day before the surgery. She is experiencing abdominal distention, and during auscultation the nurse notes an absence of bowel sounds. Further examination and testing reveal a paralytic ileus. The provider orders bethanechol. The nurse is aware that bethanechol is included in which drug classification?

Discontinue the cholinergic medication secondary to the diagnosis of bradycardia.

A female client is taking cholinergic medication to control bladder retention. She presents to the emergency department with confusion, shortness of breath, and an apical pulse of 42 beats per minute and irregular. What action would the nurse expect the health care provider to take?

Increased risk of GI bleeding

A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient?

Rivastigmine

A group of students are reviewing the drugs that are available for treating Alzheimer's disease. The students demonstrate understanding of the information when they identify which drug as appropriate for treatment?

Restore anticholinesterase function

A military nurse is part of a team reviewing the appropriate response to chemical weapons attacks, including sarin, tabun, and soman. When reviewing the physiology of a response to such drugs, the nurse should identify what goal of treatment?

cholinergic medications' ability to stimulate the parasympathetic nervous system.

A new patient has come to the clinic. The patient tells the nurse that the patient takes Aricept. It would be important for the nurse to assess the patient's medical and medication history because many bodily functions are affected by the:

Muscle weakness

A nurse administers an anticholinesterase drug to a client. What assessment finding would the nurse interpret as evidence of a toxic effect of the medication?

Imbalanced Nutrition: Less Than Body Requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy

A nurse is caring for a client who is taking rivastigmine. The client's nursing care plan will prioritize which nursing diagnosis?

Confusion

A patient is prescribed memantine for the treatment of dementia of Alzheimer's disease. Which adverse reaction should the nurse monitor for in the patient?

Cevimeline

A patient with Sjogren's syndrome is experiencing dry mouth. Which agent would the nurse expect to be prescribed?

Increase in the level of acetylcholine in CNS

A patient with dementia of Alzheimer's disease is administered donepezil HCL. What are the actions associated with cholinesterase inhibitors?

Neostigmine

After teaching a group of students about indirect acting cholinergic agonists used to treat myasthenia gravis, the instructor determines that the teaching was effective when the students identify which agent?

Alzheimer's disease.

Decreased acetylcholine levels are characteristic of what disorder?

Increased tone and contractility Relaxation of the sphincter Ability to better empty the bladder

How do direct-acting cholinergic drugs affect the bladder? (Select all that apply.)

"The drugs are best used early as they slow the progression of AD."

The caregiver of client describes the client as having Alzheimer's disease (AD) for 10 years and is currently in the late stage of the disease. The caregiver asks the nurse if the client can go back on the medication donepezil. Which response by the nurse is appropriate?

acetylcholine

The nursing student correctly identifies the transmitter in the cholinergic neuropathways that appears insufficient in clients with Alzheimer's disease is which?

Urinary urgency

When assessing a client for possible adverse effects of direct-acting cholinergic agents, what might the nurse find?

Muscarinic

When describing the action of direct-acting cholinergic agonists, which receptors would the nurse identify as being stimulated?

Atropine

Which agent would be used to counteract a severe reaction occurring with the use of neostigmine?

Donepezil

Which medication would the nurse expect to administer orally once a day to a client with AD?

Restoration of normal sinus rhythm

Which would be an expected outcome in a client who has been given atropine during a medical emergency?

Atropine

Which would be most important to have readily available for a client who is receiving an indirect-acting cholinergic agonist and develops a severe reaction?

weight loss.

A client is taking rivastigmine for Alzheimer disease. The nurse will evaluate the client regularly for:

Oral mucous membranes

The nurse administered cevimeline (Evoxac) 30 mg to a patient. What should the nurse assess to determine if the medication is having the desired effect?

Cholinergic crisis

A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following?

"I should expect the medication to decrease pressure in my eye."

A patient has just received carbachol (Miostat). Which statement indicates the patient understands the nurse's teaching about this medication?

atropine

A 78-year-old client is admitted to the Emergency Department (ED) and is diagnosed with bradycardia. The client tells the nurse that the client is taking donepezil (Aricept), a cholinergic agent, for Alzheimer's disease. The nurse knows that the drug of choice for bradycardia is:

Cholinergic overdose

A client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal cramps, and nausea. The nurse prepares to intervene for what condition?

atropine

A client is reporting diarrhea, rigidity and spasm after receiving pyridostigmine. Which medication is appropriate to suggest to the prescriber?

take the medication with food.

A client taking rivastigmine reports to the clinic nurse that she has been having gastrointestinal problems since she started the medication. The nurse will advise the client to do which?

"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine."

A client who has been prescribed bethanechol asks a nurse to explain how the drug works. What would be a correct response?

Parkinson's disease

A client with Alzheimer's disease is being treated with the medication Exelon. The nurse knows that this drug is also used to treat which disorder?

decreased effectiveness of the anticholinergic

A client with Alzheimer's disease is taking Exelon along with an anticholinergic drug to decrease the amount of secretions. What should the nurse be concerned about?

Contact the health care provider as the client may be experiencing a cholinergic crisis.

A client with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. When the nurse finds the client anxious, diaphoretic, and visibly flushed, what action should the nurse take to best assure the client's safety?

Acetylcholine

A nurse is preparing to administer a cholinergic medication. To prepare to administer the medication, the nurses is assessing the client for anticholinergic effects. Cholinergic medications act like which neurotransmitter?

Hypertension Hypersensitivity Megacolon

A nurse is preparing to administer guanidine to a client. The nurse will administer this medication cautiously if which disorder is noted in the client's record? Select all that apply.

Bethanechol

A nurse is reviewing the medication history of several clients. One of the clients is receiving a direct-acting cholinergic drug. The nurse would most likely identify which drug?

Improvement of cognition and function

An older adult client has been diagnosed with early-stage Alzheimer's disease and has begun treatment with donepezil. When providing health education to the client and the client's spouse, the nurse should identify what goal of treatment?

Jack should be cautioned about blurred vision and its hazards.

Jack Thomas is a 45-year-old automobile mechanic with a history of throat cancer. Jack has just undergone radical neck resection. As a result of the surgery, Jack suffers from xerostomia, a dry mouth condition. He is prescribed pilocarpine therapy. What advice should you give Jack regarding the drug therapy?

The parasympathetic nervous system is stimulated by these medications.

The client has been prescribed a cholinergic agonist. Which statement is true concerning the administration of cholinergic agonists?

Atropine

The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered?

bethanechol

The health care provider is preparing to write a prescription for a client diagnosed with urinary retention. Which medication does the nurse expect to be prescribed?

Improved memory

The nurse administered donepezil (Aricept) to a patient. What is the therapeutic response the nurse expects to assess?

This is cholinergic crisis, and the provider needs to be notified immediately.

The nurse administered neostigmine to a client with myasthenia gravis. The nurse is doubling the dose that the client was taking at home. Three hours later, the nurse is assessing the client and notes the following symptoms: nausea with vomiting, diarrhea, and sweating. What does the nurse interpret these symptoms to be?

Alzheimer's disease

The nurse is caring for a client who is receiving an indirect-acting cholinergic medication and knows it is indicated as a treatment for myasthenia gravis as well as which other condition?

Bronchoconstriction

The nurse is caring for a client with asthmatic bronchitis and understands that cholinergic medications are contraindicated because this classification of medication may cause which effect?

Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration.

The nurse is providing education to a client who has been prescribed an anticholinesterase drug. What caution would the nurse include in the teaching?

autoimmune

The nurse is providing education to a client who has been recently diagnosed with myasthenia gravis. During teaching, the nurse would describe it as what type of disorder?

Gastrointestinal bleeding

The nurse would be alert for what in a client who is taking rivastigmine and ibuprofen?

Parasympathetic nervous system

The nursing instructor is discussing cholinergic drugs. The nursing students understand what system is acted upon by this family of drugs?