CHAPTER 48: DRUG THERAPY FOR PARKINSON'S DISEASE, URINARY SPASTICITY, AND DISORDERS REQUIRING ANTICHOLINERGIC DRUG THERAPY

Which side effect/adverse effect of carbidopa/levodopa does the nurse realize is most important to monitor? A. Dysphagia B. Increased libido C. Agranulocytosis D. Urinary retention

C. Agranulocytosis It is most important for the nurse to monitor the patient taking carbidopa/levodopa for agranulocytosis (decreased white blood cells), which is life-threatening. Dysphagia, increased libido, and urinary retention are not life-threatening

A 65 year old woman has been taking levodopa for several weeks for symptoms of Parkinson's disease. Which of the following symptoms indicate she is not receiving an adequate dose for the treatment of her symptoms? A. edema of the feet and ankles B. widened QRS complex C. static gait D. increased intraocular pressure

C. static gait

A patient is taking benztropine mesylate (Cogentin) and reports GI upset following administration of the medication. The nurse teaches the patient to do what? A. take the medication prior to eating B. take the medication before bed C. take the medication with food D. take the medication with Maalox

C. take the medication with food

Before administering carbidopa-levodopa for the treatment of Parkinson's disease, it is most important for the nurse to assess the patient for a history of A. pulmonary disease. B. diabetes mellitus. C. allergy to penicillin. D. glaucoma.

D. glaucoma. Contraindications to therapy include narrow-angle glaucoma; severe cardiac, renal, hepatic disease; and suspicious skin lesions (activates malignant melanoma

The nurse is educating a client who has been prescribed atropine, an anticholinergic drug. Which instructions should the nurse provide to the client? a. "Do not drive or operate machinery." b. "If you experience eye pain, contact the health care provider about increasing the dosage." c. "Increase your fluid intake and activity level." d. "Take long, hot showers frequently to relieve uncomfortable side effects."

a. "Do not drive or operate machinery." Effects of anticholinergic drugs such as atropine include blurred vision and impaired ability to sweat. Clients should be cautioned to avoid activities that may be made dangerous by blurred vision; this may include driving and operating machinery. To avoid overheating, clients should avoid strenuous activity and take other measures to stay cool (e.g., frequent cool baths). Clients experiencing eye pain may have undiagnosed glaucoma; they should stop taking the medications and contact their health care providers.

A male client is diagnosed with Parkinson's disease. The nurse visits him 1 week after hospitalization to assess his progress and medication regimen compliance. He states that there is no significant improvement in his symptoms. What is the best response by the nurse? a. "Noticeable improvement may not occur for several weeks after the initial drug dose." b. "Noticeable improvement usually occurs 7 to 10 days after the initial drug dose." c. "You should have noticed improvement by now; I will notify your health care provider." d. "Are you sure that you are taking the medication as ordered?"

a. "Noticeable improvement may not occur for several weeks after the initial drug dose." The home care nurse can help clients and caregivers understand that the purpose of drug therapy for Parkinson's disease is to control symptoms and that noticeable improvement may not occur for several weeks.

The client is taking digitalis and has not been monitoring pulse rate. The client presents to the emergency department via ambulance experiencing digitalis toxicity and symptomatic bradycardia. The nurse knows that which medication may be administered to treat bradycardia? a. Atropine b. Lasix c. Norvasc d. Milrinone

a. Atropine

Which would be important to perform for a client who has received an anticholinergic agent? (Select all that apply.) a. Auscultating bowel sounds b. Monitoring urine output c. Monitoring heart rate d. Administering an antidiarrheal agent e. Assessing deep tendon reflexes

a. Auscultating bowel sounds b. Monitoring urine output c. Monitoring heart rate Anticholinergic agents can slow GI activity leading to paralytic ileus. Urinary retention is possible, so it is important to monitor the patient's urine output. Tachycardia is possible, so monitoring the heart rate would be important. The client would most likely experience constipation, not diarrhea. Anticholinergics do not affect deep tendon reflexes, so assessment is not necessary.

A nursing instructor is describing Parkinsonism to a group of nursing students. When discussing the underlying cause of the symptoms, the instructor explains the depletion of dopamine in which of the following? a. Central nervous system b. Smooth muscle c. Skeletal muscle d. Peripheral nervous system

a. Central nervous system

Administration of which classes of medications can decrease secretions of the upper respiratory tract? a. Cholinergic blocking drug b. Opioids c. Antianxiolytic d. Antiemetics

a. Cholinergic blocking drug Cholinergic antagonists are the class of medications used to decrease secretions of the upper respiratory tract. Antianxiolytics decrease preoperative anxiety. Opioids decrease both anxiety and pain preoperatively. Antiemetics are used to decrease nausea after surgery.

A nurse is caring for 70-year-old patient who is undergoing anticholinergic drug therapy. The nurse should assess for which condition when caring for this elderly patient? a. Confusion and disorientation b. Choreiform movements c. Suicidal tendencies d. Psychotic episodes

a. Confusion and disorientation The nurse should assess for confusion and disorientation when caring for this elderly patient undergoing anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.

Which would a nurse least likely expect to assess in a client experiencing mild atropine toxicity? a. Cough b. Dry mouth c. Profuse sweating d. Increasing of heart rate

a. Cough Cough is not associated with mild atropine toxicity. Dry mouth is associated with mild atropine toxicity. Inhibition of sweating is associated with mild atropine toxicity not profuse sweating. Slight cardiac slowing is associated with mild atropine toxicity not increased heart rate.

Which of the following cholinergic-blocking drugs only affect the muscarinic receptors? Select all that apply: a. Darifenacin (Enablex) b. Oxybutynin (Ditropan) c. Benztropine (Cogentin) d. Biperiden (Akineton) e. Tolterodine (Detrol)

a. Darifenacin (Enablex) b. Oxybutynin (Ditropan) e. Tolterodine (Detrol) Antispasmodic cholinergic-blocking drugs, like darifenacin , oxybutynin (Ditropan), and tolterodine, only affect muscarinic receptors in the parasympathetic nervous system and have no affect on nicotinic receptors.

After administering an antiparkinson drug to a client, the nurse assesses for the drug's effectiveness. The nurse determines that the drug is effective based on assessment of which of the following? Select all that apply. a. Decrease in muscle rigidity b. Improved gait c. Reduction in tremors d. Greater slowing of movement e. Reduced dry mouth

a. Decrease in muscle rigidity b. Improved gait c. Reduction in tremors The drug is intended to address the signs and symptoms of Parkinson disease, such as muscle rigidity, shuffling gait, tremors, and slow movements. Therefore, a decrease in muscle rigidity, improved gait, and reduction in tremors would indicate drug effectiveness. Greater slowing of movement would indicate that the drug is not effective. Dry mouth is an adverse reaction and not considered an indicator of drug effectiveness.

A nursing mother is being prepared for an eye condition which requires a prescription for atropine. What nursing intervention should the nurse implement to assure safe and effective atropine therapy? a. Discuss an alternative feeding method until the atropine is no longer prescribed b. Discuss pumping and then warming the breast milk before bottle feeding the baby c. Discuss feeding the baby prior to taking the prescribed atropine d. Discuss the mother's need to be well hydrated to minimize the amount to atropine in the breastmilk

a. Discuss an alternative feeding method until the atropine is no longer prescribed Because of the potential for serious adverse effects on the baby, nursing mothers should be assisted in finding another method of feeding the baby if an anticholinergic drug is needed. None of the other options effectively manage the safety risk to the infant.

A female client is prescribed centrally acting anticholinergics for her Parkinson's disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter's request? a. Evaluate the client for adverse reactions from the centrally acting anticholinergics b. Increase the centrally active anticholinergics to decrease the client's symptoms c. Admit the client to the hospital for a psychological evaluation d. Immediately discontinue the centrally acting anticholinergic medication

a. Evaluate the client for adverse reactions from the centrally acting anticholinergics

When describing the various anticholinergic agents to a group of students, the instructor would identify which agent as being available in sublingual form? a. Hyoscyamine b. Scopolamine c. Propantheline d. Tiotropium

a. Hyoscyamine Hyoscyamine is available in oral or sublingual form and for subcutaneous, IM, or IV use. Scopolamine is available for subcutaneous or IM injection, in ophthalmic form, and as a transdermal system. Propantheline is available for oral use only. Tiotropium is available for inhalation.

A nurse administering a cholinergic-blocking medication to a client should monitor the client for which visual adverse reactions? (Select all that apply.) a. Mydriasis b. Cycloplegia c. Miosis d. Photophobia e. Dipolpia

a. Mydriasis b. Cycloplegia d. Photophobia

A client is prescribed benztropine. The nurse would anticipate administering this drug by which route? a. Oral b. Subcutaneous c. Intramuscular d. Intravenous

a. Oral Benztropine is administered orally.

52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms? a. There is an imbalance between dopamine and acetylcholine. b. There is a decrease in stimulation of the nigrostriatal neural tracts. c. There is an increase in dopamine in the terminal nerve endings. d. There is an increased level of GABA at the striatum.

a. There is an imbalance between dopamine and acetylcholine.

Anticholinergics block acetylcholine at the muscarinic receptors. a. True b. False

a. True

What are the classic symptoms associated with Parkinson's disease? Select all that apply. a. bradykinesia b. muscle rigidity c. urinary retention d. resting tremors e. worsening eyesight

a. bradykinesia b. muscle rigidity d. resting tremors Classic symptoms of Parkinson's disease include resting tremor, bradykinesia, rigidity, and postural instability.

A client has been prescribed benztropine as drug therapy for Parkinson disease. What assessment finding would suggest a therapeutic effect to the nurse? a. decreased rigidity and tremors b. increased level of consciousness c. increased motivation and muscle strength d. absence of seizure activity

a. decreased rigidity and tremors Benztropine should cause a decrease in rigidity and tremors. It does not affect LOC, motivation, strength, or seizure risk.

Common side effects of anticholinergics include: a. dry mouth, urinary retention, constipation, and increased pulse rate. b. blurred vision, decreased liver enzymes, increased B/P, and papillary constriction. c. decreased GI absorption, nausea, heartburn, and hypotension. d. skin rashes, decreased urinary output, constipation, and increased WBCs.

a. dry mouth, urinary retention, constipation, and increased pulse rate. Anticholinergic drugs may cause blurred vision, dry mouth, tachycardia, and urinary retention. They also decrease sweating and may cause fever or heatstroke. Fever may occur in any age group, but heatstroke is more likely to occur in older adults, especially with cardiovascular disease, strenuous activity, and high environmental temperatures. When centrally active anticholinergics are given for Parkinson's disease, agitation, mental confusion, hallucinations, and psychosis may occur.

Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to: a. heat stroke related to decreased perspiration. b. diarrhea related to increased peristalsis. c. urinary frequency related to CNS effects. d. hypotension related to increased sympathetic response.

a. heat stroke related to decreased perspiration. By blocking cholinergic receptors, anticholinergic drugs reduce sweating, which decreases heat loss and increases the risk of hyperthermia and heat stroke.

What information about the use should the nurse provide a client preoperatively prescribed atropine? a. it prevents complications such as bradycardia and hypotension b. atropine is given preoperatively to assist in thinning of respiratory secretions c. it sedates the client, enhancing anesthesia. d. atropine is given to prevent nausea and vomiting

a. it prevents complications such as bradycardia and hypotension

For a client diagnosed with both Parkinson's and narrow-angle glaucoma, what medication should cause the nurse concern? a. levodopa b. gabapentin c. phenytoin d. amantadine

a. levodopa

While being intubated, a client with a head injury experienced bradycardia. Atropine was consequently administered. What assessment should be postponed until all atropine is excreted and no longer exerting an effect? a. pupil response b. electroencephalogram c. brainstem reflexes d. computed tomography of the brain

a. pupil response One test for neurological function is to shine a light in the client's eyes to test pupil reaction to light. Because this client has received atropine, pupils will be dilated and will not react normally to light. This could be mistaken as an indication of brain death if the nurse did not know atropine had been administered. This test will be postponed until the pupils are no longer dilated by the medication. The other tests would not have to be postponed because of atropine.

The nurse is speaking to a group at the senior citizen's center about Parkinson disease. What should the nurse explain is importance to avoiding when taking an anticholinergic medication? a. strenuous exercise in high environmental temperatures b. salt substitutes and foods high in potassium c. foods high in vitamin K such as dark green, leafy vegetables d. over-the-counter medications containing acetaminophen

a. strenuous exercise in high environmental temperatures Anticholinergic drugs decrease sweating. As a result, the body is not as effective at reducing internal temperature as this could result in fever and heatstroke. Elderly people taking anticholinergic drugs do not need to avoid potassium, foods high in vitamin K, or acetaminophen.

What is a common side effect of anticholinergic drug therapy? Select all that apply. a. urinary retention b. skin rash c. blurred vision d. papillary constriction e. dry mouth

a. urinary retention c. blurred vision e. dry mouth

A nurse has been invited to speak to a support group for Parkinson's disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies? a. "Persons of all cultures are treated similarly and respond in similar ways to treatment." b. "Drugs do not cure these disorders; they instead enhance quality of life." c. "Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases." d. "Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction

b. "Drugs do not cure these disorders; they instead enhance quality of life."

An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching? a. "I should make sure that I drink plenty of fluids." b. "I need to exercise frequently outside in the warm weather." c. "I should avoid driving if I feel light-headed or dizzy." d. "I should eat plenty of fiber to prevent constipation."

b. "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.

A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action? a. Contact the provider to question the route b. Administer the medication as prescribed and monitor for therapeutic and adverse effects c. Contact the provider to question the dose d. Contact the provider to question the frequency

b. Administer the medication as prescribed and monitor for therapeutic and adverse effects

Some anticholinergic drugs have the same clinical indications in the pediatric population as in the adult population. Which statement accurately describes a difference between the populations related to the use of anticholinergics? a. Anticholinergic drugs create different adverse effects in children. b. Adverse effects tend to be more severe in children. c. Anticholinergic drugs are more effective in the pediatric population. d. Adverse effects tend to be less severe in children.

b. Adverse effects tend to be more severe in children. Anticholinergic drugs have essentially the same intended effects and adverse effects in the pediatric population as in the adult population. However, children are especially sensitive to these drugs, so the adverse effects may be more severe in that population.

What would be considered a peripheral anticholinergic effect of anticholinergic drug therapy? a. Delirium b. Blurred vision c. Agitation d. Memory loss

b. Blurred vision Blurred vision is considered a peripheral anticholinergic effect. Delirium, agitation, and memory loss are considered central effects affecting the CNS.

The nurse would closely monitor a client for signs and symptoms of toxicity of which medication if the client is also prescribed a cholinergic blocking drug? a. Phenytoin b. Digoxin c. Lithium d. Clozapine

b. Digoxin

The nurse understands that older clients taking anticholinergic drugs are more likely to have all of the following symptoms EXCEPT: a. Blurred vision. b. Hypertension. c. Constipation. d. Confusion.

b. Hypertension. Older adults are especially likely to have significant adverse reactions because of slowed drug metabolism and the frequent presence of several disease processes. Some common adverse effects are blurred vision, confusion, constipation, and confusion or other psychotic symptoms. These are most likely to occur with the centrally active anticholinergics given for Parkinson's disease or drug-induced extrapyramidal effects, such as trihexyphenidyl or benztropine. They are not typically the causative agent for hypertension in routine medication treatment.

Which agent would a nurse expect to administer transdermally? a. Atropine b. Scopolamine c. Dicyclomine d. Propantheline

b. Scopolamine Only scopolamine is available as a transdermal system.

A client with Parkinson's disease began treatment with dopaminergics two weeks ago and has now presented for a follow-up assessment. What finding best suggests to the nurse that the treatment is having a therapeutic effect? a. The client describes an increase in appetite compared with two weeks ago b. The client is able to walk more briskly and stably than two weeks ago c. The client denies shortness of breath and adventitious lung sounds are absent on auscultation d. The client is oriented to person, place and time

b. The client is able to walk more briskly and stably than two weeks ago

A male client has been a paraplegic for 5 years. He reports increased incontinence, and the health care provider orders anticholinergic medication. What is the reason for this decision? a. To decrease irritation to the wall of the bladder b. To decrease bladder capacity c. To strengthen the detrusor muscles d. To increase bladder capacity

b. To decrease bladder capacity

The nurse is preparing a client for pacemaker surgery. The health care provider orders atropine to be given 30 minutes before the client is taken to the operating room. The nurse knows this medication is ordered for what reason? a. To increase the heart rate to prevent complication prior to the pacemaker being inserted b. To dry up respiratory secretions to prevent aspiration during surgery c. To cause bladder relaxation during surgery so that the client will not have the urge to void during surgery d. To relax the bowel to prevent the client from having a bowel movement during surgery

b. To dry up respiratory secretions to prevent aspiration during surgery Atropine is an anticholinergic agent. The principal actions of atropine are a reduction in salivary, bronchial, and sweat gland secretions; mydriasis; cycloplegia; changes in heart rate; contraction of the bladder detrusor muscle and of the gastrointestinal smooth muscle; decreased gastric secretion; and decreased gastrointestinal motility. The reason this client is given the medication preoperatively is to dry up secretions to prevent aspiration during surgery.

What is typically the first observable symptom of Parkinson's disease? a. the inability to either stand erect or to rise easily from a seated position b. a resting tremor that begins in one hand, involving the fingers and thumb of one hand c. frequent falls and signs of early dementia d. the inability to either support the head or control its movement

b. a resting tremor that begins in one hand, involving the fingers and thumb of one hand

Atropine must be used cautiously in clients with a history of cardiovascular disease, due to what factor? a. atropine decreases excitability and conductivity b. atropine increases the myocardial oxygen demand c. atropine causes significant blood pressure changes d. atropine causes increased respiratory tract secretions

b. atropine increases the myocardial oxygen demand

A client, diagnosed with irritable bowel syndrome, is reporting severe abdominal pain. The nurse would anticipate an order of which drug to relieve the bowel spasms? a. trihexyphenidyl or benztropine b. dicyclomine or glycopyrrolate c. darifenacin or solifenacin d. ipraptropium or tiotropium

b. dicyclomine or glycopyrrolate

A client who is going on a cruise is concerned about motion sickness and sees the health care provider, who prescribes scopolamine. The nurse informs the client that using scopolamine may cause the client to experience: a. pupil constriction. b. drowsiness. c. diarrhea. d. urinary incontinence.

b. drowsiness. Scopolamine at therapeutic doses produces CNS depression characterized by drowsiness, euphoria, amnesia, fatigue, and dreamless sleep resulting from decreased periods of rapid eye movement.

How does bethanechol affect bladder emptying? a. relaxing the urinary sphincter b. increasing the muscle tone of the detrusor muscle c. relaxing the smooth muscle that forms the urethra d. stimulating the urinary reflex in the micturition center

b. increasing the muscle tone of the detrusor muscle Bethanechol is a sympathomimetic agent that acts at the cholinergic receptors in the urinary tracts to increase muscle tone. The increased tone of the detrusor muscle in the urinary bladder allows for bladder emptying. Bethanechol does not act in the way described by any of the other options.

The therapeutic goals for use of anticholinergic drugs in the treatment for parkinsonism is to decrease what symptomology? Select all that apply a. urinary retention b. muscle spasticity c. dry mouth d. fine tremors e. salivation

b. muscle spasticity d. fine tremors e. salivation

The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client? a. Opioid b. Antiemetic c. Cholinergic blocking d. Antianxiety

c. Cholinergic blocking Cholinergic blocking agents are contraindicated in clients with prostatic hypertrophy, glaucoma, and myocardial ischemia. Opioids, antiemetics, and antianxiety drugs are not contraindicated in clients with glaucoma.

A client with advanced Parkinson's disease has undergone diagnostic testing and diagnostic imaging. What are the results most likely to reveal? a. Increased gamma-aminobutyric acid (GABA) b. Decreased enzyme dopa decarboxylase levels c. Degeneration of dopamine-producing nerve cells d. Brain infarcts

c. Degeneration of dopamine-producing nerve cells

One of the neurotransmitters can become decreased in the area of the corpus striatum. This results in the manifestations of Parkinson's disease. Which neurotransmitter will cause this? a. Gamma-aminobutyric acid (GABA) b. Acetylcholine c. Dopamine d. Serotonin

c. Dopamine When dopamine is decreased in the area of the corpus striatum there is a chemical imbalance that allows the cholinergic or excitatory cells to dominate. This affects the functioning of the basal ganglia and cortical and cerebella components of the extrapyramidal motor system. This system provides coordination for unconscious muscle movements, including those that control position, posture, and movement. The result of the imbalance produces the signs and symptoms of Parkinson's disease. The corpus striatum in the brain is connected to the substantia nigra by a series of neurons that utilize the inhibitory neurotransmitter GABA. Higher neurons from the cerebral cortex secrete acetylcholine in the area of the corpus stratum as an excitatory neurotransmitter to coordinate movements of the body. Serotonin is not involved in these functions.

Clients with what disorder should not be given anticholinergic drugs? a. Epilepsy b. Attention deficit disorder c. Glaucoma d. Severe anxiety or hyperactivity

c. Glaucoma Anticholinergic drugs are contraindicated for patients with benign prostatic hypertrophy, myasthenia gravis, hyperthyroidism, glaucoma, tachyarrhythmia, myocardial infarction, heart failure, or conditions associated with esophageal reflux.

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? a. Instruct the client's family to continue the medication and ignore the symptoms. b. Instruct the client's family to increase the dose of the medication to combat these symptoms. c. Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider. d. Instruct the client's family to take the client to the emergency department immediately.

c. Instruct the client's family to withhold the next dose and the nurse will contact the prescribing provider. Older clients taking cholinergic blocking medications may exhibit symptoms such as excitement, mental confusion, and urinary retention. If a client is exhibiting these symptoms, the medication should be withheld for the next dose and the nurse should contact the prescribing provider. Ignoring symptoms is not advised because they could become worse. Increasing the dose would probably increase the symptoms and it is not appropriate for the nurse to change medication dosage without a provider order. It is not a medical emergency, so going to the emergency department is not necessary. The family is given the instruction due to the fact the client is confused.

A client has been prescribed an anticholinergic medication. What instructions should the nurse provide related to safety when outside in hot weather? a. Wear a hat to protect the head b. Wear sunglasses to protect the eyes c. Keep well hydrated d. Keep arms and legs covered

c. Keep well hydrated Adults taking an anticholinergic medication should be encouraged to drink plenty of fluids and to avoid hot temperatures because heat intolerance can occur and it will be important to maintain hydration should this happen. While the other options are appropriate suggestions, none are directly related to the safety issue of heat intolerance caused by the medication.

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? a. Cycloplegia b. Idiosyncrasy c. Mydriasis d. Photophobia

c. Mydriasis

An elderly woman is given scopolamine while on a cruise. She becomes very agitated and confused and is taken to the sick-bay of the ship. The nurse knows that which is a likely reason for these symptoms? a. Most elderly clients have dementia, which would prevent them from having normal, visual adverse reactions to cholinergic blocking drugs. b. Urinary retention often causes agitation. c. Older clients have a greater chance of adverse reactions to cholinergic blocking drugs. d. Elderly clients have more difficulty sleeping than regular clients, so the drowsiness that is a common side effect does not occur.

c. Older clients have a greater chance of adverse reactions to cholinergic blocking drugs. Older clients receiving cholinergic blocking drugs may have a greater chance of adverse reactions, including excitement, agitation, mental confusion, drowsiness, and urinary retention. Dementia does not prevent visual adverse effects. Urinary retention does not cause agitation. Drowsiness from cholinergic blocking drugs is unrelated to the sleep pattern of a client.

A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response? a. They block nicotinic receptors. b. They compete with serotonin for muscarinic acetylcholine receptor sites. c. They act to block the effects of the parasympathetic nervous system. d. They increase norepinephrine at the neuromuscular junction.

c. They act to block the effects of the parasympathetic nervous system. Anticholinergic drugs block the effects of the parasympathetic nervous system. Atropine is the only widely used anticholinergic drug. The drug works by blocking only the muscarinic effectors in the parasympathetic nervous system. They compete with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction.

A client with diagnoses of Parkinson's disease and hepatic disease is to begin tolcapone therapy. What monitoring intervention should be included in the client's plan of care? a. daily glucose finger sticks b. annual eye examinations c. a baseline liver function test d. regular cardiograms

c. a baseline liver function test

A client, newly diagnosed with Parkinson's disease, has been prescribed an anticholinergic drug. What assessment should the nurse perform when monitoring for adverse effects of anticholinergic agents used for the treatment of Parkinson disease? a. monitoring of laboratory results for blood dyscrasias b. focused respiratory assessment c. assessment of the client's bowel pattern d. monitoring of prothrombin time and international normalized ratio (INR)

c. assessment of the client's bowel pattern Anticholinergics often cause decreased bowel motility, resulting in constipation. This is especially true in older adults. Anticholinergics are not associated with coagulation disorders, blood dyscrasias, or respiratory problems.

Which medication is the antidote for poisoning by insecticides containing organophosphates? a. darifenacin b. solifenacin c. atropine d. benztropine

c. atropine Atropine is the antidote for poisoning by cholinergic agonists such as certain species of mushrooms, cholinergic agonist drugs, cholinesterase inhibitor drugs, and insecticides containing organophosphates.

A 72-year-old man should be aware that the adverse effects of centrally acting anticholinergic drugs include: a. gout. b. diabetes mellitus. c. confusion. d. sedation.

c. confusion. Anticholinergic drugs may cause agitation, mental confusion, hallucinations, and psychosis in the older adult.

Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to: a. decrease headaches. b. improve blurred vision. c. decrease salivation, spasticity, and tremors. d. decrease motor movement.

c. decrease salivation, spasticity, and tremors. Anticholinergic drugs are used in idiopathic parkinsonism to decrease salivation, spasticity, and tremors. They are used primarily in people who have minimal symptoms or who cannot tolerate levodopa, or in combination with other antiparkinson drugs.

A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect? a. mobility. b. perspiration. c. involuntary movements. d. appetite or thirst.

c. involuntary movements.

The nurse is caring for a homebound client who is taking trospium chloride. This client likely has a history of what health problem? a. bradycardia b. irritable bowel syndrome c. urinary urgency d. Parkinson's disease

c. urinary urgency

Which would lead the nurse to suspect that a client is experiencing an adverse effect to an anticholinergic agent? a. Diarrhea b. Diaphoresis c. Excess salivation d. Agitation

d. Agitation Agitation would be noted due to the blocking of central acetylcholine receptors. Constipation, reduced sweating, and dry mouth may be noted as well.

A client taking anticholinergic drugs should be taught to minimize the risks of heat exhaustion and heat stroke. What would be one way to meet this goal? a. Wear dark, warm clothing during the summer months b. Routinely exercise indoors c. Take frequent, cold showers in the evenings and early mornings d. Avoid extremes of temperature

d. Avoid extremes of temperature

A male client, age 75, is started on flavoxate. What adverse effect should the client be made aware of? a. Skin rash b. Urinary incontinence c. Weight gain d. Blurred vision

d. Blurred vision Some adverse effects of flavoxate include blurred vision, urinary retention, pupil dilation, photophobia, cycloplegia, increased intraocular pressure, dry mouth, constipation, and decreased sweating. Skin rash and weight gain are not noted as adverse effects of flavoxate.

The nurse is aware that cholinergic blocking agents will be used preoperatively for what type of anesthesia? a. Topical b. Local c. Regional d. General

d. General Cholinergic blocking agents are used to decrease respiratory secretions that pool in the lungs when the client's cough and swallowing reflexes are lost during general anesthesia. It would not be used prior to other forms of anesthesia unless there was the possibility of the loss of the swallowing reflexes.

Which agent would the nurse identify as acting specifically on the receptors in the GI tract? a. Ipratropium b. Tiotropium c. Trospium d. Hyoscyamine

d. Hyoscyamine Hyoscyamine acts more specifically on the receptors of the gastrointestinal tract. Ipratropium and tiotropium act more specifically to decreased respiratory secretions and cause bronchodilation. Trospium acts more specifically on the smooth muscle of the urinary tract.

Which of the following is an anticholinergic drug that may be used in the treatment of overactive bladder? a. Belladonna tincture b. Benztropine c. Trihexyphenidyl d. Oxybutynin

d. Oxybutynin Oxybutynin is prescribed in the treatment of overactive bladder.

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? a. Bethanechol b. Neostigmine c. Edrophonium d. Physostigmine

d. Physostigmine Physostigmine is a specific antidote for overdose of anticholinergics such as atropine.

A male client is prescribed an anticholinergic drug by his health care provider. He likes to hike with his grandchildren. The home care nurse instructs the client that anticholinergic medications have which effect? a. Increased sweating and the risk for heat stroke and dehydration b. Postural hypotension and increased risk for falls and from exposure to the elements c. Bradycardia in older adults, which increases the risk for falls and from exposure to the elements d. Prevents sweating and heat loss and increasing the risk of heat stroke

d. Prevents sweating and heat loss and increasing the risk of heat stroke Anticholinergic drugs are commonly used in home care with children and adults. The home care nurse may need to teach older clients or caregivers that the drugs prevent sweating and heat loss and increase risks of heat stroke if precautions to avoid overheating are not taken.

Unwanted anticholinergic effects include: a. wakefulness, mental alertness, and decreased fatigue. b. drowsiness or sleep; decreased muscle tone; and decreased ability to move. c. increasing hyperactivity, excessive talking, nervousness, and insomnia. d. constipation and dry mouth.

d. constipation and dry mouth. Unwanted anticholinergic effects include dry mouth, constipation, and mydriasis.

While preparing a client for an eye examination, the nurse explains that the eyedrops, an ophthalmic anticholinergic preparation, will cause what pupil reaction? a. brisk response b. constriction c. temporary fixation d. dilation

d. dilation

A client with hypertension is to receive an anticholinergic agent. The nurse would be especially alert for: a. bladder obstruction. b. paralytic ileus. c. increased intraocular pressure. d. increased blood pressure.

d. increased blood pressure. A client with hypertension who receives an anticholinergic is at risk for additive hypertensive effects due to the dominance of the sympathetic system with parasympathetic blockage. Bladder obstruction, paralytic ileus, and increased intraocular pressure are contraindications for the use of an anticholinergic agent.

A client whose Parkinson's disease is being treated with tolcapone should concurrently take what drug? a. benztropine b. ipratroprium c. atropine d. levodopa/carbidopa

d. levodopa/carbidopa

What is the goal of carbidopa drug therapy when given in conjunction with levodopa? a. prevention of a cholinergic crisis b. reduction of the anticholinergic effects of levodopa c. prevention of extrapyramidal effects d. reduction of the necessary dose of levodopa

d. reduction of the necessary dose of levodopa

A nurse is reviewing a client's history for conditions that would contraindicate the use of anticholinergics for Parkinson's disease. Which would cause the nurse to be concerned? a. Myasthenia gravis b. Cardiac arrhythmia c. Hypertension d. Hepatic dysfunction

A Anticholinergics are contraindicated for clients with myasthenia gravis, which could be exacerbated by the blocking of acetylcholine receptor sites at the neuromuscular synapses. Hypertension, hepatic dysfunction, and cardiac arrhythmia would require cautious use.

A nurse is making a care plan for a client with Parkinson's disease and has started on an antiparkinson medication. Which nursing diagnosis would be appropriate for this client's care plan? (Select all that apply.) A) Imbalanced Nutrition: Less than Body Requirements B) Altered Bowel Movements: Constipation C) Risk for Injury D) Altered Bowel Movements: Diarrhea E) Imbalanced Nutrition: More than Body Requirements

A) Imbalanced Nutrition: Less than Body Requirements B) Altered Bowel Movements: Constipation C) Risk for Injury

A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa? A) Pyridoxine (vitamin B6) B) Cyanocobalamin (vitamin B12) C) Phylloquinone (vitamin K1) D) Ascorbic acid (vitamin C)

A) Pyridoxine (vitamin B6)

A 46-year-old woman is taking benztropine mesylate (Cogentin). The nurse teaches her which of the following? A. avoid overheating and stay well hydrated B. double the dose with excess secretions C. report diarrhea to the prescriber D. administer benztropine with phenothiazines

A. avoid overheating and stay well hydrated

The 56-year-old man is taking levodopa/carbidopa for Parkinson's disease. During the therapy, he becomes light-headed and dizzy. Which of the following is a potentially serious adverse effect of the drug treatment? A. orthostatic hypotension B. diminished fluid volume C. hematuria D. jaundice

A. orthostatic hypotension

Which comment to the nurse indicates more teaching is needed for a patient taking carbidopa/levodopa? A."I know I need to take this drug once a day." B."I know I shouldn't stop taking this drug abruptly." C."I understand my urine may become dark and discolored." D."I know it may take a few weeks or months to control my symptoms."

A."I know I need to take this drug once a day." (A statement from the patient such as "I know I need to take this drug once a day" indicates that more teaching is needed because carbidopa/levodopa has a short half-life and must be taken three or four times per day. The other answers are true.)

A patient has been diagnosed with chronic obstructive pulmonary disease. The patient is to be administered tiotropium bromide (Spiriva HandiHaler). The patient's creatinine level is 25. What is the patient at risk for developing? A) Drug toxicity B) Pneumonia C) Hepatotoxicity D) Central nervous system depression

Ans: A Feedback:The patient has an elevated creatinine level. Tiotropium bromide is eliminated by therenal system, and patients with moderate to severe renal dysfunction should be carefullymonitored for drug toxicity.

The nurse is teaching a woman who has Parkinson's disease about the dietary implications of her upcoming treatment with levodopa/carbidopa. What should the nurse teach this patient? A) "It's important to take this medication on a full stomach so that it doesn't make you nauseous." B) "Most people find that it's best to take this medication at bedtime, provided you haven't snacked in the evening." C) "If possible, try to eat extra protein when you're taking this medication." D) "Dairy products will make this medication ineffective, so make sure you don't take them at the same time."

Ans: A Feedback: Levodopa/carbidopa is administered with or just after food or following a meal to reduce nausea and vomiting. Levodopa/carbidopa is not administered with a highprotein diet. Dairy products do not interfere with pharmacokinetics.

An 80-year-old patient has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What patient education should be provided? A) "Avoid high environmental temperatures." B) "Anticholinergics increase mental alertness." C) "It is safe to take Sudafed for a cold." D) "You may experience urinary incontinence."

Ans: A Feedback: Anticholinergic drugs decrease sweating and may cause heat stroke. The patient should be instructed to avoid high environmental temperatures. Anticholinergic agents will decrease mental alertness. Sudafed will produce anticholinergic effects and should not be administered. Anticholinergic agents produce urinary retention, not incontinence.

A patient has developed symptoms of rigidity and bradykinesia. Which of the following medications has been linked to secondary parkinsonism? A) Haloperidol B) Furosemide (Lasix) C) Psyllium hydrophilic mucilloid (Metamucil) D) Valproic acid (Valproate)

Ans: A Feedback: Drugs that deplete dopamine stores or block dopamine receptors, including the older antipsychotic drugs (phenothiazines and haloperidol), reserpine, and metoclopramide, can produce movement disorders such as secondary parkinsonism. Furosemide does not deplete dopamine stores. Psyllium does not deplete dopamine stores. Valproic acid does not deplete dopamine stores.

A patient is being treated for Parkinson's disease and has been prescribed both levodopa (L-dopa) and carbidopa (Lodosyn). Why is this course of combination treatment most effective? A) Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa. B) Levodopa decreases the toxic effects of carbidopa to reduce the extrapyramidal reaction. C) Carbidopa increases the peripheral breakdown of levodopa to hasten its onset and peak. D) Levodopa and carbidopa, when combined, enhance voluntary movement to improve gait.

Ans: A Feedback: Levodopa restores dopamine levels and, in combination with carbidopa, decreases the peripheral breakdown of levodopa and allows more to reach the brain. Levodopa does not decrease the toxic effects of carbidopa to reduce the extrapyramidal reaction. Carbidopa does not increase the peripheral breakdown of levodopa to increase its effectiveness. Levodopa and carbidopa combined do not exacerbate abnormal voluntary movement to increase gait.

A patient is administered atropine to increase the heart rate. What is the action of atropine? A) It blocks the parasympathetic vagal stimulation. B) It exacerbates the parasympathetic vagal stimulation. C) It provides long-acting antihistamine blockage. D) It blocks cell wall synthesis of gram-negative bacilli.

Ans: A Feedback:Moderate to large doses of atropine increase the heart rate by blocking parasympatheticvagal stimulation. The exacerbation of the parasympathetic vagal stimulation is oppositethe effect of atropine. The blockage of histamine is seen with the antihistamine medications, not anticholinergic agents. Atropine does not block cell wall synthesis.

A patient with Parkinson's disease is being treated with rasagiline (Azilect). This medication inhibits the metabolism of dopamine by monoamine oxidase. Which of the following foods should the patient be instructed to avoid? A) Cheddar cheese and Polish sausage B) Ham and rye bread C) Roast beef and horseradish D) Dairy products

Ans: A Feedback:Cheddar cheese and Polish sausage are high in tyramine, which produces a lifethreatening reaction of hypertension when combined with rasagiline. The other listedfoods are not high in tyramine.

A patient with myasthenia gravis is experiencing rhinorrhea. Which of the following medications should not be administered to the patient? A) Azelastine hydrochloride (Astelin) B) Ipratropium (Atrovent) C) Fexofenadine (Allegra) D) Nedocromil sodium (Tilade)

Ans: B Feedback: Ipratropium (Atrovent) is administered for rhinorrhea, but is contraindicated in patientswho have been diagnosed with myasthenia gravis because of its anticholinergic effects.Azelastine hydrochloride (Astelin), fexofenadine (Allegra), and nedocromil sodium(Tilade) are not contraindicated for patients with myasthenia gravis.

A patient is scheduled for a hemithyroidectomy. She has been prescribed an anticholinergic agent prior to surgery. Why is it important to administer the anticholinergic agent in the preoperative phase? A) It will prevent tachycardia. B) It will decrease respiratory secretions. C) It will decrease gastric motility. D) It relaxes the detrusor muscle.

Ans: B Feedback: In preoperative patients, the nurse assesses for diminished secretions, particularly when an anticholinergic is administered for head and neck surgery. The administration of an anticholinergic agent will not prevent tachycardia. Anticholinergic agents do decrease gastric motility, but this rationale is not a reason for administration in the preoperative phase. The anticholinergic agents cause relaxation of the detrusor muscle, but this rationale is not the reason for administration of the medication in the preoperative phase.

A patient has been administered atropine for sinus bradycardia. Which of the following symptoms is noted with large doses of atropine? A) Pallor B) Flushing C) Edema D) Incontinence

Ans: B Feedback: Large doses of atropine cause facial flushing because of dilation of blood vessels in the neck. Pallor, edema, and incontinence are not caused by dilation of blood vessels in the neck.

A 77-year-old male patient with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone (Stalevo). Prior to starting this course of treatment, the nurse must ensure that A) the patient has committed to having weekly blood work drawn for the next 2 months. B) the patient has completed an anticholinergic challenge in a clinical setting. C) the patient's existing dose of levodopa has been reduced. D) the patient has a prognosis for complete recovery from Parkinson's disease.

Ans: B Feedback: Patients whose medication regime is being changed to Stalevo should be administered levodopa and the adjunctive entacapone. The levodopa dose should be adjusted prior to the conversion to Stalevo therapy. Weekly blood work and the completion of an anticholinergic challenge are not necessary. Complete recovery from Parkinson's disease is not a realistic goal.

A patient with long-standing Parkinson's disease has been prescribed entacapone (Comtan). The patient asks the nurse to describe exactly how this medication works. Which of the following responses is most appropriate? A) "Entacapone is best given parenterally to relieve symptoms." B) "Entacapone inhibits COMT so that dopamine is active for a longer time." C) "It increases the metabolism of levodopa in the bloodstream." D) "It increases the amount of dopamine that your brain creates."

Ans: B Feedback: Entacapone is a COMT inhibitor. COMT plays a role in brain metabolism of dopamine.Entacapone is administered orally, not parenterally. Entacapone does not increase themetabolism of dopamine in the bloodstream. It inhibits the metabolism of levodopa inthe blood stream. Entacapone is 90% excreted in the biliary tract and feces and 10% in the urine.

A patient has been administered chlorpromazine (Thorazine) for many years to treat his psychotic disorder. He has recently developed extrapyramidal symptoms related to longterm administration of this drug. Which of the following medications can be administered to assist in relieving these symptoms? A) Diazepam (Valium) B) Darifenacin (Enablex) C) Trihexyphenidyl (Trihexy) D) Trospium chloride (Sanctura)

Ans: C Feedback:Trihexyphenidyl (Trihexy) is used in the treatment of parkinsonism and extrapyramidalreactions caused by antipsychotic drugs. Valium is a benzodiazepine and is not used for this purpose. Darifenacin is used for the treatment of overactive bladder. Trospiumchloride (Sanctura) reduces the tone of the smooth muscle in the bladder.

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? A) Belladonna tincture B) Homatropine hydrobromide C) Hyoscyamine (Anaspaz) D) Ipratropium (Atrovent)

Ans: C Feedback: Hyoscyamine (Anaspaz) is a belladonna alkaloid used in genitourinary disorders characterized by spasm, increased secretion, and increased motility. Belladonna tincture is used for GI disorders because of its antispasmodic effect. Homatropine hydrobromide is used as an eyedrop to produce mydriasis and cycloplegia. Ipratropium (Atrovent) is used to treat rhinorrhea.

The physician orders benztropine mesylate (Cogentin). What disease process would contraindicate the administration of this anticholinergic medication? A) Diabetes mellitus B) Myocardial infarction C) Narrow-angle glaucoma D) Hyperparathyroidism

Ans: C Feedback: Narrow-angle glaucoma will result in increased intraocular pressure, and the patient should not receive the anticholinergic agent. Patients who suffer from diabetes mellitus, myocardial infarction, or hyperparathyroidism can normally be administered anticholinergic agents.

A 60-year-old male patient has developed a tremor of the right hand with a pill-rolling motion. Upon interviewing the patient, he states he sustained several head injuries playing football. Based on this information, what do you suspect the patient is suffering from? A) Seizure disorder B) Degenerative joint disease C) Amyotrophic lateral sclerosis D) Parkinson's disease

Ans: D Feedback: Parkinson's disease is a chronic, progressive, degenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, rigidity, and postural instability. The patient is not experiencing degenerative joint disease. The patient is not showing signs of symptoms of a seizure disorder. The patient has rigidity with tremors, not the signs of muscle weakness that are found in amyotrophic lateral sclerosis.

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? A) "I will place it on my chest each morning." B) "I will use it when I am sick to my stomach." C) "I will change the patch every 4 hours." D) "I will change the patch every 3 days."

Ans: D Feedback: Scopolamine is used for motion sickness. The disk (Transderm-V) protects against motion sickness for 72 hours. The scopolamine patch is applied behind the ear, not to the chest. The patch is used prior to the patient experiencing nausea. The patch is not changed every 4 hours.

A woman is admitted to the emergency department with a diagnosis of sinus bradycardia. The patient has been prescribed atropine 0.5 mg IV. How often can atropine be administered? A) Every 24 hours B) Every 6 hours C) Every 30 minutes D) Every 3 to 5 minutes

Ans: D Feedback: Atropine 0.5 mg should be administered IV every 3 to 5 minutes and may be repeated up to 3 mg. Atropine can be administered every 24 hours, but this administration is not the recommended therapy for bradycardia. Atropine can be administered every 6 hours, but this administration is not the recommended therapy for bradycardia. Atropine can be given in 30 minutes, but this administration is not the recommended therapy for bradycardia.

A patient with Parkinson's disease has been prescribed rasagiline. When educating this patient on this medication, which herbal supplement has the potential to produce hyperpyrexia and death with rasagiline? A) Ginger B) Dextromethorphan C) Garlic D) St. John's wort

Ans: D Feedback: Rasagiline administered with the herbal supplement St. John's wort will enhance the stimulation of serotonergic receptors to cause hyperpyrexia and death. Dextromethorphan can produce the same reaction but is not an herbal supplement. Ginger and garlic are herbal supplements but will not produce hyperpyrexia and death.

A patient who suffers from Parkinson's disease is being treated with levodopa/carbidopa. Which of the following disorders will result in the discontinuation of this drug based on a disease-related contraindication? A) Human immune deficiency virus B) Human papillomavirus C) Transient ischemic attacks D) Narrow-angle glaucoma

Ans: D Feedback:Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated innarrow-angle glaucoma. Levodopa is not contraindicated in patients with humanimmune deficiency virus. Levodopa is not contraindicated in patients with humanpapillomavirus. Levodopa is not listed as a contraindication with TIAs.

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? A) Tachycardia B) Bradycardia C) Hypertension D) Dehydration

B) Bradycardia Anticholinergic drugs are given preoperatively to prevent anesthesia-associated complications such as bradycardia, excessive respiratory secretions, and hypotension.