Nurs 125- Chapter 32: Cholinergic Agonists PrepU
A client who has been prescribed bethanechol asks a nurse to explain how the drug works. What would be a correct response?
"Bethanechol is a direct-acting cholinergic drug that causes contraction of the smooth muscles of the bladder and passage of urine."
The nurse is providing education to the caregiver of a client who has been prescribed donepezil. What statement should the nurse include in the teaching?
"It's important to take this medication at bedtime."
The pharmacology instructor is discussing age-related susceptibility to adverse effects of cholinergic drugs. Which statement could the instructor make to accurately describe the influence of age?
"Physiologic changes resulting from the normal aging process place older adults at higher risk for adverse effects."
A nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral administration?
30 to 90 minutes
A nurse has administered a drug that will have a therapeutic effect on the client's parasympathetic nervous system. The nurse understands the drug will primarily affect what neurotransmitter?
Acetylcholine
When describing the parasympathetic nervous system to a group of students, which substance would the nursing instructor discuss as being responsible for transmission of nerve impulses across this system?
Acetylcholine
A 40-year-old, diagnosed with myasthenia gravis (MG), is scheduled to begin treatment with oral neostigmine. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on what personal behavior?
Adhering strictly to the prescribed administration schedule
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?
Alzheimer's disease
Decreased acetylcholine levels are characteristic of what disorder?
Alzheimer's disease.
The nurse is providing education to a client who has been prescribed an anticholinesterase drug. What caution would the nurse include in the teaching?
Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration.
A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent?
Atropine
A nurse is caring for a 49-year-old client who has been taking bethanechol for treatment of neurogenic bladder. After one week, the client develops sweating, heavy salivation, and bronchospasm. What would the nurse suspect is happening with this client?
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?
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?
Atropine
An adult client with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this client's health problem is ultimately attributable to what pathophysiologic process?
Autoimmune destruction of acetylcholine receptors
A client is experiencing urinary retention after surgery. The nurse would anticipate administering:
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 identify which drug?
Bethanechol
A patient is brought to the emergency department following a bicycling accident. The patient is diagnosed with multiple injuries, including bladder obstruction. What might occur if this patient is administered a cholinergic drug?
Bladder rupture
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?
Bronchoconstriction
A nurse is caring for a 49-year-old client who has been taking bethanechol for treatment of neurogenic bladder. After one week, the client develops sweating, heavy salivation, and bronchospasm. What would the nurse suspect is happening with this client?
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?
Cholinergic crisis
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?
Cholinergic overdose
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?
Cholinergic stimulation in her infant
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?
Contact the health care provider as the client may be experiencing a cholinergic crisis.
The client is to receive an IV cholinergic medication. When the nurse administers the drug what reaction will the nurse anticipate?
Decrease in heart rate
The nursing instructor is teaching students about Alzheimer's disease. The instructor informs the students that clients with this illness experience problems with memory and thinking. The reason that this happens is which?
Degeneration of cholinergic pathways
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?
Direct-acting cholinergic drug
A 65-year-old male client takes cholinergic medication. He presents to the emergency department with symptoms associated with GI distress. He is diagnosed with a small bowel obstruction. What action would the nurse expect the health care provider to take?
Discontinue the cholinergic medication to prevent injury to the areas proximal to the obstruction
Which agent would be most appropriate to administer to a client with Alzheimer's disease?
Donepezil
Which medication would the nurse expect to administer orally once a day to a client with Alzheimer disease (AD)?
Donepezil
A nurse is caring for a client who is taking rivastigmine. The client's nursing care plan will prioritize which nursing diagnosis?
Imbalanced Nutrition: Less Than Body Requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy
The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms?
Improve cholinergic neurotransmission to the brain
The nurse administered donepezil (Aricept) to a patient. What is the therapeutic response the nurse expects to assess?
Improved memory
A patient with dementia of Alzheimer's disease is administered donepezil HCL. What are the actions associated with cholinesterase inhibitors?
Increase in the level of acetylcholine in CNS
Which physiologic effect would be related to the use of cholinergic agents?
Increased salivation
The nurse administers a drug that will increase micturition. What should the nurse assess for a therapeutic effect?
Increased voiding
A client diagnosed with myasthenia gravis is administered a cholinergic drug named neostigmine. How does this drug produce its therapeutic effect?
It stimulates the parasympathetic nervous system.
A client receives carbachol eye drops. Which effect would the nurse expect to assess?
Miosis
When describing the action of direct-acting cholinergic agonists, which receptors would the nurse identify as being stimulated?
Muscarinic
A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem?
Myasthenia gravis
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?
Neostigmine
The nursing instructor is discussing cholinergic drugs. The nursing students understand what system is acted upon by this family of drugs?
Parasympathetic nervous system
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?
Parkinson's disease
A patient has been newly diagnosed with myasthenia gravis. What nursing intervention is appropriate?
Recommend that one or more members of the patient's family learn CPR.
Which symptom, if assessed after the administration of donepezil (Aricept), would be cause for alarm?
Reports of nausea, vomiting, and cramping
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?
Restore anticholinesterase function
The nurse is developing a teaching plan for an outpatient receiving cholinergic drugs. What should be the role of the nurse when developing a teaching plan?
Review the purpose of the drug therapy with the patient and family.
A nursing student is preparing a care plan and is choosing a nursing diagnosis for her client with Alzheimer's disease. The client is taking Exelon. Which would be an appropriate nursing diagnosis for this client?
Risk for Injury related to dizziness and fatigue
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?
Rivastigmine
The nurse is developing a care plan for a client who will receive donepezil in the home setting. How can the nurse best facilitate safe and effective administration of the medication?
Teach the client's caregiver to administer the medication in a timely and safe manner.
The client has been prescribed a cholinergic agonist. Which statement is true concerning the administration of cholinergic agonists?
The parasympathetic nervous system is stimulated by these medications.
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?
This is cholinergic crisis, and the provider needs to be notified immediately.
When assessing a client for possible adverse effects of direct-acting cholinergic agents, what might the nurse find?
Urinary urgency
After reviewing information about cholinesterase inhibitors, a group of nursing students demonstrate understanding of the information when they identify which as an adverse effect? Select all that apply.
anorexia, dizziness, diarrhea
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:
atropine
A 78-year-old man is admitted to the emergency department (ED) with bradycardia resulting from overdose of donepezil. The nurse knows that the ED is likely to order which medication?
atropine
What drug is prescribed for mushroom poisoning?
atropine
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?
bethanechol
The nurse is caring for a client who is receiving neostigmine for the treatment of myasthenia gravis. The nurse is aware that a potential complication of the treatment is cholinergic crisis, which is characterized by which event?
excessive stimulation of the parasympathetic nervous system
The client in the final stage of Alzheimer's disease tends to suffer from weight loss and eating problems. This is primarily due to:
inability to swallow.
The caregiver of a client with Alzheimer disease (AD) tells the nurse that the client's medication is supplied as a patch applied to the skin. The nurse identifies this as which drug?
rivastigmine
A middle-aged client is being treated for myasthenia gravis with neostigmine. What change in the client's health status would warrant immediate medical follow-up?
sudden muscle weakness
A client is taking rivastigmine for Alzheimer disease. The nurse will evaluate the client regularly for:
weight loss.