Seizures, Autonomic and Neurodegenerative Disorders

Hydantoins are a common anticonvulsant used to control partial and generalized tonic-clonic seizures. Which assessment finding in a patient receiving a hydantoin does the nurse report to the healthcare provider? a. Gingival hyperplasia b. Drowsiness and fatigue c. Elevated blood glucose d. Drug blood levels within therapeutic range

c. Elevated blood glucose

***Begin Chapter 14: Drugs Used to Treat Neurodegenerative Disorders***

***End Chapter 12: Drugs Affecting the Autonomic Nervous System****

***Begin Chapter 18: Drugs Used for Seizure Disorders***

***End Chapter 14: Drugs Used to Treat Neurodegenerative Disorders***

Parkinson's disease symptoms

-Begins insidiously with a resting "pill-rolling" tremor of one hand -Cardinal signs include tremor, rigidity, akinesia, postural instability, falling backwards (retropulsion) or forwards (propulsion), mask face, micrographia

MD writes an order for Dilantin 100 mg by mouth daily. Pharmacy dispenses you with 0.5 gram per capsule of Dilantin. How many capsules do you administer per dose? A. 2 capsules/dose B. 0.5 capsules/dose C. 0.2 capsules/dose D. 3 capsules/dose

C. 0.2 capsules/dose

Monoamine Oxidase Type B Inhibitors reduces the rate at which dopamine is metabolized and this allows for increased dopaminergic activity to occur. A patient taking rasagiline or selegiline has the following dosages available.

Rasagiline > Avail. = 0.5-1mg , take 1mg qd Selegiline > Avail. = 5mg tab/cap , take 5mg qd > Avail. = 1.25mg/disintergrating tabs take 2.5mg dis. tabs qd

A patient with a history of seizures experienced a tonic-clonic seizure in the last half hour and is now very drowsy, but arousable. The family asks if this is a concern. What is the nurse's best response? a. "This is a normal occurrence after a seizure. It's called the 'postictal state'." b. "This is the atonic stage of a seizure." c. "This is not a normal part of a seizure. I'll notify the healthcare provider." d. "The medication she was given to stop her seizure shouldn't make her this drowsy."

a. "This is a normal occurrence after a seizure. It's called the 'postictal state'."

Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patient's ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

a. Determine patient's ancestry. *Asians & South Asian Indians at increased risk for fatal skin rash

What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson's disease? a. Dopamine does not cross the blood-brain barrier when administered orally. b. Levodopa is much less expensive. c. The half-life of dopamine is too short. d. Dopamine has too many reactions with other medications

a. Dopamine does not cross the blood-brain barrier when administered orally. *Dopamine cannot cross the BBB bc it doesn't have a transporter and it's too polarized to be lipid soluble.

What is the physiologic cause of tremors in patients with Parkinson's disease? a. Increase in the amount of acetylcholine in the brain b. Increase in the amount of dopamine produced in the substantia nigra c. Overgrowth of the substantia nigra in the brain d. Lack of oxygen to the brain during respiratory distress

a. Increase in the amount of acetylcholine in the brain

Parkinson's disease has which characteristic symptom(s)? (Select all that apply.) a. Muscle tremors b. Posture alterations c. Muscle flaccidity d. Tachycardia e. Slow body movement

a. Muscle tremors b. Posture alterations (rigidity) e. Slow body movement

Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.) a. Nausea b. Hypertension c. Dizziness d. Bradycardia e. Constipation

a. Nausea c. Dizziness d. Bradycardia *slows HR and stimulates GI

What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea

a. Nausea, vomiting, and indigestion are common during the initiation of therapy. *s/e during initial therapy

Common adverse effects to Cholinergic Agents include: (select all that apply) a. Nausea/Vomiting/Diarrhea, b. Ataxia c. Abdominal cramping, d. Dizziness, e. Hypotension

a. Nausea/Vomiting/Diarrhea, c. Abdominal cramping d. Dizziness e. Hypotension

Norephinepherine and Acetylcholine are the two major neurotransmitters of the ANS; each neurotransmitter is liberated by fibers. (select all that apply) a. Norephinepherine is liberated by adrenergic fibers b. Norephinepherine is liberated by cholinergic fibers c. Acetylcholine is liberated by adrenergic fibers d. Acetylcholine is liberated by cholinergic fibers

a. Norephinepherine is liberated by adrenergic fibers d. Acetylcholine is liberated by cholinergic fibers

A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.) a. Palpitations b. Dizziness c. Orthostatic hypotension d. Hypoglycemia e. Tremors f. Bradycardia

a. Palpitations b. Dizziness c. Orthostatic hypotension e. Tremors

The nurse is preparing to administer zonisamide (Zonegran) to a newly admitted patient with the diagnosis of adult partial seizures. The nurse should hold this medication if the patient has which sign(s) or symptom(s)? (Select all that apply.) a. Skin rash b. Urinary frequency c. Drowsiness d. Allergy to Bactrim e. Pruritus

a. Skin rash d. allergy to Bactrim e. Pruritus *Zonegran is a sulfonamide; this may be an allergic reaction to sulfa

Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril)

a. Topiramate (Topamax) *Topir-might get rid of my headache.

Valporic Acid (Depakote) is a single-drug therapy indicated for combination of tonic-clonic, absence, myoclonic seizures. It is also used to treat which of the following: a. acute mania of bipolar disorder b. schizophrenia c. major depressive disorder d. generalized anxiety disorder

a. acute mania of bipolar disorder *metabolite of VA is ketone

When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the: a. cheese. b. eggs. c. bread. d. coffee.

a. cheese. *avoid foods high in tyramine

Pregabalin (Lyrica) is indicated for the management of partial seizures and the treatment for pain associated with fibromyalgia along with: a. diabetic neuropathy b. mortons neuroma c. tardive dyskinesia d. spinal bifida

a. diabetic neuropathy

Medication safety alert for pregabalin (Lyrica) includes monitoring for all of the following except: (select all that apply) a. drug abuse b. drug seeking behaviors c. therapeutic management d. dosage escalation e. intolerance

a. drug abuse b. drug seeking behaviors d. dosage escalation

Neurotransmitter(s) include: (Select all that apply.) a. gamma aminobutyric acid. b. acetylcholine. c. serotonin. d. glucose. e. histamine. f. epinephrine.

a. gamma aminobutyric acid. b. acetylcholine. c. serotonin. e. histamine. f. epinephrine.

The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patient's: (Select all that apply.) a. mobility. b. orientation. c. intellectual ability. d. alertness. e. vital signs.

a. mobility. b. orientation. d. alertness. e. vital signs.

Therapeutic outcomes for Topamax (topiramate) include which of the following: (select all that apply) a. reduced frequency of seizures b. reduced injuries r/t seizures c. reduced motor function d. minimal adverse effects from drug therapy

a. reduced frequency of seizures b. reduced injuries r/t seizures d. minimal adverse effects from drug therapy

The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching? a. "This medication will help slow the development of symptoms." b. "I will place the tablet on my tongue before breakfast." c. "I may need to use a stool softener for constipation." d. "I should not push the tablet through the foil."

b. "I will place the tablet on my tongue before breakfast." *Selegiline(Eldepryl) prevents the breakdown of dopamine in your brain.

The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction? a. "I may feel tired at first, but this should improve with continued use." b. "Once my pain improves, I will stop taking this medication." c. "Taking sleeping aids will increase the sedative effect of this medication." d. "This drug may affect my mental alertness, so I need to be careful around machinery."

b. "Once my pain improves, I will stop taking this medication." *umm have you considered your pain stopped because the medication is working. ugh

A patient with chronic obstructive pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy. Which explanation by the nurse is most accurate? a. "The symptoms are typical and indicate that the medication is at a therapeutic level." b. "The symptoms will tend to resolve with continued therapy." c. "The symptoms are unusual and need to be reported to the healthcare provider immediately." d. "The symptoms are indicative of toxicity."

b. "The symptoms will tend to resolve with continued therapy."

A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta-adrenergic blocking agent. Which statement by the patient indicates a need for further teaching? a. "This medication should not be discontinued suddenly." b. "This medication lowers my blood pressure by helping me get rid of fluid." c. "I may not have my usual symptoms of a hypoglycemic reaction while on this drug." d. "This medication may take a few weeks to work."

b. "This medication lowers my blood pressure by helping me get rid of fluid." *Beta dilates vessels. It is not a diuretic

MD writes an order for a patient to receive a daily total dose of 1000 mg of Sinemet. This dosage is to be divided into 3 doses throughout the day. It is time for the second dose. Pharmacy dispenses you with 250 mg tablets. How many tablets do you administer with this dose? a. 2 tabs/dose b. 1.3 tab/dose c. 3.25 tab/dose d. 8 tab/dose

b. 1.3 tab/dose *always ask if it is a clinically acceptable dose

What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder? a. 5 mg/min b. 30 mg/min c. 60 mg/min d. 100 mg/min

b. 30 mg/min

Which nerve endings liberate norepinephrine? a. Cholinergic b. Adrenergic c. Anticholinergic d. Muscarinic

b. Adrenergic

Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynaud's disease? a. Adrenergic agents b. Alpha-adrenergic blocking agents c. Beta-adrenergic blocking agents d. Cholinergic agents

b. Alpha-adrenergic blocking agents So...it's excessive constriction and 'alpha' constricts, if it is alpha blocking then it is working against the constriction.

Which vitamin will reduce the therapeutic effects of levodopa? a. A b. B6 c. C d. D

b. B6 *inhibits absorption

The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct? a. This medication is not to be taken with carbidopa levodopa. b. Dosage is adjusted according to the patient's response. c. There will be fewer incidences of dopaminergic effects, such as confusion. d. This medication increases the production of dopamine in the brain.

b. Dosage is adjusted according to the patient's response.

The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experiencing? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation

b. Hyperglycemia

Which statement(s) is/are true about efferent nerves? (Select all that apply.) a. They transmit signals to the spinal cord and brain. b. They leave the CNS to carry impulses to other body parts. c. They are part of the peripheral nervous system. d. They transmit signals that control contractions of smooth and skeletal muscles. e. They transmit signals that control contractions of some glandular secretions.

b. They leave the CNS to carry impulses to other body parts. c. They are part of the peripheral nervous system. d. They transmit signals that control contractions of smooth and skeletal muscles. e. They transmit signals that control contractions of some glandular secretions. *Efferent (Motor) nerves leave the CNS and carry impulses to the rest of the body.

What is the drug of choice when treating a generalized tonic-clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

c. Valproic acid (Depakene)

Baseline assessment and obtaining a thorough history are important for consideration of prescribing or taking any medication. What additional information would the nurse ask a patient who was taking Pramipexole (Mirapex)? a. "How are your sleeping and eating habits?" b. "Do you find yourself short of breath upon waking?" c. "Do you see things that aren't there, feel forgetful and have nightmares?" d. "Do you experience severe abdominal pain with bowel movements?"

c. "Do you see things that aren't there, feel forgetful and have nightmares?" *A serious adverse effect of this medication is hallucinations, anxiety, nightmares and dementia

A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? a. "These drugs help you urinate." b. "These drugs will decrease your eye pressure." c. "These drugs inhibit the action of acetylcholine." d. "These drugs will assist in lowering your heart rate."

c. "These drugs inhibit the action of acetylcholine." *acetylcholine is part of the ANS and contracts smooth muscle as seen in Parkinson's with muscle tremors.

The autonomic nervous system can be subdivided into which types of adrenergic receptors? a. Nicotinic and muscarinic b. Afferent and efferent c. Alpha and beta d. Agonists and antagonists

c. Alpha and beta *alpha- and beta-adrenergic receptors

Which term describes the collective symptoms of blurred vision; constipation; urinary retention; and dry nose, mouth, and throat? a. Dehydration b. Toxic effects c. Anticholinergic effects d. Cholinergic action

c. Anticholinergic effects *can't see, can't shit, can't spit

Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously? a. Hypertension b. Raynaud's phenomenon c. Emphysema d. Cardiac dysrhythmias

c. Emphysema *beta-adrenergic blockers can produce severe bronchospasm

Although the mechanism of seizure activity is not well understood, what is the major action of anticonvulsants? a. Lowering the seizure threshold b. Increasing the effect of gamma-aminobutyric acid (GABA) c. Raising the seizure threshold d. Increasing the excitability of brain cell firing

c. Raising the seizure threshold

What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor? a. Slows the deterioration of dopaminergic nerve cells. b. Inhibits the relative excess of dopaminergic activity. c. Reduces the destruction of dopamine in peripheral tissues. d. Enhances the cholinergic symptoms of Parkinson's disease.

c. Reduces the destruction of dopamine in peripheral tissues.

Dopamine agonists have been linked with which adverse effects in patients with Parkinson's disease? a. Oculogyric crisis b. Tardive dyskinesia c. Sudden sleep events d. Akathisia

c. Sudden sleep events *d/t increase in dopamine

Why are beta blockers used cautiously in patients with respiratory conditions? a. They mask the signs and symptoms of acute hypoglycemia. b. They cause extensive vasodilation and cardiac overload. c. They may produce severe bronchoconstriction. d. They increase hypertensive episodes.

c. They may produce severe bronchoconstriction. *beta dilates, so if blocked- it then constricts

Adrenergic drugs are known to cause what common adverse effect? a. Drowsiness b. Cardiac dysrhythmias c. Tremors d. Bradycardia

c. Tremors

Which cholinergic symptoms of Parkinson's disease are reduced with anticholinergic drugs? a. Cognitive impairments b. Rigidity c. Tremors and drooling d. Postural abnormalities

c. Tremors and drooling

What is the primary response to alpha-1-receptor stimulation? a. Bronchodilation b. Tachycardia c. Vasoconstriction d. Uterine relaxation

c. Vasoconstriction

The pediatric nurse is caring for a patient diagnosed with refractory seizures. The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of: a. fat. b. salt. c. carbohydrates. d. vitamin K.

c. carbohydrates. *refractory means that it isn't controlled by meds. Keto is a diet fueled by healthy fats

A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patient's current list of medications, the nurse decides to hold the next dose of: a. dextromethorphan. b. levodopa. c. ciprofloxacin. d. Valium

c. ciprofloxacin. *cipro inhibits rasagiline

A tonic-clonic seizure is also commonly known as a: a. absent seizure b. partial seizure c. grand mal seizure d. focal seizure

c. grand mal seizure

The nurse is teaching a patient with Parkinson's disease about levodopa. Which statement by the nurse is accurate regarding drug administration? a. "Take this medication in between meals." b. "Take this medication at bedtime to prevent dizziness." c. "Take this medication when your tremors get worse." d. "Take this medication with food or antacids to reduce GI upset."

d. "Take this medication with food or antacids to reduce GI upset."

What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously? a. Deliver rapidly. b. Monitor for signs of tachycardia. c. Assess for hypertensive crisis. d. Administer without mixing with other medications

d. Administer without mixing with other medications *should administer slowly at a rate of 25-50 mg/min

Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the healthcare provider.

d. Advise the patient that this adverse effect usually resolves but should be reported to the healthcare provider. *serious adverse of Lamictal is aseptic meningitis

Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? a. Hypertension b. Infectious diseases c. Diabetes d. Closed-angle glaucoma

d. Closed-angle glaucoma

The nurse is assessing an older patient with Parkinson's disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the healthcare provider? a. Constipation b. Brownish orange urine c. Drowsiness d. Dizziness

d. Dizziness

Which adverse effect of benzodiazepines is considered serious? a. Drowsiness b. Dizziness c. Blurred vision d. Elevated liver enzymes

d. Elevated liver enzymes

Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia

d. Gingival hyperplasia

A patient hospitalized in an acute care setting reports to the nurse that since starting on an adrenergic medication, he has been feeling "dizzy and weak." The most appropriate action for the nurse is to: a. immediately notify the physician. b. teach the patient to move slowly from standing to sitting. c. discontinue the adrenergic blocker. d. monitor the blood pressure in both the supine and standing positions.

d. monitor the blood pressure in both the supine and standing positions. *assess for orthostatic hypotension which is common when initiating therapy

The healthcare provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing interventions(s) associated with administration of this medication IV should the nurse perform? (Select all that apply.) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patient's airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. d. Continuously assess the patient's airway. e. Obtain the correct dose (10 mg) and administer over slow IV push. *Airway, HR, IV 10mg

Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation

a. Blood dyscrasias (disorder) b. Hyperglycemia d. Gingival hyperplasia (overgrowth of gum tissue) f. Sedation

Prior to the administration of metoprolol, a beta-adrenergic blocking agent, which is most important for the nurse to assess? a. Blood pressure b. Lung sounds c. Mental status d. Urine output

a. Blood pressure *Beta's dilate and therefore decrease BP. Hold per pt parameters.

The system of the body that controls self-regulated actions of internal organs and glands is the: a. somatic nervous system b. autonomic nervous system c. afferent nervous system d. efferent nervous system

b. autonomic nervous system

Serious adverse effects of Cholingeric Agents include: (select all that apply) a. hypotension b. bronchospasm c. wheezing d. bradycardia

b. bronchospasm c. wheezing d. bradycardia

Pramipexole (Mirapex)is a nonergot dopamine agonist that stimulates D2 and D3 dopamine receptors. It can be used alone to manage which of the following: a. late onset of dementia b. early stages of parkinsonism c. bi-polar and tonic-clonic episodes d. multiple sclerosis

b. early stages of parkinsonism *common s/e include N/V, anorexia and ortho. hypotension

Topomax (topiramate) is a combination anticonvulsant therapy drug used for: a. focal seizures and headaches b. tonic-clonic seizures and migraines c. absent seizures and TMJ d. tonic-clonic and depression

b. tonic-clonic seizures and migraines *Phenobarbital enhances the metabolism of topiramate.

The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching? a. "I need to avoid or limit caffeine intake." b. "I will check with the pharmacist before taking over-the-counter medication." c. "If I develop enlarged gums, I will stop taking the medication." d. "It is important for me to take my medicine at the same time daily."

c. "If I develop enlarged gums, I will stop taking the medication."

Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.) a. Glaucoma b. Benign prostatic hypertrophy c. Bradycardia d. Parkinson's disease e. Preparation for surgery f. Stimulation of the vagus nerve

c. Bradycardia d. Parkinson's disease e. Preparation for surgery

What is the therapeutic outcome of antiparkinson medication therapy? a. Cure the disease b. Prevent the symptoms of the disease c. Decrease the symptoms of the disease d. Stop the progression of the disease

c. Decrease the symptoms of the disease *progressive disease with no cure

For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation

c. Trigeminal neuralgia pain

A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to: a. report development of alterations to the charge nurse. b. assess blood glucose. c. provide for resident's safety. d. medicate with anti-anxiety medication.

c. provide for resident's safety.

A patient has been prescribed an anticholinergic drug for irritable bowel syndrome (IBS). Which adverse effect must the nurse teach the patient to be aware of when beginning this drug? a. Rhinitis (runny nose) b. Drowsiness c. Diarrhea d. Orthostatic hypotension

d. Orthostatic hypotension

An older adult patient is to receive atenolol, a beta-adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first? a. Determine the therapeutic blood level. b. Encourage the patient to decrease water intake. c. Elevate the patient's legs. d. Withhold the medication.

d. Withhold the medication.

What is included in the nursing management of the patient with generalized tonic-clonic seizure activity? (Select all that apply.) a. Restraining the patient's arms to avoid further injury b. Placing padding around or under the patient's head c. Attempting to insert a tongue depressor into the patient's mouth d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

b. Placing padding around or under the patient's head d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over *protect head, place on side, request assistance if needed

Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.) a. "Take the medication with meals." b. "Increase fluids daily." c. "Decrease fiber in the diet." d. "Suck on candy or ice chips." e. "Monitor blood glucose."

b. "Increase fluids daily." d. "Suck on candy or ice chips." *anticholinergics slow digestion (constipation) and secretions (dry mouth)

Check Point: Acetylcholine is the primary neurotransmitter for the PNS that transmits neural impulses. Its name is derived from its chemical structure: ester of acetic acid and choline. Parts in the body that use or are affected by acetylcholine are referred to as cholinergic. Substances that increase or decrease the overall activity of the cholinergic system are called 'cholinergics' and 'anticholinergics', respectively Cholinergenics stimulate: can see, can shit, can spit Anti-cholinergenics slow: can't see, can't shit, can't spit

Cholinergic>mimic acetylcholine and create a stimulative effect such as muscle contraction, heart rate deceleration, constriction of the iris and of the lens, mucus secretion and broncho-constriction. Anticholinergenics >inhibit the action of acetylcholine and work to slow the autonomic nervous system. Such as the involuntary tremors and muscle stiffness associated with diseases like Parkinson's.

What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinson's disease? (Select all that apply.) a. The restoration of function resulting from stimulation of dopamine receptors is permanent. b. Apomorphine may be administered intravenously for rapid relief. c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness.

c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness.

The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to: a. provide the next dose of the cholinergic agent immediately. b. assess heart rate and blood pressure. c. reposition the patient. d. withhold the next dose and notify the physician.

d. withhold the next dose and notify the physician. *serious adverse effects of cholinergics are bronchospasms/wheezing

A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she suspects she may be pregnant. The nurse should encourage the patient to take which action(s)? (Select all that apply.) a. Consult an obstetrician. b. Discontinue medications. c. Carry an identification card. d. Provide a list of seizure medications. e. Consider oral contraception.

a. Consult an obstetrician. c. Carry an identification card. d. Provide a list of seizure medications. *consult a specialist, carry ID in case of episode, some anticonvulsants can cause birth defects.

A patient who has recently experienced a heart attack is prescribed a beta-adrenergic blocking agent. Which symptom of this therapy would be of concern to the nurse? a. Decrease in heart rate from 88/min to 46/min b. Decrease in blood pressure from 146 mm Hg systolic to 110 mm Hg systolic c. Decrease in temperature from 37.6° C to 37.2° C d. Decrease in respirations from 26/min to 20/min

a. Decrease in heart rate from 88/min to 46/min

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia

b. Nystagmus

Which adverse effects associated with levodopa therapy would support the nursing diagnosis risk for injury? a. Nausea and vomiting b. Orthostatic hypotension c. Anorexia and depression d. Tachycardia and palpitations

b. Orthostatic hypotension *Levodopa is a dopaminergic that increases fluid retention and HR

A nurse encounters a patient having a seizure. Which action is correct? a. Placing the patient's arms in restraints b. Placing a towel under the patient's head c. Placing the patient in a sitting position d. Placing a padded tongue blade between the patient's teeth

b. Placing a towel under the patient's head