Pharm chapter 20
A patient is starting therapy with donepezil. What information is essential for the nurse to tell the patient and family in relation to this medication? "Do not take this medication with food." "You will take this medication once per week." "Do not drink grapefruit juice while on this medication." "Be cautious with activity until you know how the medication affects you."
"Be cautious with activity until you know how the medication affects you." This medication can cause dizziness and hypotension. The patient starting therapy should be cautious until he knows how the medication therapy will affect him. The medication is taken daily and can be taken with food to decrease gastric upset. Grapefruit juice should not affect this medication
What will the nurse instruct a patient who is prescribed pyridostigmine? "Do not eat solid food." "Take the medication 30 minutes after eating." "Seek medical help if you develop nausea and vomiting." "Notify your health care provider if you have a headache."
"Seek medical help if you develop nausea and vomiting." Nausea and vomiting are the symptoms of a cholinergic crisis due to an overdose of anticholinesterase therapy. The patient should report these symptoms immediately so that prompt action can be taken to reverse the crisis. The nurse instructs the patient to take the medication before eating to strengthen the muscles involved in chewing and swallowing and to help prevent aspiration or choking. There is no reason for the patient to avoid solid food, and the patient does not have to report headaches because these may be common.
What will the nurse instruct a patient who is prescribed pyridostigmine? "Do not eat solid food." "Take the medication 30 minutes after eating." "Seek medical help if you develop nausea and vomiting." "Notify your health care provider if you have a headache."
"Seek medical help if you develop nausea and vomiting." Nausea and vomiting are the symptoms of a cholinergic crisis due to an overdose of anticholinesterase therapy. The patient should report these symptoms immediately so that prompt action can be taken to reverse the crisis. The nurse instructs the patient to take the medication before eating to strengthen the muscles involved in chewing and swallowing and to help prevent aspiration or choking. There is no reason for the patient to avoid solid food, and the patient does not have to report headaches because these may be common.
What is the peak plasma concentration of donepezil? 5 hours 1 to 2 hours 3 to 4 hours 30 minutes
3 to 4 hours Donepezil is a cholinesterase-inhibitor drug. It requires 3 to 4 hours to reach peak plasma concentration. Memantine requires 5 hours to reach peak plasma concentration. Pyridostigmine requires 1 to 2 hours to reach peak plasma concentration. Bethanechol requires 30 minutes to reach peak plasma concentration.
What is the peak plasma concentration of donepezil? 5 hours 1 to 2 hours 3 to 4 hours 30 minutes
3 to 4 hours Donepezil is a cholinesterase-inhibitor drug. It requires 3 to 4 hours to reach peak plasma concentration. Memantine requires 5 hours to reach peak plasma concentration. Pyridostigmine requires 1 to 2 hours to reach peak plasma concentration. Bethanechol requires 30 minutes to reach peak plasma concentration.
A patient who has experienced an overdose of rivastigmine is having difficulty breathing. What is the primary nursing intervention? Administer epinephrine. Monitor the patient's heart rate. Assess the patient's breath sounds. Measure the patient's urinary output.
Administer epinephrine. Rivastigmine is a cholinergic drug used for the treatment of Alzheimer disease. Overdosage of cholinergic drugs may lead to bronchoconstriction and difficulty in breathing. Epinephrine is given to cause bronchial dilation. This is the nurse's primary intervention. After this is completed, the nurse should monitor the patient's heart rate and breath sounds, respiratory rate, oxygenation level, etc.
A patient who has experienced an overdose of rivastigmine is having difficulty breathing. What is the primary nursing intervention? Administer epinephrine. Monitor the patient's heart rate. Assess the patient's breath sounds. Measure the patient's urinary output.
Administer epinephrine. Rivastigmine is a cholinergic drug used for the treatment of Alzheimer disease. Overdosage of cholinergic drugs may lead to bronchoconstriction and difficulty in breathing. Epinephrine is given to cause bronchial dilation. This is the nurse's primary intervention. After this is completed, the nurse should monitor the patient's heart rate and breath sounds, respiratory rate, oxygenation level, etc.
A patient is status postsurgery with general anesthesia. She has muscle paralysis because of the neuromuscular blockade used during the surgery Which intervention will assist in reversing the neuromuscular blockade? Administering an antihistamine Administering physostigmine intravenously Administering a high dose of donepezil orally Administering dextrose solution intravenously
Administering physostigmine intravenously Neuromuscular blockade can be treated by administering the antidote physostigmine intravenously, which reverses the effects of the neuromuscular blockade. Administering an antihistamine, a high dose of donepezil orally, or dextrose solution intravenously will not reverse the effects of the neuromuscular blockade
Before starting therapy with pyridostigmine, the nurse assesses the patient's history for which conditions? Asthma Emphysema Hypothyroidism Psoriatic arthritis Coronary artery disease
Asthma Coronary artery disease Contraindications to the drugs used to treat myasthenia gravis include known drug allergy, prior severe cholinergic reactions, asthma, gangrene, hyperthyroidism, cardiovascular disease, and mechanical obstruction of the gastrointestinal (GI) or gastrourinary tracts. Adverse effects include GI upset and excessive salivation. Interacting drugs include the anticholinergic drugs, which counteract the therapeutic effects of indirect-acting cholinergic drugs. The nurse does not need to assess for emphysema, hypothyroidism, and psoriatic arthritis before starting therapy with pyridostigmine.
What is the antidote to a cholinergic overdose? Atropine Memantine Epinephrine Rivastigmine
Atropine Atropine is the antidote to a cholinergic overdose. Memantine, epinephrine, and rivastigmine are not used to treat a cholinergic overdose.
A patient takes rivastigmine and is experiencing signs of a cholinergic crisis. Which medication does the nurse administer to improve the patient's condition? Atropine Dopamine Lidocaine Epinephrine
Atropine The nurse should administer atropine intravenously to reverse the effects of a cholinergic crisis. Atropine is an anticholinergic agent. The patient may also require other emergency treatment. Dopamine, lidocaine, and epinephrine are not administered for a cholinergic crisis.
What is the antidote to a cholinergic overdose? Atropine Memantine Epinephrine Rivastigmine
Atropine Atropine is the antidote to a cholinergic overdose. Memantine, epinephrine, and rivastigmine are not used to treat a cholinergic overdose.
Which cholinergic medication is prescribed to a patient who is unable to void after surgery? Donepezil Cevimeline Bethanechol Succinylcholine
Bethanechol Bethanechol is a direct-acting cholinergic drug that is used to treat atony of the bladder. It is the only direct-acting cholinergic drug that is administered orally. Donepezil, cevimeline, and succinylcholine are not used to treat atony of the bladder. Donepezil is an indirect-acting cholinergic drug that is used to treat Alzheimer's disease. Cevimeline is a direct-acting cholinergic drug used in the treatment of xerostomia (dry mouth) due to Sjögren's syndrome. Succinylcholine is used in general anesthesia as a neuromuscular blocker.
Which assessment finding in a patient receiving memantine indicates a significant side effect? Patient is unable to sleep Raised, erythematous rash Blood pressure 70/40 mm Hg Respiratory rate 30 breaths per minute
Blood pressure 70/40 mm Hg Memantine reduces blood pressure and causes hypotension as a side effect. A blood pressure of 70/40 mm Hg is a significant side effect. Insomnia, rash, and respiratory rate of 30 breaths per minute do not indicate a significant side effect.
What assessment finding is the result of parasympathetic nervous system stimulation? Bradycardia Pupil dilation Urine retention Bronchial dilation
Bradycardia When stimulated, the parasympathetic nervous system slows the heart rate, increases gastric secretions, stimulates the bladder and bowel to empty, allows the eye to focus for near vision, causes the pupils to constrict, and causes bronchial constriction. Sympathetic nervous system stimulation leads to pupil dilation. Parasympathetic nervous system stimulation helps in relaxation of the bladder, allowing emptying of the bowels. Sympathetic nervous system stimulation causes bronchial dilation.
Cholinergic agonist drugs have the potential to cause which effects? Pupil dilation Decreased heart rate Decreased gastric motility Increased respiratory secretions Decreased sweat gland secretion
Decreased heart rate Increased respiratory secretions Cholinergic agonists cause increased respiratory secretions, slowed heart rate, pupil constriction (not dilation), increased secretion from glands (not decreased), and increased gastric motility (not decreased).
The nurse administers physostigmine to a patient who has been exposed to pesticides. What is the expected therapeutic effect? Pupil dilation Pupil constriction Elevated heart rate Decreased heart rate
Decreased heart rate Pesticides contain organophosphates, which have anticholinergic actions. This may cause the patient to have an increased heart rate and dilated pupils. To reverse these actions, an antidote must be administered to the patient. Physostigmine is an indirect-acting cholinergic drug. It helps constrict the pupils and reduce the heart rate by increasing the acetylcholine concentration at the receptor site. A reduced (not elevated) heart rate is a therapeutic effect. Although the medication will cause pupil constriction, this is not necessarily a therapeutic effect.
The nurse administers pilocarpine ophthalmic drops to a patient diagnosed with glaucoma. Which finding is a desired therapeutic effect of this medication? Dry eyes Lacrimation Dilated pupils Decreased intraocular pressure
Decreased intraocular pressure A parasympathomimetic agent such as pilocarpine causes activation of muscarinic receptors in the eye, decreasing intraocular pressure in the patient with glaucoma. Stimulation of muscarinic receptors also causes miosis, or pupillary constriction (not pupillary dilation). The drug does not cause dry eyes. Although this drug may cause constriction of pupils and lacrimation, these are not the desired effects when treating glaucoma.
The nurse is caring for a patient receiving bethanechol and pyridostigmine. What assessment findings indicate potential interactions of these two medications? Ataxia Cramps Diarrhea Bleeding Syncope
Diarrhea Syncope
The nurse is caring for a patient receiving bethanechol and pyridostigmine. What assessment findings indicate potential interactions of these two medications? Ataxia Cramps Diarrhea Bleeding Syncope
Diarrhea Syncope Bethanechol is a direct-acting cholinergic drug. The patient was also given pyridostigmine, which is an indirect-acting cholinergic drug. Indirect-acting cholinergic drugs interact with bethanechol, resulting in an increase in the adverse effects of bethanechol. Therefore the nurse has to monitor symptoms such as syncope and diarrhea (gastrointestinal upset) in the patient. Ataxia, bleeding, and muscle cramps are not related to bethanechol.
The nurse assesses a patient and finds ptosis, diplopia, and difficulty swallowing. Which drug will be utilized to help confirm the diagnosis of myasthenia gravis in the patient? Memantine Bethanechol Edrophonium Physostigmine
Edrophonium Ptosis, diplopia, and difficulty swallowing and chewing are the symptoms of myasthenia gravis. Edrophonium is a medication that helps in the diagnosis of this condition. Memantine is a noncholinergic drug prescribed for Alzheimer's disease. Bethanechol is prescribed for urinary retention. Physostigmine is a neuromuscular -locking drug, but it is not prescribed for myasthenia gravis.
The nurse is assessing a patient with Alzheimer's disease who has been prescribed donepezil. What information is essential to include in the patient's teaching care plan? Get up slowly. Eat something if you feel nauseated. You may have some trouble sleeping. Stop the medication if you have headaches. Tell your health care provider if you have stomach pains.
Get up slowly. Eat something if you feel nauseated. You may have some trouble sleeping. Tell your health care provider if you have stomach pains.
Which condition is a contraindication to the administration of bethanechol? Gastric atony Hyperthyroidism Urinary retention Chronic refractory heartburn
Hyperthyroidism Contraindications to the administration of bethanechol include known drug allergy, hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease or coronary artery disease, epilepsy, and parkinsonism. Bethanechol produces parasympathomimetic action and may exacerbate the symptoms of hyperthyroidism. Gastric atony, urinary retention, and chronic refractory heartburn are indications to administer bethanechol.
What is an expected therapeutic outcome assessment for a patient who has Parkinson's disease and dementia and is prescribed rivastigmine? Decreased tremors Decreased salivation Improvement in memory Increased muscle strength
Improvement in memory Rivastigmine is an indirect-acting cholinergic drug that is used to treat dementia in patients diagnosed with Parkinson's disease. A therapeutic effect would be improvement in the dementia, possibly seen by an improvement in memory or conversation and recognition. Decreased tremors, decreased salivation, and increased muscle strength are not expected therapeutic outcomes for a patient who has Parkinson's disease and dementia and is prescribed rivastigmine.
The nurse is caring for a patient who is taking a cholinergic drug. Which assessment is caused by stimulation of the parasympathetic nervous system? Mydriasis Vasoconstriction Urinary retention Increased gastrointestinal (GI) motility
Increased gastrointestinal (GI) motility Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process. Miosis, urinary frequency, and vasodilation are all effects of cholinergic drugs. Mydriasis, vasoconstriction, and urinary retention are effects of cholinergic blockers.
The nurse is caring for a patient postoperatively. The patient has hypoactive bowel sounds and has not had a bowel movement. Which is the appropriate intervention by the nurse? Inject bethanechol Administer atropine Provide a high-fiber diet Administer a stool softener Ambulate the patient as tolerated Increase fluid intake as tolerated
Inject bethanechol Provide a high-fiber diet Administer a stool softener Ambulate the patient as tolerated Increase fluid intake as tolerated Fluid intake and a fiber-rich diet help to increase peristalsis, as does bethanechol. Stool softeners may also help the patient, as will ambulating as tolerated. Atropine is not administered in this situation.
The nurse is caring for a patient postoperatively. The patient has hypoactive bowel sounds and has not had a bowel movement. Which is the appropriate intervention by the nurse? Inject bethanechol Administer atropine Provide a high-fiber diet Administer a stool softener Ambulate the patient as tolerated Increase fluid intake as tolerated
Inject bethanechol Provide a high-fiber diet Administer a stool softener Ambulate the patient as tolerated Increase fluid intake as tolerated Fluid intake and a fiber-rich diet help to increase peristalsis, as does bethanechol. Stool softeners may also help the patient, as will ambulating as tolerated. Atropine is not administered in this situation.
What nursing intervention is essential when administering carbachol? Administer the medication after meals. Assess the patient for side effects within 2 hours. Make certain the patient takes the medication with a full glass of water. Make certain the drop is in the pocket made by pulling down the lower eyelid.
Make certain the drop is in the pocket made by pulling down the lower eyelid. Direct-acting drugs such as carbachol are used topically to reduce intraocular pressure in patients with glaucoma or those undergoing ocular surgery. The nurse should make certain the drops are administered correctly by pulling down the lower eyelid, inserting the drop, and then having the patient close the eye.
What nursing intervention is essential when administering carbachol? Administer the medication after meals. Assess the patient for side effects within 2 hours. Make certain the patient takes the medication with a full glass of water. Make certain the drop is in the pocket made by pulling down the lower eyelid.
Make certain the drop is in the pocket made by pulling down the lower eyelid. Direct-acting drugs such as carbachol are used topically to reduce intraocular pressure in patients with glaucoma or those undergoing ocular surgery. The nurse should make certain the drops are administered correctly by pulling down the lower eyelid, inserting the drop, and then having the patient close the eye.
Which medication is a noncholinergic drug used in the treatment of Alzheimer's disease? Atropine Memantine Donepezil Rivastigmine
Memantine Memantine is a noncholinergic drug that is used in the treatment of Alzheimer's disease. It helps by blocking the stimulation of the N-methyl-D-aspartate receptors. Atropine, donepezil, and rivastigmine are all cholinergic drugs. Atropine is a competitive antagonist to the acetylcholine receptor; it is used as the treatment for cholinergic overdose. Donepezil is usually prescribed for Alzheimer's patients. It inhibits acetylcholinesterase and increases the levels of acetylcholine. Rivastigmine is also a cholinesterase inhibitor that causes an increase in acetylcholine levels.
Which cholinergic agonist medication and dose is administered to a patient undergoing maintenance therapy? Donepezil 10 mg twice a day by mouth Memantine 10 mg twice a day by mouth Bethanechol 5 mg three times a day by mouth Physostigmine 2 mg every 20 minutes by mouth
Memantine 10 mg twice a day by mouth The dosage range for memantine is an initial dose of 5 mg/day; titrate by 5 mg/wk up to a target dose of 10 mg/bid (20 mg/day). The maximum dose in renal impairment is 10 mg/day. Donepezil 10 mg twice a day is an excessive dose. Bethanechol 5 mg three times a day is a subtherapeutic dose. Physostigmine 0.01 to 0.03 is repeated intravenously at 5- to 10-minute interval.
Which cholinergic agonist medication and dose is administered to a patient undergoing maintenance therapy? Donepezil 10 mg twice a day by mouth Memantine 10 mg twice a day by mouth Bethanechol 5 mg three times a day by mouth Physostigmine 2 mg every 20 minutes by mouth
Memantine 10 mg twice a day by mouth The dosage range for memantine is an initial dose of 5 mg/day; titrate by 5 mg/wk up to a target dose of 10 mg/bid (20 mg/day). The maximum dose in renal impairment is 10 mg/day. Donepezil 10 mg twice a day is an excessive dose. Bethanechol 5 mg three times a day is a subtherapeutic dose. Physostigmine 0.01 to 0.03 is repeated intravenously at 5- to 10-minute interval.
Before starting a patient on memantine therapy, what is essential for the nurse to include in the assessment? Pain assessment Neurologic status Complete blood count Cardiovascular status Gastrourinary (GU) status Assess for suicidal tendencies
Neurologic status Cardiovascular status Gastrourinary (GU) status Assess for suicidal tendencies Before a drug for Alzheimer's disease, such as donepezil or memantine, is used, assess the patient for allergies, cautions, contraindications, and drug interactions. Perform a close assessment and documentation of the patient's neurologic status with attention to short- and long-term memory; level of alertness; motor, cognitive, and sensory functioning; any suicidal tendencies or thoughts; musculoskeletal intactness; and gastrointestinal, GU, and cardiovascular functioning. Assess urinary patterns so that any problems with urinary retention may be identified. Report any abnormalities and/or complaints to the prescriber immediately. It is important to note the presence or absence of family support systems because of the chronic nature of this illness. Once the patient has begun taking the medication, it is critical for you to continue to assess the patient's response to the drug. Especially note any changes in symptoms within the first 6 weeks of therapy. It is not essential to perform a pain assessment or get a complete blood count before starting a patient on memantine therapy.
Which route of administration is preferred for treating xerostomia with pilocarpine? Oral Ocular Intravenous Intramuscular
Oral Pilocarpine is a direct-acting cholinergic drug that is used topically in the treatment of glaucoma. However, this drug is also given orally for treating xerostomia, or dry mouth. Pilocarpine is not given through ocular, intravenous, or intramuscular routes to treat xerostomia because the drug may not be effective through these routes.
What should the nurse assess as a therapeutic effect of the administration of pyridostigmine to a patient who has myasthenia gravis? Patient is no longer dizzy Patient has improved memory Patient is able to walk long distances Patient has increased muscle strength
Patient has increased muscle strength Pyridostigmine is used to treat myasthenia gravis. A primary outcome is increased muscle strength. A decrease in dizziness, improved memory, and the ability to walk long distances are not expected outcomes of administration of this medication.
Which medication may be administered to a patient who has myasthenia gravis? Donepezil Memantine Bethanechol Pyridostigmine
Pyridostigmine Pyridostigmine is an indirect-acting anticholinesterase drug used to treat myasthenia gravis. Donepezil and memantine are used to treat Alzheimer's dementia. Bethanechol is used to treat postoperative and postpartum functional urinary retention.
Which indirect-acting cholinergic drug is used to treat a patient who has both Parkinson's disease and dementia? Donepezil Memantine Galantamine Rivastigmine
Rivastigmine Rivastigmine is an indirect-acting cholinergic drug used to treat Alzheimer's disease. However, it is also effective in treating patients with Parkinson's disease who have dementia. Drugs such as donepezil and galantamine are also indirect-acting cholinergics, but are used for treating Alzheimer's disease only and are contraindicated in Parkinson's disease. Memantine is an N-methyl-D-aspartate receptor antagonist that is used for treating Alzheimer's disease
Which indirect-acting cholinergic drug is used to treat a patient who has both Parkinson's disease and dementia? Donepezil Memantine Galantamine Rivastigmine
Rivastigmine Rivastigmine is an indirect-acting cholinergic drug used to treat Alzheimer's disease. However, it is also effective in treating patients with Parkinson's disease who have dementia. Drugs such as donepezil and galantamine are also indirect-acting cholinergics, but are used for treating Alzheimer's disease only and are contraindicated in Parkinson's disease. Memantine is an N-methyl-D-aspartate receptor antagonist that is used for treating Alzheimer's disease.
Which assessment finding indicates an adverse reaction in a patient receiving bethanechol for the treatment of urinary retention? Syncope Hair loss Mydriasis Constipation Hypertension
Syncope Hypertension Adverse effects include syncope, hypotension or hypertension, tachycardia or bradycardia, headache, seizures, gastrointestinal upset, and asthmatic attacks. Hair loss should not occur. Miosis, not mydriasis, may result from use of bethanechol.
Which assessment finding indicates an adverse reaction in a patient receiving bethanechol for the treatment of urinary retention? Syncope Hair loss Mydriasis Constipation Hypertension
Syncope Hypertension Adverse effects include syncope, hypotension or hypertension, tachycardia or bradycardia, headache, seizures, gastrointestinal upset, and asthmatic attacks. Hair loss should not occur. Miosis, not mydriasis, may result from use of bethanechol.
What instruction does the nurse give to the patient who is starting therapy with pyridostigmine? Take the medication after meals. Take the medication before meals. Take the medication along with meals. Take the medication on an empty stomach.
Take the medication before meals. Pyridostigmine is useful in treating myasthenia gravis. It is to be taken 30 minutes before meals for quick onset of action and to prevent difficulty in swallowing. The medication is not to be taken after meals because it may hinder the drug absorption and the onset of action. The medication is not to be taken along with meals because the drug may not have adequate time to show its therapeutic effect. The patient is not advised to take the medication on an empty stomach because it may not show the required therapeutic effects.
Which patient would be unable to receive donepezil to treat symptoms of Alzheimer disease? The patient with constipation The patient with urinary retention The patient exhibiting heart block The patient diagnosed with hypertension
The patient exhibiting heart block Donepezil stimulates muscarinic receptors and is contraindicated in patients with disorders of cardiac conduction such as heart block. Constipation, urinary retention, and hypertension are not contraindications to the use of this drug. Patients with Alzheimer's disease who cannot use cholinergic drugs may be treated with memantine, which is not a cholinesterase inhibitor.
After administration of edrophonium, which evaluation is a positive result? The patient is able to speak clearly. The patient has difficulty breathing. The patient can swallow without difficulty. The patient has increased strength in his arms.
The patient has increased strength in his arms. Edrophonium is an indirect-acting cholinergic drug that is used to differentiate between myasthenia gravis and cholinergic crisis. If a patient has myasthenia gravis, after receiving edrophonium, the patient's muscles would be stronger, indicating she most likely has myasthenia and is possibly having a myasthenic crisis. Clear speech, difficulty breathing, and swallowing without difficulty are not indicative of a positive result after administration of edrophonium.
What is the rationale behind administering ginkgo to a patient? To prevent memory loss To treat myasthenia gravis To reverse cholinergic drug effects To treat postpartum urinary retention
To prevent memory loss Ginkgo is an herbal preparation that is used to prevent memory loss. Pyridostigmine is administered to a patient to treat myasthenia gravis. Atropine is administered to a patient to reverse cholinergic drug effects. Bethanechol is administered to a patient to treat postpartum urinary retention.
What is the rationale behind administering ginkgo to a patient? To prevent memory loss To treat myasthenia gravis To reverse cholinergic drug effects To treat postpartum urinary retention
To prevent memory loss Ginkgo is an herbal preparation that is used to prevent memory loss. Pyridostigmine is administered to a patient to treat myasthenia gravis. Atropine is administered to a patient to reverse cholinergic drug effects. Bethanechol is administered to a patient to treat postpartum urinary retention.
After administering bethanechol to a patient after surgery, what system should the nurse assess to determine a therapeutic effect? Urinary Neurologic Musculoskeletal Gastrointestinal
Urinary Bethanechol increases the tone of the detrusor muscle and causes the patient to void. Because it is used to initiate voiding, the nurse does not need to complete a neurologic, muscular, or gastric assessment to determine effectiveness.
The nurse is caring for a patient diagnosed with myasthenia gravis who has been prescribed a cholinergic medication. Which nursing action is a priority when administering the medication? Administer the medication after meals. Do not administer the medication with fruit juices Administer the medication 30 minutes before meals. Administer the medication after dissolving in water.
Administer the medication 30 minutes before meals. Patients with myasthenia gravis have difficulty swallowing food. To prevent aspiration, the nurse should administer the medication 30 minutes before meals so that the medication has enough time to begin to work before the patient eats. This prevents dysphagia and perhaps aspiration. Administering the medication fruit juices and administering the medication after dissolving it in water are not priority nursing actions for administering the medication.
The nurse administers 10 mg bethanechol to a patient after surgery. The patient has not voided. What is the next intervention needed? Assessment of bowel sounds Assessment of blood pressure Administration of a second drug Administration of another dose in an hour
Administration of another dose in an hour Bethanechol is administered by starting with 5 to 10 mg, repeated hourly, until urination occurs. A maximum dose per cycle is 50 mg. A second drug is not added to the regimen.
The nurse is assessing a patient who presents with excessive salivation and abdominal cramping. The patient has been taking rivastigmine for memory enhancement. What additional assessment findings support the diagnosis of a cholinergic crisis? Dyspnea Hypoglycemia Hypothyroidism Bronchoconstriction Orthostatic hypotension
Dyspnea Bronchoconstriction Orthostatic hypotension
The nurse is assessing a patient who presents with excessive salivation and abdominal cramping. The patient has been taking rivastigmine for memory enhancement. What additional assessment findings support the diagnosis of a cholinergic crisis? Dyspnea Hypoglycemia Hypothyroidism Bronchoconstriction Orthostatic hypotension
Dyspnea Bronchoconstriction Orthostatic hypotension Long-term use of cholinergic drugs such as rivastigmine may cause cholinergic crisis. Excessive salivation and abdominal cramps are the early symptoms of cholinergic crisis. If the patient continues to use the medication, other complications may occur, such as orthostatic hypotension because the decrease in the amount of fluids in the body. Bronchoconstriction is caused because of contraction of the bronchioles and smooth muscles. As a result, the patient has breathing difficulty and dyspnea. Cholinergic drugs do not affect insulin regulation and do not decrease the thyroid hormone levels. Therefore this drug does not cause hypoglycemia or hypothyroidism.
What is a therapeutic outcome expected from the administration of cevimeline to a patient with Sjögren's syndrome? Improved vision Relief of dry skin Increased muscle strength Moist oral mucous membranes
Moist oral mucous membranes SjÖgren's syndrome causes excessive dryness of mouth. Cevimeline is a direct-acting drug that acts on the parasympathetic nervous system and stimulates secretion of saliva by salivary glands. Improved vision, relief of dry skin, and increased muscle strength are not expected therapeutic outcomes with cevimeline.
What is a therapeutic outcome expected from the administration of cevimeline to a patient with Sjögren's syndrome? Improved vision Relief of dry skin Increased muscle strength Moist oral mucous membranes
Moist oral mucous membranes SjÖgren's syndrome causes excessive dryness of mouth. Cevimeline is a direct-acting drug that acts on the parasympathetic nervous system and stimulates secretion of saliva by salivary glands. Improved vision, relief of dry skin, and increased muscle strength are not expected therapeutic outcomes with cevimeline.
What information is true concerning cholinergic stimulation? Nicotinic receptor stimulation causes dilation of the pupils. Nicotinic receptor stimulation causes increased blood pressure. Muscarinic receptor stimulation causes constriction of blood vessels. Muscarinic receptor stimulation causes increased gastrointestinal motility. Nicotinic receptor stimulation causes increased contraction of skeletal muscle.
Nicotinic receptor stimulation causes increased blood pressure. Muscarinic receptor stimulation causes increased gastrointestinal motility. Nicotinic receptor stimulation causes increased contraction of skeletal muscle. Cholinergic drugs act by stimulating two types of cholinergic receptors, called muscarinic and nicotinic receptors. Nicotinic receptor stimulation causes increased blood pressure and increased contraction of the skeletal muscles. Muscarinic receptor stimulation causes increased gastrointestinal motility. Cholinergic drugs cause constriction of the pupils, called miosis. Therefore nicotinic receptor stimulation does not cause mydriasis (dilation of pupil). Muscarinic receptor stimulation does not lead to constriction of the blood vessels; instead, it results in dilation of the blood vessels.
What should the nurse assess as a therapeutic effect of the administration of pyridostigmine to a patient who has myasthenia gravis? Patient is no longer dizzy Patient has improved memory Patient is able to walk long distances Patient has increased muscle strength
Patient has increased muscle strength Pyridostigmine is used to treat myasthenia gravis. A primary outcome is increased muscle strength. A decrease in dizziness, improved memory, and the ability to walk long distances are not expected outcomes of administration of this medication.
Which medications are direct-acting cholinergic drugs? . Pilocarpine Galantamine Neostigmine Edrophonium Succinylcholine
Pilocarpine Succinylcholine
Which patient should receive a reduced dose of memantine? The patient with migraines The patient with bradycardia The patient with hypothyroidism The patient with elevated blood urea nitrogen and creatinine
The patient with elevated blood urea nitrogen and creatinine Memantine is a N-methyl-d-aspartate receptor antagonist that is used for the treatment of Alzheimer's dementia. The prescribed dosage of the drug is 10 mg two times per day. However, patients with renal impairment may need the dose to be reduced to 5 mg twice daily. Hypothyroidism, bradycardia, and migraines are not contraindications to this medication and do not require a reduced dose.
A patient diagnosed with Alzheimer's disease has been taking donepezil for a week. The family reports no improvement in the patient's condition. What is the nurse's best response? "The medication has an onset of action of about 3 weeks." "Let me assess what other medications the patient is taking." "Sometimes family members aren't the best at assessing these things." "I will call the health care provider and ask for the medication to be changed."
"The medication has an onset of action of about 3 weeks." Donepezil takes about 3 weeks for the onset of action. Assessment of other potentially interacting medications would have been completed before starting the patient on the medication. The family might be insulted by the comment that they are not the best at assessing. In actuality, information from people who are with the patient continuously may be more accurate than that from others who see the patient episodically. The medication does not have to be changed at this point.
A patient diagnosed with Alzheimer's disease has been taking donepezil for a week. The family reports no improvement in the patient's condition. What is the nurse's best response? "The medication has an onset of action of about 3 weeks." "Let me assess what other medications the patient is taking." "Sometimes family members aren't the best at assessing these things." "I will call the health care provider and ask for the medication to be changed."
"The medication has an onset of action of about 3 weeks." Donepezil takes about 3 weeks for the onset of action. Assessment of other potentially interacting medications would have been completed before starting the patient on the medication. The family might be insulted by the comment that they are not the best at assessing. In actuality, information from people who are with the patient continuously may be more accurate than that from others who see the patient episodically. The medication does not have to be changed at this point.
What information should the nurse include in the teaching plan of a patient who has started to take donepezil? "This medication will enhance your memory." "This medication should cure your Alzheimer's disease." "You will only need to take this medication for 3 months." "This medication will increase your ability to sleep without dreaming."
"This medication will enhance your memory." Donepezil is a cholinergic drug. When used in the treatment of Alzheimer's disease, cholinergic drugs increase concentrations of acetylcholine in the brain by inhibiting cholinesterase. This increase in acetylcholine levels helps enhance and maintain memory and learning capabilities. The statements "This medication should cure your Alzheimer's disease," "You will only need to take this medication for 3 months," and "This medication will increase your ability to sleep without dreaming" are not correct.
A patient is starting on donepezil. The nurse should include what information in the teaching plan for the patient? "Your drug dose will be increased gradually." "Do not take the medication if you feel tired." "Take the medication on an empty stomach." "Get up slowly from a sitting or lying position." "Tell your health care provider if you have gastric pain that does not subside."
"Your drug dose will be increased gradually." "Get up slowly from a sitting or lying position." "Tell your health care provider if you have gastric pain that does not subside." Donepezil is a cholinesterase inhibitor that works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase. It is used in the treatment of mild to moderate Alzheimer's disease. Contraindications for donepezil include known drug allergy. Adverse effects are normally mild and resolve on their own and can often be avoided by careful dose titration. They include gastrointestinal upset (including ulcer risk due to increased gastric secretions), drowsiness, dizziness, insomnia, and muscle cramps. The effects on the cardiovascular system are complex and may include bradycardia, syncope, hypotension with reflex tachycardia, or hypertension. The patient should be taught to rise slowly in case of dizziness. The health care provider should be notified if the patient has gastric pain because this may be an indication of an ulcer. Tiredness is not a contraindication for the medication. There is no need to take the medication on an empty stomach.
The nurse is caring for a patient diagnosed with myasthenia gravis who has been prescribed a cholinergic medication. Which nursing action is a priority when administering the medication? Administer the medication after meals. Do not administer the medication with fruit juices Administer the medication 30 minutes before meals. Administer the medication after dissolving in water.
Administer the medication 30 minutes before meals. Patients with myasthenia gravis have difficulty swallowing food. To prevent aspiration, the nurse should administer the medication 30 minutes before meals so that the medication has enough time to begin to work before the patient eats. This prevents dysphagia and perhaps aspiration. Administering the medication fruit juices and administering the medication after dissolving it in water are not priority nursing actions for administering the medication.
The nurse administers 10 mg bethanechol to a patient after surgery. The patient has not voided. What is the next intervention needed? Assessment of bowel sounds Assessment of blood pressure Administration of a second drug Administration of another dose in an hour
Administration of another dose in an hour Bethanechol is administered by starting with 5 to 10 mg, repeated hourly, until urination occurs. A maximum dose per cycle is 50 mg. A second drug is not added to the regimen.
The nurse assesses a patient and finds ptosis, diplopia, and difficulty swallowing. Which drug will be utilized to help confirm the diagnosis of myasthenia gravis in the patient? Memantine Bethanechol Edrophonium Physostigmine
Edrophonium Ptosis, diplopia, and difficulty swallowing and chewing are the symptoms of myasthenia gravis. Edrophonium is a medication that helps in the diagnosis of this condition. Memantine is a noncholinergic drug prescribed for Alzheimer's disease. Bethanechol is prescribed for urinary retention. Physostigmine is a neuromuscular -locking drug, but it is not prescribed for myasthenia gravis.
The nurse is assessing a patient with Alzheimer's disease who has been prescribed donepezil. What information is essential to include in the patient's teaching care plan? Get up slowly. Eat something if you feel nauseated. You may have some trouble sleeping. Stop the medication if you have headaches. Tell your health care provider if you have stomach pains.
Get up slowly. Eat something if you feel nauseated. You may have some trouble sleeping. Tell your health care provider if you have stomach pains. This medication may cause dizziness and syncope. The patient should be careful standing up. It can cause gastric upset, and the patient should eat something if she feels nauseated. Stomach pains may indicate gastric ulcer, which is also a risk. Insomnia may be an early symptom. Side effects are generally tolerated, and if the patient has her dose titrated slowly upward, this usually helps the tolerance. It is not necessary to teach the patient to discontinue the medication if she has a headache.
The nurse is assessing a patient with Alzheimer's disease who has been prescribed donepezil. What information is essential to include in the patient's teaching care plan? Get up slowly. Eat something if you feel nauseated. You may have some trouble sleeping. Stop the medication if you have headaches. Tell your health care provider if you have stomach pains.
Get up slowly. Eat something if you feel nauseated. You may have some trouble sleeping. Tell your health care provider if you have stomach pains. This medication may cause dizziness and syncope. The patient should be careful standing up. It can cause gastric upset, and the patient should eat something if she feels nauseated. Stomach pains may indicate gastric ulcer, which is also a risk. Insomnia may be an early symptom. Side effects are generally tolerated, and if the patient has her dose titrated slowly upward, this usually helps the tolerance. It is not necessary to teach the patient to discontinue the medication if she has a headache.
The nurse is assessing the patient for a potential cholinergic drug overdose. What indicator requires immediate action? Abdominal cramping Blood pressure 90/40 mm Hg Heart rate 30 beats per minute Respiratory rate 24 breaths per minute
Heart rate 30 beats per minute Cholinergic drugs mimic the effects of acetylcholine by binding to cholinergic receptors. An overdose of cholinergic drugs acts directly on the parasympathetic nervous system and activates the nicotinic receptors. An overdose of the drug shows its adverse effect in increased gastrointestinal secretions, which cause abdominal cramps. This drug reduces the heart rate considerably, thereby leading to hypotension. This may also cause atrioventricular block, leading to cardiac arrest. A heart rate of 30 is the most serious assessment sign and is the priority for action in this situation.
What intervention will assist the patient in coping with orthostatic hypotension caused by cholinergic drug therapy? Take ibuprofen before rising. Call for someone before rising. Move from a sitting to standing position slowly. Increase fluid intake to increase blood volume.
Move from a sitting to standing position slowly. Cholinergic drug therapy can cause side effects, including orthostatic hypotension, syncope, and dizziness. The patient should be told to rise slowly from a lying to sitting position and from a sitting to standing position. Ibuprofen will not prevent this side effect. Calling someone is not always an option. The side effect is not related to fluid volume deficit, and increasing fluids will most likely not help.
Which drug is indicated in the treatment of myasthenia gravis? Pilocarpine Neostigmine Rivastigmine Succinylcholine
Neostigmine Neostigmine is a reversible anticholinesterase agent, and its principal use is the treatment of myasthenia gravis. Neostigmine works by preventing the inactivation of acetylcholine at the neuromuscular junction, leading to increased nerve transmission and skeletal muscle activation. Pilocarpine inhibits cholinesterase to allow acetylcholine accumulation; however, it is indicated in the treatment of glaucoma and is administered as ophthalmic drops. Rivastigmine is a cholinesterase inhibitor indicated for use in Alzheimer's dementia. Succinylcholine is a direct-acting cholinergic neuromuscular-blocking agent.
Which drugs are used to reverse the effects of nondepolarizing neuromuscular-blocking drugs after surgery? Donepezil Memantine Neostigmine Pyridostigmine Physostigmine
Neostigmine Pyridostigmine Physostigmine Neostigmine, pyridostigmine, and physostigmine are useful for reversing the effects of nondepolarizing neuromuscular-blocking drugs after surgery. Donepezil and memantine are not used for this purpose.
Before starting a patient on memantine therapy, what is essential for the nurse to include in the assessment? Pain assessment Neurologic status Complete blood count Cardiovascular status Gastrourinary (GU) status Assess for suicidal tendencies
Neurologic status Complete blood count Cardiovascular status Gastrourinary (GU) status Assess for suicidal tendencies Before a drug for Alzheimer's disease, such as donepezil or memantine, is used, assess the patient for allergies, cautions, contraindications, and drug interactions. Perform a close assessment and documentation of the patient's neurologic status with attention to short- and long-term memory; level of alertness; motor, cognitive, and sensory functioning; any suicidal tendencies or thoughts; musculoskeletal intactness; and gastrointestinal, GU, and cardiovascular functioning. Assess urinary patterns so that any problems with urinary retention may be identified. Report any abnormalities and/or complaints to the prescriber immediately. It is important to note the presence or absence of family support systems because of the chronic nature of this illness. Once the patient has begun taking the medication, it is critical for you to continue to assess the patient's response to the drug. Especially note any changes in symptoms within the first 6 weeks of therapy. It is not essential to perform a pain assessment or get a complete blood count before starting a patient on memantine therapy.
What information is true concerning cholinergic stimulation? Nicotinic receptor stimulation causes dilation of the pupils. Nicotinic receptor stimulation causes increased blood pressure. Muscarinic receptor stimulation causes constriction of blood vessels. Muscarinic receptor stimulation causes increased gastrointestinal motility. Nicotinic receptor stimulation causes increased contraction of skeletal muscle.
Nicotinic receptor stimulation causes increased blood pressure. Muscarinic receptor stimulation causes increased gastrointestinal motility. Nicotinic receptor stimulation causes increased contraction of skeletal muscle. Cholinergic drugs act by stimulating two types of cholinergic receptors, called muscarinic and nicotinic receptors. Nicotinic receptor stimulation causes increased blood pressure and increased contraction of the skeletal muscles. Muscarinic receptor stimulation causes increased gastrointestinal motility. Cholinergic drugs cause constriction of the pupils, called miosis. Therefore nicotinic receptor stimulation does not cause mydriasis (dilation of pupil). Muscarinic receptor stimulation does not lead to constriction of the blood vessels; instead, it results in dilation of the blood vessels.
Which route of administration is preferred for treating xerostomia with pilocarpine? Oral Ocular Intravenous Intramuscular
Oral Pilocarpine is a direct-acting cholinergic drug that is used topically in the treatment of glaucoma. However, this drug is also given orally for treating xerostomia, or dry mouth. Pilocarpine is not given through ocular, intravenous, or intramuscular routes to treat xerostomia because the drug may not be effective through these routes.
Which conditions are a contraindication to the use of bethanechol? Emphysema Peptic ulcer Parkinsonism Hyperthyroidism Coronary artery disease Type 2 diabetes mellitus
Peptic ulcer Parkinsonism Hyperthyroidism Coronary artery disease Bethanechol is a direct-acting cholinergic agonist. It is used in the treatment of acute postoperative and postpartum nonobstructive urinary retention and for the management of urinary retention associated with neurogenic atony of the bladder. Bethanechol is available orally. Contraindications include known drug allergy, hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease or coronary artery disease, epilepsy, and parkinsonism.
Which drug may be administered to a patient who has a tricyclic antidepressant overdose? Tacrine Carbachol Memantine Physostigmine
Physostigmine Physostigmine is an indirect-acting anticholinesterase drug that can be used to treat a tricyclic antidepressant overdose condition. Tacrine is an indirect-acting drug that is used to treat Alzheimer's disease. Carbachol is a direct-acting drug that is used to lower intraocular pressure. Memantine is used to treat Alzheimer's dementia.
Which medications are direct-acting cholinergic drugs? . Pilocarpine Galantamine Neostigmine Edrophonium Succinylcholine
Pilocarpine Succinylcholine Pilocarpine and succinylcholine are direct-acting cholinergic drugs. Pilocarpine is used to treat xerostomia. Succinylcholine is used as an anesthetic. Galantamine, neostigmine, and edrophonium are indirect-acting cholinergic drugs.
Which condition is treated with bethanechol in a postoperative patient? Urinary atony Respiratory atelectasis Postoperative hypotension Postoperative ischemic colitis
Urinary atony Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying and resulting in urinary atony. Antihistamines are used to treat respiratory atelectasis in postoperative patients. Postoperative hypotension is a contraindication to cholinergic drugs.
Which condition is treated with bethanechol in a postoperative patient? Urinary atony Respiratory atelectasis Postoperative hypotension Postoperative ischemic colitis
Urinary atony Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying and resulting in urinary atony. Antihistamines are used to treat respiratory atelectasis in postoperative patients. Postoperative hypotension is a contraindication to cholinergic drugs.
Which assessment findings are adverse effects associated with the administration of cholinergic medications? Sweating Dizziness Dry cough Bradycardia Hypotension
Sweating Dizziness Bradycardia Hypotension The adverse effects of cholinergic therapy include bradycardia or tachycardia, hypotension, dizziness, and sweating. The adverse effects result from the stimulation of nicotinic receptors. Dry cough is not an adverse effect associated with cholinergic therapy.
Which patient would be unable to receive donepezil to treat symptoms of Alzheimer disease? The patient with constipation The patient with urinary retention The patient exhibiting heart block The patient diagnosed with hypertension
The patient exhibiting heart block Donepezil stimulates muscarinic receptors and is contraindicated in patients with disorders of cardiac conduction such as heart block. Constipation, urinary retention, and hypertension are not contraindications to the use of this drug. Patients with Alzheimer's disease who cannot use cholinergic drugs may be treated with memantine, which is not a cholinesterase inhibitor.
A patient has been receiving donepezil for several weeks. Which finding indicates the medication is having a therapeutic effect? The patient is awake. The patient is relaxed. The patient has urinated. The patient has increased cognition.
The patient has increased cognition. Donepezil is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition. The other responses are not evidence of a therapeutic effect from donepezil.
The nurse has administered bethanechol to a patient with hypotonic bladder. What assessment finding indicates a therapeutic response? The patient passes gas. The patient's respiratory rate is increased. The patient has micturition within an hour. The patient's blood pressure is higher than it was previously.
The patient has micturition within an hour. Patients with hypotonic bladder have urinary retention. Therefore to determine the efficacy of the drug, the nurse should reassess the patient after administering the medication. If the patient has micturition within 60 minutes of administering the medication, it indicates that the medication has had the desired therapeutic effect. Cholinergic medications prevent constipation by increasing gastric motility. These drugs may cause an increase in the bowel sounds. Bronchoconstriction is an adverse effect of the drug; when this occurs, the patient may have a change in respiratory rate; however, these changes are not the expected therapeutic effects of a patient who has hypotonic bladder. Hypotension is an adverse effect of cholinergic medications such as bethanechol.
Which patient should receive a reduced dose of memantine? The patient with migraines The patient with bradycardia The patient with hypothyroidism The patient with elevated blood urea nitrogen and creatinine
The patient with elevated blood urea nitrogen and creatinine Memantine is a N-methyl-d-aspartate receptor antagonist that is used for the treatment of Alzheimer's dementia. The prescribed dosage of the drug is 10 mg two times per day. However, patients with renal impairment may need the dose to be reduced to 5 mg twice daily. Hypothyroidism, bradycardia, and migraines are not contraindications to this medication and do not require a reduced dose.
What are the uses of cholinesterase inhibitors? To diagnose and treat myasthenia gravis To be used as an antidote in biochemical warfare To relieve severe constriction of the bronchioles To be used as an antidote to tricyclic antidepressant toxicity To treat a patient with a prolonged history of sleep deprivation
To diagnose and treat myasthenia gravis To be used as an antidote in biochemical warfare To be used as an antidote to tricyclic antidepressant toxicity When used therapeutically, cholinesterase inhibitors, such as physostigmine, affect the muscarinic receptors and nicotinic receptors of the neuromuscular junction, thereby helping restore acetylcholine to the level needed for nerve impulse transmission. Because patients with myasthenia gravis lack sufficient release of acetylcholine at the neuromuscular junction, administration of physostigmine helps improve muscle strength by decreasing the destruction of acetylcholine. Due to its capacity to restore the acetylcholine level, this medication is useful as an antidote to biochemical warfare involving anticholinergic agents, as well as in tricyclic antidepressant toxicity. Physostigmine therapy is contraindicated in patients with insomnia or bronchoconstriction.
After administering bethanechol to a patient after surgery, what system should the nurse assess to determine a therapeutic effect? Urinary Neurologic Musculoskeletal Gastrointestinal
Urinary Bethanechol increases the tone of the detrusor muscle and causes the patient to void. Because it is used to initiate voiding, the nurse does not need to complete a neurologic, muscular, or gastric assessment to determine effectiveness.
A patient is prescribed donepezil for Alzheimer's disease. What assessment is essential to be performed by the nurse before administering the medication? Vital signs Bowel sounds Body mass index Blood glucose level
Vital signs Donepezil is a cholinesterase inhibitor that works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase. It is used in the treatment of mild to moderate Alzheimer's disease. Contraindications for donepezil include known drug allergy. Adverse effects are normally mild and resolve on their own and can often be avoided by careful dose titration. They include gastrointestinal upset (including ulcer risk due to increased gastric secretions), drowsiness, dizziness, insomnia, and muscle cramps. The effects on the cardiovascular system are complex and may include bradycardia, syncope, hypotension with reflex tachycardia, or hypertension. Due to these potential effects, the nurse should assess vital signs before administering the drug. Interacting drugs include anticholinergics and nonsteroidal antiinflammatory drugs.Bowels sounds, body mass index, and blood glucose level do not need to be performed prior to administering the medication.
A patient is prescribed donepezil for Alzheimer's disease. What assessment is essential to be performed by the nurse before administering the medication? Vital signs Bowel sounds Body mass index Blood glucose level
Vital signs Donepezil is a cholinesterase inhibitor that works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase. It is used in the treatment of mild to moderate Alzheimer's disease. Contraindications for donepezil include known drug allergy. Adverse effects are normally mild and resolve on their own and can often be avoided by careful dose titration. They include gastrointestinal upset (including ulcer risk due to increased gastric secretions), drowsiness, dizziness, insomnia, and muscle cramps. The effects on the cardiovascular system are complex and may include bradycardia, syncope, hypotension with reflex tachycardia, or hypertension. Due to these potential effects, the nurse should assess vital signs before administering the drug. Interacting drugs include anticholinergics and nonsteroidal antiinflammatory drugs.Bowels sounds, body mass index, and blood glucose level do not need to be performed prior to administering the medication.