Prep U exam 2

A client with asthma will soon begin treatment with atropine as an adjunct to a normal drug regimen. What teaching point should the nurse include in client education related to this new aspect of drug treatment? "You might find that you have to urinate more often for the first few days that you take the drug." "It's possible that your eyes will take longer to adjust to bright lights." "If you develop diarrhea, it might be related to atropine and you should visit your health care provider." "You'll probably find that you are producing more saliva than normal; this is a normal side effect of atropine."

"It's possible that your eyes will take longer to adjust to bright lights." As an anticholinergic drug, atropine has the potential to cause visual disturbances, dry mouth, constipation, and urinary retention.

Norepinephrine is the main neurotransmitter in the sympathetic nervous system. Which enzyme metabolizes norepinephrine? Adenylyl cyclase Effector enzyme Choline acetyltransferase Monoamine oxidase

Monoamine oxidase or catechol-O-methyltransferase (COMT).

A nursing instructor is conducting a teaching session about the parasympathetic nervous system. The instructor determines the session is successful when the students correctly choose which receptors are involved with stimulating smooth muscles? Nicotinic Muscarinic Alpha Beta

Muscarinic muscarinic receptors (which stimulate smooth muscle) and nicotinic receptors (which stimulate skeletal muscle)

Imbalanced Nutrition: Less Than Body Requirements is a common nursing diagnosis for clients prescribed cholinesterase inhibitors. The client's daughter asks the nurse why this is common. The nurse knows that which is a common side effect of cholinesterase inhibitors? Hypotension Hyperactivity Nausea and vomiting Hypertension

Nausea and vomiting

The anatomy and physiology instructor is discussing the role of neurotransmitters in the autonomic nervous system. Which would the instructor identify as the main adrenergic neurotransmitter?

Norepinephrine

A nursing student is preparing to administer the drug bethanechol to a client with urinary retention. After researching the drug's actions and uses, the student demonstrates understanding of the drug by identifying it as which type of medication? Select all that apply. Parasympathomimetic drug Cholinergic drug Adrenergic blocker drug Sympatholytic drug

Parasympathomimetic drug Cholinergic drug

The nurse is preparing to administer donepezil to a female client. The nurse should question this order if which factor is noted in the client's record? Seizure disorder Positive pregnancy test Asthma Bladder obstruction

Positive pregnancy test The administration of donepezil is contraindicated in clients with hypersensitivity to the drug, who are pregnant or are lactating.

Parasympathetic stimulation causes the release of nitrous oxide from the endothelium of blood vessels. Which of the following results from this release? Increased inflammation Increased platelet aggregation Relaxation of vascular smooth muscle Constriction of blood vessels

Relaxation of vascular smooth muscle The release of nitrous oxide from the endothelium results in decreased platelet aggregation, decreased inflammation, relaxation of vascular smooth muscle, and dilation of blood vessels

A client with neurologic symptoms has presented for diagnostic testing that will evaluate nerve impulse transmission. The nurse assisting with the procedure should be aware of what expected process of nerve impulse transmission? "The impulse travels from the central nervous system (CNS) to the preganglionic neuron to the ganglia to the postganglionic neuron to the neuroeffector cells." "The impulse travels from the preganglionic neuron to the CNS to the ganglia to the postganglionic neuron to the neuroeffector cells." "The impulse travels from the preganglionic neuron to the ganglia to the postganglionic neuron to the CNS to the neuroeffector cell." "The impulse travels from the CNS, to the neuroeffector cells, to the preganglionic neuron to the ganglia to the postganglionic neuron."

"The impulse travels from the central nervous system (CNS) to the preganglionic neuron to the ganglia to the postganglionic neuron to the neuroeffector cells."

The nurse administers morphine 15 mg oral solution to a client with cancer pain at 09:30. What time should the nurse reassess the client for peak analgesic effect? 10:30 9:45 10:00 11:00

10:30 With oral administration, peak activity occurs in about 60 minutes.

A client's nerve has been stimulated by pain and the resulting electrical action potential has reached the end of the axon. What will happen next? A neurotransmitter will be released into the synaptic cleft The signal will cross the synaptic cleft and continue via a new neuron The signal will revert back to the neuronal cell body The adjacent nerve will be electrically stimulated

A neurotransmitter will be released into the synaptic cleft

When preparing to administer a cholinergic drug, the nurse understands that which is responsible for activating the primary neurotransmitter in the parasympathetic nervous system? Acetylcholinesterase DNA gyrase Protease Lipase

Acetylcholinesterase Acetylcholinesterase is the enzyme responsible for activating acetylcholine, the primary neurotransmitter in the parasympathetic nervous system.

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

Agitation Constipation, reduced sweating, and dry mouth may be noted as well.

The anatomy and physiology instructor is discussing adrenergic receptors with the nursing class. What adrenergic receptor would the instructor tell the students is found in the blood vessels, iris, and urinary bladder? Alpha1 Alpha2 Beta1 Beta2

Alpha1

The nurse is assessing a client who has urinary hesitation and occasional overflow incontinence. What adrenergic receptors may be overstimulated in this client?

Alpha1 Beta-2 receptors are found in the smooth muscle of the blood vessels, bronchi, in the periphery, and in uterine muscle.

Decreased acetylcholine levels are characteristic of what disorder? multiple sclerosis. Huntington's disease. Alzheimer's disease. Parkinson's disease.

Alzheimer's disease.

The nurse is providing information about how to care for clients during a bioterrorism attack. The nurse knows that which drug will be administered in the case of a sarin attack? Atropine Neostigmine Donepezil Bethanechol

Atropine In the case of a nerve gas attack, atropine is the antidote.

The client has been diagnosed with urinary retention. The nurse expects the client to receive which medication for this condition? Ambenonium Bethanechol Benadryl Guanidine

Bethanechol

When administered with other drugs that enhance stimulation of serotonergic receptors (Demerol, Dextromethorphan, antidepressants), rasagiline can: Cause a potentially fatal CNS toxic reaction. Provide good symptom control and increased ability to perform ADLs. Relieve tremors in approximately 50% of the clients taking it. Cause increased bone marrow suppression requiring discontinuation.

Cause a potentially fatal CNS toxic reaction. Rasagiline has the potential to increase serotonin neurotransmission. When given with other drugs that enhance stimulation of serotonergic receptors (e.g., antidepressants, St. John's wort, dextromethorphan, and meperidine), serotonin syndrome, a potential fatal CNS toxicity reaction characterized by hyperpyrexia and death, can occur.

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan? Many postoperative clients require less opioid when PCA is used. Use of PCA requires a greater amount of opioid. Clients experience more adverse effects when PCA is used. Clients can override the lockout interval if needed when a PCA is used.

Many postoperative clients require less opioid when PCA is used.

Which agent would the nurse identify as acting specifically on the receptors in the GI tract? Ipratropium Tiotropium Trospium Hyoscyamine

Hyoscyamine

The nurse is caring for an 8-year-old child who is experiencing an exacerbation of asthma. The nurse expects to administer which medication because of its bronchodilation effects in the treatment of asthma and chronic bronchitis? Ipratropium Atropine Hyoscyamine Scopolamine

Ipratropium Ipratropium and tiotropium are anticholinergic medications given by inhalation for bronchodilation effects in the treatment of asthma and chronic bronchitis.

The dopamine agonists selegiline and rasagiline, which are monoamine oxidase inhibitors, should not be administered with which drug as the combination increases the risk of serotonin syndrome? Meperidine Naproxen Acetaminophen Aspirin

Meperidine

The nurse provides drug teaching to a client who has Parkinson's disease and who has been prescribed amantadine. How should the nurse describe the action of this drug? It stimulates the natural release of dopamine It acts on effector cells in the same manner as dopamine It binds directly with postsynaptic dopamine receptors It acts a direct precursor of dopamine synthesis

It stimulates the natural release of dopamine Amantadine increases the release of dopamine. Levodopa is a precursor of dopamine that crosses the blood-brain barrier where it is converted to dopamine, acting like a replacement therapy. Apomorphine directly binds with postsynaptic dopamine receptors.

Stimulation of the sympathetic nervous system results in all of the following EXCEPT: Increased arterial blood pressure and cardiac output. Decreased rate of cellular metabolism. Increased breakdown of muscle glycogen for energy. Increased rate of blood coagulation.

Decreased rate of cellular metabolism.

Which medication would the nurse expect to administer orally once a day to a client with Alzheimer disease (AD)? a. Rivastigmine Memantine Donepezil Galantamine

Donepezil is given once a day. While rivastigmine, galantamine, and memantine are given twice a day.

The nurse is caring for a client in the emergency department who has a history of myasthenia gravis. The client has symptoms that could be interpreted as either myasthenic crisis or cholinergic crisis. The nurse is aware that the health care provider will order what medication to help determine the type of crisis the client is experiencing? a. Donepezil b. Edrophonium c. Galantamine hydrobromide d. Memantine hydrochloride

Edrophonium is the drug that is used to help determine if a client is experiencing a myasthenic or a cholinergic crisis.

The nurse is caring for an 82-year-old client who presents with symptoms of Parkinson's disease. The nurse recognizes that the dosage of levodopa/carbidopa may need to be reduced in this client because of which age-related conditions? Increase in peripheral AADC, the enzyme that carbidopa inhibits Decrease in peripheral AADC, the enzyme that carbidopa inhibits Cardiac incompetency and resultant congestive heart failure Pulmonary incompetency and resultant chronic obstructive pulmonary disease

Decrease in peripheral AADC, the enzyme that carbidopa inhibits

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 Cevimeline Edrophonium Pyridostigmine

Rivastigmine

A patient calls the clinic and talks to the nurse. The patient tells the nurse that the patient is going on a cruise and is concerned about motion sickness. The patient says that a friend got a prescription for scopolamine. What adverse effect would the nurse inform the patient that using scopolamine may result in? Pupil constriction Tachycardia Diarrhea Urinary incontinence

Tachycardia Scopolamine blocks the parasympathetic system, which may result in dilated pupils and an increase in heart rate (tachycardia). Blocking the parasympathetic system also results in decreased GI activity and urinary bladder tone causing constipation and urinary retention.

The nursing instructor is teaching a student about the drugs used for Alzheimer's disease. Even though cholinesterase inhibitors do not cure the disease, the instructor informs the student that they do help to slow the progression. The instructor then asks the student, "When a drug is stopped due to side effects, what happens to the client?" The student's best response would be: The side effects will worsen. The client loses any benefit they have received from the drug. The client will deteriorate at a faster rate. The client will show no changes.

The client loses any benefit they have received from the drug.

A client has been prescribed a medication that antagonizes the beta receptors of the sympathetic nervous system. What assessment finding should the nurse attribute to the effects of this medication? The client's blood pressure is decreased The client's nausea is relieved The client denies shortness of breath The client denies feeling anxious

The client's blood pressure is decreased

Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness? They should be given as soon as the client feels uncomfortable. They should be given on a regular schedule, around the clock. They should be given IM as the preferred route of administration. They should be given topically only as a last resort.

They should be given on a regular schedule, around the clock.

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? An idiosyncratic allergic reaction that should be reported to MedWatch An adverse effect of the medication that should be reported to the health care provider when the nurse rounds in the morning This is cholinergic crisis, and the provider needs to be notified immediately. The client is having a myasthenic crisis and should be transferred to the intensive care unit.

This is cholinergic crisis, and the provider needs to be notified immediately. The fact that the dosage was increased would result in a cholinergic crisis

client has benign prostatic hypertrophy and has been prescribed neostigmine. The nurse is aware that this client must be monitored for what adverse effect of this medication? Pain with urination Urinary retention Hematuria Pyuria

Urinary retention

A client who adheres strictly to a vegan diet has reported varied signs and symptoms in recent months and has eventually been diagnosed with a tyrosine deficiency. When assessing this client, the nurse should expect to identify evidence of: a. low norepinephrine levels. b. lack of acetylcholine. c. excessive sympathetic stimulation. d. low levels of monoamine oxidase.

a. low norepinephrine levels. Tyrosine is a precursor to dopamine, which is in turn a precursor to norepinephrine.

The up-regulation of receptors is responsible for what client reaction? anaphylactic shock triggered by a bee sting nausea caused by an adverse smell low blood pressure in response to severe diarrhea difficulty breathing triggered by bacterial pneumonia

anaphylactic shock triggered by a bee sting allergy related to bee stings is a hypersensitization reaction and the best example.

A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs. Which interaction should the nurse monitor for in this patient? a. Decreased effectiveness of anticholinergics b. Increased risk of theophylline toxicity c. Increased risk of GI bleeding d. Decrease GI absorption of the drug

c. Increased risk of GI bleeding The interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors causes increased risk of GI bleeding. Interaction of anticholinergics with cholinesterase inhibitors causes decreased effectiveness of anticholinergics.

A client with biliary colic has been prescribed atropine. The nurse should question this order after discovering which disorder in the client's past history? a. Hepatic disease b. Benign prostatic hypertrophy c. Myocardial infarction d. Urinary retention

c. Myocardial infarction contraindications with the use of atropine include myocardial infarction, myasthenia gravis, tachyarrhythmia, and congestive heart failure

Unwanted anticholinergic effects include:

constipation and dry mouth and mydriasis. (dilated pupils)

A 71-year-old client has sought care due to recent bradycardia, and the nurse's initial assessment reveals a heart rate of 42 beats/min. Upon reviewing the client's health history, the nurse also learns that the client has comorbidities of myasthenia gravis and type 1 diabetes. What aspect of this client's health status would contraindicate the safe use of an anticholinergic? the client's age myasthenia gravis diabetes heart rate ≥ 40 beats/min

myasthenia gravis

For clients who can't verbalize pain, the nurse assesses the client's facial expression, limb movements, guarding, and grimacing.

na

Alpha-2 stimulation

prevents overstimulation of effector sites and moderate insulin release by the beta cells of the pancreas.

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

pupil response Because this client has received atropine, pupils will be dilated and will not react normally to light. This could be mistaken as an indication of brain death if the nurse did not know atropine had been administered. This test will be postponed until the pupils are no longer dilated by the medication.

Alpha-1 stimulation leads to

vasoconstriction and increased peripheral vascular resistance, resulting in a rise in blood pressure.

Beta-2 stimulation

vasodilation and bronchodilation.

A client with an overactive bladder has been prescribed solifenacin by the health care provider. The client is also taking digoxin for the treatment of a cardiac arrhythmia. The nurse should monitor for which effects occurring due to the interaction of these two drugs? increased neuromuscular-blocking effect Increased effectiveness of digoxin Increased serum levels of digoxin Increased effectiveness of solifenacin

increased serum levels of digoxin

beta 1 stimulation leads to

increases myocardial activity

The client tells the nurse that the health care provider described a drug as having "no ceiling effect." How should the nurse respond when the client asks what that means? It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. It is a drug that has a special caution because use of this drug is more likely to have adverse effects. It is a drug that no longer has a patent and can be sold by its generic name. It is a drug that reduces the likelihood of drug abuse and dependence.

it is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. A drug with no ceiling effect is one in which there is no upper limit to the dosage that can be given to clients who have developed tolerance to previous dosages.

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

heat stroke related to decreased perspiration.