Cholinergic Drugs

Question 1

1. When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect?
   a. Bradycardia
   b. Tachycardia
   c. Vasoconstriction d. Palpitations

Answer 1

a

Question 2

2. The nurse notes in a patient’s medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse interprets that the patient has which disorder?
   a. Anticholinergic poisoning
   b. Glaucoma
   c. Bladder atony
   d. Myasthenia gravis

Answer 2

b

Question 3

3. A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote?
   a. Atenolol (Tenormin)
   b. Bethanechol (Urecholine)
   c. Dobutamine
   d. Atropine sulfate

Answer 3

d

Question 4

4. A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse will teach this patient to look for which therapeutic effect?
   a. Decreased pulse rate
   b. Abdominal cramping
   c. Passage of flatus
   d. Decreased urge to void

Answer 4

c

Question 5

5. A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important to include in the teaching?
   a. Take the medication with meals to avoid gastrointestinal distress.
   b. Give daytime doses close together for maximal therapeutic effect.
   c. Take the medication 30 minutes before eating to improve swallowing and
   chewing.
   d. Take the medication only if difficulty swallowing occurs during a meal.

Answer 5

c

Question 6

6. A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse will prepare to administer which drug?
   a. Pilocarpine (Salagen)
   b. Bethanechol (Urecholine)
   c. Physostigmine (Antilirium)
   d. Tacrine (Cognex)

Answer 6

c

Question 7

7. The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer’s disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug’s expected action?
   a. Prevents memory loss in later stages
   b. Reverses the course of Alzheimer’s disease
   c. Provides sedation to prevent agitation and restlessness
   d. May help to improve the mood and decrease confusion

Answer 7

d

Question 8

8. A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer’s disease. Her daughter calls the prescriber’s office and is upset because “Mother has not improved one bit!” Which response by the nurse is appropriate?
   a. “Increase the dosage to twice daily.”
   b. “It takes time for the cure to take effect.”
   c. “It may take up to 6 weeks to see an improvement.”
   d. “Take the medication on an empty stomach for improved absorption.”

Answer 8

d

Question 9

9. A patient who has been diagnosed with Sjögren’s syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect?
   a. Reduction of salivation
   b. Stimulation of salivation
   c. Reduction of gastrointestinal peristalsis
   d. Improvement of fine-motor control

Answer 9

b

Question 10

10. The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors?
    a. Muscarinic
    b. Nicotinic
    c. Cholinergic d. Ganglionic

Answer 10

b

Question 11

11. A patient calls the clinic to speak to the nurse about taking an herbal product that contains ginkgo (Ginkgo biloba) to “help my memory.” He states that he has read much information about the herbal product. Which statement by the patient indicates a need for further education?
    a. “I know the FDA has not approved this herbal product, but I’d like to try it to see if
    it helps my memory.”
    b. “I need to watch for possible side effects, such as headaches, or stomach or
    intestinal upset.”
    c. “I will take aspirin or ibuprofen (Motrin) if I have a headache.”
    d. “Ginkgo may cause increased bleeding, so I’ll have to be careful when doing yard
    work.”

Answer 11

c

Question 12

12. A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease?
    a. Parkinson’s disease
    b. Multiple sclerosis
    c. Myasthenia gravis
    d. Alzheimer’s disease

Answer 12

c

Question 13

1. A cholinergic drug is prescribed for a patient. The nurse checks the patient’s medical history, knowing that this drug is contraindicated in which disorders? (Select all that apply.)
   a. Bladder atony
   b. Gastrointestinal obstruction
   c. Bradycardia
   d. Alzheimer’s disease
   e. Hypotension
   f. Chronic obstructive pulmonary disease

Answer 13

b, c, e, f

Question 14

1. A patient is receiving memantine (Namenda) 10 mg PO daily. The patient is unable to swallow pills, so an oral solution that contains 2 mg/mL is ordered. Identify how much will the patient receive per dose. _______

Answer 14

5 mL

Question 15

1. The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect?
   a. Tachycardia
   b. Bradycardia
   c. Ectopic beats
   d. Cardiac standstill

Answer 15

a

Question 16

2. A patient has a prescription for oxybutynin (Ditropan), an anticholinergic drug. When reviewing the patient’s medical history, which condition, if present, would be considered a contraindication to therapy with this drug?
   a. Diarrhea
   b. Hypertension
   c. Neurogenic bladder
   d. Uncontrolled angle-closure glaucoma

Answer 16

d

Question 17

3. The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system?
   a. Central nervous system
   b. Somatic nervous system
   c. Sympathetic nervous system
   d. Parasympathetic nervous system

Answer 17

d

Question 18

4. A patient has received an accidental overdose of intravenous atropine. Which drug will the nurse prepare to administer?
   a. Atenolol (Tenormin)
   b. Bethanechol (Urecholine)
   c. Dicyclomine (Bentyl)
   d. Physostigmine (Antilirium)

Answer 18

d

Question 19

5. A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy?
   a. Drowsiness may interfere with his outdoor activities.
   b. Increased salivation may occur during exercise and outside activities.
   c. Fluid volume deficits may occur as a result of an increased incidence of diarrhea.
   d. He will need to take measures to reduce the occurrence of heat stroke during his
   activities.

Answer 19

d

Question 20

6. The nurse will monitor for which adverse effect when administering an anticholinergic drug?
   a. Excessive urination
   b. Diaphoresis
   c. Dry mouth
   d. Pupillary constriction

Answer 20

c

Question 21

7. The nurse is reviewing a patient’s medication history and notes that the patient is taking the cholinergic blocker tolterodine (Detrol). Which is an indication for this medication?
   a. Irritable bowel disease
   b. Induction of mydriasis
   c. Urge incontinence
   d. Reduction of secretions preoperatively

Answer 21

c

Question 22

8. A patient has been taking tolterodine (Detrol), but today her prescriber changed her to a newer drug, darifenacin (Enablex). What advantage does darifenacin have over the tolterodine?
   a. The newer cholinergic-blocker drugs are more effective.
   b. It helps reduce urinary retention.
   c. It can be used in patients with narrow-angle glaucoma.
   d. The incidence of dry mouth is much lower with darifenacin.

Answer 22

d

Question 23

9. The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. What is the purpose of this drug in the preoperative setting?
   a. Control the heart rate
   b. Relax the patient
   c. Reduce urinary frequency
   d. Reduce oral and gastrointestinal secretions

Answer 23

d

Question 24

10. In preparation for eye surgery, the nurse monitors for which desired drug effect in a patient who is receiving a cholinergic-blocking eyedrop medication?
    a. Miosis
    b. Mydriasis
    c. Increased intraocular fluid production
    d. Enhanced tear production

Answer 24

b

Question 25

11. A patient has a new prescription for the transdermal form of scopolamine. The nurse knows that this form of scopolamine is used for which condition?
    a. Angina
    b. Chronic pain
    c. Hypertension
    d. Motion sickness

Answer 25

d

Question 26

1. The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (Select all that apply.)
   a. A patient who has suddenly developed symptomatic bradycardia with a heart rate
   of 32 beats/min
   b. A patient who has suddenly developed symptomatic tachycardia with a heart rate
   of 180 beats/min
   c. A patient with severe narrow-angle glaucoma
   d. A patient who is about to have surgery
   e. A patient newly diagnosed with myasthenia gravis
   f. A patient with anticholinesterase inhibitor poisoning

Answer 26

a, d, f

Question 27

1. A patient is to receive glycopyrrolate (Robinul) 4 mcg/kg IM 30 minutes before a procedure. The patient weighs 110 pounds; the medication is available in a strength of 0.2 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe. _______

Answer 27

1 mL