Chapter 19: Cholinergic Agonists and Anticholinergics Nursing School Test Banks

Chapter 19: Cholinergic Agonists and Anticholinergics
Test Bank

MULTIPLE CHOICE

1. The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug
a. acts on muscarinic receptors.
b. acts on nicotinic receptors.
c. inhibits cholinesterase.
d. inhibits cholinergic receptors.
ANS: C
Agents that inhibit cholinesterase, which is the enzyme that destroys acetylcholine, indirectly enhance the actions of acetylcholine.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 270
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A nursing student asks why a direct-acting cholinergic agonist drug that is selective to muscarinic receptors is described as being non-specific. The nurse will explain that this is because
a. muscarinic receptors are present in many different tissues.
b. the action of cholinesterase alters the bioavailability at different sites.
c. these drugs can also affect nicotinic receptors.
d. they vary in their reversible and irreversible effects.
ANS: A
Although drugs classified as direct-acting cholinergic agonists are primarily selective for muscarinic receptors, they are non-specific because muscarinic receptors are located in different sites, causing actions in various organs. They are not affected differently by cholinesterase activity and have negligible actions on nicotinic receptors.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Pages 269-270
TOP: NURSING PROCESS: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg and a heart rate of 98 beats per minute. The nurse will perform which action?
a. Administer the drug and monitor urine output.
b. Administer the medication and monitor vital signs frequently.
c. Give the medication and notify the provider of the increased heart rate.
d. Hold the medication and notify the provider of the decreased blood pressure.
ANS: D
Side effects of this medication are a decrease in the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension. The nurse should hold the drug and notify the provider.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 271
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patients blood pressure is 110/70 mm Hg. The nurse will perform which action?
a. Notify the provider of bethanechol adverse effects.
b. Record the urine output and the blood pressure and continue to monitor.
c. Request an order for intravenous atropine sulfate.
d. Suggest another dose of bethanechol to the provider.
ANS: B
The patient is exhibiting desired effects and mild side effects of bethanechol, so the nurse should record information and continue to monitor the patient. There is no need to notify the provider, give an antidote, or repeat the dose.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 271
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching?
a. Excessive sweating is a normal reaction to this medication.
b. Excess salivation is a serious side effect.
c. I should get out of bed slowly while taking this drug.
d. I will not take the drug if my heart rate is less than 60 beats per minute.
ANS: A
Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 271
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is caring for a male patient with myasthenia gravis who will begin taking ambenonium chloride (Mytelase). When performing a health history, the nurse will be concerned about a history of which condition in this patient?
a. Benign prostatic hypertrophy
b. Chronic constipation
c. Erectile dysfunction
d. Upper respiratory infection
ANS: A
This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 271
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinsons disease. The nurse understands that this drug is used primarily for which purpose?
a. To decrease drooling and excessive salivation
b. To improve mobility and muscle strength
c. To prevent urinary retention
d. To suppress tremors and muscle rigidity
ANS: D
Antiparkinson-anticholinergic drugs are used mainly to reduce tremors and muscle rigidity.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 275
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider?
a. Absent bowel sounds
b. Drowsiness
c. Dry mouth
d. Heart rate of 78 beats per minute
ANS: A
These are all side effects of atropine. Absent bowel sounds can indicate a paralytic ileus. The other side effects are not harmful.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 276
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient who has irritable bowel syndrome would most likely receive which type of drug to treat this condition?
a. An anticholinergic
b. A cholinergic esterase inhibitor
c. A muscarinic agent
d. A nicotinic agent
ANS: A
Anticholinergic drugs are used to treat peptic ulcers and intestinal spasticity because of their actions to decrease gastric secretions and gastrointestinal spasms.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 278
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse is teaching a patient about the use of an anticholinergic medication. What information will the nurse include when teaching this patient about this medication?
a. Check your heart rate frequently to monitor for bradycardia.
b. Drink extra fluids while you are taking this medication.
c. Rise from a chair slowly to avoid dizziness when taking this drug.
d. Use gum or lozenges to decrease dry mouth caused by this drug.
ANS: D
Anticholinergic medications cause dry mouth, so patients should be advised to use gum or lozenges to counter this side effect. Anticholinergics cause increased heart rate and increased blood pressure. Anticholinergics can cause urinary retention so patients should not increase fluid intake.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 277
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimers disease?
a. Ambenonium chloride (Myletase)
b. Benztropine (Cogentin)
c. Donepezil HCl (Aricept)
d. Neostigmine methylsulfate (Prostigmin)
ANS: C
Donepezil is used to treat Alzheimers disease. Ambenonium and neostigmine are used to treat myasthenia gravis. Benztropine is used to treat Parkinsons disease.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 272
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse is teaching a patient who is going on a cruise about the use of transdermal scopolamine . What information will the nurse include when teaching this patient?
a. Apply the patch as needed for nausea and vomiting.
b. Apply the patch to your upper arm.
c. Change the patch every 3 days.
d. Restrict fluids while using this patch.
ANS: C
The transdermal scopolamine patch is designed to last for 72 hours. The patient should be taught to change it every 3 days. It works best when worn at all times and not just for symptomatic relief. The patch should be applied behind the ear. Patients should not restrict fluids.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 279
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinsons disease. When performing an assessment, which aspect of the patients history would cause the nurse to hold the medication and notify the provider?
a. Asthma
b. Glaucoma
c. Irritable bowel syndrome
d. Motion sickness
ANS: B
Patients who have glaucoma should not take anticholinergic medications.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 279
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1,000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform?
a. Administer a fluid bolus.
b. Give the patient ice chips.
c. Palpate the patients bladder.
d. Reassess the patient in 15 minutes.
ANS: C
Atropine can cause urinary retention. The patients urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 274
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. A patient who has Parkinsons disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinsons disease would be a contraindication for this drug?
a. Drooling
b. Muscle rigidity
c. Muscle weakness
d. Tardive dyskinesia
ANS: D
Tardive dyskinesia is a contraindication for this drug.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 276
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A patient who is intubated develops bradycardia because of vagal stimulation. Which medication will the nurse anticipate administering to treat this symptom?
a. Atropine sulfate (Atropine)
b. Benztropine (Cogentin)
c. Bethanechol chloride (Urecholine)
d. Metoclopramide (Reglan)
ANS: A
Atropine is used to treat bradycardia caused by vagal stimulation.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 274
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would be a contraindication for this drug?
a. Decreased bowel sounds
b. Drooling
c. Gastric upset
d. Pain
ANS: A
A decrease in bowel sounds could signal the beginning of paralytic ileus. Detrol is contraindicated in patients with paralytic ileus.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 276
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.)
a. Dilate pupils
b. Decrease heart rate
c. Stimulate gastric muscle
d. Dilate blood vessels
e. Dilate bronchioles
f. Increase salivation
g. Constrict pupils
ANS: B, C, D, F, G
Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 269
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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