Chapter 19: Cholinergic Agonists and Anticholinergics Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 19: Cholinergic Agonists and Anticholinergics

Test Bank

MULTIPLE CHOICE

1. The nurse is reviewing the history of a client who has been prescribed tolterodine tartrate (Detrol, Detrol LA) for treatment of incontinence. The nurse plans to contact the health care provider if the client has:

a.

cataracts.

b.

hyperthyroidism.

c.

narrow-angle glaucoma.

d.

parkinsonism.

ANS: C

Tolterodine tartrate is an antimuscarinic and anticholinergic agent. It is contraindicated in clients with narrow-angle glaucoma.

DIF: Cognitive Level: Application REF: pp. 281-282

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client is receiving bethanechol chloride (Urecholine) as part of his treatment regimen. He is experiencing swallowing difficulties. The highest priority action on the part of the nurse is to contact the physician to administer the drug by _____ injection.

a.

intramuscular

b.

intravenous

c.

subcutaneous

d.

intradermal

ANS: C

Bethanechol may be given orally or subcutaneously.

DIF: Cognitive Level: Comprehension REF: p. 277

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The client that would be a poor candidate for treatment with bethanechol chloride (Urecholine) is the client who is experiencing:

a.

severe bradycardia and hypotension.

b.

tachycardia and hypertension.

c.

urinary retention and abdominal distention.

d.

hypertension and urinary retention.

ANS: A

Side effects of this medication are decreasing the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension.

DIF: Cognitive Level: Comprehension REF: p. 277

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. Reversible cholinesterase inhibitors can be an effective treatment for glaucoma because of which action of the drug?

a.

It causes the eyeball to decrease in size.

b.

It causes the aqueous humor of the eye to expand.

c.

It produces pupillary constriction.

d.

It produces pupillary dilation.

ANS: C

With constriction, the outflow of aqueous humor is facilitated, decreasing intraocular pressure.

DIF: Cognitive Level: Comprehension REF: p. 275

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The client has myasthenia gravis. The highest priority client teaching is:

a.

instructing the client to take the drug on a strict schedule to avoid respiratory muscle weakness.

b.

informing the client if a dose of the drug is missed to double the drug dose when the next dose is scheduled.

c.

instructing the client that if muscle weakness occurs, to rest, and if it persists to call the healthcare provider the next day.

d.

informing the client that if respiratory distress occurs, rest, double the drug dose, and call the healthcare provider.

ANS: A

Even small gaps in time may cause respiratory muscle weakness; therefore the time schedule is strict.

DIF: Cognitive Level: Application REF: p. 277

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The client has been diagnosed with early-stage Alzheimers dementia. What cholinesterase inhibitor is most likely to be ordered for this client?

a.

Ambenonium chloride (Mytelase)

b.

Bethanechol chloride (Urecholine)

c.

Atropine sulfate

d.

Donepezil (Aricept)

ANS: D

This is the medication commonly given for Alzheimers dementia and is thought to improve memory.

DIF: Cognitive Level: Application REF: p. 277

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A nurse is teaching a client about bethanechol hydrochloride (Urecholine). The nurse informs the client that this drug warrants which precaution?

a.

Rising slowly from lying positions

b.

Counting pulse rate frequently to assess for bradycardia

c.

Avoiding diarrhea by eating binding foods

d.

Maintaining aspiration precautions because of excess saliva

ANS: A

This medication may lead to orthostatic hypotension and warrants careful position changes. Although bradycardia is a risk, it is not important to count pulse rate frequently.

DIF: Cognitive Level: Application REF: p. 274

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The client who is being treated with an anticholinergic medication should receive which instruction?

a.

Encourage the use of alcohol before bedtime for sleep disorders.

b.

Suggest hard candy, chewing gum, and oral hygiene for dry mouth.

c.

Instruct the client to report dizziness and a slow pulse rate immediately.

d.

Instruct the client to avoid lifting heavy objects.

ANS: B

Dry mouth is a common side effect of the anticholinergics.

DIF: Cognitive Level: Application REF: p. 278

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The client that would be a poor candidate for treatment with an atropine-like drug is the client who has:

a.

parkinsonism.

b.

a peptic ulcer.

c.

cirrhosis.

d.

glaucoma.

ANS: D

Atropine may cause pupillary dilation, which increases intraocular pressure.

DIF: Cognitive Level: Application REF: p. 279

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. Which response can the nurse expect to see in the client who has parkinsonism and is being treated with anticholinergics?

a.

Decreased cognition

b.

Increased muscle tone

c.

Diuresis

d.

Decreased tremors and rigidity

ANS: D

This is the use for parkinsonism, a disease whose symptoms include tremors, bradykinesia, rigidity, and drooling.

DIF: Cognitive Level: Comprehension REF: p. 278

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A client with nausea and vomiting has been prescribed an antihistamine and an anticholinergic. The nurse anticipates that which expected side effect of these medications will be observed in the client?

a.

Drowsiness and dry mouth

b.

Bradycardia and fatigue

c.

Tachycardia and dyspnea

d.

Abdominal cramps and nausea

ANS: A

These are common side effects associated with these medications.

DIF: Cognitive Level: Application REF: p. 276

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse notes that a client with glaucoma has been ordered an anticholinergic medication. What is the highest priority action on the part of the nurse?

a.

Administer the medication; this is appropriate for this client.

b.

Check the clients allergy history since it can cause anaphylaxis.

c.

Call the pharmacist; the drug interacts with many other medications.

d.

Call the physician; this is an inappropriate drug for this client.

ANS: D

With pupillary dilation, the outflow of aqueous humor is hampered, increasing the intraocular pressure.

DIF: Cognitive Level: Comprehension REF: p. 279

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A client is ordered bethanechol chloride (Urecholine) for urinary retention. A nurse is adding up the clients intake and output for the 8-hour shift. The clients I = 850 mL, O = 350 mL. What should the nurse do?

a.

Administer an extra dose of bethanechol.

b.

Palpate the clients bladder.

c.

Increase the clients fluid intake.

d.

Continue the plan of care.

ANS: B

The clients output is adequate but does not match the intake. The nurse should assess for bladder distention and retention.

DIF: Cognitive Level: Application REF: p. 274

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A client experiences bradycardia as a result of vagal stimulation. What will the nurse expect to administer?

a.

Bethanechol chloride (Urecholine)

b.

Benztropine (Cogentin)

c.

Metoclopramide (Reglan)

d.

Atropine sulfate (atropine)

ANS: D

Atropine is given to increase heart rate in patients with vagally stimulated bradycardia.

DIF: Cognitive Level: Application REF: p. 276

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The client has been started on Detrol LA. She is also being treated with a tricyclic antidepressant. What effect should the nurse anticipate from the interaction of the medications?

a.

Increased action of the Detrol LA

b.

Decreased action of the Detrol LA

c.

Increased action of the tricyclic medication

d.

Decreased action of the tricyclic medication

ANS: A

The combination of Detrol LA and a tricyclic antidepressant can result in an increase in the action of the Detrol LA.

DIF: Cognitive Level: Application REF: p. 280

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The client has been started on Detrol LA and tells the nurse that he is experiencing constipation. What is the highest priority action on the part of the nurse?

a.

Hold the next dose of the medication; this is an adverse reaction.

b.

Administer the drug: this is an expected response to the drug.

c.

Notify the physician; this is a side effect of the medication.

d.

Call the pharmacist; this is evidence of toxicity of the drug.

ANS: C

A side effect of Detrol LA can be constipation.

DIF: Cognitive Level: Application REF: p. 280

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The client has been started on Artane. The nurse notes that the clients bowel sounds are decreasing. What is the highest priority action on the part of the nurse?

a.

Administer the drug; this is an expected reaction.

b.

Administer the drug; this is an expected side effect.

c.

Hold the drug; this is an adverse reaction to the drug.

d.

Hold the drug; this is a life-threatening response.

ANS: D

A decrease in bowel sounds could signal the beginning of paralytic ileus.

DIF: Cognitive Level: Application REF: p. 280

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse notes that Artane has been ordered as a preoperative medication for the client. What is the highest priority action on the part of the nurse?

a.

Administer the medication; this is an expected preoperative medication for the client.

b.

Administer the drug cautiously; anaphylaxis can occur quickly with this drug.

c.

Call the physician to question the order based on the clients allergy history.

d.

Call the physician to question the order; this is not a usual preoperation medication.

ANS: D

Atropine is typically given as part of a preoperative regimen, but not Artane.

DIF: Cognitive Level: Application REF: p. 280

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The client is being treated with a large dose of an anticholinergic medication. She complains of feeling disoriented. What should be the nurses highest priority action based on the clients complaint?

a.

Call the pharmacist; the dose of the medication may be incorrect.

b.

Call the physician; the medication is causing an adverse reaction.

c.

Call the pharmacist; the medication may be reaching a toxic level.

d.

Call the physician; the medication is causing an expected side effect.

ANS: D

An expected side effect of giving large doses of an anticholinergic medication is that of disorientation.

DIF: Cognitive Level: Application REF: p. 278

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. Cholinergic agents 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

These are the actions of the parasympathetic nervous system.

DIF: Cognitive Level: Application REF: pp. 272-273

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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