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IHP310 – Cholinergic Agonists and Antagonists
IHP310 – Cholinergic Agonists and Antagonists
Chapter 16: Cholinergic Agonists and Antagonists
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition
MULTIPLE CHOICE
- 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:
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 211
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 213
TOP: Nursing Process: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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: p. 213
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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 patient’s 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:
DIF: Cognitive Level: Applying (Application) REF: p. 213
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Applying (Application) REF: p. 213
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Applying (Application) REF: p. 215
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinson 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:
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 217
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Applying (Application) REF: p. 218
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
IHP310 – Cholinergic Agonists and Antagonists
- 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:
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 216
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Applying (Application) REF: p. 218
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimer disease?
| a. | Ambenonium chloride (Mytelase) |
| b. | Benztropine (Cogentin) |
| c. | Donepezil HCl (Aricept) |
| d. | Neostigmine methylsulfate (Prostigmin) |
ANS:
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 215
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Applying (Application) REF: p. 219
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
IHP310 – Cholinergic Agonists and Antagonists
- The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinson disease. When performing an assessment, which aspect of the patient’s 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:
DIF: Cognitive Level: Applying (Application) REF: p. 219
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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 1000 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 patient’s bladder. |
| d. | Reassess the patient in 15 minutes. |
ANS:
DIF: Cognitive Level: Applying (Application) REF: p. 217
TOP: Nursing Process: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient who has Parkinson disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinson disease would be a contraindication for this drug?
| a. | Drooling |
| b. | Muscle rigidity |
| c. | Muscle weakness |
| d. | Tardive dyskinesia |
ANS:
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 219
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 217
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- 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:
DIF: Cognitive Level: Applying (Application) REF: p. 221
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
- 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: p. 213
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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