Chapter 25: Cholinergic Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford
1.A client has been prescribed pyridostigmine for myasthenia gravis. The nurse would be alert for the development of which adverse reaction following the administration? a.Seizure disorder b.Reduction of visual acuity c.Abdominal discomfort d.Cardiac arrhythmias Answer: D Rationale: The nurse should monitor for cardiac arrhythmias as a general adverse reaction in the client. Seizure disorder, reduction of visual acuity, and abdominal discomfort are not pyridostigmine-
related adverse reactions. Reduction of visual acuity is related to topical ophthalmics. When the client is receiving bethanechol for urinary retention, the nurse needs to examine for abdominal discomfort, which is an adverse reaction of bethanechol and not pyridostigmine. Seizures are a potential adverse reaction with lithium toxicity. Question format: Multiple Choice Chapter: 25 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 313, Summary Drug Table 2.A client with urinary retention is prescribed bethanechol. The nurse will administer this cautiously if which disorder is noted in the client's medical record? a.Raynaud disease b.Bradycardia c.Coronary artery disease d.Hyperthyroidism Answer: B Rationale: The nurse should administer bethanechol cautiously if a client has bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, or megacolon. Individuals with coronary artery disease and hyperthyroidism should not receive bethanechol as it is contraindicated. Individuals with Raynaud disease should not receive alpha-adrenergic blocking drugs. Question format: Multiple Choice Chapter: 25 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 310, Precautions 3.A client was emergently administered bethanechol. Which finding on ongoing assessment should the nurse prioritize and notify the health care provider immediately? a.Failure to void b.Frequent emesis c.Increased abdominal pain d.Hematuria Answer: A Rationale: Bethanechol is used to treat acute nonobstructive urinary retention. The nurse should notify the primary health care provider if the client fails to void after drug administration. Nausea, emesis, and increased abdominal pain are adverse effects of bethanechol. Hematuria is s potential adverse reaction to sulfasalazine, a disease-
modifying antirheumatic drug (DMARD). Question format: Multiple Choice Chapter: 25 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 311, Urinary Retention 4.The nurse is caring for a client with myasthenia gravis and has been administering pyridostigmine. The nurse suspects the client needs an increased dose based on which assessment finding? a.Clenching of the jaw b.Muscle spasms c.Difficulty breathing d.Abdominal cramping Answer: C Rationale: The nurse should monitor for difficulty breathing as a symptom of drug underdosage. Additional signs of underdosing include signs of the disease, rapid fatigability of muscles, and drooping of eyelids. Signs of overdosing include muscle rigidity and spasms, salivation, and clenching of jaw. Abdominal cramping may occur in the client who is receiving guanidine. Question format: Multiple Choice Chapter: 25 Learning Objective: 3 Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 311, Managing Myasthenia Gravis 5.The nurse is preparing a teaching plan for a client and caregiver concerning the cholinergic drug therapy that has been prescribed. Which teaching point should the nurse prioritize? a.Instructions to avoid fiber-rich food during therapy b.Importance of adopting a self-monitoring blood pressure program c.Review of the purpose of the drug therapy with the client and family d.Evaluation of the client's previous history of disorders Answer: C Rationale: The nurse should review the purpose of the drug therapy with the client and family when developing a teaching plan for a client
receiving outpatient therapy with a cholinergic drug. Diarrhea is a potential adverse reaction for which eating fiber may help counteract. These drugs should be used cautiously in clients with a history of hypertension, so the client may already be accomplishing this goal.
1.A client has been prescribed pyridostigmine for myasthenia gravis. The nurse would be alert for the development of which adverse reaction following the administration? a.Seizure disorder b.Reduction of visual acuity c.Abdominal discomfort d.Cardiac arrhythmias Answer: D Rationale: The nurse should monitor for cardiac arrhythmias as a general adverse reaction in the client. Seizure disorder, reduction of visual acuity, and abdominal discomfort are not pyridostigmine-
related adverse reactions. Reduction of visual acuity is related to topical ophthalmics. When the client is receiving bethanechol for urinary retention, the nurse needs to examine for abdominal discomfort, which is an adverse reaction of bethanechol and not pyridostigmine. Seizures are a potential adverse reaction with lithium toxicity. Question format: Multiple Choice Chapter: 25 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 313, Summary Drug Table 2.A client with urinary retention is prescribed bethanechol. The nurse will administer this cautiously if which disorder is noted in the client's medical record? a.Raynaud disease b.Bradycardia c.Coronary artery disease d.Hyperthyroidism Answer: B Rationale: The nurse should administer bethanechol cautiously if a client has bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, or megacolon. Individuals with coronary artery disease and hyperthyroidism should not receive bethanechol as it is contraindicated. Individuals with Raynaud disease should not receive alpha-adrenergic blocking drugs. Question format: Multiple Choice Chapter: 25 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 310, Precautions 3.A client was emergently administered bethanechol. Which finding on ongoing assessment should the nurse prioritize and notify the health care provider immediately? a.Failure to void b.Frequent emesis c.Increased abdominal pain d.Hematuria Answer: A Rationale: Bethanechol is used to treat acute nonobstructive urinary retention. The nurse should notify the primary health care provider if the client fails to void after drug administration. Nausea, emesis, and increased abdominal pain are adverse effects of bethanechol. Hematuria is s potential adverse reaction to sulfasalazine, a disease-
modifying antirheumatic drug (DMARD). Question format: Multiple Choice Chapter: 25 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 311, Urinary Retention 4.The nurse is caring for a client with myasthenia gravis and has been administering pyridostigmine. The nurse suspects the client needs an increased dose based on which assessment finding? a.Clenching of the jaw b.Muscle spasms c.Difficulty breathing d.Abdominal cramping Answer: C Rationale: The nurse should monitor for difficulty breathing as a symptom of drug underdosage. Additional signs of underdosing include signs of the disease, rapid fatigability of muscles, and drooping of eyelids. Signs of overdosing include muscle rigidity and spasms, salivation, and clenching of jaw. Abdominal cramping may occur in the client who is receiving guanidine. Question format: Multiple Choice Chapter: 25 Learning Objective: 3 Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 311, Managing Myasthenia Gravis 5.The nurse is preparing a teaching plan for a client and caregiver concerning the cholinergic drug therapy that has been prescribed. Which teaching point should the nurse prioritize? a.Instructions to avoid fiber-rich food during therapy b.Importance of adopting a self-monitoring blood pressure program c.Review of the purpose of the drug therapy with the client and family d.Evaluation of the client's previous history of disorders Answer: C Rationale: The nurse should review the purpose of the drug therapy with the client and family when developing a teaching plan for a client
receiving outpatient therapy with a cholinergic drug. Diarrhea is a potential adverse reaction for which eating fiber may help counteract. These drugs should be used cautiously in clients with a history of hypertension, so the client may already be accomplishing this goal.
