McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach,
11th Edition
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 breaks down
acetylcholine, indirectly enhance the actions of acetylcholine.
DIF: Cognitive Level: Understanding (Comprehension) 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, some are considered 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) 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. 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
Bethanechol treatment can result in hypotension. the nurse should hold the drug and
notify the provider of the low blood pressure.
DIF: Cognitive Level: Applying (Application) 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 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 sulphate.
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) 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) 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
neostigmine. When performing a health history, the nurse will be concerned and further
investigate the 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. the severity of the benign prostatic hypertrophy would need to be
investigated prior to administration.
DIF: Cognitive Level: Applying (Application) 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 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 lessen muscle rigidity
ANS: D
Anticholinergic drugs are used in Parkinson disease mainly to reduce tremors and
muscle rigidity.
DIF: Cognitive Level: Understanding (Comprehension) 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 potential side effects of atropine. Absent bowel sounds can indicate a
paralytic ileus and should be evaluated immediately. the other side effects are not
imminently harmful but should be continued to be monitored.
DIF: Cognitive Level: Applying (Application) 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. the other
options listed would activate the GI tract and potentially worsen the patient’s
symptoms.
DIF: Cognitive Level: Understanding (Comprehension) 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 necessarily increase fluid intake.
DIF: Cognitive Level: Applying (Application) 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 Alzheimer
disease?
a. Ambenonium chloride (Mytelase)
b. Benztropine (Cogentin)
11th Edition
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 breaks down
acetylcholine, indirectly enhance the actions of acetylcholine.
DIF: Cognitive Level: Understanding (Comprehension) 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, some are considered 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) 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. 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
Bethanechol treatment can result in hypotension. the nurse should hold the drug and
notify the provider of the low blood pressure.
DIF: Cognitive Level: Applying (Application) 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 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 sulphate.
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) 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) 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
neostigmine. When performing a health history, the nurse will be concerned and further
investigate the 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. the severity of the benign prostatic hypertrophy would need to be
investigated prior to administration.
DIF: Cognitive Level: Applying (Application) 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 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 lessen muscle rigidity
ANS: D
Anticholinergic drugs are used in Parkinson disease mainly to reduce tremors and
muscle rigidity.
DIF: Cognitive Level: Understanding (Comprehension) 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 potential side effects of atropine. Absent bowel sounds can indicate a
paralytic ileus and should be evaluated immediately. the other side effects are not
imminently harmful but should be continued to be monitored.
DIF: Cognitive Level: Applying (Application) 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. the other
options listed would activate the GI tract and potentially worsen the patient’s
symptoms.
DIF: Cognitive Level: Understanding (Comprehension) 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 necessarily increase fluid intake.
DIF: Cognitive Level: Applying (Application) 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 Alzheimer
disease?
a. Ambenonium chloride (Mytelase)
b. Benztropine (Cogentin)
