Chapter 21: Cholinergic-Blocking Drugs Lilley: Pharmacology and the
Nursing Process, 10th Edition
1. A patient has a new prescription for the transdermal form of scopolamine. The
nurse knows that this form of scopolamine is used for which condition?
A. Angina
B. Chronic pain
C. Hypertension
D. Motion sickness
Answer: D
Explanation: The scopolamine transdermal patch is applied behind the ear to prevent the
nausea and vomiting associated with motion sickness. It works by blocking acetylcholine in
the vestibular system and the vomiting center.
2. The nurse is reviewing the indications for atropine sulfate. Atropine is
appropriate for which of these patients? (Select all that apply.)
A. A patient who has suddenly developed symptomatic bradycardia with a heart rate
of 32 beats/min
B. A patient who has suddenly developed symptomatic tachycardia with a heart rate
of 180 beats/min
C. A patient with severe narrow-angle glaucoma
D. A patient who is about to have surgery
E. A patient newly diagnosed with myasthenia gravis
F. A patient with anticholinesterase inhibitor poisoning
Answer: A, D, F
Explanation: Atropine is used to treat symptomatic bradycardia, to reduce secretions
preoperatively, and as an antidote for poisoning from organophosphate pesticides or nerve
agents (anticholinesterase inhibitors). It is contraindicated in narrow-angle glaucoma and
tachycardia.
3. A patient is to receive glycopyrrolate 4 mcg/kg IM 30 minutes before a
procedure. The patient weighs 220 pounds; the medication is available in a
strength of 0.2 mg/mL. Identify how many milliliters of medication the nurse will
draw up into the syringe. _____
Answer: 2
,Explanation: First, convert weight to kg: 220 lbs / 2.2 = 100 kg. Calculate the dose: 4
mcg/kg × 100 kg = 400 mcg. Convert mcg to mg: 400 mcg = 0.4 mg. Finally, calculate the
volume: (0.4 mg) / (0.2 mg/mL) = 2 mL.
4. The nurse is about to administer a stat dose of intravenous atropine sulfate to a
patient who is experiencing a symptomatic cardiac dysrhythmia. During
administration of this drug, the nurse will monitor the patient closely for which
adverse effect?
A. Tachycardia
B. Bradycardia
C. Ectopic beats
D. Cardiac standstill
Answer: A
Explanation: Atropine, an anticholinergic drug, blocks vagal (parasympathetic) stimulation
to the heart, which can result in tachycardia. This is a common and expected effect, but it can
become an adverse effect if the heart rate increases excessively.
5. A patient has a prescription for oxybutynin, an anticholinergic drug. When
reviewing the patient's medical history, which condition, if present, would be
considered a contraindication to therapy with this drug?
A. Diarrhea
B. Hypertension
C. Neurogenic bladder
D. Uncontrolled angle-closure glaucoma
Answer: D
Explanation: Anticholinergic drugs cause mydriasis (pupil dilation), which can increase
intraocular pressure. This is dangerous in patients with angle-closure glaucoma and is a
contraindication. Neurogenic bladder is an indication for oxybutynin.
6. The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs
block the effects of which nervous system?
A. Central nervous system
B. Somatic nervous system
C. Sympathetic nervous system
D. Parasympathetic nervous system
Answer: D
, Explanation: Anticholinergic drugs work by blocking the neurotransmitter acetylcholine at
the muscarinic receptors in the parasympathetic nervous system. This inhibition of
parasympathetic nerve impulses leads to the drugs' effects.
7. A patient has received an accidental overdose of intravenous atropine. Which
drug will the nurse prepare to administer?
A. Atenolol
B. Bethanechol
C. Dicyclomine
D. Physostigmine
Answer: D
Explanation: Physostigmine is a cholinesterase inhibitor that is used as an antidote for
severe anticholinergic overdose (e.g., atropine overdose). It works by increasing the
availability of acetylcholine at the receptor sites.
8. A 72-year-old man has a new prescription for an anticholinergic drug. He is an
active man and enjoys outdoor activities, such as golfing and doing his own yard
work. What will the nurse emphasize to him during the teaching session about
his drug therapy?
A. Drowsiness may interfere with his outdoor activities.
B. Increased salivation may occur during exercise and outside activities.
C. Fluid loss may occur as a result of an increased incidence of diarrhea.
D. He will need to take measures to reduce the occurrence of heat stroke during his
activities.
Answer: D
Explanation: Anticholinergic drugs inhibit sweating, which is the body's primary mechanism
for cooling. This puts patients, especially the elderly, at a significantly increased risk for heat
stroke during physical activity or in hot environments.
9. The nurse will monitor for which adverse effect when administering an
anticholinergic drug?
A. Excessive urination
B. Diaphoresis
C. Dry mouth
D. Pupillary constriction
Answer: C
Nursing Process, 10th Edition
1. A patient has a new prescription for the transdermal form of scopolamine. The
nurse knows that this form of scopolamine is used for which condition?
A. Angina
B. Chronic pain
C. Hypertension
D. Motion sickness
Answer: D
Explanation: The scopolamine transdermal patch is applied behind the ear to prevent the
nausea and vomiting associated with motion sickness. It works by blocking acetylcholine in
the vestibular system and the vomiting center.
2. The nurse is reviewing the indications for atropine sulfate. Atropine is
appropriate for which of these patients? (Select all that apply.)
A. A patient who has suddenly developed symptomatic bradycardia with a heart rate
of 32 beats/min
B. A patient who has suddenly developed symptomatic tachycardia with a heart rate
of 180 beats/min
C. A patient with severe narrow-angle glaucoma
D. A patient who is about to have surgery
E. A patient newly diagnosed with myasthenia gravis
F. A patient with anticholinesterase inhibitor poisoning
Answer: A, D, F
Explanation: Atropine is used to treat symptomatic bradycardia, to reduce secretions
preoperatively, and as an antidote for poisoning from organophosphate pesticides or nerve
agents (anticholinesterase inhibitors). It is contraindicated in narrow-angle glaucoma and
tachycardia.
3. A patient is to receive glycopyrrolate 4 mcg/kg IM 30 minutes before a
procedure. The patient weighs 220 pounds; the medication is available in a
strength of 0.2 mg/mL. Identify how many milliliters of medication the nurse will
draw up into the syringe. _____
Answer: 2
,Explanation: First, convert weight to kg: 220 lbs / 2.2 = 100 kg. Calculate the dose: 4
mcg/kg × 100 kg = 400 mcg. Convert mcg to mg: 400 mcg = 0.4 mg. Finally, calculate the
volume: (0.4 mg) / (0.2 mg/mL) = 2 mL.
4. The nurse is about to administer a stat dose of intravenous atropine sulfate to a
patient who is experiencing a symptomatic cardiac dysrhythmia. During
administration of this drug, the nurse will monitor the patient closely for which
adverse effect?
A. Tachycardia
B. Bradycardia
C. Ectopic beats
D. Cardiac standstill
Answer: A
Explanation: Atropine, an anticholinergic drug, blocks vagal (parasympathetic) stimulation
to the heart, which can result in tachycardia. This is a common and expected effect, but it can
become an adverse effect if the heart rate increases excessively.
5. A patient has a prescription for oxybutynin, an anticholinergic drug. When
reviewing the patient's medical history, which condition, if present, would be
considered a contraindication to therapy with this drug?
A. Diarrhea
B. Hypertension
C. Neurogenic bladder
D. Uncontrolled angle-closure glaucoma
Answer: D
Explanation: Anticholinergic drugs cause mydriasis (pupil dilation), which can increase
intraocular pressure. This is dangerous in patients with angle-closure glaucoma and is a
contraindication. Neurogenic bladder is an indication for oxybutynin.
6. The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs
block the effects of which nervous system?
A. Central nervous system
B. Somatic nervous system
C. Sympathetic nervous system
D. Parasympathetic nervous system
Answer: D
, Explanation: Anticholinergic drugs work by blocking the neurotransmitter acetylcholine at
the muscarinic receptors in the parasympathetic nervous system. This inhibition of
parasympathetic nerve impulses leads to the drugs' effects.
7. A patient has received an accidental overdose of intravenous atropine. Which
drug will the nurse prepare to administer?
A. Atenolol
B. Bethanechol
C. Dicyclomine
D. Physostigmine
Answer: D
Explanation: Physostigmine is a cholinesterase inhibitor that is used as an antidote for
severe anticholinergic overdose (e.g., atropine overdose). It works by increasing the
availability of acetylcholine at the receptor sites.
8. A 72-year-old man has a new prescription for an anticholinergic drug. He is an
active man and enjoys outdoor activities, such as golfing and doing his own yard
work. What will the nurse emphasize to him during the teaching session about
his drug therapy?
A. Drowsiness may interfere with his outdoor activities.
B. Increased salivation may occur during exercise and outside activities.
C. Fluid loss may occur as a result of an increased incidence of diarrhea.
D. He will need to take measures to reduce the occurrence of heat stroke during his
activities.
Answer: D
Explanation: Anticholinergic drugs inhibit sweating, which is the body's primary mechanism
for cooling. This puts patients, especially the elderly, at a significantly increased risk for heat
stroke during physical activity or in hot environments.
9. The nurse will monitor for which adverse effect when administering an
anticholinergic drug?
A. Excessive urination
B. Diaphoresis
C. Dry mouth
D. Pupillary constriction
Answer: C
