Chapter 26: Cholinergic Blocking Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A client with biliary colic has been prescribed atropine. The nurse should question this order after discovering which disorder in the client's past history? a. Hepatic disease b. Benign prostatic hypertrophy c. Myocardial infarction d. Urinary retention Answer: C Rationale: The nurse should know that the use of atropine is contraindicated in clients with myocardial infarction. Other contraindications include myasthenia gravis, tachyarrhythmia, and congestive heart failure (unless bradycardia is present). Hepatic disease, benign prostatic hypertrophy, and urinary retention are conditions requiring cautious administration and are not contraindications for use. Question format: Multiple Choice Chapter: 26 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 317, Contraindications 2. The nurse is preparing to administer solifenacin to a client with an overactive bladder. Which potential reaction should the nurse prioritize after noting the client is also prescribed digoxin? a. Increased neuromuscular blocking effect b. Increased effectiveness of digoxin c. Increased serum levels of digoxin d. Increased effectiveness of solifenacin Answer: C Rationale: The nurse should monitor for increased serum levels of digoxin that occur due to the interaction of anticholinergics and digoxin. Increased neuromuscular blocking is an effect of the interaction of aminoglycoside antibiotics with cholinergic drugs. Increased effectiveness of digoxin and solifenacin are not the effects associated with the interaction of anticholinergics and digoxin. Question format: Multiple Choice Chapter: 26 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 317, Interactions 3. A nurse is caring for a client who is prescribed darifenacin. Which activity should the nurse prioritize in the ongoing assessment? a. Assessment of the client's medical history b. Evaluation of symptoms related to the client's diagnosis c. Monitoring of the client's vital signs every 24 hours d. Observation for behavioral changes in the client Answer: B Rationale: The nurse should evaluate the symptoms and reports related to the client's diagnosis during the ongoing assessment of the treatment. The nurse should assess the medical history of the client before administration of the drug as part of the preadministration assessment. The vital signs of the client should be monitored every shift. The nurse need not observe for behavioral changes in the client based on the client's diagnosis and condition. Question format: Multiple Choice Chapter: 26 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 318, Ongoing Assessment 4. The nurse has administered dicyclomine to an elderly client. Which finding on the ongoing assessment should the nurse prioritize? a. Disorientation b. Lightheadedness c. Blurred vision d. Mydriasis Answer: C Rationale: The nurse should monitor for blurred vision in the client after administration of dicyclomine. The other conditions observed are drowsiness, tachycardia, dry mouth, and urinary hesitancy. Disorientation, lightheadedness, and mydriasis are adverse reactions associated with the administration of trihexyphenidyl. Question format: Multiple Choice Chapter: 26 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 321, Summary Drug Table 5. A nurse is conducting a teaching session with a client who is prescribed scopolamine during the summer. The nurse determines the session is successful when the client correctly chooses which sign to report immediately to the health care provider which may indicate the client is experiencing heat prostration? a. Dry mouth b. Fever c. Skin rash d. Urinary retention Answer: B Rationale: During hot summer months, clients receiving a cholinergic blocking drug such as scopolamine should be instructed on the risk of heat prostration due to decreased sweating effect related to these medications. Signs of heat prostration include fever; tachycardia; flushing; warm, dry skin; and mental confusion. A dry mouth is an adverse reaction to these drugs. A skin rash is a potential adverse reaction related to a hypersensitivity to the medication. Urinary retention is an adverse reaction to scopolamine, glycopyrrolate, and propantheline. Question format: Multiple Choice Chapter: 26 Learning Objective: 1 Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Teaching/Learning Reference: p. 317, Other Reactions 6. A client with a peptic ulcer is prescribed glycopyrrolate. Which physical assessment should the nurse prioritize in the preadministration assessment? a. Saliva b. Stools c. Urine pH d. Blood glucose level