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A nurse should notify the physician immediately if a client taking a cholinergic drug develops which of the following?
- A. Hypoglycemia
- B. Excessive salivation
- C. Severe abdominal cramping
- D. Muscle rigidity
- E. Muscle spasms
Correct Answer: B,C,D,E
Rationale: A client receiving a cholinergic drug is at risk for a cholinergic crisis. The signs of cholinergic crisis include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity and spasms; and clenching of the jaw. Any of these symptoms should be reported to the physician immediately.
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A client with myasthenia gravis who is prescribed pyridostigmine comes to the emergency department complaining of abdominal cramping, excessive diarrhea, and severe muscle weakness. The nurse would suspect which of the following?
- A. Underdosage of the drug
- B. Tolerance to the drug
- C. Cholinergic crisis
- D. Underlying infection
Correct Answer: C
Rationale: Cholinergic crisis (cholinergic drug toxicity) symptoms include severe abdominal cramping; diarrhea; excessive salivation; muscle weakness, rigidity, and spasms; and clenching of the jaw. Signs of drug underdosage are signs of the disease itself, namely, rapid fatigability of the muscles, drooping of the eyelids, and difficulty breathing. Tolerance would be indicated by a reduction in the adverse reactions to the drug that the client was experiencing. There is no information to suggest that the client has an underlying infection.
After teaching a group of nursing students about cholinergic drugs, the instructor determines a need for additional teaching when the students identify which drug as being administered orally?
- A. Ambenonium
- B. Bethanechol
- C. Pyndostigmine
- D. Edrophonium
Correct Answer: D
Rationale: Edrophonium is a cholinergic drug that is administered intravenously. Ambenonium, bethanechol, and pyridostigmine are administered orally.
Based on the nurse's understanding of which body systems are affected by cholinergic drug adverse reactions, the nurse would be alert for adverse reactions involving which body system?
- A. Endocrine
- B. Circulatory
- C. Respiratory
- D. Gastrointestinal
- E. Central nervous
Correct Answer: B,C,D,E
Rationale: Cholinergic drug adverse reactions affect the circulatory, respiratory, gastrointestinal, and central nervous systems.
Prior to administering bethanechol to a client, the nurse would assess which of the following?
- A. Palpation of the bladder
- B. Palpation of the thyroid
- C. Blood glucose
- D. Blood pressure
- E. Pulse rate
Correct Answer: A,D,E
Rationale: Bethanechol is used to treat urinary retentions. The nurse's preadministration assessment should include palpation of the bladder, blood pressure, and pulse rate prior to its administration to a client.
The nurse identifies a nursing diagnosis of Diarrhea for a client being started on cholinergic drug therapy. Which of the following would the nurse most likely include in the client's plan of care?
- A. Ensure that the client has readily available access to the bathroom.
- B. Evaluate the number, frequency, and consistency of the stools.
- C. Contact the primary health care provider for an order to switch to another cholinergic drug.
- D. Limit the client's fluid intake to 1000 mL per day.
- E. Maintain the client on strict bed rest.
Correct Answer: A,B
Rationale: When a cholinergic drug is administered, the client may experience diarrhea. This reaction will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse needs to ensure that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist in the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse should document fluid intake and output and track the number, consistency, and frequency of stools if diarrhea is present. Since diarrhea occurs with any cholinergic drug, switching to another would be of no help. The client needs to replace fluids lost with diarrhea, so limiting fluid intake would be inappropriate. Ambulating to assist with the passage of flatus would be appropriate, while strict bed rest would not be necessary.