Nokea
The nurse would assess the client closely if the client has a history of which of the following?
- A. Diabetes
- B. Hypertension
- C. Tachycardia
- D. Epilepsy
- E. Megacolon
Correct Answer: B,D
Rationale: Cholinergic drugs, like ambenonium, are used cautiously in clients with hypertension, epilepsy, cardiac arrhythmias, bradycardia, recent coronary occlusion, and megacolon.
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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.
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.
When assessing a client receiving a cholinergic drug, the nurse would assess the client for increased neuromuscular blocking effects if the client is also receiving which of the following?
- A. Amoxicillin
- B. Tobramycin
- C. Cephalexin
- D. Neomycin
- E. Clarithromycin
Correct Answer: B,D
Rationale: Cholinergic drugs administered concomitantly with aminoglycoside antibiotics, like tobramycin and neomycin, can result in increased neuromuscular blocking effects.
When describing the enzyme acetylcholinesterase, which of the following would the instructor most likely include about this enzyme?
- A. Makes the parasympathetic nervous system function differently
- B. Inactivates the neurotransmitter serotonin
- C. Activates the neurotransmitter acetylcholine
- D. Inactivates the neurotransmitter norepinephrine
- E. Results in the prevention of nerve synapses to continue nerve impulses
Correct Answer: A,E
Rationale: Acetylcholinesterase makes the parasympathetic nervous system function differently by inactivating the neurotransmitter acetylcholine, thereby preventing the nerve synapse from continuing the nerve impulse.
A client has been prescribed pyridostigmine for myasthenia gravis. The nurse would be alert for the development of which of the following?
- A. Seizure disorder
- B. Reduction of visual acuity
- C. Abdominal discomfort
- D. Cardiac arrhythmias
Correct 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 chloride for urinary retention, the nurse needs to examine for abdominal discomfort, which is an adverse reaction of bethanechol chloride and not pyridostigmine.