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When conducting client teaching with a client and his family about the prescribed cholinergic therapy for myasthenia gravis, which of the following would be most important to include?
- A. How to adjust dosage
- B. Indications of drug underdosage
- C. The need to monitor blood glucose levels
- D. How to keep a record of response to therapy
- E. The need to wear medical identification
Correct Answer: A,B,D,E
Rationale: Client and family teaching should include signs and symptoms associated with underand overdosage, instructions on how to adjust the dosage up or down, how to keep a record of the response to therapy, and the importance of wearing medical identification. There is no need for the client and family to monitor blood glucose levels.
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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.
The students demonstrate understanding of the information when they identify that which type of receptor is involved with stimulating smooth muscle in the parasympathetic nervous system?
- A. Nicotinic
- B. Muscarinic
- C. Alpha
- D. Beta
Correct Answer: B
Rationale: There are two types of receptors in the parasympathetic nervous branch: muscarinic receptors (which stimulate smooth muscle) and nicotinic receptors (which stimulate skeletal muscle). Alpha and beta receptors are found in the sympathetic nervous system.
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.
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.
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.