Nokea
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.
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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.
The nurse is developing a teaching plan for a client who is receiving outpatient therapy with a cholinergic drug. Which of the following would be appropriate for the nurse to include?
- A. Instructions to avoid fiber-rich food during therapy
- B. Importance of adopting a self-monitoring blood pressure program
- C. Review of the purpose of the drug therapy with the client and family
- D. Evaluation of the client's previous history of disorders
Correct Answer: C
Rationale: The nurse should review the purpose of the drug therapy with the client and family when developing a teaching plan for a client receiving outpatient therapy with a cholinergic drug. Instructing the client to avoid fiber-rich food during therapy suggesting the client adapt a self-monitoring blood pressure program, and evaluating the client's previous history of disorders would be inappropriate to include in the teaching plan.
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.
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.
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.