Question 1

A cholinergic drug is prescribed for a patient. The nurse checks the patient's medical history, knowing that this drug is contraindicated in which disorders? (Select all that apply.)

Accepted Answer

Contraindications to the use of cholinergic drugs include gastrointestinal or genitourinary obstruction, bradycardia, hypotension, and chronic obstructive pulmonary disease. The other options are possible indications for cholinergic drugs.

Question 2

A patient is receiving memantine (Namenda) 10 mg PO daily. The patient is unable to swallow pills, so an oral solution that contains 2 mg/mL is ordered. How much will the patient receive per dose?

Accepted Answer

5 mL
2 mg : 1 mL :: 10 mg : x mL
(2 × x) = (1 × 10); 2x = 10; x = 5mL

Question 3

When monitoring a patient who is taking a cholinergic drug, the nurse will watch for which cardiovascular effect?

Accepted Answer

The cardiovascular effects of cholinergic drugs are decreased heart rate (not tachycardia) and vasodilation. Palpitations are not effects of cholinergic drugs.

Question 4

A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important to include in the teaching?

Accepted Answer

Taking the medication 30 minutes before meals allows time for the onset of action and therapeutic effects during the meal. The doses should be spaced evenly apart to optimize the effects of the medication. The other options are incorrect.

Question 5

A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease?

Accepted Answer

Edrophonium, another indirect-acting cholinergic drug, is commonly used to diagnose myasthenia gravis. Edrophonium is not used in diagnosing Parkinson's disease, multiple sclerosis, or Alzheimer's disease.

Question 6

The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer's disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug's expected action?

Accepted Answer

Donepezil is used to treat mild to moderate dementia occurring in Alzheimer's disease and may improve the symptoms of the disease.

Question 7

The nurse notes in a patient's medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse interprets that the patient has which disorder?

Accepted Answer

Pilocarpine is a direct-acting drug that is used topically to reduce intraocular pressure in patients with glaucoma. The other disorders are not indications for pilocarpine.

Question 8

A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer's disease. Her daughter calls the prescriber's office and is upset because "Mother has not improved one bit!" Which response by the nurse is appropriate?

Accepted Answer

Donepezil therapy is not a cure for Alzheimer's disease, but it may help to improve symptoms in the early stages. It may take up to 6 weeks to see improvement. The family should be taught that the medication must be taken exactly as ordered and with meals, and the medication should not be abruptly stopped or the dosage increased without the physician's approval because of the possibility of serious complications.

Question 9

A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse will prepare to administer which drug?

Accepted Answer

Indirect-acting drugs such as pyridostigmine inhibit acetylcholinesterase (AChE), thus reversing the neuromuscular blockade produced by anticholinergic poisoning as well as poisoning by irreversible cholinesterase inhibitors such as the organophosphates and carbonates, common classes of insecticides. The other drugs listed are not appropriate antidotes.

Question 10

A patient who has been diagnosed with Sjögren's syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect?

Accepted Answer

Cevimeline is a direct-acting cholinergic drug that is used to stimulate salivation in patients who have xerostomia (dry mouth), one of the manifestations of Sjögren's syndrome. The other options are incorrect.

Question 11

A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse will teach this patient to look for which therapeutic effect?

Accepted Answer

In patients suffering a decrease in gastrointestinal peristalsis postoperatively, taking a cholinergic drug should result in an increase in bowel sounds, the passage of flatus, and the occurrence of bowel movements that indicate increased gastrointestinal peristalsis.

Question 12

The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors?

Accepted Answer

Many of the undesirable adverse effects are due to nicotinic receptor stimulation. The desired effects come from muscarinic receptor stimulation. The other options are incorrect.

Question 13

A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote?

Accepted Answer

Prompt administration of atropine sulfate can reverse a toxic dose of cholinergic drugs. The other drugs listed are not antidotes to cholinergic toxicity.

Question 14

A patient calls the clinic to speak to the nurse about taking an herbal product that contains ginkgo ( Ginkgo biloba ) to "help my memory." He states that he has read much information about the herbal product. Which statement by the patient indicates a need for further education?

Accepted Answer

Drug interactions may occur between the taking of aspirin and nonsteroidal antiinflammatory drugs and the taking of ginkgo. The other options are incorrect.

Quiz 20: Cholinergic Drugs