Cholinergics & Anticholinergics / Antibacterials

1. A priority assessment of a client on antibiotic therapy includes questioning the client about.

History of seizure activity

Cardiac history

Allergies

Immunizations

Antibiotic allergy is one of the most common drug allergies. They also have the potential to cause severe anaphylaxis and death.

Explanation

Antibiotic allergy is one of the most common drug allergies. They also have the potential to cause severe anaphylaxis and death.

2. During postoperative teaching the nurse explains that the client is receiving bethanechol (Urecholine) to treat:

Postoperative hypotension

Respiratory atelectasis

Urinary atony

Postoperative ischemic colitis

Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying.

Explanation

Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying.

3. Cholinergic (parasymphatomimetic) drugs have which of the following therapeutic effects?

Urinary retention

Increased GI motility

Mydriasis

Vasoconstriction

Cholinergic effects mimic the parasympathetic nervous system (of rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the body digest. Urinary retention, mydriasis, and vasoconstriction are sympathetic nervous system responses.

Explanation

Cholinergic effects mimic the parasympathetic nervous system (of rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the body digest. Urinary retention, mydriasis, and vasoconstriction are sympathetic nervous system responses.

4. Cholinergic (parasympathomimetic) drugs are indicated for which of the following situations?

Treating a postoperative client who has bradycardia

Lowering intraocular pressure in clients with glaucoma

Inhibiting muscular activity in the bladder

Preventing salivation and sweating

Cholinergic agents stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure.

Explanation

Cholinergic agents stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure.

5. Side effects to expect from anticholinergic (parasympatholytic) agents, such as atropine, include all of the following except:

Dilated pupils (mydriasis)

Urinary retention

Dry mouth

Diarrhea

Anticholinergic effects block the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. The effect on the GI system would be to decrease GI motility, not increase it (diarrhea).

Explanation

Anticholinergic effects block the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. The effect on the GI system would be to decrease GI motility, not increase it (diarrhea).

6. Adverse reactions to bethanechol include:

Constipation

Hypertension

Tachycardia

Abdominal Cramping

Side effects of bethanechol include abdominal cramps, diarrhea, hypotension, bradycardia, and headache.

Explanation

Side effects of bethanechol include abdominal cramps, diarrhea, hypotension, bradycardia, and headache.

7. A client presents with symptomatic bradycardia.The nurse prepares to administer which dose of atropine intravenously?

0.3 mg

0.5 mg

1.25 mg

2 mg

The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

Explanation

The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.

8. If tetracycline is administered to children 8 years of age, it can cause:

Delayed achievement of developmental milestones

Neurotoxicity

GI bleeding

Permanent discoloration of the teeth

Tetracycline is contraindicated for children less than 8 years of age, because it can cause permanent discoloration of the teeth.

Explanation

Tetracycline is contraindicated for children less than 8 years of age, because it can cause permanent discoloration of the teeth.

9. The nurse would monitor which of the following laboratory values for a client receiving intravenous gentamicin (Garamycin)?

Hematocrit and hemoglobin

Sodium and cholride

PT and PTT

BUN and creatinine

Gentamycin has a high potential for nephrotoxicity and is thus contraindicated in clients with elevated renal function tests such as BUN and creatinine.

Explanation

Gentamycin has a high potential for nephrotoxicity and is thus contraindicated in clients with elevated renal function tests such as BUN and creatinine.

10. The nurse monitors a client prescribed dicyclomine (Bentyl) for which therapeutic effect?

Decrease in GI motility

Decrease in urinary frequency

Increase in heart rate

Increase in blood pressure

Dicyclomine is an antispasmodic cholinergic blocker used to decrease GI motility in clients with functional GI disorders such as irritable bowel syndrome.

Explanation

Dicyclomine is an antispasmodic cholinergic blocker used to decrease GI motility in clients with functional GI disorders such as irritable bowel syndrome.

11. Discharge teaching for a client receiving tetracycline should include.

"Take the medication until you feel better"

"Use suncreen and protective clothing when outdoor"

"keep the remainder of the medication in case of recurrence"

"Take the medication with food and milk to minimize GI upset"

Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns.

Explanation

Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns.

12. Cholinergic (parasympathomimetic) drugs should be used cautiously with clients who have a history of:

Benign prostatic hyperplasia

Hemorrhoids

Glaucoma

Leg cramps

Increased bladder muscle contractions could prove harmful in clients with benign prostatic hyperplasia secondary to obstruction of urinary outflow.

Explanation

Increased bladder muscle contractions could prove harmful in clients with benign prostatic hyperplasia secondary to obstruction of urinary outflow.

13. A client comes into the emergency room with an overdose of cholinergic drugs.The nurse prepares to administer which dose of atropine intravenously?

0.3 mg

0.5 mg

1.25 mg

2 mg

Higher doses of atropine (2-3 mg) are needed to treat cholinergic overdoses.

Explanation

Higher doses of atropine (2-3 mg) are needed to treat cholinergic overdoses.

14. A client who is allergic to penicillin is at increased risk an allergy to:

Tetracycline

Cefazolin sodium (Ancef)

Gentaminicin (Garamycin)

Erythomycin

There is a cross-sensitivity between penicillin and cephalosporin antibiotics, because they both contain a beta-lactam ring and are thus chemically related.

Explanation

There is a cross-sensitivity between penicillin and cephalosporin antibiotics, because they both contain a beta-lactam ring and are thus chemically related.

15. A priority nursing diagnosis for a client receiving anticholinergic (parasympatholytic) drugs would be:

Risk for injury related to excessive CNS stimulation

Impaired gas exchange related to thickened respiratory secretions

Urinary retention related to loss of bladder tone

Knowledge deficit related to pharmacology regimen

Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.

Explanation

Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.