Cholinergics & Anticholinergics

When monitoring a patient who is taking a cholinergic drug, the nurse should watch for which cardiovascular effect?
A. Bradycardia
B. Tachycardia
C. Vasoconstriction
D. Palpitations

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

A patient has had an overdose of an intravenous cholinergic drug. The nurse should expect to administer which drug as an antidote?
A. atenolol
B. bethanechol
C. dobutamine
D. atropine sulfate

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

A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse should teach this patient to look for which therapeutic effects?
A. Decreased pulse rate
B. Abdominal crampin

C. Increased bowel sounds and passage of flatus
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 mo

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 include in the teaching?
A. The medication should be taken with meals to a

C. The medication should be taken 30 minutes before eating to improve swallowing and chewing.
Taking the medication 30 minutes before meals allows for the onset of action and therapeutic effects during the meal. The doses should be spaced evenly apart to

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?
A. pilocarpine
B. bethanechol
C. physostigmine
D. cholinesterase

C. physostigmine
Indirect-acting drugs such as physostigmine inhibit acetylcholinesterase (AChE), thus reversing the neuromuscular blockade produced by anticholinergic poisoning. The other drugs listed are not appropriate antidotes.

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 action?
A. Prevents memory loss

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

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 physician's office and is upset because "Mother has not improved one bit!" Which response by the nurse is ap

C. "It may take up to 6 weeks to see an improvement."
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 medi

A patient who has been diagnosed with Sj�gren's syndrome will be given cevimeline (Evoxac) for the treatment of xerostomia. The nurse will monitor for what therapeutic effect?
A. Reduction of salivation
B. Stimulation of salivation
C. Reduction of gastroi

B. Stimulation of salivation
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 Sj�gren's syndrome.

The nurse is reviewing the mechanism of action of cholinergic drugs. The desired effects of cholinergic drugs come from the stimulation of which receptors?
A. Muscarinic
B. Nicotinic
C. Cholinergic
D. Ganglionic

A. Muscarinic
The desired effects come from muscarinic receptor stimulation; many of the undesirable adverse effects are due to nicotinic receptor stimulation.

A patient tells the nurse that she wants to begin taking a Ginkgo biloba preparation for memory enhancement. What possible drug interactions should the nurse warn this patient about?
A. Digoxin, diuretics, and steroids
B. All caffeine-containing products

D. Aspirin, any nonsteroidal antiinflammatory drugs, and warfarin
Drug interactions may occur between the taking of aspirin, nonsteroidal antiinflammatory drugs, and the anticoagulants warfarin and heparin and the taking of ginkgo biloba. The other option

A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of which disease?
A. Parkinson's disease
B. Multiple sclerosis
C. Myasthenia gravis
D. Bell's palsy

C. Myasthenia gravis
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 Bell's palsy.

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.
A. Bladder atony
B. Gastrointestinal obstruction
C. Bradycardia
D. Alzheim

B. Gastrointestinal obstruction
C. Bradycardia
E. Hypotension
F. Chronic obstructive pulmonary disease
Contraindications to the use of cholinergic drugs include gastrointestinal or genitourinary obstruction, bradycardia, hypotension, and chronic obstructi

The nurse is about to administer a stat dose of atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse should monitor the patient closely for which adverse effect?
A. Tachycardia

A. Tachycardia
Cardiovascular effects of cholinergic-blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. The other options are not correct.

A patient has just been switched from scopolamine to a synthetic derivative. He questions the switch and asks, "What's the big advantage for me?" Which answer by the nurse is correct?
A. "The synthetic derivatives are usually less expensive."
B. "Syntheti

B. "Synthetic derivatives may be associated with fewer adverse effects."
Synthetic derivatives are associated with fewer adverse effects than naturally occurring anticholinergic drugs.

The nurse notes in the patient's medication history that the patient is taking a cholinergic-blocking drug. Based on this finding, the nurse interprets that the patient has which disorder?
A. Glaucoma
B. Myasthenia gravis
C. Irritable bowel disease
D. Gen

C. Irritable bowel disease
Cholinergic-blockers may be used to treat irritable bowel disease. Glaucoma, myasthenia gravis, and genitourinary obstruction are contraindications to the use of these drugs.

A patient is brought to the emergency department with a severe case of atropine overdose. Which drug will the nurse expect to administer?
A. atenolol
B. bethanechol
C. scopolamine
D. physostigmine

D. physostigmine
Physostigmine salicylate is the antidote to an atropine overdose in patients who show extreme delirium or agitation and could inflict injury to themselves. Its routine use as an antidote for cholinergic-blocker overdose is controversial,

A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as hiking, golfing, and doing his own yard work. What should the nurse emphasize to him during the teaching session about his dru

D. He should take measures to reduce the occurrence of heat stroke during his activities.
Elderly patients who take an anticholinergic drug should be reminded that they are at a greater risk for suffering heat stroke because of decreased sweating and loss

When giving an anticholinergic drug, the nurse should monitor for which adverse effect from this drug?
A. Excessive urination
B. Diaphoresis
C. Dry mouth
D. Pupillary constriction

C. Dry mouth
Anticholinergic drugs commonly cause the adverse effects of dry mouth, blurred vision, constipation, and urinary retention.

The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. The purpose of this drug in this setting is to
A. control the heart rate.
B. relax the patient.
C. reduce urinary frequency.
D. reduc

D. reduce secretions.
Anticholinergic drugs are given preoperatively to control secretions during surgery. The other options are not correct.

Atropine would be appropriate for which of the following patients? Select all that apply.
A. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats per minute
B. A patient who has suddenly developed symptomatic tachycar

A. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats per minute
D. A patient, preoperatively, to reduce salivary and gastrointestinal secretions
F. A patient with severe diarrhea
Anticholinergic drugs are used for

Parasympathomimetics mimic the parasympathetic neurotransmitter acetylcholine. Another drug group name for parasympathomimetics is:
1. adrenergics
2. adrenergic blockers
3. cholinergics
4. anticholinergics

3. cholinergics
This is another word for parasympathomimetics.

Parasympathomimetics affect the cardiovascular, gastrointestinal (GI), and urinary systems, as well as the eye, causing:
1. increased pulse rate
2. decreased GI motility
3. decreased bladder contraction
4. myosis (pupil constriction)

4. myosis (pupil constriction)
These agents decrease pulse rate, increase GI motility, and increase bladder contraction.

Indirect-acting cholinergics act by:
1. inhibiting the action of the enzyme cholinesterase
2. promoting the action of the enzyme cholinesterase
3. inhibiting the action directly on the cholinergic receptors
4. promoting the action directly on the choliner

1. inhibiting the action of the enzyme cholinesterase
This is the function of indirect-acting cholinergics.

A client has urinary retention. He was prescribed bethanechol chloride 25 mg, tid, po. The primary action of direct-acting cholinergic bethanechol chloride (Urecholine) is to:
1. increase urination
2. increase salivation
3. decrease heart rate
4. increase

1. increase urination
This medication increases bladder contraction, leading to more effective bladder emptying.

A client is receiving bethanechol chloride (Urecholine) orally. What other route of administration can be used to give bethanechol?
1. intramuscular
2. intravenous
3. subcutaneous
4. intradermal

3. subcutaneous
Bethanechol may be given orally or subcutaneously.

Bethanechol chloride (Urecholine) is contraindicated if a client has a history of:
1. severe bradycardia and hypotension
2. tachycardia and hypertension
3. urinary retention and abdominal distention
4. hypertension and urinary retention

1. severe bradycardia and hypotension
Side effects of this medication are decreasing the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension.

The usefulness of cholinesterase inhibitors for controlling myasthenia gravis is:
1. for diagnostic purposes
2. to increase muscle strength
3. to decrease muscle strength
4. to promote urination

2. to increase muscle strength
By inhibiting the enzymes, acetylcholine is made more available to aid in muscle stimulation and the force of muscle contraction.

Your client has myasthenia gravis. Client teaching should include:
1. instructing the client to take the drug on time to avoid respiratory muscle weakness
2. informing the client that if a dose of the drug is missed to double the drug dose when the next d

1. instructing the client to take the drug on time to avoid respiratory muscle weakness
Even small gaps in time may cause respiratory muscle weakness; therefore the time schedule is strict.

Some cholinesterase inhibitors are used to improve memory in mild to moderate Alzheimer's dementia. These agents act by:
1. decreasing cholinergic function
2. enhancing cholinergic function
3. increasing anticholinergic function
4. blocking cholinergic ac

2. enhancing cholinergic function
These medications inhibit the enzyme designed to break down cholinergics and are thought to improve memory in mild to moderate Alzheimer's dementia

An example of a cholinesterase inhibitor used for clients with early-stage Alzheimer's dementia is:
1. ambenonium chloride (Mytelase)
2. bethanechol chloride (Urecholine)
3. atropine sulfate
4. tacrine hydrochloride (Cognex)

4. tacrine hydrochloride (Cognex)
This is the medication commonly given for Alzheimer's dementia and is thought to improve memory.

The major responses to anticholinergic drugs include:
1. decreased heart rate and increased salivation
2. pupil constriction and increased bronchial secretions
3. increased heart rate and decreased salivation
4. increased urine output and pupil constricti

3. increased heart rate and decreased salivation
These are the responses to anticholinergic medications.

Atropine and atropine-like drugs are anticholinergics. Atropine is usually prescribed as one of the preoperative drugs. The primary use for atropine as a preoperative drug is to:
1. increase heart rate
2. decrease salivation
3. decrease GI motility
4. dec

2. decrease salivation
This is the function of preoperative atropine in order to decrease the risk of aspiration during intubation.

A nurse is teaching a client about bethanechol hydrochloride (Urecholine). The nurse informs the client that this drug warrants which of the following precautions:
1. Rise slowly from lying positions.
2. Count pulse rate frequently to assess for bradycard

1. Rise slowly from lying positions.
This medication may lead to orthostatic hypotension and warrants careful position changes. Although bradycardia is a risk, it is not important to count pulse rate frequently.

Teaching clients taking anticholinergic includes:
1. encouraging the use of alcohol and caffeine before bedtime for sleep disorders
2. suggesting hard candy, chewing gum, and oral hygiene for dry mouth
3. instructing the client to report dizziness and a s

2. suggesting hard candy, chewing gum, and oral hygiene for dry mouth
Dry mouth is a common side effect of the anticholinergics.

Atropine-like drugs are contraindicated in clients with:
1. parkinsonism
2. a peptic ulcer
3. cirrhosis
4. glaucoma

4. glaucoma
Atropine may cause pupillary dilation, which increases intraocular pressure.

Certain anticholinergics are used for parkinsonism. One of the purposes for their use is to:
1. increase salivation and drooling
2. increase muscle tone
3. increase urination
4. decrease tremors and rigidity

4. decrease tremors and rigidity
This is the use for parkinsonism, a disease that includes tremors, bradykinesia, rigidity, and drooling.

Anticholinergics for parkinsonism are used during which stage of the disorder?
1. early
2. intermediate
3. late
4. They are not effective in treating this disorder.

1. early
These medications are indicated early in treatment.

Clients with nausea and vomiting are frequently prescribed antihistamines and anticholinergics. Side effects associated with antihistamines and anticholinergics include:
1. drowsiness and dry mouth
2. bradycardia and fatigue
3. tachycardia and dyspnea

1. drowsiness and dry mouth
These are common side effects.

A client is ordered bethanechol chloride (Urecholine) for urinary retention. A nurse is adding up the client's intake and output for the 8-hour shift. The client's I = 850 ml, O = 350 ml. The nurse should:
1. administer an extra dose of bethanechol
2. pal

2. palpate the client's bladder
The client's output is adequate but does not match the intake. The nurse should assess for bladder distention and retention.

A client experiences bradycardia as a result of vagal stimulation. The nurse would expect to administer:
1. bethanechol chloride (Urecholine)
2. benztropine (Cogentin)
3. metoclopramide (Reglan)
4. atropine sulfate (atropine)

4. atropine sulfate (atropine)
Atropine is given to increase heart rate in patients with vagally stimulated bradycardia.

Cholinergic agents have specific effects on the body. Select the actions of cholinergic medications from the following:
1. dilate pupils
2. decrease heart rate
3. stimulate gastric muscle
4. dilate blood vessels
5. dilate bronchioles
6. increase salivatio

2. decrease heart rate
3. stimulate gastric muscle
4. dilate blood vessels
6. increase salivation
7. constrict pupils
These are the actions of the parasympathetic nervous system, or the "feed and breed response.