The nurse is assessing a patient who has been taking a cholinergic drug for 3 days. The patient has flushed skin and orthostatic blood pressure changes and is complaining of abdominal cramps and nausea. The nurse recognizes that the patient is most likely experiencing
a) early signs of a choliner...
Pharm exam 4 review Questions Graded
A+ And Answers
The nurse is assessing a patient who has been taking a cholinergic drug for 3 days. The patient
has flushed skin and orthostatic blood pressure changes and is complaining of abdominal
cramps and nausea. The nurse recognizes that the patient is most likely experiencing
a) early signs of a cholinergic crisis.
b) late signs of a cholinergic crisis.
c) an allergic reaction to the drug.
d) expected adverse effects. - ANS A. Early signs of a cholinergic crisis
Rationale: The items listed are early signs of a cholinergic crisis, which can become more
severe and lead to hypotension, circulatory collapse, bloody diarrhea, shock, and cardiac arrest.
A 60-year-old woman asks the nurse about taking ginkgo to help with her memory. The patient
has a history of arthritis, type 2 diabetes, thyroid disease, and hypertension. She is currently
taking NSAIDs for arthritis, oral antidiabetic medications, thyroid replacement hormone, and a
beta blocker for blood pressure. What potential adverse effect from the gingko would be of most
concern for this patient?
a) Stomach upset
b) Diarrhea
c) Bleeding
d) Drowsiness - ANS C. Bleeding
Rationale: Potential adverse effects of gingko include stomach or intestinal upset, headache,
bleeding, and allergic skin reaction. Potential drug interactions include aspirin, NSAIDs,
anticoagulants, and other drugs. The ginkgo may interact with the NSAID medication and cause
increased bleeding.
A patient is scheduled to have lunch at 1200. The nurse will administer the pyridostigmine
(Mestinon) at what time for optimal therapeutic effect?
a) 1100
b) 1130
c) 1200
d) 1230 - ANS B. 11:30
Rationale: The drug should be taken 30 minutes before a meal for maximal therapeutic effect.
A patient with Alzheimer's disease accidentally took 2 weeks' worth of a cholinergic medication.
He is brought to the emergency department, is going into shock, and experiencing severe
hypotension and vomiting. The nurse will expect which initial treatment?
a) Administration of physostigmine
, b) Administration of atropine
c) Administration of epinephrine
d) Cardiovascular support with dopamine - ANS B. Administration of atropine
Rationale: Atropine can be given to reverse the effects of an overdose of a cholinergic drug.
Which finding would the nurse anticipate when assessing a patient with an atropine overdose?
a) Moist skin
b) Miosis
c) Bradycardia
d) Urinary retention - ANS D. Urinary retention
Rationale: Atropine overdose is manifested by flushing, dry skin and mucous membranes,
mydriasis, altered mental status, and fever. Other serious effects include sinus tachycardia,
urinary retention, hypertension, hallucinations, and cardiovascular collapse. Activated charcoal
is usually given along with supportive therapy.
Glycopyrrolate (Robinul) and an opioid are administered to a patient before surgery in the
preoperative area. The anticholinergic is used to
a) Potentiate the action of the opioid
b) Assist the patient in retaining urine during surgery
c) Control secretions during surgery
d) Prevent nausea - ANS C. Control secretions during surgery
Rationale: Anticholinergics such as glycopyrrolate and atropine are given preoperatively to
reduce or control secretions before and during surgery. Don't give with acute asthma, glaucoma,
or GI/GU obstruction.
Before administering tolterodine (Detrol), it is most important for the nurse to assess the patient
for a history of which condition?
a) Angle-closure glaucoma
b) Cataracts
c) Hypothyroidism
d) Hyponatremia - ANS A. Angle-closure glaucoma
Rationale: Tolterodine (Detrol) may worsen preexisting angle-closure glaucoma and urinary
retention, so its use should be avoided in patients with these conditions.
The "off-on phenomenon" that some patients with PD experience is best explained as the
a) need to take a drug holiday to improve response to medications.
b) variable response to levodopa, resulting in periods of good control and periods of poor control
of PD symptoms.
c) alternating schedule of medications needed to control PD.
d) fluctuation of emotions that often occurs with PD - ANS B. Variable response to
levodopa, resulting in periods of good control and periods of poor control of PD symptoms
Rationale: Some patients who take levodopa on a long-term basis experience times when their
PD symptoms are under control and other times when symptoms are not well controlled.
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