Chapter 20: Cholinergic Drugs

Test Bank

MULTIPLE CHOICE

1. When monitoring a patient who is taking a cholinergic drug, the nurse will watch for which
cardiovascular effect?
a. Bradycardia
b. Tachycardia
c. Vasoconstriction
d. Palpitations
ANS: A
The cardiovascular effects of cholinergic drugs are decreased heart rate (not tachycardia) and
vasodilation. Palpitations are not effects of cholinergic drugs.

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2. 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?
a. Anticholinergic poisoning
b. Glaucoma
c. Bladder atony
d. Myasthenia gravis
ANS: B
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.

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3. A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to
administer which drug as an antidote?
a. atenolol (Tenormin)
b. bethanechol (Urecholine)
c. dobutamine
d. atropine sulfate
ANS: D
Prompt administration of atropine sulfate can reverse a toxic dose of cholinergic drugs. The
other drugs listed are not antidotes to cholinergic toxicity.

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4. 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?
a. Decreased pulse rate
b. Abdominal cramping
c. Passage of flatus
d. Decreased urge to void
ANS: C
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.

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5. 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?
a. Take the medication with meals to avoid gastrointestinal distress.
b. Give daytime doses close together for maximal therapeutic effect.
c. Take the medication 30 minutes before eating to improve swallowing and
chewing.
d. Take the medication only if difficulty swallowing occurs during a meal.
ANS: C
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.

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6. 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 (Salagen)
b. bethanechol (Urecholine)
c. pyridostigmine (Mestinon)
d. tacrine (Cognex)

ANS: C
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.

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7. 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?
a. Prevents memory loss in later stages
b. Reverses the course of Alzheimer’s disease
c. Provides sedation to prevent agitation and restlessness
d. May help to improve the symptoms of Alzheimer’s disease
ANS: D
Donepezil is used to treat mild to moderate dementia occurring in Alzheimer’s disease and
may improve the symptoms of the disease.

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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?
a. “Increase the dosage to twice daily.”
b. “It takes time for the cure to take effect.”
c. “It may take up to 6 weeks to see an improvement.”
d. “Take the medication on an empty stomach for improved absorption.”
ANS: C
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.

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9. 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?
a. Reduction of salivation
b. Stimulation of salivation
c. Reduction of gastrointestinal peristalsis
d. Improvement of fine-motor control
ANS: B
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.

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10. The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of
cholinergic drugs come from the stimulation of which receptors?
a. Muscarinic
b. Nicotinic
c. Cholinergic
d. Ganglionic
ANS: B
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.

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11. 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?
a. “I know the FDA has not approved this herbal product, but I’d like to try it to see
if it helps my memory.”
b. “I need to watch for possible side effects, such as headaches, or stomach or
intestinal upset.”
c. “I will take aspirin or ibuprofen (Motrin) if I have a headache.”
d. “Ginkgo may cause increased bleeding, so I’ll have to be careful when doing yard
work.”
ANS: C
Drug interactions may occur between the taking of aspirin and nonsteroidal antiinflammatory
drugs and the taking of ginkgo. The other options are incorrect.

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12. 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. Alzheimer’s disease
ANS: C
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.

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MULTIPLE RESPONSE

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.)
a. Bladder atony
b. Gastrointestinal obstruction
c. Bradycardia
d. Alzheimer’s disease
e. Hypotension
f. Chronic obstructive pulmonary disease
ANS: B, C, E, F
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.

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OTHER

1. 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?

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

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies