Cholinergic Drugs

Every question here, with the answer

1. A client with myasthenia gravis takes pyridostigmine and now has increasing weakness, excess saliva, watery eyes, bradycardia and diarrhea. Which medication should the nurse anticipate?

   1. Atropine
   2. Neostigmine IV
   3. Succinylcholine
   4. An additional dose of pyridostigmine

   Answer: Atropine

   Weakness with signs of excessive cholinergic stimulation points to cholinergic crisis, and atropine blocks muscarinic receptors to reverse most symptoms. More pyridostigmine or neostigmine would worsen the crisis, and succinylcholine is a neuromuscular blocker.

2. A client with myasthenia gravis has difficulty chewing and swallowing. When should the nurse give the scheduled pyridostigmine?

   1. So that its peak effect occurs at mealtimes
   2. Immediately after each meal
   3. Only at bedtime
   4. Only when the client reports weakness

   Answer: So that its peak effect occurs at mealtimes

   Timing the drug so peak effects occur at meals helps the client eat and swallow. Giving it after meals or only at bedtime misses that window, and dosing only for weakness risks confusing overdose with underdose.

3. A nurse is teaching a client who is starting pyridostigmine. Which instructions should the nurse include? Select all that apply.

   1. Do not crush extended-release capsules.
   2. Change positions slowly.
   3. Wear a medic alert bracelet.
   4. Stop the drug once muscle strength returns.
   5. Contact the prescriber immediately for any difficulty breathing or swallowing.

   Answer: Do not crush extended-release capsules., Change positions slowly., Wear a medic alert bracelet., Contact the prescriber immediately for any difficulty breathing or swallowing.

   Clients should wear a medic alert bracelet, move slowly because of hypotension, not crush extended-release capsules, and report trouble breathing or swallowing at once. The drug must not be stopped abruptly because symptoms will quickly return.

4. A client with asthma is prescribed an AChE inhibitor for myasthenia gravis. What is the nurse's priority when monitoring this client?

   1. Skin integrity
   2. Blood glucose
   3. Respiratory status for bronchoconstriction
   4. Hearing

   Answer: Respiratory status for bronchoconstriction

   AChE inhibitors constrict the bronchi, so clients with asthma must be closely monitored. Glucose, hearing and skin are not linked to this effect in the section.

5. A nurse is caring for a client receiving an indirect-acting reversible AChE inhibitor. Which nursing actions are appropriate? Select all that apply.

   1. Encourage the client to rise quickly to prevent dizziness.
   2. Monitor the client's ability to raise the eyelids.
   3. Monitor heart rate, rhythm and blood pressure periodically.
   4. Assess respiratory pattern and airway patency.
   5. Monitor for dehydration if vomiting or diarrhea is present.

   Answer: Monitor the client's ability to raise the eyelids., Monitor heart rate, rhythm and blood pressure periodically., Assess respiratory pattern and airway patency., Monitor for dehydration if vomiting or diarrhea is present.

   The nurse monitors vital signs, respiratory status, eyelid strength as a sign of improvement, and dehydration from GI losses. Clients should not rise quickly because of possible orthostatic hypotension.

6. A client who takes pyridostigmine is scheduled for surgery. The nurse notes succinylcholine may be used. Why should the nurse alert the anesthesia provider?

   1. The combination can intensify the neuromuscular blockade.
   2. Succinylcholine makes pyridostigmine ineffective.
   3. Pyridostigmine speeds the breakdown of succinylcholine.
   4. The combination causes hyperglycemia.

   Answer: The combination can intensify the neuromuscular blockade.

   Reversible AChE inhibitors decrease the breakdown of succinylcholine, so the combination can intensify the neuromuscular blockade. It is atropine, not succinylcholine, that negates AChE inhibitor effects.