A 27-year-old male is taking an anticholinergic drug as adjunctive therapy to treat his peptic ulcer disease. The client comes to the clinic and tells the nurse that he "feels his heart beating." What adverse effect is the client experiencing from the anticholinergic medication?

Urinary Frequency

Tachycardia

Tachypnea

Hypotension

Answer and Explanation

The Correct Answer is B

B) Tachycardia:
Anticholinergic drugs, by blocking the action of acetylcholine at muscarinic receptors, can lead to increased sympathetic activity, resulting in tachycardia. Acetylcholine normally acts to moderate heart rate via vagal stimulation, so blocking its effects with anticholinergic medications can lead to an unopposed sympathetic response, causing an increase in heart rate.

A) Urinary Frequency:
Anticholinergic drugs typically cause urinary retention rather than urinary frequency. By blocking muscarinic receptors in the bladder, these medications can lead to decreased bladder contractility and urinary retention. Urinary frequency is not a common adverse effect of anticholinergic drugs.

C) Tachypnea:
Tachypnea, or rapid breathing, is not a typical adverse effect of anticholinergic medications. While anticholinergic drugs can affect respiratory secretions and cause drying of mucous membranes, leading to potential respiratory issues, tachypnea specifically is not commonly associated with their use.

D) Hypotension:
Anticholinergic drugs are more likely to cause hypertension rather than hypotension. By blocking the parasympathetic nervous system, these medications can lead to sympathetic dominance, resulting in increased blood pressure. Hypotension is not a typical adverse effect of anticholinergic drugs.

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Correct Answer is C

Explanation

A) Lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake:
This statement is accurate. Lifestyle modifications are essential components of hypertension management and are recommended as the first step in treatment. These modifications include regular physical activity, adopting a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet, reducing sodium intake, limiting alcohol consumption, and quitting smoking. These changes can help lower blood pressure and reduce the risk of cardiovascular events.

B) Use of diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes:
This statement is also accurate. If lifestyle modifications alone are insufficient to achieve blood pressure control, pharmacotherapy may be initiated. The choice of antihypertensive medications depends on various factors, including the individual's comorbidities, medication tolerance, and response to treatment. Diuretics, beta-blockers, and ACE inhibitors are commonly used as first-line agents in the management of hypertension, either as monotherapy or in combination with other drugs.

C) All of the above:
This statement is correct. The stepped-care approach to hypertension management involves a combination of lifestyle modifications and pharmacotherapy. Lifestyle changes are typically recommended as the initial step, followed by the addition of antihypertensive medications if necessary to achieve target blood pressure goals. Therefore, both lifestyle modifications and pharmacological interventions are integral components of the stepped-care approach.

D) A combination of antihypertensive drug classes to achieve desired control:
While this statement is true, it does not encompass all aspects of the stepped-care approach. The use of combination therapy with multiple antihypertensive drug classes may be necessary in some cases to achieve optimal blood pressure control. However, it is only one component of the broader treatment strategy, which also includes lifestyle modifications as the foundation of therapy. Therefore, while combination therapy is important, it does not fully represent the stepped-care approach on its own.

A. STAT administration of atropine B. administration of activated charcoal C. hemodialysis D. intravenous administration of pseudoephedrine

Correct Answer is A

Explanation

A) STAT administration of atropine:
This is the correct answer. Atropine is a cholinergic antagonist that can increase heart rate by blocking the action of acetylcholine on cardiac muscarinic receptors. In cases of severe bradycardia, especially if associated with symptoms such as dizziness, syncope, or hypotension, atropine is often administered to increase heart rate and improve cardiac output. The dose of atropine and frequency of administration depend on the severity of bradycardia and the clinical response.

B) Administration of activated charcoal:
Activated charcoal is used in cases of overdose or poisoning to absorb ingested toxins and prevent their absorption into the bloodstream. However, in this scenario, where the primary concern is bradycardia resulting from cholinesterase inhibitor (donepezil) toxicity, activated charcoal would not be effective in reversing the bradycardic effects of the medication.

C) Hemodialysis:
Hemodialysis is a renal replacement therapy used to remove toxins and waste products from the blood in individuals with kidney failure. While hemodialysis may be indicated in cases of severe drug overdose or poisoning to enhance toxin elimination, it is not typically used as a first-line intervention for bradycardia associated with cholinesterase inhibitor toxicity.

D) Intravenous administration of pseudoephedrine:
Pseudoephedrine is a sympathomimetic drug that acts as a vasoconstrictor and can increase heart rate and blood pressure. While it may be used to treat bradycardia in some cases, such as severe symptomatic bradycardia unresponsive to atropine, it is not the first-line treatment for cholinesterase inhibitor toxicity-induced bradycardia. Atropine is preferred due to its direct antagonism of muscarinic receptors in the heart.

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A 27-year-old male is taking an anticholinergic drug as adjunctive therapy to treat his peptic ulcer disease. The client comes to the clinic and tells the nurse that he "feels his heart beating." What adverse effect is the client experiencing from the anticholinergic medication?

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Naxlex Comprehensive Predictor Exams

The stepped-care approach to the treatment of hypertension includes

Correct Answer is C

Explanation

A 78-year-old client is admitted to the emergency department with a heart rate of 34 beats/min. Family members tell the nurse that the client may have mistakenly taken several doses of donepezil. The nurse should anticipate what intervention to treat the client's bradycardia?

Correct Answer is A

Explanation

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