A client with myxedema reports experiencing fatigue, cold intolerance, and swelling around the eyes and face. The nurse plans care, understanding that these clinical manifestations are caused by a lack of or diminished production of which hormones? (Select all that apply)

Choice A reason: Atropine is an anticholinergic medication that blocks the effects of the parasympathetic nervous system. One of its effects is relaxation of the smooth muscles in the bladder, which can lead to urinary retention. This occurs because the bladder's ability to contract is inhibited, making it difficult for the patient to void.

Choice B reason: Bradycardia is not an expected effect of atropine. In fact, atropine is often used to treat bradycardia by increasing heart rate. It works by blocking the vagus nerve's influence on the heart, which normally acts to slow the heart rate. Therefore, atropine would be expected to cause an increase in heart rate, not a decrease.

Choice C reason: Diarrhea is not a common effect of atropine. Atropine works by reducing the activity of the gastrointestinal tract, leading to a decrease in bowel movements and potentially causing constipation rather than diarrhea. Anticholinergic drugs like atropine reduce gastrointestinal motility, which can lead to a slower passage of food through the intestines.

Choice D reason: Vomiting is not typically associated with the administration of atropine. While nausea and vomiting can be side effects of many medications, atropine more commonly causes dry mouth, blurred vision, and constipation. The medication's action on the gastrointestinal tract tends to slow digestive processes rather than stimulate vomiting.

Rationale

• B. Sudden pain relief: The intense pain associated with otitis media is caused by the accumulation of fluid and pressure against the tympanic membrane. When the membrane ruptures, that pressure is instantaneously released, resulting in a sudden and dramatic decrease in pain. This is often followed by purulent (pus-filled) or serosanguineous (bloody) drainage in the external ear canal.

Why the others are incorrect

• A. Increased temperature: While a fever is a common sign of an acute infection (Acute Otitis Media), it is not a specific indicator that the eardrum has ruptured. In fact, systemic symptoms like fever may actually decrease once the pressure and infection are vented through a rupture.

• C. Popping sensation when swallowing: This sensation is typically associated with the opening and closing of the Eustachian tube as it attempts to equalize pressure in the middle ear. It is a common symptom of Eustachian tube dysfunction or fluid in the ear, but it indicates an intact eardrum rather than a ruptured one.

• D. Green-blue discharge in the ear canal: While drainage (otorrhea) occurs after a rupture, the color is typically clear, bloody, or yellowish-white (purulent). Green-blue discharge is more characteristic of Pseudomonas infections, often seen in otitis externa (swimmer's ear), rather than a standard tympanic membrane rupture from middle ear effusion.