DT is a 58 year old female starting treatment for overactive bladder with the anticholinergic tolteridine (Detrol) ER 4 mg po daily. Which of the following adverse reactions would we be counseling her about? Select one:
Urinary incontinence and excessive sweating
Constipation and impaired cognition
Diarrhea and anxiety
Insomnia and bradycardia
The Correct Answer is B
Overactive bladder is characterized by urinary urgency, frequency, nocturia, and sometimes urge incontinence caused by involuntary detrusor muscle contractions. Tolterodine (Detrol) is an anticholinergic medication used to reduce bladder spasms by blocking muscarinic receptors in the bladder. While effective in improving urinary symptoms, it also produces systemic anticholinergic effects. Patient teaching should focus on recognizing common adverse reactions and preventing complications, especially in older adults.
Rationale:
A. Urinary incontinence and excessive sweating are not expected adverse effects of tolterodine. The medication is prescribed specifically to reduce urge incontinence by decreasing detrusor overactivity, not worsen it. Anticholinergic drugs also tend to reduce sweating rather than increase it because they inhibit muscarinic stimulation of sweat glands, which can sometimes lead to dry skin and heat intolerance.
B. Constipation and impaired cognition are common adverse effects of anticholinergic medications such as Tolterodine (Detrol). Reduced parasympathetic activity slows gastrointestinal motility, leading to constipation, while central nervous system anticholinergic effects may cause confusion, memory problems, or impaired concentration. These effects are particularly important to monitor in middle-aged and older adults receiving long-term therapy.
C. Diarrhea and anxiety are not typical effects of tolterodine because anticholinergics usually decrease gastrointestinal motility rather than increase it. Diarrhea is more associated with increased parasympathetic stimulation. Anxiety is also not a common primary adverse effect, although some patients may report general discomfort from dry mouth or urinary retention rather than direct mood disturbances.
D. Insomnia and bradycardia are not the expected major adverse reactions with tolterodine therapy. Anticholinergics more commonly cause mild tachycardia rather than bradycardia because of vagal inhibition on the heart. Sedation or confusion may occur more often than insomnia, and cardiovascular monitoring is usually focused on urinary retention and anticholinergic burden rather than slowed heart rate.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Testosterone is the primary androgen hormone responsible for male sexual development, secondary sexual characteristics, and anabolic effects on muscle and bone. Beyond its direct androgenic activity, testosterone is also metabolized into other biologically active hormones that influence both masculinizing and estrogenic effects in the body. These metabolic conversions occur through enzymatic pathways involving aromatase and 5-alpha reductase. Understanding these pathways helps explain the diverse physiologic effects of testosterone in both males and females.
Rationale:
A. Testosterone is converted into Dihydrotestosterone (DHT) via the enzyme 5-alpha reductase, which produces a more potent androgen responsible for effects such as prostate growth, body hair development, and male pattern baldness. It is also converted into Estradiol through the enzyme aromatase, which plays a role in bone health, libido regulation, and feedback control of gonadotropin release. These two metabolites represent the primary active hormonal derivatives of testosterone.
B. Estradiol and progesterone are not both direct metabolic products of testosterone. While estradiol can be derived from testosterone via aromatization, progesterone is a separate steroid hormone primarily produced in the ovaries and adrenal glands. This pairing does not accurately reflect testosterone metabolism.
C. Dihydrotestosterone is correctly derived from testosterone, but progesterone is not a downstream metabolite of testosterone. Progesterone is an upstream precursor in steroid hormone synthesis pathways rather than a direct breakdown product of testosterone. This makes the combination biologically inaccurate.
D. Ethinyl estradiol is a synthetic estrogen used in oral contraceptives and is not a natural metabolite of testosterone. Androstenedione is actually a precursor in androgen and estrogen synthesis pathways rather than a breakdown product of testosterone. Therefore, this option is incorrect.
Correct Answer is B
Explanation
Impetigo is a highly contagious superficial bacterial skin infection commonly caused by Staphylococcus aureusand sometimes Streptococcus pyogenes. It typically presents as honey-colored crusted lesions and is most often managed with topical or systemic antibiotics depending on severity and extent. Localized, mild cases are best treated with topical agents to limit systemic exposure and effectively eradicate the infection. Early treatment also helps prevent spread to others and further skin involvement.
Rationale:
A. Miconazole (Lotrimin) is an antifungal agent used to treat fungal infections such as tinea corporis or candidiasis. Since impetigo is a bacterial infection, miconazole has no activity against Staphylococcus aureusor Streptococcus pyogenes. Using an antifungal would not resolve the infection and could allow progression or spread.
B. Mupirocin (Bactroban) is the first-line treatment for mild, localized impetigo. It works by inhibiting bacterial protein synthesis, effectively targeting common causative organisms such as Staphylococcus aureus. For limited lesions, topical therapy is preferred because it is highly effective, reduces systemic side effects, and directly treats the infected skin area.
C. Amoxicillin-clavulanate (Augmentin) is an oral antibiotic reserved for more extensive, severe, or systemic infections. While it has activity against common impetigo pathogens, it is not necessary for mild localized lesions. Oral therapy increases systemic exposure and is typically avoided when topical treatment is sufficient.
D. Cephalexin (Keflex) is effective against many gram-positive organisms and may be used for more widespread impetigo. However, for 2–3 localized lesions, systemic therapy is not indicated as first-line management. Topical treatment is equally effective in mild cases and minimizes unnecessary antibiotic exposure.
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