The client or family of a client taking tacrine (Cognex) should be taught to be observant for which of the following adverse effects that may signal that a possible overdose has occurred?
Excessive sweating, salivation, and drooling
Extreme constipation
Hypertension and tachycardia
Excessively dry eyes and reddened sclera
The Correct Answer is A
Tacrine (Cognex) is a cholinesterase inhibitor used in the treatment of Alzheimer’s disease. It increases acetylcholine levels in the brain to enhance memory and cognition. However, excessive cholinergic stimulation from overdose can lead to signs of cholinergic toxicity, which nurses and caregivers must closely monitor.
Rationale for correct answer:
1. Excessive sweating, salivation, and drooling
These are hallmark signs of cholinergic toxicity. Tacrine increases parasympathetic activity, and an overdose may lead to excessive secretions, bradycardia, muscle weakness, and in severe cases, respiratory compromise.
Rationale for incorrect answer:
2. Extreme constipation
Constipation is more typical of anticholinergic toxicity, not cholinergic excess. Tacrine enhances cholinergic activity, which usually increases GI motility rather than slowing it down.
3. Hypertension and tachycardia
These are signs more often associated with sympathetic nervous system overactivity, not with cholinergic overstimulation caused by drugs like tacrine.
4. Excessively dry eyes and reddened sclera
Dry eyes are an anticholinergic effect. Tacrine, being a cholinergic agent, would more likely cause increased lacrimation (tear production), not dryness.
Take-home points:
- Tacrine overdose manifests with signs of cholinergic excess, including sweating, salivation, drooling, and bradycardia.
- Cholinergic drugs increase parasympathetic activity; caregivers should know the early signs of overdose to act promptly.
- Differentiating between cholinergic and anticholinergic effects is essential for safe medication management in Alzheimer’s care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Beta-adrenergic blocking agents (beta blockers) are commonly used for hypertension, arrhythmias, and other cardiovascular disorders. However, non-selective beta blockers can block beta-2 receptors in the lungs, which may lead to bronchoconstriction, especially in patients with a history of asthma or COPD.
Rationale for correct answer:
3. Bronchoconstriction
Non-selective beta blockers can block beta-2 receptors in bronchial smooth muscle, leading to bronchoconstriction. This is particularly dangerous in individuals with underlying reactive airway disease.
Rationale for incorrect answer:
1. Pneumonia
Pneumonia may cause shortness of breath, but it is unrelated to beta-blocker therapy and would typically present with fever, cough, and crackles rather than sudden respiratory distress.
2. Pulmonary embolism
A pulmonary embolism is a possible cause of acute shortness of breath, but it is not a common adverse effect of beta blockers and requires other risk factors for thrombosis.
4. Bronchodilation
Bronchodilation is caused by beta-2 agonists, not beta blockers. Beta blockers would have the opposite effect on the airways.
Take-home points:
- Non-selective beta blockers may induce bronchoconstriction by blocking beta-2 receptors in the lungs.
- Patients with asthma or COPD should be prescribed cardio-selective beta blockers with caution.
- Shortness of breath following beta-blocker initiation requires immediate assessment for potential respiratory complications.
Correct Answer is C
Explanation
Bethanechol (Urecholine) is a direct-acting cholinergic agonist prescribed to stimulate bladder emptying in clients with urinary retention. Older adults are more vulnerable to its parasympathomimetic effects, which can lead to cardiovascular and neurological side effects that require close monitoring.
Rationale for correct answer:
3. Dizziness
Dizziness is a common concern in older adults taking bethanechol due to the risk of orthostatic hypotension and decreased cardiac output. This increases the risk for falls, making frequent assessment essential in this population.
Rationale for incorrect answer:
1. Tachycardia
Bethanechol typically causes bradycardia by stimulating the parasympathetic nervous system. Tachycardia is not a common effect of this drug and would not be the primary concern.
2. Hypertension
Cholinergic agonists tend to lower blood pressure through vasodilation and enhanced parasympathetic tone. Hypertension is not a typical adverse reaction.
4. Urinary retention
Bethanechol is used to treat urinary retention by stimulating the bladder. Retention would indicate a lack of therapeutic effect rather than an adverse one.
Take-home points:
- Bethanechol stimulates the parasympathetic system and can cause dizziness from hypotension, especially in older adults.
- Older clients require close monitoring for orthostatic changes and fall risks while on cholinergic medications.
- This drug is intended to treat urinary retention, not cause it, so effectiveness is measured by successful voiding.
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