Dopaminergic & Anticholinergics
A nurse is teaching a patient newly diagnosed with Parkinson’s disease about the pathophysiology of the condition. Which of the following statements by the patient indicates a correct understanding of the disease?
A. “Parkinson’s is caused by an overproduction of dopamine in the brain.”
B. “The symptoms I’m experiencing are related to the destruction of cells that produce dopamine.
C. “My muscle rigidity is due to a lack of calcium in my nerves.”
D. “Parkinson’s disease primarily affects the spinal cord and its ability to send motor signals.”
ANS: B
Rationale: Parkinson’s disease is caused by the loss of dopamine-secreting cells in the basal ganglia, leading to impaired regulation of movement by the extrapyramidal system.
A nurse is teaching a patient about the autonomic nervous system (ANS). Which of the following is a correct statement about the ANS?
A. The ANS controls voluntary movements of the skeletal muscles.
B. The ANS regulates involuntary functions such as heart rate, digestion, and respiratory rate.
C. The ANS is part of the central nervous system only.
D. The ANS primarily uses somatic nerves to transmit signals.
ANS: B
Rationale: The autonomic nervous system regulates involuntary body functions like heart rate, digestion, and respiratory rate. It controls smooth muscle, cardiac muscle, and glands. Voluntary movements of skeletal muscles are controlled by the somatic nervous system.
A nurse is providing education to a client newly diagnosed with peptic ulcer disease (PUD) caused by Helicobacter pylori (H. pylori). Which of the following statements by the client indicates a need for further teaching?
A. “The infection is damaging the protective lining of my stomach.”
B. “I may need to take two antibiotics to treat this infection.”
C. “I will take antacids to kill the bacteria in my stomach.”
D. “This infection increases my risk for developing stomach cancer.”
ANS: C
Rationale: Antacids help neutralize gastric acid but do not kill H. pylori. Treatment for H. pylori includes a combination of antibiotics (usually two) along with medications that reduce gastric acid (e.g., PPIs) or protect the mucosa. The other statements reflect accurate patient understanding of PUD and its complications.
A nurse is educating a patient about home use of over-the-counter bisacodyl (Dulcolax). Which patient statement indicates a need for further teaching?
A. "I’ll only use this medication if I haven’t had a bowel movement for a few days."
B. "I can take this every day so I stay regular."
C. "I might feel some cramping after taking this."
D. "If I don’t want to take it by mouth, I can use a suppository."
ANS: B
Rationale: Stimulant laxatives should not be used daily due to the risk of dependence and electrolyte imbalances. Many people misuse them for daily bowel movements, even when medically unnecessary. All other statements reflect appropriate understanding.
A nurse is explaining the purpose of an antiemetic to a patient receiving chemotherapy. Which of the following explanations by the nurse is most accurate?
A. “This medication works by increasing the activity of neurons in the vomiting center.”
B. “The antiemetic will prevent your stomach from sending signals to your brain.”
C. “This drug blocks the messages from the chemoreceptor trigger zone to reduce nausea.”
D. “It increases neurotransmitters in your intestines to speed up digestion and reduce vomiting.”
ANS: C
Rationale: Chemotherapy-induced nausea is often triggered through stimulation of the chemoreceptor trigger zone (CTZ), which sends signals to the vomiting center. Antiemetics work by blocking these signals, often through neurotransmitter antagonism (e.g., dopamine or serotonin blockers). The other answer choices either misrepresent the mechanism or describe it inaccurately.
A patient with Parkinson’s disease is prescribed carbidopa-levodopa (Sinemet). The nurse understands that the purpose of this medication combination is to:
A. Prevent the destruction of dopamine in the peripheral nervous system
B. Stimulate the production of acetylcholine in the basal ganglia
C. Inhibit the action of dopamine in the extrapyramidal system
D. Increase the reuptake of dopamine at neuronal synapses
ANS: A
Rationale: Levodopa is converted into dopamine in the brain, and carbidopa prevents the peripheral breakdown of levodopa, allowing more to reach the brain where it can be converted to dopamine. This helps regulate movement and reduce Parkinsonian symptoms.
A nurse is administering dopamine to a patient with shock. Which of the following effects should the nurse expect from dopamine?
A. Decreased heart rate and vasodilation
B. Increased heart rate and improved cardiac output
C. Bronchoconstriction and decreased blood pressure
D. Sedation and decreased respiratory rate
ANS: B
Rationale: Dopamine is a catecholamine that acts as both an alpha-adrenergic and beta-1 adrenergic agonist, depending on the dose. At moderate doses, it primarily stimulates beta-1 receptors in the heart, increasing heart rate (positive chronotropic effect) and contractility (positive inotropic effect). This leads to improved cardiac output, which is especially important in treating shock or heart failure. At higher doses, dopamine also stimulates alpha-1 receptors, causing vasoconstriction, which can raise blood pressure. It does not cause bronchoconstriction or sedation, and it increases, rather than decreases, heart rate.
A patient prescribed omeprazole (Prilosec) for GERD reports new bone pain. What adverse effect should the nurse suspect is associated with long-term use of PPIs?
A. Acid rebound
B. Fractures
C. Pneumonia
D. C. difficile infection
ANS: B
Rationale: Long-term PPI use can increase the risk of bone fractures, especially in older adults. Acid rebound, pneumonia, and C. difficile are also potential adverse effects but bone pain specifically points to fractures.
The nurse is caring for a patient with chronic constipation related to opioid use. Which combination of medications is most appropriate for this patient?
A. Docusate sodium and polyethylene glycol
B. Bisacodyl and lactulose
C. Docusate sodium and bisacodyl
D. Lactulose and promethazine
ANS: C
Rationale: Docusate sodium (a stool softener) and bisacodyl (a stimulant laxative) are commonly used together in opioid-induced constipation. Docusate softens stool, while bisacodyl increases GI motility. Lactulose is more often used for hepatic encephalopathy. Promethazine is not a laxative.
A nurse is caring for a patient receiving prochlorperazine (Compazine) for chemotherapy-induced nausea. Which adverse effect should the nurse monitor for due to the dopamine-blocking action of this medication?
A. Sedation
B. Extrapyramidal symptoms
C. Prolonged QT interval
D. Diarrhea
ANS: B
Rationale: Prochlorperazine blocks dopamine in the chemoreceptor trigger zone, which can cause extrapyramidal symptoms such as tremors, rigidity, or restlessness.
A nurse is educating a patient newly prescribed carbidopa-levodopa for Parkinson’s disease. Which statement by the patient indicates a need for further teaching?
A. “I should take this medication with a full glass of water.”
B. “If I feel nauseous, I’ll take it with a high-protein snack.”
C. “This drug may cause my blood pressure to drop when I stand up.”
D. “I may notice some involuntary movements while taking this medication.”
ANS: B
Rationale: High-protein foods can delay absorption of carbidopa-levodopa, reducing its effectiveness. The patient should avoid high-protein snacks around the time of dosing. The other statements correctly reflect known teaching points and side effects such as postural hypotension and dyskinesias.
Which of the following drugs is a selective alpha-1 adrenergic agonist primarily used to increase blood pressure in hypotensive patients?
A. Dobutamine
B. Phenylephrine
C. Clonidine
D. Epinephrine
ANS: B
Phenylephrine is a selective alpha-1 adrenergic receptor agonist. Activation of alpha-1 receptors on vascular smooth muscle causes vasoconstriction, which increases systemic vascular resistance and raises blood pressure. It is commonly used in settings such as hypotension or to increase blood pressure during anesthesia. Dobutamine mainly stimulates beta-1 receptors and is used to increase cardiac output. Clonidine is an alpha-2 adrenergic agonist, which works centrally to reduce sympathetic outflow and lower blood pressure. Epinephrine acts on alpha and beta receptors but is less selective.
A patient taking omeprazole (Prilosec) also requires anticoagulation with clopidogrel. What is the nurse’s best action?
A. Discontinue omeprazole immediately
B. Administer both medications with caution and monitor for effectiveness
C. Substitute omeprazole with ranitidine
D. Hold clopidogrel and notify provider
ANS: B
Rationale: Omeprazole can reduce clopidogrel’s effectiveness, but they can be used together if the patient has a high risk of GI bleeding. Close monitoring is essential.
Which adverse effect should the nurse monitor for when administering stimulant laxatives such as bisacodyl?
A. Headache
B. Cramping and diarrhea
C. Dry mouth
D. Sedation
ANS: B
Rationale: Stimulant laxatives often cause cramping and diarrhea due to increased intestinal motility and water secretion.
Ondansetron (Zofran) is prescribed for a patient undergoing surgery to prevent nausea and vomiting. Which patient condition requires the nurse to exercise caution and consider cardiac monitoring during treatment?
A. History of asthma
B. Electrolyte imbalances
C. Diabetes mellitus
D. Chronic kidney disease
ANS: B
Rationale: Ondansetron can prolong the QT interval, especially in patients with electrolyte imbalances, increasing risk for cardiac arrhythmias.
Which of the following patient medications would concern the nurse when reviewing a new prescription for carbidopa-levodopa?
A. Lorazepam
B. Haloperidol
C. Omeprazole
D. Metoprolol
ANS: B
Rationale: Haloperidol (Haldol) is an antipsychotic that blocks dopamine receptors, which can counteract the effects of carbidopa-levodopa. This drug interaction is important to monitor, as it can worsen Parkinson’s symptoms or reduce medication efficacy.
Which of the following is a nonselective beta-adrenergic blocker that should be used cautiously in patients with asthma?
A. Atenolol
B. Propranolol
C. Metoprolol
D. Labetalol
ANS: B
Propranolol is a nonselective beta blocker, meaning it blocks both beta-1 (heart) and beta-2 (lungs) receptors. Blocking beta-2 receptors can cause bronchoconstriction, which can exacerbate asthma or other obstructive pulmonary diseases. Therefore, propranolol should be used cautiously or avoided in patients with asthma or COPD. Atenolol and metoprolol are beta-1 selective blockers and have less effect on beta-2 receptors, making them safer for patients with respiratory conditions. Labetalol blocks both alpha-1 and beta receptors but is less commonly used specifically for asthma concerns.
Which statement by the patient indicates understanding of proton pump inhibitor therapy?
A. “I will take this medication as long as I have symptoms, even if that’s for months.”
B. “I will stop the medication abruptly when I feel better.”
C. “I should take the medication for the shortest time possible to avoid side effects.”
D. “I can take this medication with antacids to increase effectiveness.”
ANS: C
Rationale: PPIs are recommended for the shortest duration possible to minimize adverse effects like acid rebound and infections.
Which instruction is most important for a nurse to include when teaching about stimulant laxatives?
A. "These medications can be used daily without concern."
B. "Expect a bowel movement within 24 to 48 hours after taking the medication."
C. "Use the suppository form for faster relief if needed."
D. "These laxatives are the safest for long-term use."
ANS: C
Rationale: Stimulant laxatives like bisacodyl and sennosides work by stimulating intestinal motility and pulling water into the bowel to speed up transit. They usually act quickly — typically within 6 to 12 hours when taken orally, and even faster when given as a suppository. Because of this rapid action, patients can use suppositories if they need quick relief from constipation.
A patient is receiving IV metoclopramide (Reglan) for gastroparesis. Which nursing intervention is most important to prevent adverse effects during administration?
A. Administer the medication rapidly to ensure effectiveness
B. Monitor the patient closely for signs of sedation and psychosis
C. Encourage the patient to increase fluid intake immediately after administration
D. Administer the medication with food to reduce nausea
ANS: B
Rationale:
Rapid IV administration of metoclopramide can cause acute psychosis; therefore, the medication should be given slowly and the patient monitored for sedation and psychosis.
A nurse is caring for a client with Parkinson’s disease who has been prescribed benztropine. Which of the following findings would require immediate intervention?
A. Dry mouth
B. Blurred vision
C. Urinary retention
D. Drowsiness
ANS: C
Rationale: While dry mouth, blurred vision, and drowsiness are common anticholinergic side effects, urinary retention requires immediate intervention, especially in older adults, as it can lead to bladder distention, infection, or acute renal issues. Anticholinergics reduce parasympathetic activity, which can impair bladder emptying.
A patient is prescribed atenolol for hypertension. What advantage does atenolol have compared to nonselective beta blockers?
A. It increases bronchial smooth muscle relaxation
B. It selectively blocks beta-1 receptors with fewer respiratory side effects
C. It blocks alpha-1 receptors causing vasodilation
D. It increases heart rate and cardiac output
ANS: B
Atenolol is a cardioselective beta blocker, meaning it primarily blocks beta-1 adrenergic receptors found in the heart. This selectivity results in reduced heart rate and contractility, lowering blood pressure and myocardial oxygen demand without significant effects on beta-2 receptors in the lungs. Because beta-2 receptors remain unaffected, atenolol is less likely to cause bronchospasm, making it safer for patients with asthma or COPD compared to nonselective beta blockers like propranolol. Atenolol does not block alpha-1 receptors and does not increase heart rate or cardiac output; it reduces them.
A nurse is teaching a patient about the difference between proton pump inhibitors (PPIs) and H2 receptor antagonists for managing GERD. Which statement by the patient demonstrates correct understanding?
A. "PPIs work faster but have more side effects than H2 blockers."
B. "H2 blockers are more effective than PPIs at reducing stomach acid long-term."
C. "PPIs block acid production more completely and are preferred for healing ulcers."
D. "H2 blockers should never be given with other medications due to dangerous interactions."
ANS: C
Rationale: PPIs suppress gastric acid production more effectively and are preferred for ulcer healing, while H2 blockers have milder effects and fewer side effects. PPIs do not necessarily work faster, and H2 blockers can interact with other drugs but can still be given safely with monitoring.
A nurse is teaching a patient about how polyethylene glycol (Miralax) works to relieve constipation. Which explanation best describes the mechanism of action of this medication?
A. It stimulates the intestinal muscles to increase peristalsis.
B. It pulls water into the intestinal lumen to soften stool and increase bowel movement.
C. It changes the consistency of stool by acting as a stool softener.
D. It lubricates the intestinal walls to facilitate stool passage.
ANS: B
Rationale: Polyethylene glycol is an osmotic laxative that works by drawing water into the intestines, which softens the stool and promotes bowel movements. Choice A describes stimulant laxatives. Choice C describes surfactant laxatives like docusate sodium. Choice D describes lubricant laxatives such as mineral oil.
Metoclopramide (Reglan) helps reduce nausea and improve gastric emptying by which of the following mechanisms?
A. Blocking serotonin receptors in the chemoreceptor trigger zone and slowing GI motility
B. Blocking dopamine and serotonin receptors in the chemoreceptor trigger zone and increasing GI motility
C. Stimulating opioid receptors in the GI tract to reduce nausea
D. Blocking histamine receptors and decreasing gastric acid secretion
ANS: B
Metoclopramide works by blocking dopamine and serotonin receptors in the chemoreceptor trigger zone and by acting as a prokinetic agent to increase gastrointestinal motility.