A home health nurse is making a home visit to a client with multiple sclerosis. The nurse reviews the home medications taken by the client. Which question should the nurse ask to determine the effectiveness of the client's medication, baclofen (Lioresal)?

A) Bradycardia:
Benztropine is an anticholinergic medication used to manage the symptoms of Parkinson's disease by blocking the action of acetylcholine. While anticholinergic medications can affect heart rate, bradycardia is not a common side effect of benztropine. In fact, benztropine may have the opposite effect, potentially causing tachycardia (increased heart rate).

B) Excess salivation:
Excessive salivation is typically a symptom of Parkinson's disease itself, due to difficulty swallowing, rather than a side effect of benztropine. In fact, benztropine, as an anticholinergic agent, generally reduces salivation (anticholinergic effect), so this side effect is unlikely to occur with benztropine therapy.

C) Urinary retention:
Benztropine, being an anticholinergic drug, can inhibit the action of acetylcholine at muscarinic receptors in the bladder, leading to urinary retention. This is a common and serious side effect of anticholinergic drugs like benztropine. Urinary retention can lead to discomfort, urinary tract infections (UTIs), and kidney problems if not addressed.

D) Diarrhea:
Benztropine is more likely to cause constipation rather than diarrhea due to its anticholinergic effects. Anticholinergic medications often slow down gastrointestinal motility, leading to constipation.

A) Continue to monitor as this is a normal response to the medication: The symptoms the patient is experiencing (cramping, diaphoresis, increased oral secretions) are not normal responses to the edrophonium test and suggest a cholinergic crisis rather than a simple reaction to the medication. A cholinergic crisis occurs when there is overmedication with cholinergic drugs, leading to excessive stimulation of the parasympathetic nervous system. While mild effects like slight nausea or dizziness can occur, cramping, diaphoresis, and increased oral secretions indicate toxicity, requiring immediate intervention.

B) Administration of atropine: The symptoms the patient is exhibiting—cramping, diaphoresis, and increased oral secretions—are indicative of cholinergic toxicity. Edrophonium, a cholinesterase inhibitor, is used in the Tensilon test to diagnose myasthenia gravis by temporarily improving muscle strength. However, in some cases, the patient may experience a cholinergic crisis from an overdose of the medication, resulting in excess acetylcholine at synapses, which overstimulates the parasympathetic nervous system. Atropine, an anticholinergic agent, blocks the effects of acetylcholine and is used to reverse these symptoms by reducing the excessive parasympathetic activity (e.g., reducing secretions and improving heart rate).

C) Place the patient in the Trendelenburg position: The Trendelenburg position (head down, feet up) is often used in cases of shock to help increase venous return to the heart. However, it is not appropriate for a cholinergic crisis. The patient’s symptoms are not due to hypotension or shock but are related to an overdose of edrophonium causing parasympathetic overstimulation.

D) Administer diphenhydramine (Benadryl) for the allergic reaction: The symptoms the patient is experiencing (cramping, diaphoresis, increased oral secretions) are not related to an allergic reaction. Diphenhydramine (Benadryl) is an antihistamine used for allergic reactions, such as urticaria or anaphylaxis, but it does not treat cholinergic toxicity.