A nurse is assessing a client who has muscarinic agonist poisoning. Following administration of atropine, which of the following findings should indicate to the nurse that the treatment has been effective?
Hyperactive bowel sounds
Heart rate 90/min
Blood pressure 90/50 mm Hg
Increased salivation
The Correct Answer is B
A. Hyperactive bowel sounds: Muscarinic agonist poisoning typically results in increased gastrointestinal motility and hyperactive bowel sounds. Atropine, an anticholinergic medication, works by blocking muscarinic receptors and reducing gastrointestinal motility. Therefore, the presence of hyperactive bowel sounds may indicate ongoing muscarinic stimulation and inadequate treatment with atropine.
B. Heart rate 90/min: Atropine is an anticholinergic medication that increases heart rate by blocking the parasympathetic effects of acetylcholine on the heart. Bradycardia is a common manifestation of muscarinic agonist poisoning, and an increase in heart rate following atropine administration indicates reversal of this effect and effective treatment.
C. Blood pressure 90/50 mm Hg: Atropine administration may result in transient hypertension due to its effect on increasing heart rate and cardiac output. Hypotension is a common
manifestation of muscarinic agonist poisoning, and an increase in blood pressure following atropine administration may indicate improvement in cardiovascular function. Therefore, a blood pressure of 90/50 mm Hg may not necessarily indicate effective treatment with atropine.
D. Increased salivation: Muscarinic agonist poisoning typically results in excessive salivation (sialorrhea) due to stimulation of muscarinic receptors in the salivary glands. Atropine administration works by blocking these muscarinic receptors and reducing salivation. Therefore, increased salivation would indicate ongoing muscarinic stimulation and inadequate treatment with atropine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
A. "Consumption of a high protein meal can reduce the effectiveness of the medication."
High-protein meals can interfere with levodopa absorption in the intestine, reducing its effectiveness. Clients should consume protein in moderate amounts and distribute intake throughout the day.
B. "You may notice your urine becomes lighter in color."
Levodopa can cause urine, sweat, and saliva to become darker (brown, red, or black), not lighter. This is a harmless side effect but should be discussed with the client.
C. "You may initially notice an increase in involuntary movements."
Levodopa can cause dyskinesia (involuntary movements), especially with prolonged use or at higher doses. These movements can include facial twitching, jerking, or head bobbing.
D. "The medication can cause nausea, so take with a meal."
Levodopa can cause nausea, particularly when first starting the medication. Taking it with food can help reduce gastrointestinal discomfort, but avoiding high-protein meals is important.
E. "This medication can make you light-headed if you stand up too quickly from a seated or lying position."
Levodopa can cause orthostatic hypotension, leading to dizziness or light-headedness when changing positions. Clients should be advised to rise slowly to prevent falls.
Correct Answer is C
Explanation
A. Hang the TPN solution to gravity to infuse: TPN solutions are typically administered using an infusion pump to control the rate of infusion accurately. Hanging the solution to gravity is not recommended because it may lead to inconsistent flow rates and inaccurate delivery of nutrients.
B. Titrate TPN solution to blood pressure: TPN solutions are not titrated based on blood pressure.
The composition and rate of TPN infusion are typically determined by the client's nutritional needs and metabolic status, not blood pressure.
C. Monitor the client's weight daily: Monitoring the client's weight daily is essential when administering TPN to assess for fluid balance, nutritional status, and response to therapy. Changes in weight can indicate fluid retention, dehydration, or changes in nutritional status, which may require adjustments to the TPN regimen.
D. Obtain the client's blood glucose level weekly: Blood glucose levels should be monitored frequently in clients receiving TPN, as hyperglycemia is a common complication. Weekly monitoring may not be sufficient to detect and manage hyperglycemia promptly. Therefore,
blood glucose levels are typically monitored more frequently, such as multiple times daily or according to institutional protocols.
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