The nurse caring for a patient with a productive cough would anticipate an order for the following medication:

Choice A reason: Vasodilation is not the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can cause vasodilation by inhibiting the muscarinic receptors on the blood vessels, which normally cause vasoconstriction. However, this effect is not significant or consistent, and it does not improve the symptoms of bradycardia, which is a slow heart rate that can cause dizziness, fatigue, or fainting. The nurse should monitor the blood pressure and the peripheral pulses of the patient after administering atropine.

Choice B reason: Bronchodilation is not the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can cause bronchodilation by inhibiting the muscarinic receptors on the bronchial smooth muscle, which normally cause bronchoconstriction. However, this effect is not relevant or beneficial for the patient with symptomatic bradycardia, who does not have any respiratory problems. The nurse should assess the respiratory rate and the breath sounds of the patient after administering atropine.

Choice C reason: Increase in heart rate is the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can increase the heart rate by inhibiting the muscarinic receptors on the sinoatrial node and the atrioventricular node, which normally slow down the heart rate. This effect is desirable and beneficial for the patient with symptomatic bradycardia, who has a slow heart rate that can cause dizziness, fatigue, or fainting. The nurse should monitor the electrocardiogram and the heart rate of the patient after administering atropine.

Choice D reason: Diuresis is not the primary therapeutic effect of atropine in this scenario. Atropine is a medication that blocks the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Atropine can cause diuresis by inhibiting the muscarinic receptors on the bladder, which normally promote urination. However, this effect is not important or helpful for the patient with symptomatic bradycardia, who does not have any urinary problems. The nurse should measure the urine output and the specific gravity of the patient after administering atropine.

Choice A reason: This is correct. The liver is the main organ responsible for drug metabolism. The enzymes that the body uses to metabolize drugs are present throughout the body but are most abundant in the liver. The liver can transform drugs into more polar and water-soluble compounds, which can then be excreted by the kidneys or the biliary system.

Choice B reason: This is incorrect. The lungs are not primarily responsible for drug metabolism, although they can play a minor role in some cases. The lungs can metabolize some drugs that are inhaled, such as anesthetics, or drugs that circulate through the pulmonary blood vessels, such as propranolol. However, the lungs have a lower capacity and a lower variety of enzymes than the liver.

Choice C reason: This is incorrect. The heart is not responsible for drug metabolism, although it can be affected by it. The heart is the organ that pumps blood throughout the body, delivering oxygen and nutrients to the tissues and organs. The heart can be influenced by the pharmacokinetics and pharmacodynamics of drugs, which are the processes of drug absorption, distribution, metabolism, and excretion, and the effects of drugs on the body, respectively.

Choice D reason: This is incorrect. The kidney is not primarily responsible for drug metabolism, although it is important for drug excretion. The kidney is the organ that filters the blood and removes waste products and excess fluid as urine. The kidney can excrete drugs that are water-soluble or that are not reabsorbed by the tubules. The kidney can also metabolize some drugs, such as aspirin, but to a lesser extent than the liver.