The nurse is caring for a 49-year-old patient, who has been ...

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The nurse is caring for a 49-year-old patient, who has been receiving bethanechol (Duvoid) for 1 week. The patient develops progressive muscle weakness and respiratory difficulty. Edrophonium is ordered and injected and the patient's symptoms worsen.
 
  How would the nurse interpret this response? A) Myasthenic crisis
  B) Cholinergic crisis
  C) Anaphylactic reaction
  D) Pulmonary edema

Question 2

A patient, who is 77 years old, is admitted with a diagnosis of dementia. Haloperidol (Haldol) has been ordered for this patient. What nursing considerations would govern the nurse's actions? (Select all that apply.)
 
  A) It is classed as an atypical antipsychotic.
  B) A lowered dosage is indicated for older adult.
  C) It often has a hyperactive effect on patients.
  D) It should not be used to control behavior with dementia.
  E) It should only be given every other day.

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Answer to Question 1

B
Feedback:
The patient with a cholinergic crisis presents with progressive muscle weakness and respiratory difficulty because the accumulation of acetylcholine at the cholinergic receptor site leads to reduced impulse transmission and muscle weakness. This is a crisis when the respiratory muscles are involved. Myasthenic crisis and cholinergic crisis display similar clinical pictures. The drug edrophonium can be used as a diagnostic agent to distinguish the two conditions. If the patient improves immediately after the edrophonium injection, the problem is a myasthenic crisis, which is improved by administration of the cholinergic drug. If the patient gets worse, the problem is probably a cholinergic crisis, so withdrawal of the patient's cholinergic drug along with intense medical support is indicated. The situation does not depict an anaphylactic reaction or pulmonary edema.

Answer to Question 2

B, D
Feedback:
Haloperidol is classified as a typical antipsychotic with a high risk of extrapyramidal effects and lower risk for hypotension and sedation. Older patients may be more susceptible to the adverse effects of antipsychotic drugs. All dosages need to be reduced and patients monitored very closely for toxic effects and to provide safety measures if central nervous system effects do occur. They should not be used to control behavior with dementia. Haloperidol does not have a hyperactive effect on patients; it should not be given on an every-other-day schedule.

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