A client is taking cyclobenzaprine (Flexeril) for acute muscle spasms of the back. The nurse educates the client on which possible anticholinergic side effects associated with this medication? (Select all that apply)
Decreased Urination
Diarrhea
Dry Mouth
Tachycardia
Excessive Lacrimation
Excessive Sweating
Correct Answer : A,C,D
A. Decreased urination is an anticholinergic side effect due to the medication's action on the bladder.
B. Diarrhea is not an anticholinergic side effect; in fact, anticholinergics typically cause constipation.
C. Dry mouth is a common anticholinergic side effect, resulting from reduced saliva production.
D. Tachycardia can occur as an anticholinergic effect due to decreased vagal tone.
E. Excessive lacrimation is not associated with anticholinergic effects; it is the opposite, as anticholinergics usually lead to dry eyes.
F. Excessive sweating is contrary to anticholinergic effects, which often result in decreased sweating.
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Correct Answer is ["B","C","F"]
Explanation
A. Morphine administered intravenously bypasses the gastrointestinal tract and liver, avoiding the first-pass effect entirely.
B. Diphenhydramine in tablet form is absorbed through the gastrointestinal tract and undergoes significant first-pass metabolism in the liver, affecting its bioavailability.
C. Famotidine in tablet form is also subject to first-pass metabolism, which can reduce its effectiveness.
D. Nitroglycerin sublingual tablets are designed to bypass the first-pass metabolism by being absorbed directly into the bloodstream through the mucous membranes.
E. The same applies to nitroglycerin 10mg sublingual tablets; they also avoid the first-pass effect due to sublingual administration.
F. Acetaminophen is taken orally and undergoes first-pass metabolism in the liver, which can significantly affect its overall bioavailability.
Correct Answer is C
Explanation
A. Glucose tablets are appropriate for clients with mild hypoglycemia who are alert and able to chew and swallow; they are not suitable for someone who is difficult to arouse.
B. Epinephrine is not used as a treatment for hypoglycemia; it does not directly increase blood glucose levels.
C. IVP (intravenous push) dextrose 50% is indicated for severe hypoglycemia in clients who are lethargic or unresponsive, as it rapidly increases blood glucose levels.
D. Orange juice is effective for mild hypoglycemia but is not appropriate in this case due to the client’s altered mental status and risk of aspiration.