Page 1916 - Saunders Comprehensive Review For NCLEX-RN

Rationale: Cholinergic overdose of bethanechol chloride produces manifestations
of excessive muscarinic stimulation such as salivation, sweating, involuntary
urination and defecation, bradycardia, and severe hypotension. Remember that the
sympathetic nervous system speeds the heart rate and the cholinergic
(parasympathetic) nervous system slows the heart rate. Treatment includes
supportive measures and the administration of atropine sulfate (anticholinergic)
subcutaneously or intravenously.
Test-Taking Strategy: Focus on the subject, signs of cholinergic overdose. Noting
that options 1, 2, and 4 are comparable or alike will assist in eliminating these
options.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pharmacology: Renal and Urinary Medications: Cholinergics
Health Problem: N/A
Priority Concepts: Elimination; Safety
Reference: Lilley et al. (2017), pp. 327-328.

668. Answer: 4

Rationale: Toxicity (overdosage) of oxybutynin produces central nervous system
excitation, such as nervousness, restlessness, hallucinations, and irritability. Other
signs of toxicity include hypotension or hypertension, confusion, tachycardia,
flushed or red face, and signs of respiratory depression. Drowsiness is a frequent
side effect of the medication but does not indicate overdosage.
Test-Taking Strategy: Focus on the subject, signs of toxicity (overdosage) of
oxybutynin. Remember that restlessness is a sign of toxicity.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pharmacology: Renal and Urinary Medications:
Anticholinergics/antispasmodics
Priority Concepts: Clinical Judgment; Safety
Health Problem: N/A
Reference: Hodgson, Kizior (2018), pp. 874-875.

669. Answer: 3

Rationale: Cyclosporine is an immunosuppressant. Nephrotoxicity can occur from
the use of cyclosporine. Nephrotoxicity is evaluated by monitoring for elevated
blood urea nitrogen and serum creatinine levels. The normal blood urea nitrogen
level is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). The normal creatinine level for a male is
0.6 to 1.2 mg/dL (53 to 106 mcmol/L) and for a female is 0.5 to 1.1 mg/dL (44 to 97
mcmol/L). Cyclosporine can lower complete blood cell count levels. A normal
hemoglobin is 14 to 18 g/dL (140 to 180 mmol/L) for a male and 12 to 16 g/dL (120 to
160 mmol/L) for a female. A normal hemoglobin is not an adverse effect.
Cyclosporine does affect the glucose level. The normal fasting glucose is 70 to 99

1916