A client is taking pyridostigmine for muscle weakness associated with myasthenia gravis. The nurse educates the client on which possible cholinergic side effects associated with this medication? (Select all that apply)
Dry Mouth
Diarrhea
Decreased Urination
Excessive Lacrimation
Tachycardia
Excessive sweating
Correct Answer : B,D,F
A. Dry mouth is not a cholinergic side effect; cholinergic effects typically increase secretions.
B. Diarrhea is a common cholinergic side effect due to increased gastrointestinal motility.
C. Decreased urination is not expected; cholinergic agents may increase urination.
D. Excessive lacrimation (tearing) is a common cholinergic effect, as these agents stimulate glandular secretions.
E. Tachycardia is not a cholinergic side effect; bradycardia is more likely due to cholinergic effects.
F. Excessive sweating is a cholinergic effect due to increased glandular activity.
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Correct Answer is C
Explanation
A. A pulse oximetry of 92% indicates mild hypoxia but does not directly contraindicate the use of verapamil.
B. A respiratory rate of 12 is within the normal range for adults and does not indicate a need to hold the medication.
C. A pulse of 78 is within the normal range but should be assessed in the context of the client’s overall condition; however, if the pulse were significantly lower (e.g., <60 bpm), it would necessitate holding the medication due to the risk of bradycardia.
D. A history of myocardial infarction a week ago would warrant caution but is not an absolute reason to hold verapamil unless other contraindications are present, as verapamil can be beneficial for managing hypertension post-MI.
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.