A nurse is reviewing the medical history of a client who has myasthenia gravis and is asking about starting neostigmine. The nurse should identify which of the following client conditions as a potential contraindication for cholinesterase inhibitor therapy?
Cataracts
Hypertension
Hypothyroidism
Peptic ulcer disease
The Correct Answer is D
Rationale:
A. Cataracts are not a contraindication for cholinesterase inhibitors like neostigmine.
B. Hypertension is not a direct contraindication for cholinesterase inhibitor therapy, although caution may be exercised depending on the overall health status of the client.
C. Hypothyroidism is not contraindicated for cholinesterase inhibitors; however, it should be managed appropriately.
D. Peptic ulcer disease is a significant contraindication for cholinesterase inhibitors like neostigmine because these medications can increase gastric secretions and motility, potentially exacerbating ulcer conditions and leading to complications.
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Correct Answer is C
Explanation
Rationale:
A. Applying a warming blanket is not appropriate and may worsen the client’s reaction to the infusion. It does not help prevent infusion-related reactions.
B. Infusing amphotericin B deoxycholate over 1 hour is too fast; the medication should be infused over 2-6 hours to reduce the risk of adverse effects.
C. Administering diphenhydramine prior to administration is recommended to help prevent infusion-related reactions, such as fever and chills, which the client experienced during previous infusions.
D. Monitoring vital signs once per hour is inadequate; vital signs should be monitored more frequently during and immediately after the infusion to promptly identify and manage any adverse reactions.
Correct Answer is A
Explanation
Rationale:
A. Frequent sputum tests may be needed to monitor the effectiveness of isoniazid, particularly in assessing the resolution of tuberculosis infection.
B. Isoniazid is usually prescribed for a minimum of six months for tuberculosis treatment, not just a month. Thus, stopping after one month is incorrect.
C. Antacids containing aluminum should not be taken concurrently with isoniazid, as they can interfere with the absorption of the medication, reducing its effectiveness.
D. Constipation is not a common side effect of isoniazid. The more frequent side effects include peripheral neuropathy and liver toxicity, making this statement incorrect.