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 B
Explanation
Rationale:
A. Abbreviate "daily" as "QD": The abbreviation "QD" is no longer recommended because it can be confused with "QID" (four times daily), potentially leading to dangerous medication errors.
B. Abbreviate "by mouth" as "PO": "PO" is the standard and accepted abbreviation for "by mouth," and it is widely used in medical documentation without ambiguity.
C. Abbreviate "acetaminophen" as "APAP": "APAP" is not universally recognized and may lead to confusion. Using the full name of the drug "acetaminophen" is safer and clearer.
D. Abbreviate "at bedtime" as "qhs": "Qhs" is discouraged as it can be easily misinterpreted. Writing "at bedtime" without abbreviations is the recommended practice to avoid errors.
Correct Answer is C
Explanation
Rationale:
A. Bradycardia: Albuterol can cause an increase in heart rate (tachycardia) as a common side effect, not a decrease in heart rate, so bradycardia would not be expected.
B. Wheezing: Albuterol is used to relieve wheezing by causing bronchodilation, so continued wheezing after administration would suggest ineffective treatment rather than being an expected finding.
C. Tremors: Tremors are a common side effect of albuterol due to its stimulation of beta-2 receptors in the muscles. This is often seen after nebulizer treatments.
D. Sleepiness: Albuterol generally causes stimulation of the central nervous system, leading to restlessness or nervousness, not sleepiness.