A patient newly diagnosed with myasthenia gravis is being discharged. The electronic prescription system was off-line so the patient has a hand-written prescription for pyridostigmine (Mestinon) ER 540 mg three times per day. The maximum safe dosage is 1500 mg in 24 hours. What should the nurse who is reviewing discharge instructions with the patient do?

A. Collaborate frequently with the respiratory therapist: Frequent collaboration with the respiratory therapist is essential to ensure the ventilator settings are appropriate for the patient's needs and to make adjustments as needed based on the patient's condition.

B. Adjust the ventilator settings based on the client's level of consciousness: While it’s important to monitor the patient’s level of consciousness, adjusting ventilator settings should primarily be done based on the patient's respiratory parameters (e.g., oxygenation, ventilation, lung mechanics), not solely on their level of consciousness. Ventilator settings should be adjusted by the respiratory therapist or physician as appropriate.

C. Document the patient's pulse oximetry once every shift: Pulse oximetry should be monitored and documented more frequently than once per shift, especially for a patient on a ventilator. Continuous monitoring is essential to assess oxygenation status and detect changes in the patient’s condition.

D. Ensure that a bag valve mask (BVM) with face mask is at the bedside: A BVM with face mask is an essential emergency equipment for a patient on a ventilator in case of ventilator failure or the need for resuscitation. Having it readily available ensures quick response in an emergency.

E. Assess the client's respiratory status hourly & as needed: Frequent assessment of the patient's respiratory status is critical for identifying any changes in condition, such as distress, ventilator malfunction, or need for adjustments. Monitoring should occur at least hourly and more frequently if the patient's condition requires it.

A. Contact the prescriber because the current prescription is at an unsafe dose: The prescribed dose of 540 mg three times per day totals 1620 mg in 24 hours, which exceeds the maximum safe dosage of 1500 mg for pyridostigmine (Mestinon). The nurse should immediately contact the prescriber to clarify or adjust the prescription to ensure the patient is not put at risk for toxicity.

B. Instruct the patient to take their medication with juice & crackers if stomach upset occurs: While taking pyridostigmine with food may help minimize gastrointestinal upset, this is not the priority concern. The primary issue is the unsafe dosage. The nurse should focus on addressing the dosage error before providing further instructions on food intake.

C. Inform the patient that abdominal cramping & diarrhea will decrease as their body adjusts: While abdominal cramping and diarrhea are common side effects of pyridostigmine, this does not address the critical issue of the unsafe dosage. The nurse should first ensure that the prescription is safe before discussing side effects.

D. Remind the patient to take their doses on time to prevent cholinergic crisis: While it is important for patients with myasthenia gravis to take their medication on time to avoid cholinergic crisis (a potentially life-threatening condition due to excessive cholinergic activity), this is secondary to ensuring the dosage is correct. The priority action is to contact the prescriber regarding the unsafe dose.