An adolescent boy is admitted to the emergency department (ED) following a bee sting. He arrives with a body rash and 30 minutes later he becomes short of breath. The nurse obtains vital signs with a blood pressure of 90/52 mm Hg, heart rate 130 beats/minute, and respiratory rate 40 breaths/minute. The client is exhibiting clinical manifestations of which type of immune reaction?

Choice A reason: Unexplained weight loss is not directly relevant to pyridostigmine administration. Myasthenia gravis affects neuromuscular junctions, and pyridostigmine enhances acetylcholine, improving muscle strength. Weight loss may indicate systemic issues, but it does not affect the drug’s immediate safety or efficacy, making this choice secondary.

Choice B reason: Trouble sleeping is unrelated to pyridostigmine’s administration. The drug targets acetylcholinesterase, increasing muscle strength in myasthenia gravis, but does not typically affect sleep. Insomnia may reflect other conditions, but it is not a critical pre-administration concern compared to cholinergic side effects.

Choice C reason: Difficulty with urination is critical, as pyridostigmine’s cholinergic effects can exacerbate urinary retention by stimulating bladder smooth muscle. In myasthenia gravis, this may worsen existing autonomic dysfunction, risking complications like infection, making this the most important information to assess before administration.

Choice D reason: Recent oral intake is relevant for gastrointestinal side effects, as pyridostigmine may cause nausea, but it is less critical than urinary issues. Taking the drug with food can mitigate nausea, but urinary retention poses a greater immediate risk, making this choice secondary.

Choice A reason: Daily use of tiotropium via its handihaler is correct, as this long-acting anticholinergic bronchodilator is administered once daily for COPD maintenance. It relaxes airway smooth muscles, improving airflow, and consistent use prevents exacerbations, indicating proper understanding of the medication’s administration schedule.

Choice B reason: Using tiotropium for sudden shortness of breath is incorrect, as it is not a rescue inhaler. Tiotropium provides sustained bronchodilation over 24 hours, not rapid relief. Short-acting beta-agonists like albuterol are used for acute symptoms, indicating a need for further teaching.

Choice C reason: Using another inhaler between tiotropium doses suggests misunderstanding, as tiotropium is a once-daily maintenance therapy. Additional inhalers may be prescribed, but this statement implies incorrect timing or overuse, which could lead to improper COPD management, requiring clarification.

Choice D reason: Expecting thinner sputum is incorrect, as tiotropium does not affect mucus viscosity. It dilates airways, not liquefying secretions, which is the role of mucolytics. This misunderstanding indicates a need for teaching about tiotropium’s bronchodilatory, not mucolytic, effects in COPD.