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

Answer and Explanation

The Correct Answer is D

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 A

Explanation

A. Increase fluids while taking the medication: Amitriptyline is a tricyclic antidepressant that can cause anticholinergic side effects such as dry mouth and constipation. Increasing fluid intake helps to mitigate these effects and prevent dehydration and constipation.

B. Expect an elevation in blood pressure with initial doses of the medication: Amitriptyline can cause orthostatic hypotension rather than elevated blood pressure. Clients should be informed about the risk of dizziness or fainting.

C. Stop the medication immediately if urine becomes orange in color: Orange urine is not a common side effect of amitriptyline. Clients should not stop the medication without consulting their provider.

D. Take the medication in the morning: Amitriptyline has sedative effects and is typically taken at night to help manage sleep disturbances and reduce daytime drowsiness.

A. Mostly cloudy B. Apical heart rate C. Blood pressure D. Respiratory rate E. Level of consciousness

Correct Answer is D

Explanation

A. Mostly cloudy: This option appears to be incorrectly stated. It does not pertain to a critical client assessment related to morphine administration.

B. Apical heart rate: Monitoring the heart rate is important, but respiratory depression is a more immediate and life-threatening concern with morphine administration, so it is not the first priority.

C. Blood pressure: Morphine can cause hypotension, but this is not as critical as respiratory depression, which must be assessed first in opioid administration.

D. Respiratory rate: The most critical assessment when administering morphine is the respiratory rate, as opioid medications like morphine can cause respiratory depression, which can be life-threatening if not addressed.

E. Level of consciousness: While important, changes in consciousness typically follow respiratory depression, so assessing the respiratory rate takes priority.

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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?

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