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 C

Explanation

A. Requesting a serum trough level blood draw for 60 min after completion of infusion is incorrect. Trough levels should be drawn just before the next dose (not after infusion completion) to ensure therapeutic drug levels and avoid toxicity.
B. Changing the infusion site after each dose administration is incorrect. Vancomycin can cause phlebitis, but routine site changes after every dose are unnecessary unless signs of irritation or infiltration are present.
C. Contacting the provider for prescription clarification is correct. Vancomycin should be infused over at least 60 minutes to reduce the risk of Red Man Syndrome, a histamine reaction that can cause flushing, hypotension, and rash. A 30-minute infusion is too rapid and should be adjusted.
D. Requesting a serum peak level to be drawn 30 min prior to infusion is incorrect. Peak levels are drawn 30–60 minutes after infusion completion, not before infusion. Trough levels, not peak levels, are used to monitor vancomycin dosing.

A. Apply a warming blanket prior to administration. B. Infuse the medication over 1 hr. C. Administer diphenhydramine prior to administration. D. Monitor vital signs once per hour following administration.

Correct Answer is C

Explanation

A. Applying a warming blanket is not appropriate, as it may exacerbate the client's reaction to the infusion and is not a standard pre-medication strategy.

B. Infusing amphotericin B deoxycholate over 1 hour is too rapid; it is typically infused over 2-6 hours to minimize adverse effects.

C. Administering diphenhydramine prior to the administration of amphotericin B can help prevent or alleviate infusion-related reactions such as fever and chills, which the client experienced during previous infusions.

D. Monitoring vital signs once per hour following administration is insufficient; vital signs should be monitored more frequently during and immediately after the infusion to promptly detect and address any adverse reactions.

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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?

Nursing Test Bank

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Correct Answer is C

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Correct Answer is C

Explanation

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