The nurse is caring for a patient who has had an anterior wall MI. Which of the following complications should the nurse assess for in this patient?
(Select All that Apply.)

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.

A. Arrange for social service consult for assistance with medication purchase: While this is important for ensuring the patient has access to necessary medications, it is not directly related to fall prevention. Medication access is a separate concern and does not address the immediate environmental or physical aspects contributing to falls in a patient with Parkinson's Disease.

B. Remove any obstacles such as area rugs, wires and unnecessary decorations: Environmental safety is crucial in fall prevention for patients with Parkinson's Disease. Due to motor symptoms like tremors, rigidity, and bradykinesia, individuals with PD are at an increased risk of tripping and falling. Removing obstacles in the home environment helps create a safer space and reduces the risk of falls.

C. Have the patient seen by a nursing assistant 3 times a week for hygiene assistance: While hygiene assistance may be helpful, this does not directly address fall prevention. Regular nursing or caregiver assistance can help with activities of daily living, but the most effective fall prevention strategy would be to modify the environment and address physical factors directly.

D. Refer the client to a nutritionist to address dietary measures: A nutritionist can be helpful for managing the patient's overall health, but diet does not directly prevent falls in Parkinson's Disease. Fall prevention strategies focus more on environmental changes, physical safety, and managing motor symptoms.