A nurse in a clinic is assessing a 60-year-old client at an annual examination. The client asks the nurse about receiving a shingles vaccination. The nurse should identify that which of the following medications prescribed to the client is a contraindication for receiving this vaccine?

A. Hyperactive bowel sounds: Muscarinic agonist poisoning typically results in increased gastrointestinal motility and hyperactive bowel sounds. Atropine, an anticholinergic medication, works by blocking muscarinic receptors and reducing gastrointestinal motility. Therefore, the presence of hyperactive bowel sounds may indicate ongoing muscarinic stimulation and inadequate treatment with atropine.
B. Heart rate 90/min: Atropine is an anticholinergic medication that increases heart rate by blocking the parasympathetic effects of acetylcholine on the heart. Bradycardia is a common manifestation of muscarinic agonist poisoning, and an increase in heart rate following atropine administration indicates reversal of this effect and effective treatment.
C. Blood pressure 90/50 mm Hg: Atropine administration may result in transient hypertension due to its effect on increasing heart rate and cardiac output. Hypotension is a common
manifestation of muscarinic agonist poisoning, and an increase in blood pressure following atropine administration may indicate improvement in cardiovascular function. Therefore, a blood pressure of 90/50 mm Hg may not necessarily indicate effective treatment with atropine.
D. Increased salivation: Muscarinic agonist poisoning typically results in excessive salivation (sialorrhea) due to stimulation of muscarinic receptors in the salivary glands. Atropine administration works by blocking these muscarinic receptors and reducing salivation. Therefore, increased salivation would indicate ongoing muscarinic stimulation and inadequate treatment with atropine.

Convert the client's weight from pounds to kilograms by dividing by 2.2. 198 lb / 2.2 = 90 kg

Calculate the dose of filgrastim in micrograms by multiplying the client's weight in kilograms by the prescribed dose per kilogram. 90 kg x 5 mcg/kg = 450 mcg

Calculate the volume of filgrastim in milliliters by dividing the dose in micrograms by the concentration of the available solution. 450 mcg / 300 mcg/mL = 1.5 mL

Round the answer to the nearest tenth. The nurse should plan to give 1.5 mL of filgrastim with each dose.