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MSN Exam for Myasthenia Gravis (PM)
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Question 1
A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as:
A
Getting too little exercise
B
Increasing intake of fatty foods
C
Omitting doses of medication
D
Taking excess medication
Question 1 Explanation:
Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.
Question 2
Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by:
A
Brudzinski’s sign
B
A positive sweat chloride test
C
A positive edrophonium (Tensilon) test
D
Kernigs sign
Question 3
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by:
A
Doing all chores early in the day while less fatigued
B
Doing muscle-strengthening exercises
C
Eating large, well-balanced meals
D
Taking medications on time to maintain therapeutic blood levels
Question 3 Explanation:
Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.
Question 4
Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse’s priority intervention is to:
A
Evaluate the client’s muscle strength hourly after medication
B
Administer the medication with food or mild
C
Administer the medication exactly on time
D
Evaluate the client’s emotional side effects between doses
Question 4 Explanation:
Peak response occurs 1 hour after administration and lasts up to 8 hours; the response will influence dosage levels.
Question 5
The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:
A
Atropine (atropine sulfate)
B
Prostigmine (neostigmine)
C
Didronel (etidronate)
D
Tensilon (edrophonium)
Question 5 Explanation:
Protigmine is used to treat clients with myasthenia gravis. Atropine (atropine sulfate) is incorrect because it is used to reverse the effects of neostigmine. Didronel (etidronate)is incorrect because the drug is unrelated to the treatment of myasthenia gravis. Tensilon (edrophonium) is incorrect because it is the test for myasthenia gravis.
Question 6
Myasthenia gravis reflects a deficiency in communication by _______________ because receptors for this neurotransmitter have been destroyed.
A
GABA
B
norepinephrine
C
dopamine
D
acetylcholine
Question 7
Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it:
A
Promotes the removal of antibodies that impair the transmission of impulses
B
Inhibits the breakdown of acetylcholine at the neuromuscular junction.
C
Decreases the production of autoantibodies that attack the acetylcholine receptors.
D
Stimulates the production of acetylcholine at the neuromuscular junction.
Question 7 Explanation:
Steroids decrease the body’s immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction
Question 8
The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to:
A
Maintain the present muscle strength
B
Facilitate psychologic adjustment
C
Develop a teaching plan
D
Prepare for the appearance of myasthenic crisis
Question 8 Explanation:
Until diagnosis is confirmed, primary goal should be to maintain adequate activity and prevent muscle atrophy
Question 9
The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?
A
Visual disturbances, including diplopia
B
Cogwheel rigidity and loss of coordination
C
Ascending paralysis and loss of motor function
D
Progressive weakness that is worse at the day’s end
Question 9 Explanation:
The client with myasthenia develops progressive weakness that worsens during the day. Visual disturbances, including diplopia is incorrect because it refers to symptoms of multiple sclerosis. Ascending paralysis and loss of motor function is incorrect because it refers to symptoms of Guillain Barre syndrome. Cogwheel rigidity and loss of coordination is incorrect because it refers to Parkinson’s disease.
Question 10
A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by:
A
Accelerating transmission along neural swaths
B
Stimulating the cerebral cortex
C
Replacing deficient neurotransmitters
D
Blocking the action of cholinesterase
Question 11
The most significant initial nursing observations that need to be made about a client with myasthenia include:
A
Respiratory exchange and ability to swallow
B
Ability to smile an to close her eyelids
C
Ability to chew and speak distinctly
D
Degree of anxiety about her diagnosis
Question 11 Explanation:
Muscle weakness can lead to respiratory failure that will require emergency intervention and inability to swallow may lead to aspiration
Question 12
In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in:
A
Consciousness
B
Blood pressure
C
Muscle strength
D
Symptoms
Question 12 Explanation:
Tensilon, an anticholinesterase drug, causes temporary relief of symptoms of myasthenia gravis in client who have the disease and is therefore an effective diagnostic aid.
Question 13
Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies.
A
Nicotinic
B
Epinephrine
C
Acetylcholine
D
Transient
Question 14
Jane, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:
A
Rapid but brief symptomatic improvement
B
Symptomatic improvement of just the ptosis
C
Prolonged symptomatic improvement
D
Brief exaggeration of symptoms
Question 14 Explanation:
Tensilon acts systemically to increase muscle strength; with a peak effect in 30 seconds, It lasts several minutes.
Question 15
A client with myasthenia gravis ask the nurse why the disease has occurred. The nurse bases the reply on the knowledge that there is:
A
An inhibition of the enzyme ACHE leaving the end plates folded
B
A reduced amount of neurotransmitter acetylcholine
C
A decreased number of functioning acetylcholine receptor sites
D
A genetic in the production acetylcholine
Question 16
Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to:
A
Place an emergency tracheostomy set in her room
B
Coordinate her meal schedule with the peak effect of her medication, Mestinon
C
Assess her respiratory status before and after meals
D
Change her diet order from soft foods to clear liquids
Question 16 Explanation:
Dysphagia should be minimized during peak effect of Mestinon, thereby decreasing the probability of aspiration. Mestinon can increase her muscle strength including her ability to swallow.
Question 17
The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent off urine and stool. What is your best first action at this time?
A
Recheck vital signs in 1 hour.
B
Notify the physician immediately.
C
Administer an acetaminophen suppository.
D
Reschedule patient’s physical therapy.
Question 17 Explanation:
The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient’s respiratory status. The patient may need incubation and mechanical ventilation. The nurse would notify the physician before giving the suppository because there may be orders for cultures before giving acetaminophen. This patient’s vital signs need to be re-checked sooner than 1 hour. Rescheduling the physical therapy can be
delegated to the unit clerk and is not urgent. Focus: Prioritization
Question 18
Which of the following is not an autoimmune disease?
A
Myasthenia gravis
B
Insulin-dependent diabetes mellitus
C
Alzheimer's disease
D
Graves disease
Question 19
A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client’s history. Which preexisting condition would contraindicate the use of pyridostigmine?
A
Spinal cord injury
B
Intestinal obstruction
C
Blood dyscrasia
D
Ulcerative colitis
Question 19 Explanation:
Anticholinesterase agents such as pyridostigmine are contraindicated in a client with a mechanical obstruction of the intestines or urinary tract, peritonitis, or hypersensitivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord injury don’t contraindicate use of the drug.
Question 20
While reviewing a client’s chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition?
A
Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage.
B
Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage.
C
The client may be less sensitive to the effects of a neuromuscular blocking agent.
D
Pancuronium and succinylcholine both require cautious administration.
Question 20 Explanation:
The nurse must cautiously administer pancuronium, succinylcholine, and any other neuromuscular blocking agent to a client with myasthenia gravis. Such a client isn’t less sensitive to the effects of a neuromuscular blocking agent. Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis.
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MSN Exam for Myasthenia Gravis (EM)
Choose the letter of the correct answer. You got 20 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Myasthenia Gravis (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by:
A
Eating large, well-balanced meals
B
Doing muscle-strengthening exercises
C
Taking medications on time to maintain therapeutic blood levels
D
Doing all chores early in the day while less fatigued
Question 1 Explanation:
Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.
Question 2
A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as:
A
Omitting doses of medication
B
Getting too little exercise
C
Taking excess medication
D
Increasing intake of fatty foods
Question 2 Explanation:
Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.
Question 3
While reviewing a client’s chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition?
A
The client may be less sensitive to the effects of a neuromuscular blocking agent.
B
Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage.
C
Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage.
D
Pancuronium and succinylcholine both require cautious administration.
Question 3 Explanation:
The nurse must cautiously administer pancuronium, succinylcholine, and any other neuromuscular blocking agent to a client with myasthenia gravis. Such a client isn’t less sensitive to the effects of a neuromuscular blocking agent. Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis.
Question 4
A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client’s history. Which preexisting condition would contraindicate the use of pyridostigmine?
A
Intestinal obstruction
B
Blood dyscrasia
C
Spinal cord injury
D
Ulcerative colitis
Question 4 Explanation:
Anticholinesterase agents such as pyridostigmine are contraindicated in a client with a mechanical obstruction of the intestines or urinary tract, peritonitis, or hypersensitivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord injury don’t contraindicate use of the drug.
Question 5
In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in:
A
Muscle strength
B
Blood pressure
C
Consciousness
D
Symptoms
Question 5 Explanation:
Tensilon, an anticholinesterase drug, causes temporary relief of symptoms of myasthenia gravis in client who have the disease and is therefore an effective diagnostic aid.
Question 6
The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?
A
Ascending paralysis and loss of motor function
B
Progressive weakness that is worse at the day’s end
C
Cogwheel rigidity and loss of coordination
D
Visual disturbances, including diplopia
Question 6 Explanation:
The client with myasthenia develops progressive weakness that worsens during the day. Visual disturbances, including diplopia is incorrect because it refers to symptoms of multiple sclerosis. Ascending paralysis and loss of motor function is incorrect because it refers to symptoms of Guillain Barre syndrome. Cogwheel rigidity and loss of coordination is incorrect because it refers to Parkinson’s disease.
Question 7
Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to:
A
Assess her respiratory status before and after meals
B
Place an emergency tracheostomy set in her room
C
Change her diet order from soft foods to clear liquids
D
Coordinate her meal schedule with the peak effect of her medication, Mestinon
Question 7 Explanation:
Dysphagia should be minimized during peak effect of Mestinon, thereby decreasing the probability of aspiration. Mestinon can increase her muscle strength including her ability to swallow.
Question 8
Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it:
A
Inhibits the breakdown of acetylcholine at the neuromuscular junction.
B
Promotes the removal of antibodies that impair the transmission of impulses
C
Decreases the production of autoantibodies that attack the acetylcholine receptors.
D
Stimulates the production of acetylcholine at the neuromuscular junction.
Question 8 Explanation:
Steroids decrease the body’s immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction
Question 9
Which of the following is not an autoimmune disease?
A
Graves disease
B
Insulin-dependent diabetes mellitus
C
Myasthenia gravis
D
Alzheimer's disease
Question 10
Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse’s priority intervention is to:
A
Evaluate the client’s muscle strength hourly after medication
B
Administer the medication with food or mild
C
Evaluate the client’s emotional side effects between doses
D
Administer the medication exactly on time
Question 10 Explanation:
Peak response occurs 1 hour after administration and lasts up to 8 hours; the response will influence dosage levels.
Question 11
Jane, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:
A
Brief exaggeration of symptoms
B
Symptomatic improvement of just the ptosis
C
Prolonged symptomatic improvement
D
Rapid but brief symptomatic improvement
Question 11 Explanation:
Tensilon acts systemically to increase muscle strength; with a peak effect in 30 seconds, It lasts several minutes.
Question 12
Myasthenia gravis reflects a deficiency in communication by _______________ because receptors for this neurotransmitter have been destroyed.
A
GABA
B
norepinephrine
C
acetylcholine
D
dopamine
Question 13
Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by:
A
A positive sweat chloride test
B
Kernigs sign
C
Brudzinski’s sign
D
A positive edrophonium (Tensilon) test
Question 14
A client with myasthenia gravis ask the nurse why the disease has occurred. The nurse bases the reply on the knowledge that there is:
A
A genetic in the production acetylcholine
B
A reduced amount of neurotransmitter acetylcholine
C
An inhibition of the enzyme ACHE leaving the end plates folded
D
A decreased number of functioning acetylcholine receptor sites
Question 15
The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:
A
Prostigmine (neostigmine)
B
Didronel (etidronate)
C
Atropine (atropine sulfate)
D
Tensilon (edrophonium)
Question 15 Explanation:
Protigmine is used to treat clients with myasthenia gravis. Atropine (atropine sulfate) is incorrect because it is used to reverse the effects of neostigmine. Didronel (etidronate)is incorrect because the drug is unrelated to the treatment of myasthenia gravis. Tensilon (edrophonium) is incorrect because it is the test for myasthenia gravis.
Question 16
Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies.
A
Acetylcholine
B
Epinephrine
C
Nicotinic
D
Transient
Question 17
The most significant initial nursing observations that need to be made about a client with myasthenia include:
A
Ability to smile an to close her eyelids
B
Respiratory exchange and ability to swallow
C
Ability to chew and speak distinctly
D
Degree of anxiety about her diagnosis
Question 17 Explanation:
Muscle weakness can lead to respiratory failure that will require emergency intervention and inability to swallow may lead to aspiration
Question 18
The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent off urine and stool. What is your best first action at this time?
A
Notify the physician immediately.
B
Recheck vital signs in 1 hour.
C
Administer an acetaminophen suppository.
D
Reschedule patient’s physical therapy.
Question 18 Explanation:
The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient’s respiratory status. The patient may need incubation and mechanical ventilation. The nurse would notify the physician before giving the suppository because there may be orders for cultures before giving acetaminophen. This patient’s vital signs need to be re-checked sooner than 1 hour. Rescheduling the physical therapy can be
delegated to the unit clerk and is not urgent. Focus: Prioritization
Question 19
A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by:
A
Stimulating the cerebral cortex
B
Blocking the action of cholinesterase
C
Accelerating transmission along neural swaths
D
Replacing deficient neurotransmitters
Question 20
The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to:
A
Develop a teaching plan
B
Prepare for the appearance of myasthenic crisis
C
Facilitate psychologic adjustment
D
Maintain the present muscle strength
Question 20 Explanation:
Until diagnosis is confirmed, primary goal should be to maintain adequate activity and prevent muscle atrophy
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1) The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:
Prostigmine (neostigmine)
Atropine (atropine sulfate)
Didronel (etidronate)
Tensilon (edrophonium)
2) Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it:
Promotes the removal of antibodies that impair the transmission of impulses
Stimulates the production of acetylcholine at the neuromuscular junction.
Decreases the production of autoantibodies that attack the acetylcholine receptors.
Inhibits the breakdown of acetylcholine at the neuromuscular junction.
3) Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies.
Epinephrine
Nicotinic
Acetylcholine
Transient
4) A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by:
Stimulating the cerebral cortex
Blocking the action of cholinesterase
Replacing deficient neurotransmitters
Accelerating transmission along neural swaths
5) The most significant initial nursing observations that need to be made about a client with myasthenia include:
Ability to chew and speak distinctly
Degree of anxiety about her diagnosis
Ability to smile an to close her eyelids
Respiratory exchange and ability to swallow
6) In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in:
Muscle strength
Symptoms
Blood pressure
Consciousness
7) Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to:
Change her diet order from soft foods to clear liquids
Place an emergency tracheostomy set in her room
Assess her respiratory status before and after meals
Coordinate her meal schedule with the peak effect of her medication, Mestinon
8) Myasthenia gravis reflects a deficiency in communication by _______________ because receptors for this neurotransmitter have been destroyed.
acetylcholine
norepinephrine
GABA
dopamine
9) While reviewing a client’s chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition?
The client may be less sensitive to the effects of a neuromuscular blocking agent.
Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage.
Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage.
Pancuronium and succinylcholine both require cautious administration.
10) Which of the following is not an autoimmune disease?
Graves disease
Myasthenia gravis
Insulin-dependent diabetes mellitus
Alzheimer’s disease
11) A client with myasthenia gravis ask the nurse why the disease has occurred. The nurse bases the reply on the knowledge that there is:
A genetic in the production acetylcholine
A reduced amount of neurotransmitter acetylcholine
A decreased number of functioning acetylcholine receptor sites
An inhibition of the enzyme ACHE leaving the end plates folded
12) The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by:
Eating large, well-balanced meals
Doing muscle-strengthening exercises
Doing all chores early in the day while less fatigued
Taking medications on time to maintain therapeutic blood levels
13) The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?
Visual disturbances, including diplopia
Ascending paralysis and loss of motor function
Cogwheel rigidity and loss of coordination
Progressive weakness that is worse at the day’s end
14) Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse’s priority intervention is to:
Administer the medication exactly on time
Administer the medication with food or mild
Evaluate the client’s muscle strength hourly after medication
Evaluate the client’s emotional side effects between doses
15) The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to:
Develop a teaching plan
Facilitate psychologic adjustment
Maintain the present muscle strength
Prepare for the appearance of myasthenic crisis
16) A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as:
Getting too little exercise
Taking excess medication
Omitting doses of medication
Increasing intake of fatty foods
17) Jane, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:
Brief exaggeration of symptoms
Prolonged symptomatic improvement
Rapid but brief symptomatic improvement
Symptomatic improvement of just the ptosis
18) Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by:
Kernigs sign
Brudzinski’s sign
A positive sweat chloride test
A positive edrophonium (Tensilon) test
19) A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client’s history. Which preexisting condition would contraindicate the use of pyridostigmine?
Ulcerative colitis
Blood dyscrasia
Intestinal obstruction
Spinal cord injury
20) The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent off urine and stool. What is your best first action at this time?
Administer an acetaminophen suppository.
Notify the physician immediately.
Recheck vital signs in 1 hour.
Reschedule patient’s physical therapy.
Answers and Rationales
A. Prostigmine (neostigmine). Protigmine is used to treat clients with myasthenia gravis. Atropine (atropine sulfate) is incorrect because it is used to reverse the effects of neostigmine. Didronel (etidronate)is incorrect because the drug is unrelated to the treatment of myasthenia gravis. Tensilon (edrophonium) is incorrect because it is the test for myasthenia gravis.
C. Decreases the production of autoantibodies that attack the acetylcholine receptors. Steroids decrease the body’s immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction
C. Acetylcholine
B. Blocking the action of cholinesterase
D. Respiratory exchange and ability to swallow . Muscle weakness can lead to respiratory failure that will require emergency intervention and inability to swallow may lead to aspiration
A. Muscle strength. Tensilon, an anticholinesterase drug, causes temporary relief of symptoms of myasthenia gravis in client who have the disease and is therefore an effective diagnostic aid.
D. Coordinate her meal schedule with the peak effect of her medication, Mestinon. Dysphagia should be minimized during peak effect of Mestinon, thereby decreasing the probability of aspiration. Mestinon can increase her muscle strength including her ability to swallow.
A. acetylcholine
D. Pancuronium and succinylcholine both require cautious administration. The nurse must cautiously administer pancuronium, succinylcholine, and any other neuromuscular blocking agent to a client with myasthenia gravis. Such a client isn’t less sensitive to the effects of a neuromuscular blocking agent. Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis.
D. Alzheimer’s disease
C. A decreased number of functioning acetylcholine receptor sites
D. Taking medications on time to maintain therapeutic blood levels. Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.
D. Progressive weakness that is worse at the day’s end . The client with myasthenia develops progressive weakness that worsens during the day. Visual disturbances, including diplopia is incorrect because it refers to symptoms of multiple sclerosis. Ascending paralysis and loss of motor function is incorrect because it refers to symptoms of Guillain Barre syndrome. Cogwheel rigidity and loss of coordination is incorrect because it refers to Parkinson’s disease.
C. Evaluate the client’s muscle strength hourly after medication. Peak response occurs 1 hour after administration and lasts up to 8 hours; the response will influence dosage levels.
C. Maintain the present muscle strength. Until diagnosis is confirmed, primary goal should be to maintain adequate activity and prevent muscle atrophy
C. Omitting doses of medication. Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.
C. Rapid but brief symptomatic improvement . Tensilon acts systemically to increase muscle strength; with a peak effect in 30 seconds, It lasts several minutes.
D. A positive edrophonium (Tensilon) test
C. Intestinal obstruction . Anticholinesterase agents such as pyridostigmine are contraindicated in a client with a mechanical obstruction of the intestines or urinary tract, peritonitis, or hypersensitivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord injury don’t contraindicate use of the drug.
B. Notify the physician immediately.The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient’s respiratory status. The patient may need incubation and mechanical ventilation. The nurse would notify the physician before giving the suppository because there may be orders for cultures before giving acetaminophen. This patient’s vital signs need to be re-checked sooner than 1 hour. Rescheduling the physical therapy can be delegated to the unit clerk and is not urgent. Focus: Prioritization