1.
Jane, a 20- year old college student gets admitted 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. While preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:
Correct Answer
C. Rapid but brief symptomatic improvement
Explanation
The correct answer is "Rapid but brief symptomatic improvement." In a Tensilon test, a medication called Tensilon (edrophonium) is administered to the patient. If the patient has myasthenia gravis, which is a neuromuscular disorder, their muscle weakness and fatigue will temporarily improve after taking Tensilon. However, this improvement is short-lived and only lasts for a short period of time. Therefore, if the patient experiences a rapid but brief improvement in their symptoms after taking Tensilon, it confirms the diagnosis of myasthenia gravis.
2.
Which of the following is not an autoimmune disease?
Correct Answer
D. Alzheimer's disease
Explanation
Alzheimer's disease is not an autoimmune disease because it is a neurodegenerative disorder that primarily affects the brain. Autoimmune diseases occur when the immune system mistakenly attacks and damages healthy cells and tissues in the body. Graves disease, Myasthenia gravis, and Insulin-dependent diabetes mellitus are all examples of autoimmune diseases where the immune system attacks specific organs or tissues in the body.
3.
Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies.
Correct Answer
C. Acetylcholine
Explanation
Myasthenia gravis is an autoimmune disorder where antibodies block and destroy acetylcholine receptors. Acetylcholine is a neurotransmitter that plays a crucial role in transmitting signals between nerve cells and muscles. When the acetylcholine receptors are blocked and destroyed, it leads to muscle weakness and fatigue, which are characteristic symptoms of myasthenia gravis.
4.
In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in:
Correct Answer
A. Muscle strength
Explanation
Edrophonium HCI (Tensilon) is used in the diagnosis of myasthenia gravis, a condition characterized by muscle weakness and fatigue. This drug works by inhibiting the breakdown of acetylcholine, a neurotransmitter responsible for muscle contraction. By temporarily increasing the levels of acetylcholine, Edrophonium HCI can improve muscle strength in individuals with myasthenia gravis. Therefore, the correct answer is muscle strength.
5.
Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by:
Correct Answer
D. A positive edropHonium (Tensilon) test
Explanation
A positive edrophonium (Tensilon) test is used to confirm the diagnosis of myasthenia gravis. Edrophonium is a medication that temporarily improves muscle strength in individuals with myasthenia gravis. If the patient's muscle strength improves after receiving edrophonium, it suggests that they have myasthenia gravis. This test is commonly used in the diagnostic process for this condition. Kernig's sign and Brudzinski's sign are not specific to myasthenia gravis, and a positive sweat chloride test is associated with cystic fibrosis, not myasthenia gravis.
6.
Myasthenia gravis reflects a deficiency in communication by _______________ because receptors for this neurotransmitter have been destroyed.
Correct Answer
A. Acetylcholine
Explanation
Myasthenia gravis is an autoimmune disorder where the body's immune system mistakenly attacks and destroys the acetylcholine receptors at the neuromuscular junction. Acetylcholine is a neurotransmitter responsible for transmitting signals between nerve cells and muscles, allowing them to communicate. Therefore, the deficiency in communication in myasthenia gravis occurs because the receptors for acetylcholine have been destroyed.
7.
The nurse is caring for a patient admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?
Correct Answer
D. Progressive weakness that is worse at the day’s end
Explanation
Myasthenia gravis is a neuromuscular disorder characterized by muscle weakness and fatigue. The progressive weakness that worsens at the end of the day is a common symptom of myasthenia gravis. This is known as "fatigubility" and is a result of the muscles becoming weaker with repeated use. The weakness tends to improve after periods of rest. Visual disturbances, such as diplopia (double vision), can also occur in myasthenia gravis, but they are not as specific to the diagnosis as the progressive weakness. Ascending paralysis and loss of motor function, as well as cogwheel rigidity and loss of coordination, are not typically associated with myasthenia gravis.
8.
The medication that is used to treat myasthenia gravis is:
Correct Answer
A. Prostigmine (neostigmine)
Explanation
The correct answer is Prostigmine (neostigmine). Myasthenia gravis is a neuromuscular disorder characterized by muscle weakness and fatigue. Prostigmine (neostigmine) is a medication that works by increasing the levels of acetylcholine, a neurotransmitter, in the body. This helps improve muscle strength and control in individuals with myasthenia gravis. Atropine (atropine sulfate) is not used to treat myasthenia gravis, and the combination of both medications is not typically recommended for this condition. Therefore, the correct medication for treating myasthenia gravis is Prostigmine (neostigmine).
9.
The initial nursing goal for a patient with myasthenia gravis during the diagnostic phase of her hospitalization would be to:
Correct Answer
C. Maintain the present muscle strength
Explanation
During the diagnostic phase of hospitalization for a client with myasthenia gravis, the initial nursing goal would be to maintain the present muscle strength. This is important because myasthenia gravis is a chronic autoimmune neuromuscular disorder that causes muscle weakness and fatigue. By maintaining the present muscle strength, the nurse can prevent further deterioration and complications. Developing a teaching plan, facilitating psychological adjustment, and preparing for the appearance of a myasthenic crisis may be important goals in the overall care of the client, but they are not the initial priority during the diagnostic phase.
10.
The most significant initial nursing observations that need to be made about a patient with myasthenia include:
Correct Answer
D. Respiratory exchange and ability to swallow
Explanation
The most significant initial nursing observations that need to be made about a client with myasthenia include respiratory exchange and ability to swallow. This is because myasthenia gravis is a neuromuscular disorder that can affect the muscles involved in breathing and swallowing. Monitoring the client's respiratory exchange and ability to swallow is crucial in order to assess their respiratory function and ensure their safety and well-being.
11.
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:
Correct Answer
C. Evaluate the client’s muscle strength hourly after medication
Explanation
The nurse's priority intervention is to evaluate the client's muscle strength hourly after medication. Myasthenia gravis is a neuromuscular disorder characterized by muscle weakness and fatigue. Pyridostigmine bromide (Mestinon) is a medication commonly used to treat this condition by improving muscle strength. However, the dosage of Mestinon needs to be frequently adjusted during the first week to achieve the optimal therapeutic effect. By evaluating the client's muscle strength hourly after medication, the nurse can assess the effectiveness of the current dosage and make any necessary adjustments to ensure the client's symptoms are adequately managed.
12.
Helen, a patient 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:
Correct Answer
D. Coordinate her meal schedule with the peak effect of her medication, Mestinon
Explanation
Myasthenia gravis is a neuromuscular disorder that affects the muscles, including those involved in swallowing. As the patient experiences increased difficulty in swallowing, coordinating her meal schedule with the peak effect of her medication, Mestinon, would be the most effective nursing action. Mestinon is a medication commonly used to treat myasthenia gravis by improving muscle strength and reducing symptoms. By scheduling meals when the medication is at its peak effect, the client's swallowing ability may be improved, reducing the risk of aspiration of food.
13.
A physician diagnoses a patient with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the patient's history. Which preexisting condition would contraindicate the use of pyridostigmine?
Correct Answer
C. Intestinal obstruction
Explanation
Pyridostigmine is an anticholinesterase agent that works by increasing the levels of acetylcholine in the body. It is commonly used to treat myasthenia gravis. However, in the case of intestinal obstruction, the use of pyridostigmine would be contraindicated. Pyridostigmine can increase gastrointestinal motility, which can potentially worsen the obstruction and lead to complications. Therefore, it is important to avoid using pyridostigmine in patients with intestinal obstruction.
14.
While reviewing a patient's chart, the nurse notices that the female patient has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition?
Correct Answer
D. Pancuronium and succinylcholine both require cautious administration.
Explanation
In patients with myasthenia gravis, the effects of neuromuscular blocking agents may be prolonged or exaggerated due to the underlying muscle weakness. Therefore, both pancuronium and succinylcholine, which are neuromuscular blocking agents, should be administered with caution in myasthenia gravis patients.
15.
A female patient has experienced an episode of myasthenic crisis. The nurse would assess whether the patient has precipitating factors such as:
Correct Answer
C. Omitting doses of medication
Explanation
The nurse would assess whether the client has precipitating factors such as omitting doses of medication. Omitting doses of medication can lead to a myasthenic crisis, as it can cause a decrease in the effectiveness of the medication and a worsening of symptoms. It is important for the nurse to assess if the client has been adhering to their medication regimen in order to determine if this may have contributed to the crisis.
16.
The nurse is teaching the female patient with myasthenia gravis about the prevention of myasthenic and cholinergic crisis. The nurse tells the patient that this is most effectively done by:
Correct Answer
D. Taking medications on time to maintain therapeutic blood levels
Explanation
Taking medications on time to maintain therapeutic blood levels is the most effective way to prevent myasthenic and cholinergic crises in a client with myasthenia gravis. Myasthenic crisis occurs when there is a severe exacerbation of muscle weakness, while cholinergic crisis is caused by overmedication with cholinesterase inhibitors. By taking medications on time, the patient can ensure that the medication levels in their blood are maintained at a therapeutic level, preventing both types of crises. Eating large, well-balanced meals, doing muscle-strengthening exercises, and doing chores early in the day may be beneficial for managing symptoms, but they do not directly prevent crises.
17.
A patient with myasthenia gravis asks the nurse why the disease has occurred. The nurse bases the reply on the knowledge that there is:
Correct Answer
C. A decreased number of functioning acetylcholine receptor sites
Explanation
The correct answer is "A decreased number of functioning acetylcholine receptor sites." Myasthenia gravis is an autoimmune disorder where the immune system mistakenly attacks and destroys acetylcholine receptors at the neuromuscular junction. This leads to a decreased number of functioning acetylcholine receptor sites, which affects the transmission of nerve impulses to the muscles, causing muscle weakness and fatigue.
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 of urine and stool. What is your best first action at this time?
Correct Answer
B. Notify the pHysician immediately.
Explanation
The patient with myasthenia gravis is presenting with symptoms of a potential medical emergency, including an elevated temperature, increased heart rate, elevated blood pressure, and incontinence. These symptoms may indicate a worsening of the condition or a potential complication. Therefore, the best first action would be to notify the physician immediately to ensure prompt evaluation and appropriate intervention.
19.
Karina, a patient who has myasthenia gravis, is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it:
Correct Answer
C. Decreases the production of autoantibodies that attack the acetylcholine receptors.
Explanation
Immunosuppressive therapy is effective in myasthenia gravis because it decreases the production of autoantibodies that attack the acetylcholine receptors. In myasthenia gravis, the immune system mistakenly produces antibodies that target and attack the acetylcholine receptors at the neuromuscular junction. This leads to impaired transmission of impulses and muscle weakness. By decreasing the production of these autoantibodies, immunosuppressive therapy helps to alleviate the symptoms of myasthenia gravis and improve muscle function.
20.
A patient with myasthenia gravis has been receiving Neostigmine (Prostigmin). What does this drug act by?
Correct Answer
B. Blocking the action of cholinesterase
Explanation
Neostigmine (Prostigmin) acts by blocking the action of cholinesterase. Cholinesterase is an enzyme that breaks down acetylcholine, a neurotransmitter involved in muscle contraction. By blocking the action of cholinesterase, Neostigmine increases the levels of acetylcholine in the synaptic cleft, leading to improved muscle strength and function in patients with myasthenia gravis.