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: Show A.Taking medications on time to maintain therapeutic blood levels A.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
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 D. Progressive weakness that is worse at the days 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 Parkinsons disease. 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. C. D. 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. 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 :Tensilon acts systemically to increase muscle strength; with a peak effect in 30 seconds, It lasts several minutes 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. Facilitate psychologic adjustment C. Maintain the present muscle strength D. Prepare for the appearance of myasthenic crisis C. Maintain the present muscle strength Until diagnosis is confirmed, primary goal should be to maintain adequate activity and prevent muscle atrophy The most significant initial nursing observations that need to be made about a client with myasthenia include: A. Ability to chew and speak distinctly B. Degree of anxiety about her diagnosis C. Ability to smile an to close her eyelids D. Respiratory exchange and ability to swallow A. Ability to chew and speak distinctly Muscle weakness can lead to respiratory failure that will require emergency intervention and inability to swallow may lead to aspiration. 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. Administer the medication exactly on time D. Evaluate the clients muscle strength hourly after medication Peak response occurs 1 hour after administration and lasts up to 8 hours; the response will influence dosage levels. 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. Change her diet order from soft foods to clear liquids 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 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. Ulcerative
colitis 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 dont contraindicate use of the drug. 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 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 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 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. 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 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 Which of the following is not an autoimmune disease? C.Alzheimer's disease Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by: A positive edrophonium (Tensilon) test Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: B.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 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 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. A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by: A.Blocking the action of
cholinesterase Blocking the action of cholinesterase Correct 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 You
are teaching your patient diagnosed with myasthenia gravis about treatments. Which of the following statements, if made by the patient indicates the need for further teaching? Answer: B. A thymectomy may help reduce symptoms, but the effects may not be seen for many months after surgery. Plasmapheresis is the removal of antibodies from blood plasma. It must be done daily for a period of time. Corticosteroids are mostly used for short periods of time unless the patient is experiencing ocular complications. Pyridostigmine bromide (Mestinon) is divided into several doses and should be taken at the same time daily. The patient with myasthenia gravis arrives to the clinic and states that he is experiencing nausea and diarrhea. His blood pressure is 125/85 HR 70 Temp 100.0 R 19 O2 97%. What is the nursing priority? Answer: C. Although the GI symptoms is a common side effect of medicaitons, it is important to follow up on the high temperature and assess for sings of infection. An infection can often exacerbate a Myasthenic crisis and should be carefully monitored for. There is no evidence that this person is about to have a myasthenic crisis and intubation should only be done if the patient is experiencing respiratory failure. There is no evidence that this patient has had a thymectomy. The patient with myasthenia gravis is complaining about dealing with muscle weakness. Which of the following could the nurse do for this patient? Answer: D. Taking medications at the same time each day will help reduce the exacerbation of muscle weakness. Antispasmodic medications are not indicated for this patient. Exercising for that much time each day will worsen muscle weakness and fatigue and is not feasible. The patient does not need to avoid all forms of physical activity. They need to time out physical activity with peaks of the medication in order to conserve energy. The client is experiencing a myasthenic crisis. Which of the following is a priority action of the following ordered actions? Answer: A. Inserting the NG tube is the priority because it will help reduce risk for aspiration. The patient experiencing a myasthenic crisis is at a large risk for respiratory failure due to dysphagia and extreme muscle weakness. All priority actions should be focused on respiratory assessment and support. Ativan and any other sedating medication should NEVER be administered. Stopping anticholinesterase medications is associated with a cholinergic crisis. Monitoring I&O is important, but not as important as NG tube The nurse is teaching a client about myasthenia gravis. Which
statement, if made by the patient indicates the need for further teaching? Answer: C. OTC medication should be avoided as they may worsen MG symptoms. The doctor may stop a beta blocker as they can exacerbate symptoms (unless benefit outweighs the risk). Any signs of infection should be reported as they can exacerbate a myasthenic crisis. Long walks should be avoided due to muscle weakness and fatigue Which of the following would be most likely given as a top nursing diagnosis for a patient experiencing a cholinergic crisis? Answer: C. During a cholinergic crisis, secretions are increased and the gag reflex is decreased, putting the patient at risk for a blocked airway. Impaired gas exchange, while has to do with respiratory, is not as appropriate as ineffective airway clearance based on the problems of the crisis. Acute fatigue and altered mental status are not priorities Your patient has just been diagnosed with myasthenia
gravis. Which of the following orders should be questioned? Answer: D. Novocain is contraindicated in patients with MG because of its long lasting effects. Your patient diagnosed with Myasthenia Gravis begins taking Mestinon.
During the first week, the dosage is changed frequently. While the dosage is being adjusted, the nurse's priority intervention is to: Peak response occurs 1 hour after administration and lasts up to 8 hours. By giving the medication exactly on time, this will help determine dosage levels. Mestinon can be given with or without food/water. There is nothing in this question that indicates vitals should be taken every 15 minutes. The client's muscle strength is important to assess, but the priority intervention is to give the medication on time. Which statement by the client supports the diagnosis Correct answer 2: These are ocular signs/symptoms of MG. Ptosis is drooping of the eyelid, and diplopia is unilateral or bilateral double vision. Weakness and fatigue of upper body muscle occur with MG. . Which
response to the Tensilon (edrophonium Correct answer 4: Clients with myasthenia gravis The nurse is discharging a client diagnosed with Correct answer 3: The anti cholinesterase medications used to treat MG must be taken on time in order to prevent muscle weakness and respiratory complications. These medications are one of the very few that the nurse should administer at the exact scheduled time. Steroids are not prescribed for MG. The
client diagnosed with MG is being discharged home. Which intervention should the nurse teach the significant other? Correct answer 1: The client is at risk for choking, and knowing specific measures to help the client helps decrease the client's as well as significant other's anxiety and promotes confidence in managing potential complications. The client should perform oral care. The client should perform isotonic exercises, not isometric exercises, and the client is not at an increased risk for cardiac complications, so teaching about chest compression is not necessary Which referral is appropriate for the client in the late Correct answer 4: Speech therapists address swallowing problems, and clients with myasthenia gravis are dysphagic and at risk for aspiration. The infection control and occupational health nurses do not consult with the client. A vocational counselor helps The male client with MG is undergoing plasmapheresis at the bedside. Which assessment data would warrant immediate intervention by the nurse? Correct answer 1: Hypovolemia is a complication of plasmapheresis, especially during the procedure when up to 15% of the blood volume is in the cell separator. The nurse should immediately assess for shock. All other options are expected. Which statement by the 20-year-old female client diagnosed with MG indicates the client understands the discharge teaching? Correct answer 1: MG will not prevent conception or delivery but can cause the client to experience an exacerbation of the disease. The client should be seen
regularly by the neurologist and the obstetrician. Young children are ill frequently, and infections The client diagnosed with MG is admitted to the Correct answer 2: This assessment datum indicates a myasthenic crisis that is due to undermedication,
missed doses of medication, or developing an infection. Serum assays are useful in diagnosing the disease, not in identifying a crisis. Vital signs do not differentiate the type of crisis. No improvement after Tensilon indicates a cholinergic crisis, not a The male client diagnosed with MG is prescribed the Correct answer 3: Dysphonia and inability to utilize the muscles of the eye and eyelid indicate the medication is not effective. Performing ADLs, having clear vision, and smiling and laughing using the facial muscles indicate the medication is effective The client is diagnosed with MG. Which intervention 1. Assess for excess salivation and abdominal cramps. Correct answer 1: Anticholinesterase medications can cause the client to have excessive salivation and abdominal cramping. When this occurs, the client receives the antidote atropine simultaneously in small doses. Mestinon is administered with milk and/or crackers to prevent stomach upset. Mestinon How does pyridostigmine treat myasthenia gravis?Pyridostigmine. The first medicine used for myasthenia gravis is usually a tablet called pyridostigmine, which helps electrical signals travel between the nerves and muscles. It can reduce muscle weakness, but the effect only lasts a few hours so you'll need to take it several times a day.
Which finding is usually associated with a diagnosis of myasthenia gravis?The main test for myasthenia gravis is a blood test to look for a type of antibody (produced by the immune system) that stops signals being sent between the nerves and muscles. A high level of these antibodies usually means you have myasthenia gravis.
What can cause trigger a myasthenic crisis quizlet?A myasthenic crisis is a medical emergency that occurs when the muscles that control breathing weaken to the point where individuals require a ventilator to help them breathe. It may be triggered by infection, stress, surgery, or an adverse reaction to medication.
How does atropine help myasthenia gravis?Atropine (0.5–1 mg) should be available to antagonize possible muscarinic side effects. The rapid action after intravenous administration allows repeated interaction between ACh and the reduced number of still functional AChR, and partially compensates for the functional deficit of receptors.
|
A client with myasthenia gravis has been receiving neostigmine (prostigmin). this drug acts by:
zusammenhängende Posts
Urheberrechte © © 2024 WIKIFI Inc.
