Myasthenia Gravis
14. The nurse advises a patient with myasthenia gravis (MG) to
1.perform physically demanding activities early in the day.
2.anticipate the need for weekly plasmapheresis treatments.
3.do frequent weight-bearing exercise to prevent muscle atrophy.
4.protect the extremities from injury due to poor sensory perception.
ANS: A
Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG, and muscle atrophy does not occur because although there is muscle weakness, they are still used.
A patient with Parkinson’s disease has bradykinesia. Which action will the nurse include in the plan of care?
1.Instruct the patient in activities that can be done while lying or sitting.
2.Suggest that the patient rock from side to side to initiate leg movement.
3.Have the patient take small steps in a straight line directly in front of the feet.
4.Teach the patient to keep the feet in contact with the floor and slide them forward.
ANS: B
Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait.
A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care?
1. Observe for agitation and paranoia.
2. Assist with active range of motion (ROM).
3. Give muscle relaxants as needed to reduce spasms.
4. Use simple words and phrases to explain procedures.
ANS: B
ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient’s ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.
When measuring the blood pressure to ensure consistency and to facilitate early detection of blood pressure changes consistent with preeclampsia, the nurse should:
A. place the woman in a sitting position with feet flat on the floor
B. Allow the woman to rest for 5 minutes after positioning her before measuring her blood pressure
C. Record Korotkoff phase IV (muffled sound) as the diastolic pressure
D. Use a proper-sized cuff that covers at least 50% of her upper arm
Ans A: The woman should rest for at least 10 minutes after assuming her position and the cuff should cover 80% of the upper arm or be 1.5 times the length of the upper arm; either Korotkoff phase V alone or with phase IV should be used when recording the diastolic pressure.
After change-of-shift report, which patient should the nurse assess first?
1. Patient with myasthenia gravis who is reporting increased muscle weakness
2. Patient with a bilateral headache described as “like a band around my head”
3. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin)
4. Patient with Parkinson’s disease who has developed cogwheel rigidity of the arms
ANS: A
Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse should assess this patient first. The other patients should also be assessed but do not appear to need immediate nursing assessments or actions to prevent life-threatening complications.
The nurse will ask a patient being admitted with acute pancreatitis specifically about a history of?
ANS: D
Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.
Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis?
1.Pupil size
2.Respiratory effort
3.Grip strength
4.Level of consciousness
ANS: C
Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.
A 62-yr-old patient who has Parkinson’s disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dosage?
1.The patient has a chronic dry cough.
2.The patient has four loose stools in a day.
3.The patient develops a deep vein thrombosis.
4.The patient’s blood pressure is 92/52 mm Hg.
ANS: D
Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine use.
A patient has finally been diagnosed with amyotrophic lateral sclerosis (ALS) after seeing several physicians. The patient expresses frustration that the diagnosis has taken so long. What information can the healthcare professional give to the patient about this situation?
1. Many diseases cause weakness and fatigue.
2. Only upper motor neurons are involved.
3. Several nerves are connected to each muscle.
4. Lack of sensation makes it hard to describe.
ANS: C
The weakness resulting from the segmental paresis and paralysis characteristic of anterior horn cell injury is difficult to recognize because two or more nerve roots supply each muscle. Many diseases do cause weakness and fatigue, but this answer is not specific for ALS. ALS involves both upper and lower motor neurons. The disease involves a disturbance in motor, not sensory function.
A woman with preeclampsia is admitted to the hospital and her primary health care provider has ordered that an infusion of magnesium sulfate be started. In implementing this order, the nurse should : (Select all that apply)
A. Prepare a solution of 20g of magnesium sulfate in 100mL of 5% glucose in water
B. Monitor maternal vital signs, fetal heart rate (FHR) patterns, and uterine contractions every hour
C. Expect the maintenance dose to be approximately 1 to 3g/hour
D. Administer a loading dose of 4 to 6 g over 15 to 30 minutes
E. Prepare to administer hydralazine (Apresoline) if signs of magnesium toxicity occur
F. Report a respiratory rate of less than 12 breath/minute to the primary health care provider immediately
ANS: C, D, and F. RR of 12 or less indicates central nervous system depression caused by the magnesium sulfate: the solution should be 40g in 1000mL of LR, assessment should occur every 15 to 30 minutes and the maintenance dose should be 1 to 3 g/hour; calcium gluconate is the antidote for magnesium sulfate toxicity.
A patient with Parkinson’s disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)?
a. Provide an elevated toilet seat.
b. Cut patient’s food into small pieces.
c. Serve high-protein foods at each meal.
d. Place an armchair at the patient’s bedside.
e. Observe for sudden exacerbation of symptoms.
ANS: A, B, D
Because the patient with Parkinson’s disease has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High-protein foods will decrease the effectiveness of L-dopa. Parkinson’s disease is a steadily progressive disease without acute exacerbations.
The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase)
ANS: B
Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.
After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first?
1. the patient’s bowel sounds.
2. Notify the patient’s health care provider.
3. Administer the prescribed PRN antiemetic drug.
4. Give the scheduled dose of prednisone (Deltasone).
ANS: B
The patient’s history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
When a 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling–type tremor, the nurse will anticipate teaching the patient about
1. oral corticosteroids.
2. antiparkinsonian drugs.
3. magnetic resonance imaging (MRI).
4. electroencephalogram (EEG) testing.
ANS: B
The clinical diagnosis of Parkinson’s is made when tremor, rigidity, and akinesia, and postural instability are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. MRI and EEG are not useful in diagnosing Parkinson’s disease, and corticosteroid therapy is not used to treat it.
The client is being evaluated to rule out ALS. Which signs/symptoms would the nurse note to confirm the diagnosis?
1. Muscle atrophy and flaccidity.
2. Fatigue and malnutrition.
3. Slurred speech and dysphagia.
4. Weakness and paralysis.
4. ALS results from the degeneration and demyelination of motor neurons in the spinal cord, which results in paralysis and weakness of the muscles.
A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug?
A) Gastrointestinal bleeding
B) Blurred vision
C) Tachycardia
D) Sweating
Ans: C Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision, or sweating. Magnesium sulfate may cause sweating.
Parkinson disease is a degenerative disorder of which part of the brain?
1. Hypothalamus
2. Anterior pituitary
3. Frontal lobe
4. Basal ganglia
ANS: D
Parkinson disease is a commonly occurring degenerative disorder of the basal ganglia and not of any of the other brain structures.
When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient’s right hand. Which action should the nurse take next?
ANS: C
The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau’s sign. The health care provider should be notified after the nurse checks the patient’s calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.
What does a healthcare professional explain to a student about myasthenia gravis?
1. It is an acute autoimmune disease.
2. It affects the nerve roots.
3. It may result in adrenergic crisis.
4. It causes muscle weakness.
ANS: D
Exertional fatigue and weakness that worsens with activity, improves with rest, and recurs with resumption of activity characterizes myasthenia gravis. Myasthenia gravis is not an acute autoimmune disease, does not affect nerve roots, and does not lead to adrenergic crisis.
A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson’s disease. Which information indicates a need for change in the medication or dosage?
1. Shuffling gait
2. Cogwheel rigidity of limbs
3. Tremor at rest
4. Uncontrolled head movement
ANS: D
Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson’s disease.
The client with ALS is admitted to the medical unit with shortness of breath, dyspnea, and respiratory complications. Which intervention should the nurse implement first?
1. Elevate the head of the bed 30 degrees.
2. Administer oxygen via nasal cannula.
3. Assess the client's lung sounds.
4. Obtain a pulse oximeter reading.
Oxygen should be given immediately to help alleviate the difficulty breathing. oxygenation is priority.
The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome?
A) Hyperglycemia
B) Elevated platelet count
C) Leukocytosis
D) Elevated liver enzymes
Ans: D
HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia or leukocytosis is not a part of this syndrome.
In which disorder are acetylcholine receptor antibodies (IgG antibodies) produced against acetylcholine receptors?
1. Guillain-Barré syndrome
2. Multiple sclerosis
3. Myasthenia gravis
4. Parkinson disease
ANS: C
The main defect of myasthenia gravis is the formation of autoantibodies (an immunoglobulin G [IgG] antibody) against receptors at the Ach-binding site on the postsynaptic membrane. Guillain-Barré syndrome is a rare demyelinating disorder caused by a humoral (antibody) and cell-mediated immunologic reaction directed at the peripheral nerves. Multiple sclerosis is a chronic inflammatory disease involving degeneration of CNS myelin, scarring (sclerosis or plaque formation), and loss of axons. Parkinson disease is a slowly progressive brain disorder caused by diminishing dopamine production.
A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?
ANS: D
NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status has been effective. Electrolyte levels may be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this to occur to determine whether treatment was effective.
The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis?
A. The patient experiences worsening of the muscle weakness.
B. The patient experiences wheezing along with facial flushing.
C. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears.
D. The patient experiences improved muscle strength.
The answer is D. During a Tensilon test Edrophonium is administered. This medication prevents the breakdown of acetylcholine, which will allow more of the neurotransmitter acetylcholine to be present at the neuromuscular junction....hence IMPROVING muscle strength IF myasthenia gravis is present. Therefore, if a patient with MG is given this medication they will have improved muscle strength.
Which nursing diagnosis is of highest priority for a patient with Parkinson’s disease who is unable to move the facial muscles?
1. Activity intolerance
2. Self-care deficit: toileting
3. Ineffective self-health management
4. Imbalanced nutrition: less than body requirements
ANS: D
The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses may also be appropriate for a patient with Parkinson’s disease, but the data do not indicate that they are current problems for this patient.
A 50-yr-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What strategy will prevent a common cause of death for patients with ALS?
A. Reduce fat intake.
B. Reduce the risk of aspiration. Correct
C. Decrease injury related to falls.
D. Decrease pain secondary to muscle weakness.
ANS: B Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.
Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?
A) Calcium gluconate
B) Potassium chloride
C) Ferrous sulfate
D) Calcium carbonate
Ans: A
The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity.
5. You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?
A. Atropine
B. Protamine sulfate
C. Narcan
D. Leucovorin
The answer is A. Atropine will help reverse the effects of the drug given during a Tensilon test, which is Edrophonium, in case an emergency arises. Edrophonium is a short-acting cholinergic drug, while atropine is an anticholinergic.
Which assessment finding is of most concern for a patient with acute pancreatitis?
ANS: D
A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.