Q.

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:

A. Prostigmine (neostigmine)
B. Atropine (atropine sulfate)
C. Didronel (etidronate)
D. Tensilon (edrophonium)

Q.2) 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. Stimulates the production of acetylcholine at the neuromuscular junction.
C. Decreases the production of autoantibodies that attack the acetylcholine receptors.
D. Inhibits the breakdown of acetylcholine at the neuromuscular junction.

Q.3) Myasthenia gravis is due to ____ receptors being blocked and destroyed by
antibodies.

A. Epinephrine
B. Nicotinic
C. Acetylcholine
D. Transient

Q.4) 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. Replacing deficient neurotransmitters
D. Accelerating transmission along neural swaths

Q.5) 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

Q.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:

A. Muscle strength
B. Symptoms
C. Blood pressure
D. Consciousness
Q.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. Change her diet order from soft foods to clear liquids

B. Place an emergency tracheostomy set in her room
C. Assess her respiratory status before and after meals
D. Coordinate her meal schedule with the peak effect of her medication, Mestinon

Q.8) Myasthenia gravis reflects a deficiency in communication by _______________

because receptors for this neurotransmitter have been destroyed.

A. acetylcholine
B. norepinephrine
C. GABA
D. dopamine

Q.9) While reviewing a clients 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 shouldnt be used; pancuronium may be used in a lower dosage.
C. Pancuronium shouldnt be used; succinylcholine may be used in a lower dosage.
D. Pancuronium and succinylcholine both require cautious administration.

Q.10) Which of the following is not an autoimmune disease?

A. Graves disease
B. Myasthenia gravis
C. Insulin-dependent diabetes mellitus
D. Alzheimer's disease

Q.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. A genetic in the production acetylcholine

B. A reduced amount of neurotransmitter acetylcholine
C. A decreased number of functioning acetylcholine receptor sites
D. An inhibition of the enzyme ACHE leaving the end plates folded

Q.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:

A. Eating large, well-balanced meals

B. Doing muscle-strengthening exercises
C. Doing all chores early in the day while less fatigued
D. Taking medications on time to maintain therapeutic blood levels
Q.13) 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. Ascending paralysis and loss of motor function
C. Cogwheel rigidity and loss of coordination
D. Progressive weakness that is worse at the days end

Q.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 nurses priority intervention is to:

A. Administer the medication exactly on time

B. Administer the medication with food or mild
C. Evaluate the clients muscle strength hourly after medication
D. Evaluate the clients emotional side effects between doses

Q.15) 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

Q.16) 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. Taking excess medication
C. Omitting doses of medication
D. Increasing intake of fatty foods

Q.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:

A. Brief exaggeration of symptoms

B. Prolonged symptomatic improvement
C. Rapid but brief symptomatic improvement
D. Symptomatic improvement of just the ptosis

Q.18) Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make
up. Myasthenia gravis can confirmed by:

A. Kernigs sign
B. Brudzinskis sign
C. A positive sweat chloride test
D. A positive edrophonium (Tensilon) test

Q.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 clients history. Which preexisting condition would contraindicate the
use of pyridostigmine?

A. Ulcerative colitis
B. Blood dyscrasia
C. Intestinal obstruction
D. Spinal cord injury

Q.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?

A. Administer an acetaminophen suppository.

B. Notify the physician immediately.
C. Recheck vital signs in 1 hour.
D. Reschedule patients physical therapy.
Q.1) A. Prostigmine (neostigmine)
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.

Q.2) C. Decreases the production of autoantibodies that attack the acetylcholine

receptors.
Explanation
Steroids decrease the bodys immune response thus decreasing the production of antibodies
that attack the acetylcholine receptors at the neuromuscular junction

Q.3) C. Acetylcholine

Q.4) B. Blocking the action of cholinesterase

Q.5) D. Respiratory exchange and ability to swallow

Explanation
Muscle weakness can lead to respiratory failure that will require emergency intervention and
inability to swallow may lead to aspiration

Q.6) A. Muscle strength

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.

Q.7) D. Coordinate her meal schedule with the peak effect of her medication,
Mestinon
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.

Q.8) A. acetylcholine

Q.9) D. Pancuronium and succinylcholine both require cautious administration.

Explanation
The nurse must cautiously administer pancuronium, succinylcholine, and any other
neuromuscular blocking agent to a client with myasthenia gravis. Such a client isnt 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.

Q.10) D. Alzheimer's disease

Q.11) C. A decreased number of functioning acetylcholine receptor sites

Q.12) D. Taking medications on time to maintain therapeutic blood levels

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.

Q.13) D. Progressive weakness that is worse at the days end

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 Parkinsons disease.

Q.14) C. Evaluate the clients muscle strength hourly after medication (Correct
Answer)
Explanation
Peak response occurs 1 hour after administration and lasts up to 8 hours; the response will
influence dosage levels.

Q.15) C. Maintain the present muscle strength

Explanation
Until diagnosis is confirmed, primary goal should be to maintain adequate activity and
prevent muscle atrophy

Q.16) C. Omitting doses of medication

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.

Q.17) C. Rapid but brief symptomatic improvement

Explanation
Tensilon acts systemically to increase muscle strength; with a peak effect in 30 seconds, It
lasts several minutes.

Q.18) D. A positive edrophonium (Tensilon) test

Q.19) C. Intestinal obstruction

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 dont
contraindicate use of the drug.

Q.20) B. Notify the physician immediately.

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
patients 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 patients 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