CH1-Myasthenia Gravis Practice

The nurse is caring for a patient with Guillain-Barré syndrome (GBS) who is receiving immunoglobulin (IVIG). Which assessment finding warrants immediate evaluation?

Headache with stiff neck Rationale: A headache with a stiff neck may be a sign of aseptic meningitis, a possible serious complication of IVIG therapy. Chills, generalized malaise, and a low-grade fever are minor adverse effects of IVIG therapy and do not indicate that the therapy should be stopped.

An unlicensed assistive personnel documents vital signs on a patient being treated for Guillain-Barré syndrome with plasmapheresis. Which set of vital signs is most concerning to the nurse when reviewing the electronic medical record?

Heart rate 101, respiratory rate 22, temperature 100.8˚F

Which statement correctly illustrates the commonality between Guillain-Barré syndrome (GBS) and myasthenia gravis (MG)

Both diseases affect the patient's respiratory status and muscle function. Rationale: Both GBS and MG affect respiratory status and muscle function. Only MG is an autoimmune disease with ocular symptoms, and is characterized by exacerbations and remissions, whereas GBS has three acute stages. GBS causes demyelination of the peripheral neurons.

A patient's spouse expresses concern that the patient, who has Guillain-Barré syndrome, is becoming very depressed and will not leave the house. What is the nurse's best response?

"Contact the Guillain-Barré Foundation International for resources."

The nurse is providing teaching to a patient diagnosed with myasthenia gravis (MG). Which statement by the patient indicates a correct understanding of the teaching?

"I may need to tape my eyes shut at night to help prevent corneal abrasion." Rationale: Patients with MG are at increased risk of corneal dryness and abrasion and should be taught techniques to prevent this. It may be necessary to tape the eyes shut at night to allow the eyelids to protect the eyes. Lubricant gel is used at night; other eye lubricants are used during the day. Liquid diets increase the risk of aspiration. Moderate exercise is recommended for patients with MG.

A patient with myasthenia gravis (MG) is receiving cholinesterase inhibitor drugs to improve muscle strength. The nurse is educating the family about this therapy. Which statement by a family member indicates a correct understanding of the nurse's instruction?

"I should call 911 if a sudden increase in weakness occurs." A potential adverse effect of cholinesterase inhibitors is cholinergic crisis. Sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately indicate that the patient is experiencing crisis. The family member should call 911 for emergency assistance. The dose of cholinesterase inhibitors should never be increased without provider supervision. The patient should eat meals 45-60 minutes after taking cholinesterase inhibitors to avoid aspiration. Cholinesterase inhibitors should be taken with a small amount of food to help alleviate GI side effects.

The family member of a patient with Guillain-Barré syndrome (GBS) who is receiving intravenous immunoglobulin (IVIG) asks the nurse why the provider has not ordered plasmapheresis which another family member received for this condition. What is the best response by the nurse?

"IVIG has been shown to be as effective as plasmapheresis in treating GBS."

A nurse is assessing pain in a patient with trigeminal neuralgia. Which patient response describes classic pain with trigeminal neuralgia?

"The pain is excruciating, sharp, and shooting."

Which assessment finding is most indicative of Guillain-Barré syndrome (GBS)?

A sudden onset of muscle weakness and pain

A patient is receiving plasmapheresis through a shunt in the right arm for Guillain-Barré syndrome. The nurse should notify the physician of which abnormal finding?

Absence of a bruit Rationale: Absence of bruit is an abnormal finding in the nurse's assessment because the plasmapheresis shunt may not be patent. A dry access site is a normal finding when assessing the shunt access site. Presence of a thrill is an expected finding when assessing patency of the shunt. An access site without bruising is a normal finding when assessing the skin at the access site.

In caring for a patient with myasthenia gravis (MG), the nurse should keep which item by the bedside?

Ambu bag Rationale: Because of the respiratory complications associated with myasthenia gravis, the nurse should keep an Ambu bag by the bedside. Nurses should never place anything in the patient's mouth. The prefilled syringe of calcium is typically for the postoperative thyroidectomy patient at risk for removal of the parathyroid and calcium loss. The AED should always be available, but it does not need to be at the bedside since the majority of complications are due to respiratory depression.

A patient is being treated for myasthenia gravis with bulbar involvement with a cholinesterase (ChE) inhibitor. The nurse instructs the patient to eat at least 45 minutes after the drug is given. What complication is the nurse helping to prevent?

Aspiration Rationale: For a patient with bulbar involvement with myasthenia gravis, it is important to educate the patient to eat at least 45 minutes after ChE inhibitor administration to prevent aspiration. Instructing the patient to eat at least 45 minutes after ChE inhibitor administration will not prevent pneumonia, bowel obstruction, or respiratory distress.

A nurse is caring for a patient with myasthenia gravis. What nursing intervention should be implemented to promote mobility and prevent fatigue in the patient?

Assist the patient in planning periods of rest.

The nurse is assisting with the performance of a Tensilon test to aid in the diagnosis of myasthenia gravis (MG). Which medication should be available to treat complications that may occur during the test?

Atropine sulfate Rationale: The Tensilon test can result in ventricular fibrillation and cardiac arrest. Atropine sulfate, the antidote for Tensilon, must be available during testing. Epinephrine, dexamethasone, and scopolamine are not antidotes for Tensilon and will not correct these complications.

The patient with restless leg syndrome (RLS) has been prescribed gabapentin. What does the nurse teach the patient about this medication?

Be careful while driving because it may cause drowsiness. Rationale: Gabapentin is an antiepileptic drug. These drugs are usually taken at bedtime because they can cause daytime sleepiness. Opioids are prescribed for RLS as a last resort. Melatonin may be taken at bedtime for insomnia that is caused by RLS. Correcting iron and magnesium deficiencies can reduce RLS symptoms.

The nurse encourages a ventilated patient with advanced Guillain-Barré syndrome (GBS) to communicate by which simple technique?

Blinking for "yes" or "no" Rationale: A simple technique involving eye blinking or moving a finger to indicate "yes" and "no" is the best way for the ventilated patient with GBS to communicate. Moving the lips is difficult to do around an endotracheal tube and is exhausting for the patient. Sign language is very time-consuming to learn, unless the patient and family already know it. Use of a laptop may prove too challenging for the patient in advanced stages of GBS.

The patient with myasthenia gravis is undergoing Tensilon testing. The nurse is alert for the possibility of which complication?

Cardiac dysrhythmias Rationale: Although rare, the Tensilon test can cause cardiac arrhythmias and cardiac arrest. Atropine sulfate should be available in case these complications occur. The Tensilon test is performed to determine if increasing weakness in the myasthenic patient is due to a cholinergic crisis or a myasthenic crisis. Respiratory failure and pulmonary edema are not known complications of Tensilon testing.

A nurse is discharging a patient diagnosed with Bell palsy who is experiencing muscle weakness on the left side of the mouth. What information does the nurse include in the discharge education for management of Bell palsy?

Drink using the right side of the mouth. Rationale: Patient education should include encouraging the patient to eat and drink using the unaffected side of the mouth, which would be the right side of the mouth for this patient. Antibiotics are not used to treat Bell palsy. A patient with muscle weakness on the left side of the mouth should not be encouraged to eat using the left side of the mouth. Patients with myasthenia gravis should avoid heat, crowds, and overeating.

The nurse reviews a patient's medical record and notes a history of lung carcinoma and a medication history of pyridostigmine. The patient is experiencing weakness of the pelvis and shoulder. Which diagnosis does the nurse anticipate?

Eaton-Lambert syndrome Rationale: Eaton-Lambert syndrome is a type of myasthenia gravis that occurs with lung carcinoma. The patient experiences weakness of the pelvic muscles and shoulder muscles. Pyridostigmine is a cholinesterase inhibitor prescribed for Eaton-Lambert syndrome. Corticosteroids and antiviral medications are useful in the treatment of Bell's palsy. Antiepileptics and dopamine agonists are prescribed for restless leg syndrome. The peripheral nerves are injured in a patient with peripheral nerve trauma, and this patient does not have a history of this.

The nurse admits a patient with suspected Eaton-Lambert syndrome. The nurse anticipates that the health care provider will request which test to confirm the diagnosis

Electromyography (EMG)

The nurse suspects the patient with myasthenia gravis is experiencing a cholinergic crisis when she exhibits which symptoms? Select all that apply.

Flaccid Paralysis Abd. cramps worsening of Sx. w/ Tensilon test

The nurse is providing care to a patient who is experiencing difficulty in swallowing, impaired speech, and ascending paralysis. The patient has tested positive for the Epstein-Barr virus. The nurse anticipates that the patient will be diagnosed with what neurological disorder?

GBS

A nurse is assessing an adult patient in an inpatient unit. The patient states, "I came into the emergency department because I was experiencing numbness in my feet. On the way to the hospital, it got worse and went up my legs and I couldn't move them." What disease of the peripheral nervous system is the patient experiencing?

Guillain-Barré syndrome Rationale: Numbness and paralysis that started in the feet and traveled up the legs is a hallmark sign of ascending paralysis in Guillain-Barré syndrome. Bell palsy is characterized by a drawing sensation and paralysis of all facial muscles on the affected side. Myasthenia gravis is characterized by general weakness. Restless leg syndrome is characterized by leg paresthesias associated with an irresistible urge to move.

A nurse is assessing a patient diagnosed with Bell palsy. Bell palsy is believed to be the result of inflammation triggered by a formerly dormant herpes simplex virus type 1. What is an expected finding in a patient with Bell palsy?

Inability to close the eye

Which laboratory result is consistent with the diagnosis of Guillain-Barré syndrome (GBS)?

Increased protein in the cerebrospinal fluid Rationale: An increase in the cerebrospinal fluid protein level occurs in GBS due to the release of plasma proteins from inflammation and damage to nerve roots. This release does not affect serum protein levels, which remain normal. The rheumatoid factor is not elevated in this disease and the erythrocyte sedimentation rate could rise.

Which statement best describes the pathophysiologic changes associated with Guillain-Barré syndrome (GBS)?

It is an immune disorder in which the immune system destroys the myelin sheath of peripheral nerves. Rationale: In GBS, the immune system destroys the myelin sheath, causing demyelination of the nerves leading to weakness and sensory abnormalities. Myasthenia gravis is the autoimmune disorder resulting in decreased acetylcholine. GBS is not an infectious disorder; however, it is often preceded by an infectious illness. Rheumatoid arthritis is the degenerative disease that leads to bone loss and muscle wasting.

What is the priority nursing intervention for a patient with rapidly ascending Guillain-Barré Syndrome (GBS)?

Maintain airway patency and adequate gas exchange

A patient with restless leg syndrome (RLS) reports insomnia. What medication does the nurse anticipate will be ordered?

Melatonin Rationale: Melatonin is a widely available supplement that can treat insomnia without interfering with drugs the patient may be taking for restless leg syndrome (RLS). Diazepam, gabapentin, and carbamazepine are prescription drugs used to treat RLS but not insomnia.

An older patient with myasthenia gravis (MG) is preparing for discharge home. Which aspect of long-term management is a priority for this patient?

Mobility and independence Rationale: Patients with MG must learn adaptive skills to cope with the fatigue and weakness associated with the disorder. Eye closure and ptosis, pain and comfort, and speech and communication are also problems, but promoting mobility and independence addresses the overall issue.

A nurse administers endrophonium chloride (Tensilon) to a patient with myasthenia gravis to help determine definitive treatment for the patient. What finding indicates to the nurse that the patient is experiencing a cholinergic crisis?

Muscle twitching Rationale: Muscle twitching, or fasciculations, may be seen around the eyes and face in a patient experiencing a cholinergic crisis after endrophonium chloride (Tensilon) administration. Cardiac dysrhythmias are a reaction caused by endrophonium chloride (Tensilon). Improved muscle tone occurs in a myasthenic crisis after giving endrophonium chloride (Tensilon). Decreased muscle weakness occurs in a myasthenic crisis after giving endrophonium chloride (Tensilon).

The patient presents with complaints of weakness that seems to increase when she is tired. She states the weakness limits her mobility so that she is unable to participate in most activities. The nurse suspects which neurologic condition?

Myasthenia gravis Rationale: The classic presentation of myasthenia gravis is muscle weakness that increases when the patient is fatigued and limits his or her mobility and ability to participate in activities. Bell's palsy is characterized by facial paralysis. Trigeminal neuralgia is a chronic pain condition. Guillain-Barré Syndrome is characterized by weakness and paralysis that generally starts in the lower extremities and ascends.

A patient arrives to the emergency department with new-onset ptosis, diplopia, and dysphagia. The nurse anticipates that the patient will be tested for which neurologic disease?

Myasthenia gravis (MG)

A patient with myasthenia gravis (MG) has developed dysphagia, ptosis, and muscle weakness. With a provider's order, the nurse administers intravenous edrophonium chloride and notes marked improvement of symptoms within 30-60 seconds after administration. Which type of crisis does this response indicate?

Myasthenic Rationale: Symptoms of too many anticholinesterase drugs, or cholinergic crisis, and an exacerbation of MG are similar. To differentiate between these, the provider orders edrophonium chloride, which is a rapid-onset cholinesterase inhibitor. A rapid improvement in symptoms indicates that the symptoms are caused by a myasthenic crisis. No improvement or worsening indicates a cholinergic or a mixed crisis.

What other term is used to refer to Guillain-Barré syndrome?

Polyradiculoneuropathy Rationale: Guillain-Barré syndrome is also called polyradiculoneuropathy because it is a polyneuropathy affecting peripheral nerves. Cranial polyneuritis is the term for Bell's palsy. Eaton-Lambert syndrome is a type of myasthenia gravis. Trigeminal neuralgia is a disease affecting the trigeminal nerve or cranial nerve V.

A patient with myasthenia gravis is admitted with generalized fatigue, a weak voice, and dysphagia. Which patient problem has the highest priority?

Potential for aspiration related to difficulty with swallowing

The nurse is reviewing the medication history of a patient diagnosed with myasthenia gravis (MG) who has been prescribed a cholinesterase inhibitor (ChE). The nurse should contact the health care provider if the patient is taking which medication?

Procainamide Rationale: Procainamide should be avoided because it may increase the patient's weakness. Ibuprofen is a nonsteroidal analgesic and does not interact with ChE inhibitors. Acetaminophen does not interact with ChE inhibitors. Furosemide is a diuretic and does not interact with ChE inhibitors.

A patient with myasthenia gravis (MG) is being discharged home. The nurse teaches the caregiver about measures to improve the nutritional status in the patient. Which actions of the caregiver indicate effective learning? Select all that apply.

Provides bread cut into small bites Instructs the patient to chew slowly Provides a high-calorie snack, for example, pudding Rationale: Providing bread cut into small pieces helps the patient chew it better and promotes swallowing. Instructing the patient to chew slowly prevents choking and aspiration. A high-calorie snack helps to meet the caloric demand for the basic body function, and prevents fatigue. Liquids can be easily aspirated; therefore, a soft diet is preferred. The patient should sit upright for 30 to 45 minutes after meals to prevent aspiration.

The patient with myasthenia gravis experiencing a severe cholinergic crisis requires mechanical intubation. Which medication, if ordered by the provider, should the nurse question?

Pyridostigmine Rationale: In cholinergic crisis, anticholinesterase drugs (pyridostigmine) are not given while the patient is on a ventilator because they increase respiratory secretions. Atropine is given to reverse the crisis. Immunosuppressants such as methotrexate and rituximab may be given to reduce the symptoms of crisis.

A patient with myasthenia gravis (MG) is admitted to the hospital to treat a myasthenic crisis. What is the priority nursing assessment for this patient?

Respiratory effort Rationale: Respiratory failure is the most serious consequence of myasthenic crisis, so the nurse should assess respiratory effort as a priority. Assessing the cough and gag reflex, eyelid movements, and ability to speak are part of an ongoing evaluation of patients with MG, but do not take priority over the potential for respiratory failure.

The nurse is providing care for a patient who has a burning sensation in the legs at bedtime and constant leg movement. Which diagnosis does the nurse suspect on the basis of these initial data?

Restless leg syndrome

A patient is undergoing IV immunoglobin (IVIG). Which finding is indicative of a complication of the procedure?

Retinal necrosis Rationale: A major complication of IVIG is retinal necrosis. Hypocalcemia and allergic pulmonary edema are potential complications of plasmapheresis. The inability to maintain an airway is a complication of GBS.

A patient with myasthenia gravis (MG) has been hospitalized after a myasthenic crisis. Once the patient is free from respiratory symptoms, which diet does the nurse anticipate the provider to order for this patient?

Soft Rationale: Patients with MG have difficulty chewing and swallowing; the patient will do best with a soft diet. There is no need for a clear liquid diet to be ordered for this patient. Liquid diets increase the risk for aspiration. Regular diets are difficult for patients with MG to chew.

A patient who has Guillain-Barré syndrome with involvement of cranial nerves IX and X has a sudden decrease in oxygen saturation to 88%. The nurse auscultates crackles and rhonchi in the lungs. The patient is receiving oxygen at 2 L/minute by nasal cannula. Which action does the nurse perform next?

Suction the patient to remove secretions from the airway.

Which signs/symptoms are associated with an initial diagnosis of myasthenia gravis (MG)? Select all that apply.

Symptoms of MG are related to weakness and include ptosis, diplopia, dysphagia, and paresthesia. A masklike expression is associated with Parkinsonism. Paralytic ileus can be seen in MG, but occurs very late in the disease, not as an initial finding.

Which are risk factors for restless legs syndrome? Select all that apply.

T2DM Sleep deprivation CKD Presence of Polyneuropathies

Which drug can be used to differentiate whether a patient is experiencing a myasthenic crisis as opposed to a cholinergic crisis?

Tensilon Rationale: Cholinesterase inhibitors, edrophonium chloride, and neostigmine bromide, or Tensilon (used in Tensilon testing), may be used to help determine whether increasing weakness in the previously diagnosed myasthenic patient is due to a cholinergic crisis (too much cholinesterase inhibitor drugs) or a myasthenic crisis (too little cholinesterase inhibitor drugs). Tensilon produces a temporary improvement in myasthenic crisis, but worsening or no improvement of symptoms in cholinergic crisis. Atropine sulfate is used to treat cholinergic crisis. Epinephrine and dexamethasone will not aid in the diagnosis and are not indicated at this time.

A patient takes pyridostigmine for treatment of myasthenia gravis (MG). During a follow-up visit, the nurse finds that the patient has an increased pulse, respiratory rate, and blood pressure. The patient reports decreased urine output and an inability to cough properly. The nurse anticipates that which test will be performed?

Tensilon testing Rationale: Patients treated with pyridostigmine are at risk for cholinergic crisis as well as myasthenic crisis. These two conditions may be difficult to differentiate; therefore, a tensilon test may be performed. Upon injecting tensilon intravenously, symptoms of myasthenic crisis would improve temporarily, but the symptoms of cholinergic crisis may worsen or remain unaffected. Electromyography is used to confirm the diagnosis of MG. A thyroid function test is performed to determine the role of thyroid dysfunction in MG. An acetylcholine receptor antibody test is used to confirm the diagnosis of MG.

A patient with myasthenia gravis is prescribed pyridostigmine. The nurse provides the patient with education regarding safe drug administration. Which actions by the patient indicate a need for further teaching? Select all that apply.

The patient takes the same dose of medication every day. The patient takes concomitant neomycin with the medication. Rationale: Pyridostigmine prevents a decrease in acetylcholine by the enzyme cholinesterase, thereby enhancing the neuromuscular impulse transmission. The patient may have to vary the prescribed dose based of his or her activity level so the same dose may not be effective every day. Concomitant neomycin may aggravate the muscular weakness and should not be used. Taking the medication 1 hour before the meal helps prevent aspiration. Taking sedatives concomitantly with pyridostigmine may aggravate muscle weakness and must not be taken. Taking the medication with a salt cracker and water reduces gastrointestinal irritation.

Which surgical intervention does the nurse expect to be included in long-term management for symptoms of myasthenia gravis (MG)?

Thymectomy Rationale: For patients with MG, thymectomy is usually performed early in the course of the disease. Removal of the thyroid gland, the pineal gland, or the anterior pituitary is not indicated and will not improve symptom management.

A patient diagnosed with ascending Guillain-Barré syndrome 2 months ago has experienced improved motor and sensory function in the upper extremities in the past few weeks. The patient asks the nurse why movement and sensation have not improved in the trunk and legs. How does the nurse respond?

"Complete recovery of motor and sensory function may take months to years."

The nurse is preparing the myasthenic patient with a thymoma for a thymectomy. Which statement made by the patient indicates a need for further education?

"I will have improvement of my symptoms once the surgery is over." Thymectomy is not always immediately effective, and there may be no improvement in symptoms at all. It is important to be optimistic, but there is no way to predict if improvement will occur. The procedure requires a sternal split so the surgeon can view all the surrounding structures in the chest. A single chest tube is placed in the anterior mediastinum. The patient is usually admitted to the critical care unit for ventilator weaning and chest tube management following surgery. Plasmapheresis may be used before and after surgery to reduce circulating antibodies.

The nurse is educating the patient with myasthenia gravis (MG) about the importance of taking medications on time. The patient asks why this is so important. What is the nurse's best response?

"It will help maintain blood levels and increase muscle strength." Rationale: Patients with MG can maintain blood levels and increase muscle strength for activities such as eating when medications are taken on time. Although it may help the patient to remember to take medications by taking them at the same time each day, this is not the priority reason. The timing of medication administration does not prevent side effects or complications, nor does it promote absorption.

A nurse is teaching the family members of a patient who has myasthenia gravis about drug therapy. Which of the family member's statements indicates a need for further teaching?

"We should plan strenuous activities when the drugs wear off."

A nurse is working on a medical-surgical unit taking care of patients with peripheral nervous system disorders. After receiving the report from the previous shift, which patient does the nurse see first?

58-year-old male with Guillain-Barré and an oxygen saturation of 90% on room air reported by the unlicensed assistive personnel Rationale: The nurse should see the patient with Guillain-Barré with an oxygen saturation of 90% first, because patients with Guillain-Barré syndrome are at risk for respiratory distress and the patient's pulse oximetry level is below the normal range. Tinnitus is a normal finding in patients with Bell palsy and is not the first priority. A heart rate of 60 bpm is within normal range for the patient with myasthenia gravis. A calcium level of 9.0 mg/dL is within normal range, so the patient with AIDP is not the nurse's first priority.

The nurse is preparing to discharge a patient with myasthenia gravis. What self-management activities should the nurse include in the discharge education to prevent exacerbations of myasthenia gravis? Select all that apply.

Avoid heat Plan rest periods

The nurse admits a patient with suspected myasthenia gravis (MG). The nurse anticipates that the health care provider will request which medication to aid in the diagnosis of MG?

Edrophonium chloride Rationale: Edrophonium chloride and neostigmine bromide may be used for testing for MG. Tensilon is used most often because of its rapid onset and brief duration of action. This drug inhibits the breakdown of acetylcholine (ACh) at the postsynaptic membrane, which increases the availability of ACh for excitation of postsynaptic receptors. Atropine has parasympatholytic effects and is the antidote for edrophonium chloride. Methylprednisolone is a glucocorticoid that is used to treat inflammatory disorders. Morphine is an opioid analgesic and is not used in the diagnosis of MG.

The patient presents with complaints of pain, numbness, and paresthesias for the past two days and now has sudden onset of lower extremity muscle weakness. The nurse expects the patient to be tested for which neurological disease?

Guillain-Barré Syndrome

The nurse is providing care for a patient who is experiencing ptosis, double vision and difficulty in chewing and swallowing. Based on this data, which diagnosis does the nurse suspect?

Myasthenia gravis

The patient with a thymoma is at risk for which neurologic disease?

Myasthenia gravis

When caring for a patient with myasthenia gravis, the nurse notices the patient's eyelids are drooping. What term best describes this phenomenon?

Ptosis

Which phase of Guillain-Barré syndrome (GBS) coincides with axonal regeneration?

Recovery phase Rationale: The recovery phase (gradually over 4 to 6 months, maybe up to 2 years) is thought to coincide with remyelination and axonal regeneration. The acute phase begins with onset of the first symptoms and ends when no further deterioration occurs. The plateau period follows the acute phase before remyelination and axonal regeneration occurs. Some patients do not completely recover and have permanent neurologic deficits, referred to as chronic GBS.

Which are clinical manifestations of Guillain-Barré syndrome? Select all that apply.

Respiratory failure Ascending paralysis

A patient with myasthenia gravis has just undergone a thymectomy. The nurse monitors the patient for which potential complication?

Sudden onset of shortness of breath Rationale: A thymectomy removes the thymus gland. The nurse should monitor a patient who is post-thymectomy for symptoms of pneumothorax or hemothorax, which include sudden shortness of breath, chest pain, and diminished breath sounds. Decorticate posturing occurs with elevated intracranial pressure, which is unlikely with thymectomy. Trousseau's and Chvostek's signs indicate low levels of calcium, which should not occur with thymectomy. Inability to void may occur secondary to surgical intervention, but it is not the priority and would not be a result of the thymectomy.

The patient with Guillain-Barré Syndrome (GBS) is experiencing an inability to smile, frown, and drink from a straw. The nurse knows the GBS has involved which cranial nerve (CN)?

VII

A patient has returned to the unit after a thymectomy and is extubated. The patient begins to report chest pain. What does the nurse do next?

Informs the surgeon immediately

A patient is admitted with an exacerbation of Guillain-Barré syndrome (GBS), presenting with dyspnea. Which intervention does the nurse perform first?

Raises the head of the bed to 45 degrees Rationale: The head of the patient's bed should be raised to 45 degrees because this allows for increased lung expansion, which improves the patient's ability to breathe. Intubation is indicated only if dyspnea is severe or oxygenation saturation does not respond to oxygen therapy. Close monitoring of respiratory status is indicated because of the acute stages of GBS. Instructing the patient on how to cough effectively is not the priority in this case. The patient should be suctioned only if needed to avoid vagal stimulation.

An older patient reports having restless legs during the night, interfering with sleep. What does the nurse initially suggest to this patient?

Avoid caffeine, alcohol, and nicotine.

A nurse is caring for a patient with myasthenia gravis, an acquired autoimmune disease characterized by muscle weakness. What symptoms exhibited by the patient indicate to the nurse that the patient is experiencing a myasthenic crisis? Select all that apply.

Increased respiration Decrerased UO Rationale: Increased respiration and decreased urine output are characteristics of a myasthenic crisis. Diarrhea, vomiting, and bradycardia are characteristic of a cholinergic crisis.

A patient reports a burning and prickly sensation in the leg, which is associated with an irresistible urge to move. What risk factors are associated with these symptoms? Select all that apply.

The patient's symptoms are suggestive of restless leg syndrome (RLS). Caffeine, calcium channel blockers, lithium or neuroleptics, and withdrawal from sedatives are risk factors for this syndrome. Opioids are used as a last resort to manage RLS; it is typically managed with the oral dopamine agonist ropinirole.