Myasthenia Gravis

Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies. Transient Epinephrine Nicotinic Acetylcholine

Acetylcholine

Myasthenia gravis reflects a deficiency in communication by _______________ because receptors for this neurotransmitter have been destroyed. Dopamine Norepinephrine GABA Acetylcholine

Acetylcholine

Which of the following is an indication for withholding indirect-acting cholinergic agonists? Visual acuity of 20/150 Blood pressure of 140/90 mmHg GFR of 30 mL/hour Adult heart rate of 55 beats per minute

Adult heart rate of 55 beats per minute It can be exacerbated by the parasympathetic effects of the drug

Which of the following is not an autoimmune disease? Graves disease Alzheimer's disease Insulin-dependent diabetes mellitus Myasthenia gravis

Alzheimer's disease

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: Taking excess medication Omitting doses of medication Getting too little exercise Increasing intake of fatty foods

Omitting doses of medication

The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis? Progressive weakness that is worse at the day's end Ascending paralysis and loss of motor function Cogwheel rigidity and loss of coordination Visual disturbances, including diplopia

Progressive weakness that is worse at the day's end

The medication that is used to treat myasthenia gravis is: Both A & B Prostigmine (neostigmine) Atropine (atropine sulfate) None of these

Prostigmine (neostigmine)

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication? As soon as possible 1 hour after the patient has eaten (at 1300) 1 hour before the patient eats (at 1100) at 1200 right before the patient eats

1 hour before the patient eats (at 1100) Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used...hence improving muscle strength.

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 genetic in the production acetylcholine A reduced amount of neurotransmitter acetylcholine A decreased number of functioning acetylcholine receptor sites An inhibition of the enzyme ACHE leaving the end plates folded

A decreased number of functioning acetylcholine receptor sites

Which patient below is MOST at risk for developing a cholinergic crisis? A patient with myasthenia gravis is who is not receiving sufficient amounts of their anticholinesterase medication. A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks. A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.

A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication. Remember patients who experience a cholinergic crisis are most likely to because they've received too much of their anticholinesterase medications (example Pyridostigmine). However, on the other hand, patients who have received insufficient amount of their anticholinesterase medication or have experienced an illness/stress/surgery are most likely to experience a myasthenia crisis. Both conditions will lead to muscle weakness and respiratory failure but from different causes, which is why a Tensilon test is used to help differentiate between the two conditions.

Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by: A positive edrophonium (Tensilon) test Kernigs sign A positive sweat chloride test Brudzinski's sign

A positive edrophonium (Tensilon) test

You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency? Atropine Protamine sulfate Narcan Leucovorin

Atropine 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.

A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by: Stimulating the cerebral cortex Blocking the action of cholinesterase Replacing deficient neurotransmitters Accelerating transmission along neural swaths

Blocking the action of cholinesterase

You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition? Plasmapheresis Cholinesterase medications Thymectomy Corticosteroids

Cholinesterase medications These medications are not used to treat MG, but ANTIcholinesterase medications (like Pyridostigmine) are used to treat this condition.

Which meal option would be the most appropriate for a patient with myasthenia gravis? Roasted potatoes and cubed steak Hamburger with baked fries Clam chowder with mashed potatoes Fresh veggie tray with sliced cheese cubes

Clam chowder with mashed potatoes Patients with MG have weak muscles and this can include the muscles that are used for chewing and swallowing. The patient should choose meal options that require the least amount of chewing and that are easy to swallow. Option C is a thick type of soup and the mashed potatoes are soft....both are very easy to eat and swallow compared to the other options.

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: Coordinate her meal schedule with the peak effect of her medication, Mestinon Place an emergency tracheostomy set in her room Assess her respiratory status before and after meals Change her diet order from soft foods to clear liquids

Coordinate her meal schedule with the peak effect of her medication, Mestinon

Karina, a client who has myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: Decreases the production of autoantibodies that attack the acetylcholine receptors. Inhibits the breakdown of acetylcholine at the neuromuscular junction. Stimulates the production of acetylcholine at the neuromuscular junction. Promotes the removal of antibodies that impair the transmission of impulses

Decreases the production of autoantibodies that attack the acetylcholine receptors.

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: Evaluate the client's emotional side effects between doses Administer the medication with food or mild Evaluate the client's muscle strength hourly after medication Administer the medication exactly on time

Evaluate the client's muscle strength hourly after medication

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? Ulcerative colitis Spinal cord injury Intestinal obstruction Blood dyscrasia

Intestinal obstruction

The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to: Prepare for the appearance of myasthenic crisis Maintain the present muscle strength Facilitate psychologic adjustment Develop a teaching plan

Maintain the present muscle strength

You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks? Mid-afternoon Morning Evening Before bedtime

Morning Patients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day....the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.

In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in: Blood pressure Muscle strength Symptoms Consciousness

Muscle strength

All of the following are direct-acting cholinergic agonists, except: Pilocarpine Neostigmine Carbachol Cevimeline

Neostigmine It is an agent for myasthenia gravis and is therefore an indirect-acting cholinergic agonist.

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? Reschedule patient's physical therapy. Recheck vital signs in 1 hour. Notify the physician immediately. Administer an acetaminophen suppository.

Notify the physician immediately.

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? Pancuronium shouldn't be used; succinylcholine may be used in a lower dosage. Pancuronium and succinylcholine both require cautious administration. The client may be less sensitive to the effects of a neuromuscular blocking agent. Succinylcholine shouldn't be used; pancuronium may be used in a lower dosage.

Pancuronium and succinylcholine both require cautious administration.

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: Prolonged symptomatic improvement Rapid but brief symptomatic improvement Symptomatic improvement of just the ptosis Brief exaggeration of symptoms

Rapid but brief symptomatic improvement

The most significant initial nursing observations that need to be made about a client with myasthenia include: Ability to chew and speak distinctly Degree of anxiety about her diagnosis Ability to smile an to close her eyelids Respiratory exchange and ability to swallow

Respiratory exchange and ability to swallow

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: Eating large, well-balanced meals Taking medications on time to maintain therapeutic blood levels Doing all chores early in the day while less fatigued Doing muscle-strengthening exercises

Taking medications on time to maintain therapeutic blood levels

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? The patient experiences worsening of the muscle weakness. The patient experiences wheezing along with facial flushing. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears. The patient experiences improved muscle strength.

The patient experiences improved muscle strength. 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.

The following are true about cholinergic agonists, except: These drugs exert their effect by mobilizing the acetylcholine into their receptors found throughout the body. Some of their effects include vasodilation, bronchoconstriction, and bladder relaxation. Ophthalmic agents can induce miosis or pupil constriction. Edrophonium is used for diagnosis of myasthenia gravis only.

These drugs exert their effect by mobilizing the acetylcholine into their receptors found throughout the body. Cholinergic agonists act at the same site as the neurotransmitter acetylcholine (ACh) and increase the activity of the ACh receptor sites throughout the body. They do not mobilize acetylcholine into their receptors.

A patient on neostigmine complained of frequent diarrhea and salivation. Which is the best nursing action for this situation? Educate client about drug therapy to alleviate anxiety as these are expected drug effects. Withhold the dose of the drug and refer to physician. Arrange for increasing the dose of the drug as it is not effective. Document patient response and endorse accordingly for bedside care.

Withhold the dose of the drug and refer to physician. Discontinue drug if excessive salivation, diarrhea, emesis, or frequent urination becomes a problem to decrease the risk of severe adverse reactions. The nurse should refer this to the physician.

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located? behind the thyroid gland within the adrenal glands behind the sternum in between the lungs anterior to the hypothalamus

behind the sternum in between the lungs The thymus is located anteriorly in the upper part of the chest behind the sternum in between the lungs.

This drug is usually indicated for postoperative and postpartum urinary retention as well as bladder atony. carbachol bethanechol tacrine pyridostigmine

bethanechol This drug has specific affinity for receptors in the urinary bladder.

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________. metabotropic; muscle weakness nicotinic acetylcholine; muscle weakness dopaminergic adrenergic; muscle contraction nicotinic adrenergic; muscle contraction

nicotinic acetylcholine; muscle weakness In myasthenia gravis, either the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system (hence why this disease is considered autoimmune) or antibodies are inhibiting the function of muscle-specific kinase (which is a receptor tyrosine kinase that helps with maintaining and building the neuromuscular junction). Either way this leads to the neurotransmitter acetylcholine from being able to communicate with the muscle fiber to make it contract.