Chapter 47: DT for Myasthenia Gravis, Alzheimer's Disease and Urinary Retention
An accidental overdose of neostigmine has prompted the emergency administration of atropine. When assessing the patient, the emergency department nurse should take into account that this intervention will not relieve the effects of neostigmine on A) skeletal muscle. B) smooth muscle. C) the heart. D) glands.
Ans: A Feedback: Atropine reverses only the muscarinic effects of cholinergic drugs, primarily in the heart, smooth muscle, and glands. Atropine does not interact with nicotinic receptors and therefore cannot reverse the nicotinic effects of skeletal muscle weakness due to overdose of indirect anticholinergic drugs.
A patient who is being treated for myasthenia gravis is receiving neostigmine, and her pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia? A) Atropine B) Pseudoephedrine C) Propranolol (Inderal) D) Bethanechol (Urecholine)
Ans: A Feedback: Atropine will reverse the muscarinic effects of cholinergic crisis. Pseudoephedrine will not affect bradycardia in this patient. Propranolol (Inderal) will not affect the bradycardia. Bethanechol will increase the bradycardia.
A patient is administered edrophonium (Tensilon) to confirm the diagnosis of myasthenia gravis. What effect will the edrophonium (Tensilon) have 30 minutes after the medication administration, which will confirm the diagnosis? A) Improved breathing B) Decreased fatigue C) Decreased muscle spasms D) Increased urinary output
Ans: A Feedback: Edrophonium (Tensilon) is used to diagnose myasthenia gravis. After administration, it will improve breathing in patients who have myasthenia gravis. Edrophonium will not decrease fatigue. Edrophonium will not decrease muscle spasms or increase urinary output.
A patient with myasthenia gravis is administered pyridostigmine (Mestinon) for the first time. She asks the nurse the reason why she has been changed to this medication. Which of the following is the nurse's best response? A) "Pyridostigmine (Mestinon) will allow you to awaken with the ability to swallow." B) "Pyridostigmine (Mestinon) can be taken every other day." C) "Pyridostigmine (Mestinon) is a faster-release form of cholinergic agent." D) "Pyridostigmine (Mestinon) is taken one time per day for better control."
Ans: A Feedback: Pyridostigmine is a slow-release form that is taken at bedtime and allows the patient the ability to swallow in the morning. Pyridostigmine is usually taken two times per day, not every other day. Pyridostigmine is a slow-release form, not a fast-release form. Pyridostigmine is taken two times per day, not one time per day.
A military nurse is part of a team reviewing the appropriate response to chemical weapons attacks, including sarin, tabun, and soman. When reviewing the physiology of a response to such drugs, the nurse should identify what goal of treatment? A) Restore anticholinesterase function. B) Restore GABA function. C) Restore dopamine function. D) Increase serotonin reuptake.
Ans: A Feedback: These drugs are irreversible anticholinesterase agents. The goal of treatment, such as atropine administration, is to restore normal function of anticholinesterase and rid synapses of excessive acetylcholine.
A patient has been receiving bethanechol (Urecholine) for 1 week. One hour after the dose is administered, he develops sweating, flushing, abdominal cramps, and nausea. What is the rationale for the development of these symptoms? A) Myasthenic crisis B) Cholinergic overdose C) Anaphylactic reaction D) Pulmonary edema
Ans: B Feedback: A patient who suffers cholinergic overdose will experience sweating, flushing, abdominal cramps, and nausea. An accurate diagnosis may be determined from timing in relation to medication. Signs and symptoms having an onset within approximately 1 hour after a dose of anticholinesterase drug are likely to be caused by cholinergic crisis. Signs and symptoms beginning 3 hours or more after a drug dose are more likely to be caused by myasthenic crisis. These symptoms are not the result of anaphylaxis or pulmonary edema.
A nurse is conducting health education with a man who has Alzheimer's disease and his daughter, who is his primary caregiver. The man has been deemed to be a good candidate for treatment with donepezil (Aricept) and will soon begin taking this medication. What teaching point should the nurse convey? A) "Aricept should be taken 1 hour before or 2 hours after any dairy products." B) "It's important to take this medication at bedtime." C) "Aricept should be taken with food to reduce the chance of stomach upset." D) "If you don't notice any cognitive improvement within 2 weeks, the drug should be discontinued."
Ans: B Feedback: Aricept should normally be taken at bedtime. It does not have to be taken with food. Dairy does not interfere with pharmacokinetics. The drug should be continued even if improvement is not noticeable.
A patient has atony of the smooth muscle of the gastrointestinal tract. Which type of medication may be administered to increase smooth muscle strength? A) Anticholinergic drugs B) Cholinergic drugs C) Muscle relaxants D) Selective serotonin reuptake inhibitors
Ans: B Feedback: Cholinergic drugs are used to treat atony of the smooth muscle of the gastrointestinal tract and urinary systems. Anticholinergic agents will decrease muscle strength. Muscle relaxants will decrease muscle strength. Selective serotonin reuptake inhibitors are not used for atony of the smooth muscle of the gastrointestinal tract.
A 33-year-old female patient with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this patient's health problem is ultimately attributable to what pathophysiological process? A) Idiopathic overproduction of anticholinesterase B) Autoimmune destruction of acetylcholine receptors C) Demyelination of parasympathetic nerve pathways D) Deficient synthesis of dopamine by the substantia nigra
Ans: B Feedback: Myasthenia gravis occurs when antibodies produced by the body's own immune system block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents muscle contraction from occurring. The disease does not involve dopamine deficits, demyelination, or excess anticholinesterase.
A patient with myasthenia gravis is administered neostigmine (Prostigmin). How does this drug produce its therapeutic effect? A) It stimulates the sympathetic nervous system. B) It stimulates the parasympathetic nervous system. C) It stimulates the cardiac smooth muscle. D) It stimulates the respiratory system.
Ans: B Feedback: Neostigmine (Prostigmin) stimulates the parasympathetic nervous system. It does not stimulate the sympathetic nervous system, cardiac system, or respiratory system.
A man with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. The patient has illuminated his call light, and the nurse has found him anxious, diaphoretic, and visibly flushed. Following a safety assessment, what action should the nurse take? A) Prepare to administer an IV dose of epinephrine to mitigate the effects of acetylcholine. B) Contact the physician as the patient may be experiencing a cholinergic crisis. C) Insert a Foley catheter as the patient may have excessive urine in his bladder. D) Assess the volume of the patient's bladder contents using a bladder ultrasound.
Ans: B Feedback: The presence of sweating and skin flushing in a patient taking bethanechol is suggestive of a cholinergic crisis. This is a medical emergency that warrants prompt intervention by the care team. This problem is not treated with epinephrine. Assessing the patient's bladder or inserting a Foley catheter is not sufficient.
A patient is diagnosed with a paralytic ileus. Which of the following medications will be administered to treat a paralytic ileus? A) Neostigmine (Prostigmin) B) Donepezil (Aricept) C) Bethanechol (Urecholine) D) Ambenonium (Mytelase)
Ans: C Feedback: Bethanechol (Urecholine) produces smooth muscle contractions and is used for obstructive conditions of the gastrointestinal tract. Neostigmine is used to treat myasthenia gravis. Donepezil is used to treat Alzheimer's disease. Ambenonium is used to treat myasthenia gravis.
A patient is diagnosed with Alzheimer's disease. The nurse should anticipate administering which of the following medications? A) Bethanechol (Urecholine) B) Neostigmine (Prostigmin) C) Donepezil (Aricept) D) Physostigmine salicylate (Antilirium)
Ans: C Feedback: Donepezil (Aricept) is used to treat mild to moderate Alzheimer's disease. Bethanechol (Urecholine) produces smooth muscle contractions and is not used to treat Alzheimer's disease. Neostigmine (Prostigmin) is not used to treat Alzheimer's disease; it is used to treat myasthenia gravis. Physostigmine is not used to treat Alzheimer's disease; it is an antidote for overdose of anticholinergic drugs.
A 40-year-old woman has received a diagnosis of myasthenia gravis (MG) and is scheduled to begin treatment with oral neostigmine in her home. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on A) matching each dose of neostigmine to the severity of symptoms at that time. B) making lifestyle modifications to prioritize a healthy diet and regular activity. C) adhering strictly to the prescribed administration schedule. D) developing acceptance of the functional deficits that result from MG.
Ans: C Feedback: Strict adherence to timely medication administration promotes optimal blood levels of neostigmine and optimal symptom control. Doses are not typically matched to shortterm symptom severity, except in emergencies. Lifestyle modifications and acceptance may be of benefit, but pharmacologic therapy is of paramount importance in the treatment of MG.
An 80-year-old man has been diagnosed with early-stage Alzheimer's disease and has begun treatment with donepezil (Aricept). When providing health education to the patient and his wife, the nurse should identify what goal of treatment? A) Remission of Alzheimer's disease B) Cure of Alzheimer's disease C) Improvement of cognition and function D) Resolution of memory and cognitive deficits
Ans: C Feedback: The goal of drug therapy for Alzheimer's disease is to slow the loss of memory and cognition, thus preserving the independence of the individual person for as long as possible. Remission, cure, and resumption of preillness levels of memory and cognition are unrealistic goals.
Following recent changes in memory and personality, a 72-year-old man is undergoing neurological testing to rule out Alzheimer's disease. The nurse is aware that this disease is characterized by what pathophysiological phenomena? Select all that apply. A) Meningiomas B) Neuritic plaques C) Neurofibrillary tangles D) Arteriovenous malformations (AVMs) E) Gliomas
Ans: C, D Feedback: The neuropathologic hallmarks of Alzheimer's disease are neuritic plaques and neurofibrillary tangles. Gliomas, meningiomas, and AVMs are not associated with Alzheimer's disease.
Which of the following medications is administered for ingestion of clitocybe mushrooms? A) Pyridostigmine (Mestinon) B) Donepezil (Aricept) C) Rivastigmine (Exelon) D) Atropine sulfate
Ans: D Feedback: Atropine sulfate is the specific antidote for mushroom poisoning. Pyridostigmine, donepezil, and rivastigmine are all cholinergic agents that would contribute to the symptoms of toxicity.
A middle-aged female patient has been admitted to the outpatient treatment unit of the hospital for an edrophonium (Tensilon) test. Shortly after the administration of the medication, the patient reports that her muscle strength is significantly weaker than before the test. The nurse who is participating in the test should recognize that this finding is suggestive of what diagnosis? A) Alzheimer's disease B) Anticholinergic crisis C) Myasthenia gravis D) Cholinergic crisis
Ans: D Feedback: If the edrophonium test makes the patient even weaker, the diagnosis is cholinergic crisis.
An older adult patient with a diagnosis of moderate Alzheimer's disease will soon return home with her husband. How can the nurse best facilitate the safe and effective administration of donepezil in the home setting? A) Have the patient explain the rationale for drug therapy repeatedly before discharge. B) Provide a detailed drug monograph to the patient and her husband and offer to answer any questions. C) Assess the patient's need for home care. D) Teach the patient's husband to administer the medication in a timely and safe manner.
Ans: D Feedback: It is important for the home care nurse to work with responsible family members in such cases to ensure accurate drug administration. Assessing the family's need for home care may be warranted, but this action does not necessarily ensure safe drug administration. The presence of moderate Alzheimer's disease may preclude effective patient teaching. Written teaching materials must normally be supplemented by other forms of teaching.
When administering anticholinesterase drugs, what assessment finding would indicate the patient is experiencing a toxic effect of the medication? A) Loss of consciousness B) Abdominal distention C) Hypertension D) Muscle weakness
Ans: D Feedback: The administration of anticholinesterase medications can result in profound muscle weakness. Decreased LOC, abdominal distention, and hypertension are not characteristic adverse effects of the anticholinesterase medications.
