extra

During shift report the nurse learns that a patient with MG deteriorated toward the end of the shift and the physician was called. A tensilon test indicated that the patient was having a myasthenic crisis, what is the priority problem for this patient

Potential for inadequate oxygenation

A nurse is caring for a client with the diagnosis of Guillain-Barré syndrome. The nurse identifies that the client is having difficulty expectorating respiratory secretions. What should be the nurses first intervention?

Suction the clients oropharynx

The nurse is assessing a patient with a diagnosis of Guillain-Barré syndrome, which signs and symptoms are consistent with GBS

Sudden onset of weakness in the legs, decreased deep tendon reflexes, ataxia

The nurse is performing patient teachign about plasmapheresis, which statement by the patient indicates understanding of the material

The goal of the treatment is to decrease symptoms, but it is not a cure

A client is admitted to the hospital for myasthenia gravis, for which common early clinical finding should the nurse assess the client

diplopia (double vision)

A patient reports increased fatigue and stiffness of the extremities. These symptoms have occurred in the past but resolved and no medical attention was sought, which questions does the nurse ask to assess whether the symptoms may be associated with multiple sclerosis

Do you have persistent sensitivity to cold, do you ever have slurred speech or trouble swallowing, has anyone in your family been diagnosed with MS

What does the nurse understand that clients with myasthenia gravis, Guillain-Barré syndrome and amyotrophic lateral sclerosis share in common?

Increased risk for respiratory complications

To what does the nurse contribute the increased risk of respiratory complications in clients with myasthenia gravis?

Ineffective coughing

What is the priority expected outcome in a patient with GBS

Maintain airway patency and gas exchange

The nurse is reviewing medication orders for a patient with MG, which order does the nurse question

PRN order for milk of magnesia

A patient with MG has been referred to a surgeon for a procedure that may improve the patients symptoms. Which procedure does the nurse anticipate will be recommended for this patient

Thymectomy

A client with myasthenia gravis experiences dysphagia, what is the priority risk associated with dysphagia that must be considered when planning nursing care?

aspiration

An ambulatory female client with relapsing remitting multiple sclerosis is to receive every other day injections of interferon beta 1a. What adverse effects should the nurse explain may occur when taking this medication

depression, constipation, flulike symptoms, increased heart rate

A patient with MG is having difficulty maintaining an adequate intake of food and fluid because of difficulty chewing and swallowing. Which task for this patient is best to delegate to unlicensed assistive personnel

Weigh patient daily

The nurse is reviewing the cerebral spinal fluid results for a patient with probably GBS, which abnormal finding is common in GBS

Increase in CSF protein level

Which client should be assigned to the traveling nurse, new to neurologic nursing care, who has been on the neuro unit for 1 week

A 68 year old with chronic ALC

A client with myasthenia gravis asks the nurse why the disease has occured, what pathology underlies the nurses reply?

A decreased number of functioning acetylcholine receptor sites

A client with myasthenia gravis has been receiving neostigmine and asks about its actions, what information about its action should the nurse consider when formulating a response

Blocks the action of cholinesterase

A patient with GBS has been intubated for the respiratory failure, the nurse must suction the patient, in assessing for risk of vagal nerve stimulation, what does the nurse closely monitor the patient for

Bradycardia

During shift report the nurse hears that a patient with GBS has a decreased vital capacity that is less than 2/3 of normal and there is a progressive inability to clear and cough up secretions. The physician has been notified and is coming to evaluate the patient, what intervention is the nurse prepared to implement for this patient

Elective intubation

A patient with MS is prescribed oral prednisone 60 mg daily for 7 days following a course of IV methylprednisone, which lab abnormality is a side effect of the medication

Decrease in serum potassium

A patient with MG experienced a cholinergic crisis and is currently being maintained on a ventilator, the patient received several 1 mg doses of atropine, what does the nurse closely monitor this patient for

Development of mucus plugs

Which clinical finding does the nurse anticipate a client with an exacerbation of multiple sclerosis to experience?

Double vision and scanning speech

A patient is admitted for a probably diagnosis of GBS but needs additional diagnostic testing for confirmation, which test does the nurse anticipate will be ordered for this patient

Electrophysiologic studies (EPS), EMG

Which interventions are appropriate to protect a patient with MG from corneal abrasions

Administer artificial tears to keep corneas moist

A patient with GBS is receiving IV immunoglobulin, the nurse monitors for which major potential complications of this drug therapy

Anaphylaxis

The patient with GBS describes a chronological progression of motor weakness that started in the legs and then spread to the arms and the upper body, which type of GBS do these symptoms indicate

Ascending

The LPN whom you are supervising comes to you and says she gave a client with myasthenia gravis 90 mg of neostigmine instead of 45 mg in which order would you provide the follwing tasks

Assess the patient, notify the physician of the incorrect medication, ask the LPN to explain how an error occurred, complete the medication error report

Following a thymectomy, what postoperation care does the nurse provide for a patient with MG

Assist the patient to turn cough and deep breathe every 2 hours, assess for chest pain, dyspnea hypotension, assess for diminished or absent breath sounds

A client with myasthenia gravis asks the nurse what is going to happen to me and my family? What information about what the client can anticipate should be incorporated into the nurses response?

Chronic illness with exacerbation and remissions

The nurse explains to the family of a client suspected of having myasthenia gravis that edrophonium is used to establish the diagnosis. An increase in which factor will confirm diagnosis

Muscle strength

The patient with GBS is in the plateau period. Which intervention is best for the nurse to delegate to the nursing assistant

Perform passive range of motion every 2-4 hours

Which strategies should be incorporated in the plan of care to provide emotional support for a patient with GBS who has ascending paralysis

Encourage the patient to verbalize feelings, teach the patient and family about the condition, explain all procedures and tasks, assess previous coping skills

A patient is receiving cholinesterase inhibitor drug for the treatment of MG, what is a nursing implication for the safe administration of this medication

Feed meals 45-60 minutes after administration

A patient has been newly diagnosed with GBS, the nurse is teaching the patient and family about the condition, which statement by the family indicates a need for additional teaching

He will never be able to walk again

Which statement by a client with multiple sclerosis indicates to the nurse that the client needs further teaching?

I will take a hot bath to help relax my muscles

Which interventions are appropriate for pain management in an older adult with GBS

IV opiates, gabapentin, massage, music therapy

A patient with MG is experiencing impaired communication related to weakness of the facial muscles, which interventions are best in assisting the patient to communicate with the family and staff

Instruct the patient to speak slowly, ask yes or no questions, have the patient use a picture, letter or word board.

Which statements about MG are accurate

It is an acquired autoimmune disease, it occurs equally in men and women, there is a small familial incidence, it is characterized by remission and exacerbations

The patient is a woman in her early 30s who has recently been diagnosed with multiple sclerosis. The nurse has taught the patients husband about the course of the illness and what problems might occur in the future, which statement by the husband indicates the need for additional teaching

Later on she could have intermittent short term memory loss

What nursing intervention is anticipated for a client with Guillain-Barré syndrome?

Maintaining ventilator settings to support respiration

A patient with a thymoma had surgery too relieve symptoms of MG, a single chest tube has been inserted into the patients anterior mediastinum. The nurse notes that the patient is restless with diminished breath sounds and decreased chest wall expansion. What is the nurses priority action

Provide oxygen and elevate the head of the bed

The nurse is assessing a patient with myasthenia gravis, which manifestation can the nurse expect to observe

Ptosis, diploia, incomplete eye closure

A nurse enters the room of a client with myasthenia gravis and identifies the client is experiencing increased dysphagia, what should the nurse do first?

Raise the head of the bed

The nurse is reviewing the admission and history notes for a patient admitted for GBS. Which medical condition is most likely to be presented before the onset of GBS

Recent GI illness

What factors are associated with development of GBS

Recent immunization, systemic lupus erythematosus, acute illness, trauma

What is the most common electrodiagnostic test performed to detect MG

Repetitive nerve stimulation (RNS)

The patient is scheduled to receive immunoglobulin therapy, before administering the medication, the nurse ensures that which laboratory test has been completed

Serum IgA

What early symptoms does the nurse expect to observe in a 50 year old patient recently diagnosed with ALS

Tongue atrophy and dysphagia

What is the cause of a cholinergic crisis

Too many anticholinergic drugs

The nurse is performing teaching for the family of a patient with MG about fatigue and activities of daily living, which statement by a family member indicates a need for additional teaching

We should do hygenic care for her to avoid undue frustration and fatigue

An ambulatory patient has sought treatment for symptoms of GBS within two weeks of symptom onset, which drug therapy is likely preferred for this patient

immunoglobulin

A patient with GBS is identified as having poor dietary intake secondary to dysphagia, a feeding tube is prescribed, how does the nurse monitor the patients nutritional status

weighing the patient 3 times a week, monitoring weekly serum prealbumin level

The nurse is monitoring a patient with GBS undergoing plasmapheresis, the patient reports dizziness and has a heart rate that has dropped to 48 beats per minute, the nurse identifies the primary care provider, which order does the nurse anticipate

atropine IV push

A client with Guillain-Barré syndrome has been hospitalized for 3 days, which assessment finding indicates a need for more frequent monitoring?

Ascending weakness

The nurse is teaching the patient and family about factors that predispose the patient to episodes of exacerbation of MG, which factors does the nurse mention

infection, stress, enemas, strong cathartics-p

The patient and family are referred to the nurse for education about amyotrophic lateral sclerosis, what information does the nurse include in the educational session

its a progressive disease involving the motor system, the cause of ALS is unknown, there is no cure for ALS

The nursing assistant reports to you that a client with myasthenia gravis has an elevated temp 102.2, increased heart rate 120, and rise in BP 158/94, what is your best first action

notify the physician immediately

A client with MS tells the nursing assistant after physical therapy that she is too tired to take a bath, what is the priority nursing diagnosis at this time

self care deficit related to fatigue and neuromuscular weakness

The nurse is caring for a patient receiving anticholinesterase drugs for MG, which symptoms does the nurse immediately report to the physician

Dyspnea and difficulty swallowing

A client with myasthenia gravis continues to become weaker despite treatment with neiostigmine. What reason should the nurse identify for the health care providers prescription for edrophonium

Rule out cholinergic crisis

A nurse is caring for a client in the home who has diagnosis of amyotrophic lateral sclerosis (ALS). Which position should the nurse recommend that the client assume after eating?

Semi-fowlers

An LPN under your supervision is providing nursing care for a client with GBS, what observation should you instruct the LPN to report immediately?

Shallow respirations and decreased breath sounds

A recently hospitalized client with multiple sclerosis is concerned about generalized weakness and fluctuating physical status. What is the priority nursing intervention for this client?

Space activities throughout the day

A home care nurse is counseling a client with ALS, what information should the nurse include in the discussion?

Space activities throughout the day, Anticipate the use of alternative ways to communicate

What test is used to differentiate a cholinergic crisis from a myasthenic crisis

Tensilon testing