Myasthenia Gravis

In MG, the nurse knows that there is a decrease in the number of receptor sites of which neurotransmitter? A. Acetylcholine B. Epinephrine C. Norepinephrine D. Dopamine

A. Acetylcholine

Progressive weakness in a client diagnosed with MG is related to which component of the disease process? A. Spasticity of skeletal muscles which may cause immediate paralysis B. Myelin sheath destruction by the immune system causing paralysis C. Defect in the transmission of nerve impulses to the skeletal muscles D. Involuntary twitching of small facial muscle groups causing paralysis

C. Defect in the transmission of nerve impulses to the skeletal muscles

Which statement by the female client diagnosed with myasthenia gravis indicates the client needs more discharge teaching? 1. "I will not have any menstrual cycles because of this disease." 2. "I should avoid people who have respiratory infections." 3. "I should not take a hot bath or swim in cold water." 4. "I will drink at least 2,500 mL of water a day."

1. "I will not have any menstrual cycles because of this disease." 1. MG has no effect on the ovarian function and the uterus is an involuntary muscle, not a skeletal muscle, so the menstrual cycle is not affected. 2. Infections can result in an exacerbation and extreme weakness. 3. An extremely hot or cold environment may cause an exacerbation of MG. 4. This will help the client mobilize and expectorate sputum.

The client with myasthenia gravis is prescribed the cholinesterase inhibitor neostigmine (Prostigmin). Which data indicate the medication is effective? 1. The client is able to feed self independently. 2. The client is able to blink the eyes without tearing. 3. The client denies any nausea or vomiting when eating. 4. The client denies any pain when performing ROM exercises.

1. The client is able to feed self independently. 1. This medication promotes muscle contraction, which improves muscle strength, which, in turn, allows the client to perform ADLs without assistance. 2. This medication does not affect secretions of the eye. 3. This medication does not help with the digestion of food. 4. This medication does not help with pain; clients with MG do not have muscle pain.

The client with myasthenia gravis is undergoing plasmapheresis at the bedside. Which assessment data warrant immediate intervention? 1. The client's BP is 94/60 and AP is 112. 2. Negative Chvostek's and Trousseau's signs. 3. The serum potassium level is 3.5 mEq/L. 4. Ecchymosis at the vascular site access.

1. The client's BP is 94/60 and AP is 112. 1. Hypovolemia is a complication of plasmapheresis, especially during the procedure, when up to 15% of the blood volume is in the cell separator. 2. Positive Chvostek's and Trousseau's signs (not negative signs) warrant intervention and indicate hypocalcemia, which is a complication of plasmapheresis. 3. This is a normal serum potassium level (3.5 to 5.5 mEq/L), which does not warrant intervention, but the level should be monitored because plasmapheresis could cause hypokalemia. 4. Ecchymosis (bruising) does not warrant immediate intervention. Signs of infiltration or infection warrant immediate intervention.

Which ocular or facial signs/symptoms should the nurse expect to assess for the client diagnosed with myasthenia gravis? 1. Weakness and fatigue. 2. Ptosis and diplopia. 3. Breathlessness and dyspnea. 4. Weight loss and dehydration.

2. Ptosis and diplopia. 1. These are musculoskeletal manifestations of myasthenia gravis. 2. These are ocular signs/symptoms of MG. Ptosis is drooping of the eyelid, and diplopia is unilateral or bilateral blurred vision. 3. These are respiratory manifestations of myasthenia gravis. 4. These are nutritional manifestations of myasthenia gravis.

Which surgical procedure should the nurse anticipate the client with myasthenia gravis undergoing to help prevent the signs/symptoms of the disease process? 1. There is no surgical option. 2. A transsphenoidal hypophysectomy. 3. A thymectomy. 4. An adrenalectomy.

3. A thymectomy. 1. There is a surgical option available. 2. This surgery is performed in clients with pituitary tumors and is accomplished by going through the client's upper lip though the nasal passage. 3. In about 75% of clients with MG, the thymus gland (which is usually inactive after puberty) continues to produce antibodies, triggering an autoimmune response in MG. After a thymectomy, the production of autoantibodies is reduced or eliminated, and this may resolve the signs/symptoms of MG. 4. An adrenalectomy is the surgery for a client diagnosed with Cushing's disease, a disease in which there is an increased secretion of glucocorticoids and mineralocorticoids.

The wife of a client diagnosed with myasthenia gravis is crying and shares with the nurse she just doesn't know what to do. Which response is the best action by the nurse? 1. Discuss the Myasthenia Foundation with the client's wife. 2. Refer the client to a local myasthenia gravis support group. 3. Ask the client's wife if she would like to talk to a counselor. 4. Sit down and allow the wife to ventilate her feelings to the nurse.

4. Sit down and allow the wife to ventilate her feelings to the nurse. 1. This is an appropriate action by the nurse, but it is not the best action. 2. Support groups are helpful to the client's significant others, but in this situation, it is not the best action for the nurse. 3. A counselor is an appropriate intervention, but it is not the best action. 4. Directly addressing the wife's feelings is the best action for the nurse in this situation. All the other options can be done, but the best action is to address the wife's feelings.

Which collaborative health-care team member should the nurse refer the client to in the late stages of myasthenia gravis? 1. Occupational therapist. 2. Recreational therapist. 3. Vocational therapist. 4. Speech therapist.

4. Speech therapist. 1. The occupational therapist assists the client with ADLs, but with MG the client has no problems with performing them if the client takes the medication correctly (30 minutes prior to performing ADLs). 2. A recreational therapist is usually in a psychiatric unit or rehabilitation unit. 3. A vocational therapist or counselor helps with the client finding a job which accommodates the disease process; clients with MG are usually not able to work in the late stages. 4. Speech therapists address swallowing problems, and clients with MG are dysphagic and at risk for aspiration. The speech therapist can help match food consistency to the client's ability to swallow, which enhances client safety.

The client diagnosed with myasthenia gravis is admitted to the emergency department with a sudden exacerbation of motor weakness. Which assessment data indicate the client is experiencing a cholinergic crisis? 1. The serum assay of circulating acetylcholine receptor antibodies is increased. 2. The client's symptoms improve when administering a cholinesterase inhibitor. 3. The client's blood pressure, pulse, and respirations improve after IV fluid. 4. The Tensilon test does not show improvement in the client's muscle strength.

4. The Tensilon test does not show improvement in the client's muscle strength. 1. This is a diagnostic test done to diagnose MG. 2. These assessment data indicate the client is experiencing a myasthenic crisis, which is the result of undermedication, missed doses of medication, or the development of an infection. 3. The vital signs do not indicate if the client is experiencing a cholinergic crisis. 4. The injection of edrophonium chloride (Tensilon test) not only diagnoses MG but helps to determine which type of crisis the client is experiencing. In a myasthenic crisis, the test is positive (the client's muscle strength improves), but in cholinergic crisis, the test is negative (there is no improvement in muscle strength), or the client will actually get worse and emergency equipment must be available.

The client is being evaluated to rule out myasthenia gravis and being administered the Tensilon (edrophonium chloride) test. Which response to the test indicates the client has myasthenia gravis? 1. The client has no apparent change in the assessment data. 2. There is increased amplitude of electrical stimulation in the muscle. 3. The circulating acetylcholine receptor antibodies are decreased. 4. The client shows a marked improvement of muscle strength.

4. The client shows a marked improvement of muscle strength. 1. No change in the client's muscles strength indicates it is not MG. 2. There is reduced amplitude in an electromyogram (EMG) in a client with MG. 3. The serum assay of circulating acetylcholine receptor antibodies is increased, not decreased, in MG, and this test is only 80% to 90% accurate in diagnosing MG. 4. Clients with MG show a significant improvement of muscle strength lasting approximately five (5) minutes when Tensilon (edrophonium chloride) is injected.

A nurse is teaching a client who was recently diagnosed with MG. Which statement should the nurse include in her teaching? A. "You'll continue to experience progressive muscle weakness and sensory deficits" B. "You'll need to take tension to treat the disease" C. "The disease is a disorder of motor and sensory dysfunction" D. "This disease doesn't cause sensory impairment"

D. "This disease doesn't cause sensory impairment"

During lunch, a bedridden client with MG experiences increased dysphagia. What nursing action is the priority? A. Call the physician for a change in diet B. Administer oxygen at 2 LPM C. Gather oral equipment stat D. Raise the HOB immediately

D. Raise the HOB immediately

A nurse is caring for a client admitted with a diagnosis of exacerbation of MG. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis

The client is diagnosed with myasthenia gravis. Which intervention should the nurse implement when administering the anticholinesterase pyridostigmine (Mestinon)? 1. Administer the medication 30 minutes prior to meals. 2. Instruct the client to take with eight (8) ounces of water. 3. Explain the importance of sitting up for one (1) hour after taking medication. 4. Assess the client's blood pressure prior to administering medication.

1. Administer the medication 30 minutes prior to meals. 1. This medication will increase muscle strength to help enhance swallowing and chewing during meals. 2. There is no need for the client to take this medication with eight (8) ounces of water. 3. The client does not have to sit up after taking this medication. 4. These assessment data would not cause the nurse to question administering this medication.

The client diagnosed with myasthenia gravis is admitted with an acute exacerbation. Which interventions should the nurse implement? Select all that apply. 1. Assist the client to turn and cough every two (2) hours. 2. Place the client in a high or semi-Fowler's position. 3. Assess the client's pulse oximeter reading every shift. 4. Plan meals to promote medication effectiveness. 5. Monitor the client's serum anticholinesterase levels.

1. Assist the client to turn and cough every two (2) hours. 2. Place the client in a high or semi-Fowler's position. 4. Plan meals to promote medication effectiveness. 1. Position changes promote lung expansion, and coughing helps clear secretions from the tracheobronchial tree. 2. This position expands the lungs and alleviates pressure from the diaphragm. 3. The respiratory system and pulse oximeter reading should be assessed more frequently than every shift; it should be done every four (4) hours or more often. 4. The medications should be administered 30 minutes before the meal to provide optimal muscle strength for swallowing and chewing. 5. There is no serum level available for medications used to treat MG; the client's signs/symptoms are used to determine the effectiveness of this medication.

The client diagnosed with myasthenia gravis is being discharged home. Which intervention has priority when teaching the client's significant others? 1. Discuss ways to help prevent choking episodes. 2. Explain how to care for a client on a ventilator. 3. Teach how to perform passive range-of-motion exercises. 4. Demonstrate how to care for the client's feeding tube.

1. Discuss ways to help prevent choking episodes. 1. The client is at risk for choking; knowing specific measures to help the client helps decrease the client's, as well as the significant other's, anxiety and promotes confidence in managing potential complications. 2. Clients diagnosed with MG may end up on a ventilator at the end stage of the disease, but these clients would not be cared for at home; this would be a very unusual situation. 3. The client should be encouraged to perform active range-of-motion exercises, but the most important intervention is treating choking episodes. 4. The client with MG doesn't necessarily have a feeding tube, and this information is not in the stem.