Chapter 15: Cholinesterase Inhibitors and Their Use in Myasthenia Gravis
A nurse is teaching a group of nursing students about irreversible cholinesterase inhibitors. Which statement by a student indicates understanding of the teaching? A. "Diazepam is given to reverse inhibition of cholinesterase when overdose occurs." B. "Irreversible cholinesterase inhibitors are rapidly absorbed by all routes." C. "These agents are often used to treat glaucoma." D. "Toxic doses of these agents produce an anticholinergic crisis."
B
A nurse is helping a nursing student who is administering a medication to a patient with myasthenia gravis. Which statement by the student indicates the need for further teaching? A. "I will ask the patient to sip some water before giving the medication." B. "I will let the patient sleep after giving the medication, because rest is important." C. "I will record muscle strength assessments before and after I give the medication." D. "I will report excessive salivation to the patient's prescriber."
B
A patient who has myasthenia gravis will be taking neostigmine [Prostigmin]. What will the nurse emphasize when teaching this patient about the medication? A. "Stop taking the drug if you have diarrhea." B. "Take a supplementary dose before exercise." C. "Use atropine if you have excessive salivation." D. "Withhold the dose if ptosis occurs."
B
A patient with myasthenia gravis who is taking a cholinesterase inhibitor is being admitted to the intensive care unit and is on mechanical ventilation. The prescriber has ordered a challenge dose of edrophonium to distinguish between a myasthenic crisis and a medication overdose. The nurse will expect to do what? A. Administer neostigmine if muscle strength decreases. B. Be prepared to administer atropine and oxygen if muscle weakness increases. C. Give a second dose of edrophonium if no improvement is seen. D. Give pralidoxime [Protopam] if cholinergic symptoms worsen.
B
The nurse is teaching a patient who is newly diagnosed with myasthenia gravis about managing the disease. Which is important when teaching this patient about adverse effects of cholinesterase inhibitors? A. "There are very few serious side effects associated with your medication." B. "It is important to notify your provider if you have excessive saliva." C. "If you experience urinary urgency, you may need to increase your dose." D. "Excessive sweating is a minor side effect and will improve over time."
B
Two nurses are discussing the major differences between physostigmine [Antilirium] and neostigmine [Prostigmin]. One nurse correctly makes which statement about physostigmine [Antilirium]? A. "It is not effective for treating poisoning by muscarinic blocking drugs." B. "It can readily cross the blood-brain barrier." C. "It does not cause any side effects." D. "It can be given by all routes."
B
A nurse working in the emergency department is assigned to a child who is arriving by ambulance after being involved in a spill of organophosphate insecticides. What will the nurse expect to be the initial priority for treating this child? A. Administering diphenhydramine to control secretions B. Giving diazepam to control seizures C. Providing mechanical ventilation and oxygen D. Reporting the spill to the Environmental Protection Agency
C
A nurse is caring for a patient who has myasthenia gravis. The prescriber has ordered neostigmine [Prostigmin]. An important initial nursing action before administration of the medication includes assessing: A. the ability to raise the eyelids. B. level of fatigue. C. skeletal muscle strength. D. swallowing ability.
D
A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication will the nurse expect to administer? A. Donepezil [Aricept] B. Edrophonium [Reversol] C. Neostigmine [Prostigmin] D. Physostigmine
D