Myasthenia Gravis

A client is diagnosed with myasthenia gravis. Which response does the nurse expect the client to demonstrate? A. Partial improvement of muscle strength with mild exercise B. Fluctuating weakness of muscles innervated by the cranial nerves C. Little or no change of muscle strength regardless of therapy initiated D. Dramatic worsening of muscle strength with anticholinesterase drugs

B. Muscle use reduces strength, and rest increases strength; eyelid movement, chewing, swallowing, speech, facial expression, and breathing often are affected. Muscle strength increases with rest and decreases with activity. Anticholinesterase drugs improve muscle strength. Anticholinesterase drugs increase, not decrease, muscle strength.

A client with myasthenia gravis experiences generalized weakness. What is most important when planning this client's nursing care? A. Maintain bed rest B. Provide frequent rest periods C. Reassure the client that there are many tasks that still can be performed D. Arrange for a relative to be present

B. Spacing activities encourages maximum functioning within the limits of the client's strength and fatigue. Bed rest and limited activity may lead to muscle atrophy and calcium depletion and should be avoided. Although pointing out things the client can do is important, this does not address the client's concerns. Arranging for a relative to be present is unnecessary if the client is observed closely by the nursing staff; however, it should be permitted if requested by the client or family.

A client is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. The nurse explains to the client that the diagnosis of myasthenia gravis is confirmed if the administration of Tensilon produces which reponse? A. Brief exaggeration of symptoms B. Prolonged symptomatic improvement C. Rapid but brief symptomatic improvement D. Symptomatic improvement of only the ptosis

C. Tensilon acts systemically to increase muscle strength; it lasts several minutes. Tensilon produces a brief increase in symptoms. Tensilon may intensify muscle weakness in a cholinergic crisis. Tensilon does not cause lasting effects. Tensilon acts systemically on all muscles, rather than selectively on the eyelids.

A HCP prescribes a diagnostic workup for a client who may have myasthenia gravis. What is the initial nursing objective for the client during the diagnostic phase? A. "The client will adhere to the teaching plan." B. "The client will achieve psychologic adjustment." C. "The client will maintain present muscle strength." D. "The client will prepare for a possible myasthenic crisis."

C. Until the diagnosis has been confirmed, the primary goal should be to maintain appropriate activity and prevent muscle atrophy. It is too early to develop a teaching plan; the diagnosis has not yet been established. The response "achieve psychologic adjustment" is too early; the client cannot adjust if a diagnosis has not yet been confirmed. The response "prepare for a possible myasthenic crisis" is an intervention, not an objective.