Myasthenia Gravis

Which is a motor symptom of myasthenia gravis? A. Fatigue B. Paresthesias C. Muscle achiness D. Decreased sense of smell and taste

ANS: 1 Fatigue is a motor manifestation of myasthenia gravis. Paresthesias, muscle achiness, and decreased sense of smell and taste are sensory symptoms of myasthenia gravis

What surgical intervention does the nurse expect to be included in long term management for symptoms of MG? A. Thyroidectomy B. Thymectomy C. Pineal gland removal D. Anterior pituitary removal

ANS: 2 For patient with MG, thymectomy is usually performed early in the course of the disease.

A patient arrives to the emergency department with new onset ptosis, diplopia, and dysphagia. The nurse anticipates that the patient will be tested for which neurological disease? A. Bell's palsy B. Trigeminal neuralgia C. Myasthenia gravis (MG) D. Guillian-Barre' syndrome (GBS)

ANS: 3 Myasthenia graves (MG)

The nurse is reviewing the medication history of a patient diagnosed with MG who has been prescribed a cholinesterase inhibitor (ChE). The nurse should contact the health care provider if the patient is taking which medication? A. Ibuprofen B. Furosemide C. Procainamide D. Acetaminophem

ANS: 3 Procainamide should be avoided because it may increase the patient's weakness. Ibuprofen is a non steroidal analgesic and does not interact with ChE inhibitors. Acetaminophen does not interact with ChE inhibitors. Furosemide is a diuretic and does not interact with ChE inhibitors.

In caring for a patient with MG, the nurse should keep which item by the bedside? A. Ambu bag B. Tongue depressor C. Automatic external defibrillator (AED) D. Prefilled syringe of calcium gluconate

ANS: A Because of the respiratory complications associated with MG, the nurse should keep an ambulance bag by the bedside. Nurses should never place anything in the patient's mouth. The profiled syringe of calcium gluconate is typically for the postoperative thyroidectomy patient at risk for removal of the parathyroid and calcium loss. The AED should always be available, but it does not need to be at the bedside since the majority of complications are due to respiratory depression.

Which drug can be used to differentiate whether a patient is experiencing a myasthenic crisis as opposed to a cholinergic crisis? A. Tensilon B. Epinephrine C. Atropine sulfate D. Dexamethasone

ANS: A Cholinesterase inhibitors, edrophonium chloride, and neostigmine bromide, or Tensilon (used in Tensilon testing), may be used to help determine whether increasing weakness in the previously diagnosed myasthenic patient is due to a cholinergic crisis (too much cholinesterase inhibitor drugs) or a myasthenic crisis (too little cholinesterase inhibitor drugs). Tensilon produces a temporary improvement in myasthenic crisis, but worsening or no improvement of symptoms in cholinergic crisis. Atropine sulfate is used to treat cholinergic crisis. Epinephrine and dexamethasone will not aid in the diagnosis and are not indicated at this time.

5. A client is taking long-term corticosteroids for myasthenia gravis. What teaching is most important? a. Avoid large crowds and people who are ill. b. Check blood sugars four times a day. c. Use two forms of contraception. d. Wear properly fitting socks and shoes. lmfaoooo

ANS: A Corticosteroids reduce immune function, so clients taking these medications must avoid being exposed to illness. Long-term use can lead to secondary diabetes, but the client would not need to start checking blood glucose unless diabetes had been detected. Corticosteroids do not affect the effectiveness of contraception. Wearing well-fitting shoes would be important to avoid injury, but not just because the client takes corticosteroids.

When caring for a patient with myasthenia gravis, the nurse notices the patient's eyelids are drooping. What term best describes this phenomenon? A. Ptosis B. Diplopia C. Thymoma D. Dysphagia

ANS: A Drooping eyelids is also called ptosis. Diplopia is the term for double vision. Dysphagia refers to difficulty in chewing or swallowing. A thymoma is an encapsulated thymus gland tumor.

A patient is being treated for myasthenia gravis with bulbar involvement with a cholinesterase (ChE) inhibitor. The nurse instructs the patient to eat at least 45 minutes after the drug is given. What complication is the nurse helping to prevent? A. Aspiration B. Pneumonia C. Bowel obstruction D. Respiratory distress

ANS: A For a patient with bulbar involvement with myasthenia gravis, it is important to educate the patient to eat at least 45 minutes after ChE inhibitor administration to prevent aspiration. Instructing the patient to eat at least 45 minutes after ChE inhibitor administration will not prevent pneumonia, bowel obstruction, or respiratory distress.

13. A client with myasthenia gravis (MG) asks the nurse to explain the disease. What response by the nurse is best? a. "MG is an autoimmune problem in which nerves do not cause muscles to contract." b. "MG is an inherited destruction of peripheral nerve endings and junctions." c. "MG consists of trauma-induced paralysis of specific cranial nerves." d. "MG is a viral infection of the dorsal root of sensory nerve fibers."

ANS: A MG is an autoimmune disorder in which nerve fibers are damaged and their impulses do not lead to muscle contraction. MG is not an inherited or viral disorder and does not paralyze specific cranial nerves. DIF: Understanding/Comprehe

A nurse administers endrophonium chloride (Tensilon) to a patient with myasthenia gravis to help determine definitive treatment for the patient. What finding indicates to the nurse that the patient is experiencing a cholinergic crisis? A. Muscle twitching B. Cardiac dysrhythmia C. Improved muscle tone D. Decreased muscle weakness

ANS: A Muscle twitching, or fasciculations, may be seen around the eyes and face in a patient experiencing a cholinergic crisis after endrophonium chloride (Tensilon) administration. Cardiac dysrhythmias are a reaction caused by endrophonium chloride (Tensilon). Improved muscle tone occurs in a myasthenic crisis after giving endrophonium chloride (Tensilon). Decreased muscle weakness occurs in a myasthenic crisis after giving endrophonium chloride (Tensilon).

A patient takes pyridostigmine for treatment of myasthenia gravis (MG). During a follow-up visit, the nurse finds that the patient has an increased pulse, respiratory rate, and blood pressure. The patient reports decreased urine output and an inability to cough properly. The nurse anticipates that which test will be performed? A. Tensilon testing B. Electromyography C. Thyroid function test D. Acetylcholine receptor antibody test

ANS: A Patients treated with pyridostigmine are at risk for cholinergic crisis as well as myasthenic crisis. These two conditions may be difficult to differentiate; therefore, a tensilon test may be performed. Upon injecting tensilon intravenously, symptoms of myasthenic crisis would improve temporarily, but the symptoms of cholinergic crisis may worsen or remain unaffected. Electromyography is used to confirm the diagnosis of MG. A thyroid function test is performed to determine the role of thyroid dysfunction in MG. An acetylcholine receptor antibody test is used to confirm the diagnosis of MG.

A patient with myasthenia gravis (MG) has been hospitalized after a myasthenic crisis. Once the patient is free from respiratory symptoms, which diet does the nurse anticipate the provider to order for this patient? A. Soft B. Regular C. Full liquid D. Clear liquid

ANS: A Patients with MG have difficulty chewing and swallowing; the patient will do best with a soft diet. There is no need for a clear liquid diet to be ordered for this patient. Liquid diets increase the risk for aspiration. Regular diets are difficult for patients with MG to chew.

1. A client with myasthenia gravis is prescribed pyridostigmine (Mestinon). What teaching should the nurse plan regarding this medication? (Select all that apply.) a. "Do not eat a full meal for 45 minutes after taking the drug." b. "Seek immediate care if you develop trouble swallowing." c. "Take this drug on an empty stomach for best absorption." d. "The dose may change frequently depending on symptoms." e. "Your urine may turn a reddish-orange color while on this drug."

ANS: A, B, D Pyridostigmine should be given with a small amount of food to prevent GI upset, but the client should wait to eat a full meal due to the potential for aspiration. If difficulty with swallowing occurs, the client should seek immediate attention. The dose can change on a day-to-day basis depending on the client's manifestations. Taking the drug on an empty stomach is not related although the client needs to eat within 45 to 60 minutes afterwards. The client's urine will not turn reddish-orange while on this drug.

The nurse is preparing to discharge a patient with myasthenia gravis. What self-management activities should the nurse include in the discharge education to prevent exacerbations of myasthenia gravis? Select all that apply. A. Avoid heat. B. Use laxatives. C. Utilize enemas. D. Plan rest periods. E. Perform high-intensity exercise.

ANS: A,D The patient needs to be educated on self-management techniques to prevent exacerbations of myasthenia gravis, such as avoiding heat and planning rest periods with activity. Patients with myasthenia gravis should avoid using laxatives, utilizing enemas, and performing high-intensity exercise

The patient with a thymoma is at risk for which neurologic disease? A. Bell's palsy B. Myasthenia gravis C. Trigeminal neuralgia D. Guillain-Barré Syndrome

ANS: B Some patients with myasthenia gravis have a thymoma, and therefore they are assessed for this condition. There is no correlation with thymoma and Bell's palsy, trigeminal neuralgia, or GBS.

3. A client with myasthenia gravis is malnourished. What actions to improve nutrition may the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Assessing the client's gag reflex b. Cutting foods up into small bites c. Monitoring prealbumin levels d. Thickening liquids prior to drinking e. Weighing the client daily

ANS: B, D Cutting food up into smaller bites makes it easier for the client to chew and swallow. Thickened liquids help prevent aspiration. The UAP can weigh the client, but this does not help improve nutrition. The nurse assesses the gag reflex and monitors laboratory values.

The patient with myasthenia gravis is undergoing Tensilon testing. The nurse is alert for the possibility of which complication? A. Cholinergic crisis B. Respiratory failure C. Cardiac dysrhythmias D. Flash pulmonary edema

ANS: C Although rare, the Tensilon test can cause cardiac arrhythmias and cardiac arrest. Atropine sulfate should be available in case these complications occur. The Tensilon test is performed to determine if increasing weakness in the myasthenic patient is due to a cholinergic crisis or a myasthenic crisis. Respiratory failure and pulmonary edema are not known complications of Tensilon testing.

A nurse is caring for a patient with myasthenia gravis. What nursing intervention should be implemented to promote mobility and prevent fatigue in the patient? A. Teach the assisted-cough technique. B. Keep a bag-valve-mask setup at bedside. C. Assist the patient in planning periods of rest. D. Encourage the patient to eat high-calorie snacks.

ANS: C Assisting the patient in planning periods of rest is important to promote mobility in the patient with myasthenia gravis. The assisted-cough technique provides respiratory support to the patient with myasthenia gravis. Keeping a bag-valve-mask setup at bedside is a safety precaution in case of respiratory distress. Encouraging the patient to eat high-calorie snacks promotes adequate nutrition in the patient with myasthenia gravis.

The nurse is providing teaching to a patient diagnosed with myasthenia gravis (MG). Which statement by the patient indicates a correct understanding of the teaching? A. "I should consume a liquid diet which is high in protein and calories." B. "I should participate in strenuous exercise to maintain muscle strength." C. "I may need to tape my eyes shut at night to help prevent corneal abrasion." D. "I should apply a lubricant gel to my eyes during the day to prevent dryness."

ANS: C Patients with MG are at increased risk of corneal dryness and abrasion and should be taught techniques to prevent this. It may be necessary to tape the eyes shut at night to allow the eyelids to protect the eyes. Lubricant gel is used at night; other eye lubricants are used during the day. Liquid diets increase the risk of aspiration. Moderate exercise is recommended for patients with MG.

An older patient with myasthenia gravis (MG) is preparing for discharge home. Which aspect of long-term management is a priority for this patient? A. Pain and comfort B. Eye closure and ptosis C. Mobility and independence D. Speech and communication

ANS: C Patients with MG must learn adaptive skills to cope with the fatigue and weakness associated with the disorder. Eye closure and ptosis, pain and comfort, and speech and communication are also problems, but promoting mobility and independence addresses the overall issue.

11. A client is receiving plasmapheresis. What action by the nurse best prevents infection in this client? a. Giving antibiotics prior to treatments b. Monitoring the client's vital signs c. Performing appropriate hand hygiene d. Placing the client in protective isolation

ANS: C Plasmapheresis is an invasive procedure, and the nurse uses good hand hygiene before and after client contact to prevent infection. Antibiotics are not necessary. Monitoring vital signs does not prevent infection but could alert the nurse to its possibility. The client does not need isolation.

A patient with myasthenia gravis has just undergone a thymectomy. The nurse monitors the patient for which potential complication? A. Inability to void B. Decorticate posturing C. Trousseau's and Chvostek's signs D. Sudden onset of shortness of breath

ANS: D A thymectomy removes the thymus gland. The nurse should monitor a patient who is post-thymectomy for symptoms of pneumothorax or hemothorax, which include sudden shortness of breath, chest pain, and diminished breath sounds. Decorticate posturing occurs with elevated intracranial pressure, which is unlikely with thymectomy. Trousseau's and Chvostek's signs indicate low levels of calcium, which should not occur with thymectomy. Inability to void may occur secondary to surgical intervention, but it is not the priority and would not be a result of the thymectomy.

A patient is being evaluated for signs associated with myasthenic crisis or cholinergic crisis. Which symptoms lead the nurse to suspect that the patient is experiencing a cholinergic crisis? A. Bowel and bladder incontinence, pallor, cyanosis B. Increased pulse, anoxia, decreased urine output C. Restlessness, increased salivation and tearing, dyspnea D. Abdominal cramps, blurred vision, facial muscle twitching

ANS: D Abdominal cramps, blurred vision, and facial muscle twitching are signs of an acute exacerbation of muscle weakness symptoms of cholinergic crises caused by overmedication with cholinergic (anticholinesterase) drugs. Bowel and bladder incontinence, pallor, cyanosis, increased pulse, anoxia, and decreased urine output are symptoms indicating a myasthenic crisis. Restlessness, increased salivation and tearing, and dyspnea are symptoms indicating a mixed myasthenic-cholinergic crisis.

The nurse reviews a patient's medical record and notes a history of lung carcinoma and a medication history of pyridostigmine. The patient is experiencing weakness of the pelvis and shoulder. Which diagnosis does the nurse anticipate? A. Bell's palsy B. Restless leg syndrome C. Peripheral nerve trauma D. Eaton-Lambert syndrome

ANS: D Eaton-Lambert syndrome is a type of myasthenia gravis that occurs with lung carcinoma. The patient experiences weakness of the pelvic muscles and shoulder muscles. Pyridostigmine is a cholinesterase inhibitor prescribed for Eaton-Lambert syndrome. Corticosteroids and antiviral medications are useful in the treatment of Bell's palsy. Antiepileptics and dopamine agonists are prescribed for restless leg syndrome. The peripheral nerves are injured in a patient with peripheral nerve trauma, and this patient does not have a history of this.

The nurse admits a patient with suspected myasthenia gravis (MG). The nurse anticipates that the health care provider will request which medication to aid in the diagnosis of MG? A. Atropine B. Morphine sulfate C. Methylprednisolone D. Endrophonium chloride

ANS: D Endrophonium chloride and neostigmine bromide may be used for testing for MG. Tensilon is used most often because of its rapid onset and brief duration of action. This drug inhibits the breakdown of acetylcholine (ACh) at the postsynaptic membrane, which increases the availability of ACh for excitation of postsynaptic receptors.

The patient with myasthenia gravis experiencing a severe cholinergic crisis requires mechanical intubation. Which medication, if ordered by the provider, should the nurse question? A. Atropine B. Rituximab C. Methotrexate D. Pyridostigmine

ANS: D In cholinergic crisis, anticholinesterase drugs (pyridostigmine) are not given while the patient is on a ventilator because they increase respiratory secretions. Atropine is given to reverse the crisis. Immunosuppressants such as methotrexate and rituximab may be given to reduce the symptoms of crisis.

The nurse is educating the patient with myasthenia gravis (MG) about the importance of taking medications on time. The patient asks why this is so important. What is the nurse's best response? A. "It promotes absorption" B. "It will help you remember to take your medication" C. "It prevents medication side effects and complications" D. "It will help maintain blood levels and increase muscle strength"

ANS: D Patients with MG can maintain blood levels and increase muscle strength for activities such as eating when medications are taken on time.

6. A client with myasthenia gravis has the priority client problem of inadequate nutrition. What assessment finding indicates that the priority goal for this client problem has been met? a. Ability to chew and swallow without aspiration b. Eating 75% of meals and between-meal snacks c. Intake greater than output 3 days in a row d. Weight gain of 3 pounds in 1 month

ANS: D Weight gain is the best indicator that the client is receiving enough nutrition. Being able to chew and swallow is important for eating, but adequate nutrition can be accomplished through enteral means if needed. Swallowing without difficulty indicates an intact airway. Since the question does not indicate what the client's meals and snacks consist of, eating 75% may or may not be adequate. Intake and output refers to fluid balance.

A nurse is caring for a patient with myasthenia gravis, an acquired autoimmune disease characterized by muscle weakness. What symptoms exhibited by the patient indicate to the nurse that the patient is experiencing a myasthenic crisis? Select all that apply. A. Diarrhea B.Vomiting C.Bradycardia D. Increased respiration E. Decreased urine output

ANS: D, E Increased respiration and decreased urine output are characteristics of a myasthenic crisis. Diarrhea, vomiting, and bradycardia are characteristic of a cholinergic crisis.