PNS/SNS EAQ #1
A client with myasthenia gravis has been receiving neostigmine and asks about its action. What information about its action should the nurse consider when formulating a response?
blocks the action of cholinesterase -Stimulates the cerebral cortexBlocks the action of cholinesteraseReplaces deficient neurotransmittersAccelerates transmission along neural sheaths
The healthcare provider prescribes neostigmine for a client with myasthenia gravis. The nurse evaluates that the client understands the teaching about this drug when the client makes what statement regarding drug management plans?
-Take the drug at the exact time that is listed on the prescription." Neostigmine should be taken as prescribed, usually before meals, to limit dysphagia and possible aspiration. Keeping neostigmine refrigerated is not necessary; it may be kept at room temperature. Neostigmine should be taken with milk to prevent gastrointestinal irritation; usually it is taken about 30 minutes before meals. The onset of the action of neostigmine occurs 45 to 75 minutes after administration; the duration of its action is 2.5 to 4 hours.
A client is admitted to the hospital with the diagnosis of Parkinson disease. What medication does the nurse expect the healthcare provider to prescribe to relieve the client's physiologic responses to this disease? 1. Carbidopa-levodopa 2 Isocarboxazid 3 Selegiline 4 Dopamine 5 Pyridoxine (vitamin B6)
1. Carbidopa-levodopa Levodopa crosses the blood-brain barrier and converts to dopamine, a substance depleted in Parkinson disease. Isocarboxazid is a monoamine oxidase inhibitor used for the treatment of psychological symptoms associated with severe depression, not physiologic symptoms of Parkinson disease. Dopamine is not given because it does not cross the blood-brain barrier. Pyridoxine can reverse the effects of some antiparkinsonian medications and is contraindicated.
A client residing in an assisted living facility is diagnosed with Parkinson disease, and the healthcare provider prescribes selegiline. What precaution will the nurse teach the client? 1. Change to a standing position slowly. 2 Take the medication between meals. 3 Perform self-blood glucose monitoring. 4 Withhold the next dose if nausea occurs.
1. Change to a standing position slowly A common side effect of selegiline is dizziness. Safety precautions are necessary to prevent falls caused by orthostatic hypotension. Taking the medication with food or milk limits gastrointestinal irritation. Monitoring blood glucose levels is not necessary. Nausea is a common side effect of selegiline; the medication should not be withheld without the healthcare provider's supervision. Abrupt withdrawal may precipitate a parkinsonian crisis.
Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse monitors the client for which side effects of the medication? Select all that apply. 1. vomiting 2. Anorexia 3. slow heart rate 4. changes in moods 5. peripheral edema
1. vomiting 2.anorexia 4. changes in mood Nausea and vomiting may occur; it reflects a central emetic reaction to levodopa. Anorexia may occur; decreased appetite results because of nausea and vomiting. Changes in affect, mood, and behavior are related to toxic effects of the drug. Tachycardia and palpitations, not bradycardia, occur. Peripheral edema is not a side effect of carbidopa-levodopa.
A client newly diagnosed with myasthenia gravis is to begin taking pyridostigmine, a cholinesterase inhibitor. Two days later the client develops loose stools and increased salivation. What conclusion does the nurse make about these new developments? 1Indicative of a myasthenic crisis 2Cholinergic effects 3A temporary response 4Toxic effects of the medication
2. Cholinergic effects Because this drug inhibits the destruction of acetylcholine, parasympathetic activity may be increased. The signs do not indicate a myasthenic crisis. Myasthenic crisis is characterized by difficulty breathing or speaking, morning headaches, feeling tired during the daytime, waking up frequently at night, not sleeping well, weak cough with increased secretions (mucus or saliva), an inability to clear secretions, a weak tongue, trouble swallowing or chewing, and weight loss. Side effects are not temporary; they continue as long as the drug is continued. The dosage may be adjusted or an anticholinergic given to limit side effects. Toxicity or cholinergic crisis is manifested by increased muscle weakness, including muscles of respiration.
A nurse is caring for a client who reports urinary problems, and the healthcare provider prescribes a cholinergic medication. Which urinary problem will this medication correct? 1. Urinary frequency due to bladder spasticity 2 Urinary retention due to bladder atony 3 Pain due to urinary tract calculi 4 Urinary urgency due to urinary tract infections
2. Urinary retention due to bladder atony (bladder flaccidity) Cholinergics intensify and prolong the action of acetylcholine, which increases tone in the genitourinary tract, preventing urinary retention. Anticholinergics are prescribed for frequency and urgency associated with a spastic bladder. Cholinergics will not prevent renal calculi. Urinary tract infections are a secondary gain because cholinergics help prevent urinary retention that can lead to urinary tract infection, but this is not the primary purpose for administering a cholinergic.
What should the nurse include when teaching a client with severe Parkinson disease about carbidopa-levodopa? 1.Multivitamins should be taken daily. 2.Alcohol consumption should be in moderation. 3.The medication should be taken with meals. 4.A high-protein diet should be followed.
3. The medication should be taken with meals Carbidopa-levodopa is often taken with meals to reduce the nausea and vomiting commonly associated with this drug. Although the best practice is to take carbidopa-levodopa on an empty stomach, this is often not feasible for many clients who suffer from gastrointestinal disturbances related to this medication. Multivitamins are contraindicated as they often contain pyridoxine (vitamin B6), which diminishes the effects of levodopa. Moderate alcohol consumption can also antagonize the drug effect. A high-protein diet is contraindicated because levodopa is an amino acid that may increase blood urea nitrogen (BUN) levels. Additionally, some proteins contain pyridoxine, which diminishes the desired therapeutic effect by increasing peripheral levodopa metabolism and reducing the amount of bioavailable levodopa crossing the blood-brain barrier.
A client who has been experiencing double vision, drooping of the eyelids, and fatigue visits the neurologic clinic. A diagnosis of myasthenia gravis is made, and the healthcare provider prescribes pyridostigmine. The nurse should teach the client that it is important to take this drug based on what schedule? 1 On an empty stomach 2One hour before meals 3According to muscle strength 4At the exact time intervals prescribed
4. At the exact time intervals prescribed Taking the medication as prescribed promotes an even therapeutic blood level, which maintains muscle strength. Because of drug-related nausea and gastric irritation, the drug should be taken with crackers or milk. Thirty, not 60, minutes before meals is recommended for maximum chewing and swallowing function. Taking the drug according to muscle strength is unsafe because it will not maintain constant therapeutic drug levels.
A client is admitted and diagnosed with myasthenia gravis. Pyridostigmine bromide therapy via tablets has been prescribed. The nurse anticipates that the dosage will be changed frequently during the first week of therapy. While the dosage is being adjusted, what action does the nurse perform? 1Administer the medication after meals. 2Administer the medication on an empty stomach. 3Evaluate the client's psychological responses between medication doses. 4Evaluate the client's muscle strength every hour after the medication is given
4. Evaluate the client's muscle strength every hour after the medication is given The onset of action of pyridostigmine is 30 to 45 minutes after administration, and the effects last up to 6 hours; the client's response will influence dosage levels. Pyridostigmine usually is administered before meals to promote mastication. Pyridostigmine should be administered with food to prevent gastric irritation. There are no psychological side effects associated with pyridostigmine.
A healthcare provider prescribes selegiline 5 mg twice a day for a client with a diagnosis of Parkinson disease. What is most important for the nurse to teach the client? A. Eat food high in tyramine B. Ensure that an opioid is not taken currently. C. Take the medication in the morning and evening. D. Monitor for signs of hypoglycemia and hyperglycemia.
B. Ensure that an opioid is not taken currently Selegiline concurrently used with an opioid analgesic can result in a fatal reaction (e.g., excitation, rigidity, hypertension, hypotension, coma). Foods high in tyramine (e.g., cheese, wine, beer, pickled products) should be avoided, not encouraged. When foods high in tyramine are broken down, they release specific biogenic amines. When the breakdown of these biogenic amines is inhibited by monoamine oxidase inhibitors, such as selegiline, pressor substances accumulate in the body, causing a quick increase in blood pressure to excessively high levels, precipitating intracranial bleeding and death. It is recommended that this medication be taken at breakfast and lunch, so its effects are more apparent while the client is awake; it should not be taken in the evening or at bedtime. Selegiline does not influence serum glucose levels. It can produce false-positive or false-negative results for glycosuria.
A client with myasthenia gravis is to receive immunosuppressive therapy. What assures the nurse that this therapy will be effective? A. Inhibits the breakdown of acetylcholine at the neuromuscular junction B. timulates the production of acetylcholine at the neuromuscular junction C. Decreases the production of autoantibodies that attack acetylcholine receptors D. Promotes the removal of autoantibodies that impair the transmission of impulses
C. Decreases the production of autoantibodies that attack acetylcholine receptors Rationale: Steroids decrease the body's immune response, limiting the production of antibodies that attack acetylcholine receptors at the neuromuscular junction. Inhibiting the breakdown of acetylcholine at the neuromuscular junction is the action of anticholinergic medications. Stimulating the production of acetylcholine at the neuromuscular junction is not the action of immunosuppressives. Promoting the removal of autoantibodies that impair the transmission of impulses is the rationale for plasmapheresis.
