MYASTHENIA GRAVES

Question 1

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.

a.metabotropic; muscle weakness
b.nicotinic acetylcholine; muscle weakness
c.dopaminergic adrenergic; muscle contraction
d.nicotinic adrenergic; muscle contraction

Answer 1

B

Question 2

You’re educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located?

a.behind the thyroid gland
b.within the adrenal glands
c.behind the sternum in between the lungs
d.anterior to the hypothalamus

Answer 2

C

Question 3

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication?

a.As soon as possible
b.1 hour after the patient has eaten (at 1300)
c.1 hour before the patient eats (at 1100)
d.at 1200 right before the patient eats

Answer 3

C

Question 4

The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis?

a.The patient experiences worsening of the muscle weakness.
b.The patient experiences wheezing along with facial flushing.
c.The patient reports a tingling sensation in the eyelids and sudden ringing in the ears.
d.The patient experiences improved muscle strength.

Answer 4

D

Question 5

You’re preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?

a.Atropine
b.Protamine sulfate
c.Narcan
Leucovorin

Answer 5

A

Question 6

Which patient below is MOST at risk for developing a cholinergic crisis?

a.A patient with myasthenia gravis is who is not receiving sufficient amounts of their anticholinesterase medication.
b.A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks.
c.A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery.
d.A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.

Answer 6

D

Question 7

Which meal option would be the most appropriate for a patient with myasthenia gravis?

a.Roasted potatoes and cubed steak
b.Hamburger with baked fries
c.Clam chowder with mashed potatoes
d.Fresh veggie tray with sliced cheese cubes

Answer 7

C

Question 8

Select all the signs and symptoms below that can present in myasthenia gravis:

a.Respiratory failure
b.Increased salivation
c.Diplopia
d.Ptosis
e.Slurred speech
f.Restlessness
g.Mask-like appearance of looking sleepy
h.Difficulty swallowing

Answer 8

A,C,D,E,F

Question 9

You’re providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition?

a.Plasmapheresis
b.Cholinesterase medications
c.Thymectomy
d.Corticosteroids

Answer 9

B

Question 10

You’re a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks?

a.Mid-afternoon
b.Morning
c.Evening
d.Before bedtime

Answer 10

B

Question 11

The patient with myasthenia gravis arrives to the clinic and states that he is experiencing nausea and diarrhea. His blood pressure is 125/85 HR 70 Temp 100.0 R 19 O2 97%. What is the nursing priority?

A) Prepare the patient for intubation. He is about to go into a myasthenic crisis.
B) Perform teaching on medication side effects
C) Assess for signs of infection
D) Further assess for other thymectomy complications

Answer 11

C

Question 12

The client is experiencing a myasthenic crisis. Which of the following is a priority action of the following ordered actions?

A) Insert NG tube
B) Administer Ativan
C) Monitor I&O
D) Immediately stop anticholinesterase medications

Answer 12

A

Question 13

The nurse is teaching a client about myasthenia gravis. Which statement, if made by the patient indicates the need for further teaching?

A) The doctor will take me off of my beta blocker because it could exacerbate my symptoms
B) I should report any signs of infection to my PCP
C) I can take a ibuprofen to help with pain that may occur with spasms
D) I should avoid taking long walks

Answer 13

C

Question 14

Which of the following would be most likely given as a top nursing diagnosis for a patient experiencing a cholinergic crisis?

A) Impaired Gas Exchange
B) Acute Fatigue
C) Ineffective airway clearance
D) Altered mental status

Answer 14

C

Question 15

Your patient has just been diagnosed with myasthenia gravis. Which of the following orders should be questioned?

A) Prednisone PO daily
B) Eyepatch to be worn every night
C) Pyrodostigmine bromide (Mestinon) 4 times daily PO
D) Procaine (Novocain) SQ stat to reduce pain in lower limb

Answer 15

D

Question 16

Which of the following is a side effect of Methylprednisolone (Solu-Medrol)?
A) Hypovolemia
B) Tinnitus
C) Euphoria
D) Respiratory Depression

Answer 16

C

Question 17

Which statement by the client supports the diagnosis
of myasthenia gravis (MG)?

1. “I have weakness and fatigue in my feet and legs.”
2. “My eyelids droop, and I see double everything.”
3. “I get chest pain and faint after I walk in the hall.”
4. “I gained 3 pounds this week, and I am spitting up pink frothy sputum.”

Answer 17

2

Question 18

The nurse is discharging a client diagnosed with
MG. Which statement by the client indicates an
understanding of the discharge instructions?

1. “I can control the MG with medication, but an adenectomy will cure it.”
2. “I should take a holiday from my medications every 4 or 5 weeks.”
3. “I must take my medications on time every day, or I could have problems.”
4. “I should take my steroid medications with food so it won’t upset my stomach.

Answer 18

3

Question 19

The client diagnosed with MG is being discharged home. Which intervention should the nurse teach the significant other?

1. Discuss how to perform the Heimlich maneuver.
2. Explain how to perform oral hygiene on a
   conscious client.
3. Teach how to perform isometric exercises. l 4. Demonstrate correct hand placement for chest compressions.

Answer 19

1

Question 20

Which referral is appropriate for the client in the late
stages of myasthenia gravis?

1. The infection control nurse.
2. The occupational health nurse.
3. A vocational guidance counselor.
4. The speech therapist.

Answer 20

4

Question 21

The male client with MG is undergoing plasmapheresis at the bedside. Which assessment data would warrant immediate intervention by the nurse?

1. The client complains of being lightheaded and dizzy.
2. The client can smile and clamp his teeth together.
3. The client states that his leg cramps have gone away.
4. The client has a small hematoma at the vascular access site.

Answer 21

1

Question 22

Which statement by the 20-year-old female client diagnosed with MG indicates the client understands the discharge teaching?

1. “I can have children, but I will have to see my neurologist during my pregnancy.”
2. “I have a new job at a children’s day care center to help with expenses.”
3. “I should not take a bath because I could pass out and drown while in the tub.”
4. “I will drink at least 1000 mL of water or other liquid every day.”

Answer 22

1

Question 23

The client is diagnosed with MG. Which intervention should the nurse implement when administering the anticholinesterase pyridostigmine (Mestinon)?

1. Assess for excess salivation and abdominal cramps.
2. Administer the medication before the client has eaten.
3. Break the capsule and sprinkle the medication on the food.
4. Assess the client’s potassium level prior to administering medication

Answer 23

1

Question 24

Which ocular or facial signs/ symptoms should the nurse expect to assess for the client diagnosed with myasthenia gravis?

A) Weakness & Fatigue
B) Ptosis & diplopia
C) Breathlessness & dyspnea
D) Weight loss & Dehydration

Answer 24

B

Question 25

The client is being evaluated to rule out myasthenia gravis & being administered the Tensilon test. Which response to the test indicates the client has MG?

A) The client has no apparent change in the assessment data
B) This is increased amplitude of electrical stimulation in the muscle
C) The circulating acetylcholine receptor antibodies are decreased
D) The client shows a marked improvement of muscle strength

Answer 25

D

Question 26

Which surgical procdure should the nurse anticipate the client with myasthenia gravis undergoing to help prevent the s/s of the disease process?

A) There is no surgical option
B) A transsphenoidal hypophysectomy
C) A thymectomy
D) An adrenalectomy

Answer 26

C

Question 27

The client diagnosed w/ myasthenia gravis is being discharged home. Which intervention has priority when teaching the client’s significant others?

A) discuss ways to help prevent choking episodes
B) Explain how to care for a client on a ventilator
C) Teach how to perform passive ROM exercises
D) Demonstrate how to care for the client’s feeding tube

Answer 27

A

Question 28

The client w/ MG is undergoing plasmapheresis at the bedside. Which assessment data warrant immediate intervention?

A) Client’s BP is 94/60 and AP is 112
B) Negative Chvosteks & Trousseaus
C) Serum potassium 3.5
D) Echymosis at vascular site access

Answer 28

A

Question 29

Which statement by the female client diagnosed w/ MG indicates the client needs more discharge teaching?

A) I will not have a menstrual cycle bcs. Of the disease
B) I should avoid people who have respiratory infections
C) I should not take a hot back or swim in cold water
D) I will drink at least 2,500 ml of h20 a day

Answer 29

A