Chapter 21: Drugs for Neuromuscular Disorders and Muscle Spasms

Chapter 21: Drugs for Neuromuscular Disorders and Muscle Spasms

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is preparing to care for a patient who has myasthenia gravis. The nurse will be alert to symptoms affecting which body system in this patient?

a.	Cardiovascular system and postural muscles
b.	Central nervous system (CNS), memory, and cognition
c.	Gastrointestinal system (GI) and lower extremity muscles
d.	Respiratory system and facial muscles

 

 

ANS:   D

Myasthenia gravis causes fatigue and muscular weakness of the respiratory system, facial muscles, and extremities. It does not directly affect the cardiovascular system, CNS, or GI systems.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 267

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pathophysiology

 

2. A 40-year-old woman is diagnosed with myasthenia gravis, and her provider recommends removal of her thymus gland. She asks the nurse why this would be helpful. The nurse will explain that removal of the thymus gland may

a.	increase binding of acetylcholine (ACh) molecules to ACh receptors.
b.	increase the amount of ACh available at neuromuscular junction sites.
c.	reduce the number of acetylcholine receptor sites.
d.	reduce the autoimmune destruction of ACh receptor sites.

 

 

ANS:   D

Myasthenia gravis is an autoimmune disorder involving an antibody response against a subunit of the ACh receptor site. Since the thymus is involved in systemic immunity, it is thought that removing the thymus can inhibit this process. It does not increase binding of ACh molecules to receptors or increase the amount of ACh or reduce the number of ACh receptor sites.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 268

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pathophysiology

 

3. The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms?

a.	Excessive salivation
b.	Muscle spasms
c.	Muscle weakness
d.	Respiratory paralysis

 

 

ANS:   C

Neostigmine must be given on time to prevent myasthenic crisis, which is characterized by generalized, severe muscle weakness. The other symptoms are characteristic of cholinergic crisis, caused by too much medication.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 268

TOP:    Nursing Process: Assessment/Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pathophysiology

 

4. The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours. The patient’s last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action?

a.	Assess the patient for signs of ptosis.
b.	Notify the provider to discuss an order for intravenous immune globulin (IVIG).
c.	Obtain an order for atropine sulfate.
d.	Request an order for an extra dose of pyridostigmine.

 

 

ANS:   C

Severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction are the major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is atropine, so the nurse should obtain an order to give this. Ptosis is a sign of myasthenic crisis. IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra pyridostigmine would increase the symptoms.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 270

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies