Chapter 15: Cholinesterase Inhibitors and Their Use in Myasthenia Gravis

Chapter 15: Cholinesterase Inhibitors and Their Use in Myasthenia Gravis

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A patient is brought to the emergency department by paramedics. The patient is a farmer who was exposed to large quantities of organophosphate insecticides. Which assessment finding would the nurse anticipate to see in this patient?

a.	Urinary retention
b.	Increased gastrointestinal motility
c.	Mydriasis
d.	Vasoconstriction

 

 

ANS:   B

Overstimulation of muscarinic receptors results in increased gastrointestinal motility.

Overstimulation of muscarinic receptors results in involuntary urination, not urinary retention.

Overstimulation of muscarinic receptors does not result in mydriasis.

Overstimulation of muscarinic receptors results in bronchoconstriction, not vasoconstriction.

 

DIF:    Cognitive Level: Application             REF:    pp. 135-136

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

2. A patient is admitted to the unit with complaints of abdominal pain and a history of myasthenia gravis. During the health history the nurse determines that the patient has been taking neostigmine (Prostigmin). The nurse should further assess the patient for

a.	bradycardia, diaphoresis, and urinary urgency.
b.	tachycardia, diaphoresis, and urinary retention.
c.	xerostomia, diaphoresis, and mydriasis.
d.	increased gastric motility, mydriasis, and urinary retention.

 

 

ANS:   A

Accumulation of acetylcholine, seen in patients with myasthenia gravis, results in bradycardia, diaphoresis, and urinary urgency. These assessment findings are also a result of the adverse effects of neostigmine.

Tachycardia and urinary retention are not adverse effects of excessive muscarinic stimulation.

Xerostomia and mydriasis are not adverse effects of neostigmine or an accumulation of acetylcholine.

Increased gastric motility, mydriasis, and urinary retention are not adverse effects of neostigmine or an accumulation of acetylcholine.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 133-136

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A patient is brought into the emergency department by ambulance. Based on the patient’s signs and symptoms, the physician suspects an overdose of a cholinesterase inhibitor. Which primary intervention would the nurse prepare for to treat the resultant respiratory depression?

a.	Physostigmine (Antilirium)
b.	Succinylcholine (Anectine)
c.	Atropine (Sal-Tropine)
d.	Mechanical ventilation

 

 

ANS:   D

An overdose of a cholinesterase inhibitor can lead to respiratory depression, respiratory failure, and death secondary to neuromuscular blockade; therefore the nurse should prepare to place the patient on mechanical ventilation.

Physostigmine is not the primary treatment for cholinesterase overdose.

Succinylcholine is not the primary treatment for cholinesterase overdose.

Atropine can be used to reduce muscarinic stimulation after cholinesterase overdose, but it is not the first action the nurse should anticipate.

 

DIF:    Cognitive Level: Application             REF:    pp. 134-136

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential