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

MULTIPLE CHOICE

1. A nurse is caring for a patient who has myasthenia gravis. The prescriber has ordered neostigmine [Prostigmin]. An important initial nursing action before administration of the medication includes assessing:

ANS:  D

Many patients hospitalized for myasthenia gravis do not have the muscle strength to swallow well and need a parenteral form of the medication; therefore, assessing the patient’s ability to swallow is an important initial safety measure. Evaluating the patient’s ability to raise the eyelids, level of fatigue, and skeletal muscle strength are important assessments before drug administration and during drug treatment, because they indicate the effectiveness of the drug and help determine subsequent doses.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 131

TOP:   Nursing Process: Assessment

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

2. A nurse working in the emergency department is assigned to a child who is arriving by ambulance after being involved in a spill of organophosphate insecticides. What will the nurse expect to be the initial priority for treating this child?

ANS:  C

All of these courses of action may be part of the treatment. However, the initial concern is to prevent death from apnea caused by laryngospasm, bronchoconstriction, and paralysis leading to apnea; therefore, maintaining an airway is the most important consideration. Pralidoxime is the specific antidote and should be given next. Atropine is used to control secretions. Diazepam is given when seizures occur. Reporting the accident to the proper authorities is not a priority during a life-threatening emergency.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 130

TOP:   Nursing Process: Implementation

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

3. A patient who has myasthenia gravis will be taking neostigmine [Prostigmin]. What will the nurse emphasize when teaching this patient about the medication?

ANS:  B

Neostigmine doses must be adjusted continually, and patients usually need supplemental doses before exertion; therefore, patients must be taught how to modify doses as needed. Increased gastrointestinal (GI) secretions can cause loose stools; this is a known adverse effect that does not warrant stopping the drug. Atropine will help with excessive salivation but should not be used routinely, because it can mask the early signs of anticholinesterase overdose. Ptosis is one of the symptoms of myasthenia gravis and is an indication for taking neostigmine.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 131

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

4. Two nurses are discussing the major differences between physostigmine [Antilirium] and neostigmine [Prostigmin]. One nurse correctly makes which statement about physostigmine [Antilirium]?

ANS:  B

The basic pharmacology of physostigmine is nearly identical to that of neostigmine, except that physostigmine readily crosses membranes, including the blood-brain barrier; neostigmine does not. Physostigmine and neostigmine are both effective for treating poisoning by muscarinic blocking drugs. Neither physostigmine nor neostigmine is devoid of side effects. Physostigmine can be given only intramuscularly (IM) or intravenously (IV); neostigmine is given orally (PO), IM, IV, and subcutaneously (subQ).

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 129

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies