A nurse is caring for a client who has a suspected diagnosis of myasthenia gravis. The provider prescribes a Tensilon test. Which of the following findings indicates a positive test?

Muscle strength shows no change.

Muscle contractions become progressively stronger.

Electrical charge in a muscle increases in intensity.

A pill-rolling tremor appears.

Answer and Explanation

The Correct Answer is B

A.   If there is no change in muscle strength after the Tensilon test, it indicates a negative result for myasthenia gravis.
B.   Muscle contractions become progressively stronger is a positive result for myasthenia gravis. Tensilon temporarily improves muscle strength in patients with this condition.
C.   Electrical charge in a muscle increases in intensity is not a relevant parameter for the Tensilon test.
D.   A pill-rolling tremor appears is a symptom of Parkinson's disease, not myasthenia gravis.

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Correct Answer is C

Explanation

A. Sedatives would further depress the respiratory muscles, worsening the myasthenic crisis.
B. Instruct the client to perform pursed lip breathing can be helpful for managing dyspnea in other conditions. However, it's not the priority in a myasthenic crisis where respiratory muscles are rapidly weakening.
C. As respiratory muscles weaken in a myasthenic crisis, the patient is at risk for respiratory failure. Preparing for mechanical ventilation is crucial.
D. A vasoconstrictor is used to treat shock, not a myasthenic crisis.

A. Drooling B. Blood pressure at 1800 C. Breath sounds at 1000 D. Hoarse voice E. Temperature at 1800

Correct Answer is ["A","D","E"]

Explanation

A. Drooling
Drooling can be concerning due to impaired swallowing and risk of aspiration.
D. Hoarse voice
Hoarseness after swallowing can indicate aspiration, which is a serious complication for stroke patients due to difficulty swallowing.
E. Temperature at 1800
A temperature of 39.6°C (103.3°F) is significantly elevated and suggests a potential infection, which is a serious complication after a stroke

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A nurse is caring for a client who has a suspected diagnosis of myasthenia gravis. The provider prescribes a Tensilon test. Which of the following findings indicates a positive test?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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