A nurse suspects a client with myasthenia gravis is experiencing a myasthenic crisis. Which of the following interventions should the nurse take?
Prepare to administer a vasopressor.
Administer an anticholinesterase medication.
Prepare the client for intubation.
Instruct the client to perform pursed lip breathing.
The Correct Answer is C
The correct answer is: c. Prepare the client for intubation.
Choice A: Prepare to administer a vasopressor
Reason: Vasopressors are typically used to manage hypotension (low blood pressure) and are not a standard treatment for myasthenic crisis. Myasthenic crisis primarily involves respiratory muscle weakness, which can lead to respiratory failure, rather than issues with blood pressure.
Choice B: Administer an anticholinesterase medication
Reason: While anticholinesterase medications like pyridostigmine are used to manage myasthenia gravis, they are generally not recommended during a myasthenic crisis. During a crisis, the focus is on stabilizing the patient, often requiring more immediate interventions such as intubation and mechanical ventilation.
Choice C: Prepare the client for intubation
Reason: Intubation is a critical intervention in a myasthenic crisis due to the risk of respiratory failure. The crisis is characterized by severe muscle weakness, including the muscles that control breathing. Intubation ensures that the airway is protected and that the patient can receive adequate ventilation.
Choice D: Instruct the client to perform pursed lip breathing
Reason: Pursed lip breathing is a technique used to improve breathing efficiency in conditions like chronic obstructive pulmonary disease (COPD). However, it is not appropriate for managing a myasthenic crisis, where the primary issue is severe muscle weakness leading to respiratory failure.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is B
Explanation
Choice A reason: Avoiding driving in winter is not necessary unless it is a personal trigger for Raynaud's attacks. It's more important to keep warm and manage stress.
Choice B reason: Stress management classes can teach techniques to control stress, which is beneficial for clients with Raynaud's disease as stress can trigger episodes.
Choice C reason: Using nicotine gum to quit smoking is a positive step for overall health, but it is not directly related to the management of Raynaud's disease.
Choice D reason: Limiting coffee intake may help some individuals with Raynaud's disease, as caffeine can constrict blood vessels, but it is not a universal recommendation.
Correct Answer is A
Explanation
Choice A reason: play a crucial role in transplant rejection. They can recognize and attack foreign tissues, including transplanted organs, leading to rejection. This immune response is a significant concern in transplant medicine, and managing T cell activity is essential for the success of organ transplants.
Choice B reason: While anaphylaxis is an acute allergic reaction, it is more commonly associated with the release of histamines and other mediators from mast cells and basophils. can contribute to the severity of the reaction, but they are not the primary cells involved in anaphylaxis.
Choice C reason: Bacterial phagocytosis is primarily the function of phagocytes like neutrophils and macrophages. do not directly engage in phagocytosis but can activate other immune cells that do.
Choice D reason: Hay fever, or allergic rhinitis, involves an immune response to airborne allergens, with contributing to the development of symptoms by helping to produce IgE antibodies. However, the immediate symptoms of hay fever are more directly related to mast cell activation rather than activity.
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