A patient newly diagnosed with myasthenia gravis is being discharged. The electronic prescription system was off-line so the patient has a hand-written prescription for pyridostigmine (Mestinon) ER 540 mg three times per day. The maximum safe dosage is 1500 mg in 24 hours. What should the nurse who is reviewing discharge instructions with the patient do?

Contact the prescriber because the current prescription is at an unsafe dose

Instruct the patient to take their medication with juice & crackers if stomach upset occurs

Inform the patient that abdominal cramping & diarrhea will decrease as their body adjusts

Remind the patient to take their doses on time to prevent cholinergic crisis

Answer and Explanation

The Correct Answer is A

A. Contact the prescriber because the current prescription is at an unsafe dose: The prescribed dose of 540 mg three times per day totals 1620 mg in 24 hours, which exceeds the maximum safe dosage of 1500 mg for pyridostigmine (Mestinon). The nurse should immediately contact the prescriber to clarify or adjust the prescription to ensure the patient is not put at risk for toxicity.

B. Instruct the patient to take their medication with juice & crackers if stomach upset occurs: While taking pyridostigmine with food may help minimize gastrointestinal upset, this is not the priority concern. The primary issue is the unsafe dosage. The nurse should focus on addressing the dosage error before providing further instructions on food intake.

C. Inform the patient that abdominal cramping & diarrhea will decrease as their body adjusts: While abdominal cramping and diarrhea are common side effects of pyridostigmine, this does not address the critical issue of the unsafe dosage. The nurse should first ensure that the prescription is safe before discussing side effects.

D. Remind the patient to take their doses on time to prevent cholinergic crisis: While it is important for patients with myasthenia gravis to take their medication on time to avoid cholinergic crisis (a potentially life-threatening condition due to excessive cholinergic activity), this is secondary to ensuring the dosage is correct. The priority action is to contact the prescriber regarding the unsafe dose.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is D

Explanation

A. Decreased motivation and apathy: While decreased motivation and apathy can be seen in some neurological conditions, they are not typical manifestations of emotional lability in ALS. Emotional lability in ALS typically involves sudden and exaggerated emotional responses, such as inappropriate crying or laughing, rather than apathy.

B. Increased irritability and anger: Increased irritability and anger are not characteristic of emotional lability in ALS. Emotional lability is more about unpredictable and disproportionate emotional reactions, such as inappropriate laughing or crying, rather than a constant irritability or anger.

C. Heightened anxiety and restlessness: Anxiety and restlessness may occur in ALS, but they are not typically the hallmark signs of emotional lability. Emotional lability in ALS primarily involves sudden, exaggerated emotional responses.

D. Inappropriate sadness and tearfulness:Emotional lability in ALS is characterized by sudden, uncontrollable episodes of inappropriate sadness, tearfulness, or laughter, often without an apparent cause. This is a result of the brain's inability to regulate emotions due to the progressive damage of motor neurons in ALS.

A. Providing pain management to adhere to coughing and deep breathing exercises B. Teaching the client to use the tripod position C. Adding humidity with supplemental oxygen to keep secretions thin D. Supplying additional oxygen while the client is at rest

Correct Answer is C

Explanation

A. Providing pain management to adhere to coughing and deep breathing exercises: While pain management is important for overall comfort and encouraging deep breathing and coughing, it is not the primary intervention for managing hypoxemia due to altered alveolar diffusion. The key intervention for hypoxemia from impaired alveolar diffusion focuses more on improving oxygenation and addressing the underlying cause.

B. Teaching the client to use the tripod position: The tripod position, which involves sitting upright and leaning forward with hands on knees, can help improve breathing for patients with certain respiratory conditions (e.g., COPD), but it is not directly related to the management of hypoxemia caused by altered alveolar diffusion.

C. Adding humidity with supplemental oxygen to keep secretions thin: Hypoxemia related to altered alveolar diffusion often results from difficulty in gas exchange due to thickened secretions or inflammation. Adding humidity to supplemental oxygen helps thin the secretions, making it easier to clear them, and can improve gas exchange in the lungs, which directly helps address the hypoxemia.

D. Supplying additional oxygen while the client is at rest: While providing supplemental oxygen to maintain adequate oxygen levels is important in managing hypoxemia, this option does not specifically address the issue of altered alveolar diffusion. Humidified oxygen can be more beneficial in improving secretion clearance and promoting better diffusion in such cases.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse identifies which of the following as a manifestation of emotional lability in patients with Amyotrophic Lateral Sclerosis (ALS)?

Correct Answer is D

Explanation

The nurse is developing a plan of care for a client admitted with hypoxemia related to altered alveolar diffusion. When formulating a plan of care the nurse is aware which intervention must be included?

Correct Answer is C

Explanation

The nurse is caring for a patient diagnosed with Myasthenia Gravis (MG) prescribed plasmapheresis for treatment. Which statement by the nurse includes accurate education? "Plasmapheresis....

The nurse is caring for a client with hypercapnic respiratory failure. The client is lethargic & slow to follow commands. Current vitals: BP 78/52. pulse 132. respirations 8, and pulse ox 84% on 35% Venturi mask. The nurse would anticipate which medical prescription?

The nurse is providing instructions to the patient diagnosed with Multiple Sclerosis (MS) about baclofen. What would the nurse emphasize in the instructions?

Which of the following are common characteristics of patients diagnosed with Amyotrophic Lateral Sclerosis (ALS)?

The patient with pneumonia is being treated with intravenous antibiotics. The nurse evaluates that the therapy has been effective by which data?

A 75-year-old patient with emphysema states "Every year I end up getting admitted to the ICU because of bad breathing problems. I'm really trying to stay out of there this year. Which points are appropriate for the nurse to include in a teaching session? (SELECT ALL THAT APPLY)

The nurse is caring for a patient waiting for proper diagnosis with Multiple Sclerosis (MS) or Myasthenia Gravis (MG). The patient is reporting severe fatigue. Which priority intervention would the nurse implement to address this issue for either diagnosis?

Which of the following patients diagnosed with Myasthenia Gravis would the nurse identify as most at risk for developing a cholinergic crisis? A patient who: