A patient who has been prescribed pyridostigmine for myasthenia gravis presents with excessive sweating vomiting, and bradycardia. Which of the following nursing actions should be prioritized to address these symptoms suspected to be from a cholinergic crisis?
Provide fluids and monitor vital signs only
Administer atropine as prescribed
Increase the dosage of pyridostigmine
Assess the patient's neurological status every hour
The Correct Answer is B
Rationale:
A. While fluid replacement and vital sign monitoring are important supportive measures, they do not reverse the life-threatening muscarinic and nicotinic effects of a cholinergic crisis. Solely providing fluids is insufficient for symptom management.
B. Excessive sweating, vomiting, and bradycardia in a patient taking pyridostigmine indicate cholinergic crisis due to excessive acetylcholine. Atropine, an anticholinergic medication, blocks muscarinic effects, alleviating symptoms such as bradycardia, excessive salivation, and gastrointestinal hyperactivity. This is the priority intervention to prevent further complications and stabilize the patient.
C. Increasing the dosage would worsen a cholinergic crisis, as the symptoms are caused by overstimulation of acetylcholine receptors, not by insufficient medication. This action is contraindicated and dangerous.
D. Neurological assessment is important for ongoing monitoring, but it is not the priority intervention. Immediate treatment with atropine takes precedence to prevent deterioration such as severe bradycardia, respiratory compromise, or further muscarinic effects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Hyperparathyroidism is characterized by overproduction of parathyroid hormone (PTH). PTH stimulates osteoclast activity, which breaks down bone tissue and releases calcium into the bloodstream, leading to hypercalcemia. Other effects of elevated PTH include increased renal calcium reabsorption and enhanced activation of vitamin D, which further increases intestinal calcium absorption.
B. In hyperparathyroidism, PTH promotes conversion of vitamin D to its active form (calcitriol), which enhances intestinal absorption of calcium rather than decreasing it. Low intestinal calcium absorption is more associated with vitamin D deficiency, not primary hyperparathyroidism.
C.PTH actually increases renal calcium reabsorption in the distal tubules. Decreased reabsorption would result in calcium loss and hypocalcemia, which is opposite of what occurs in hyperparathyroidism.
D. PTH is elevated in hyperparathyroidism, not low. Increased calcium excretion (hypercalciuria) can occur secondary to extremely high serum calcium levels, but it is not due to low PTH.
Correct Answer is ["B","C","F","G","H"]
Explanation
Rationale:
A. During thyroid storm, patients are critically ill with severe tachycardia, fever, dehydration, and possible cardiac compromise. Encouraging ambulation at this stage can worsen cardiovascular stress, fatigue, and oxygen consumption, potentially precipitating complications such as arrhythmias or heart failure. Ambulation is deferred until the patient is hemodynamically stable.
B. Thyroid storm significantly increases the metabolic rate and oxygen demand. Patients may develop tachypnea and hypoxia if oxygen delivery is inadequate. Administering supplemental oxygen ensures that tissues receive sufficient oxygen, prevents hypoxia-related complications, and supports organ function during the acute crisis.
C. Antithyroid medications such as propylthiouracil (PTU) or methimazole inhibit thyroid hormone synthesis, which is the underlying cause of thyroid storm. Prompt administration is essential to reduce circulating thyroid hormone levels and mitigate the risk of cardiovascular collapse, hyperthermia, and multi-organ failure. PTU also inhibits the peripheral conversion of T4 to T3, which is particularly beneficial in acute crises.
D. Thyroidectomy is not an immediate intervention during thyroid storm because surgery carries a high risk of mortality and exacerbation of the storm in an unstable patient. Definitive surgery is considered only after stabilization with medications and supportive care.
E. While patient education is essential for long-term management, it is not a priority during an acute thyroid storm. The immediate focus is on life-saving interventions and stabilization. Education can be provided after the patient is stable and able to participate safely.
F. Thyroid storm often causes severe tachycardia, hypertension, and hyperthermia, which increase cardiac workload and risk of arrhythmias. Beta-blockers, particularly propranolol, reduce heart rate, control blood pressure, and limit peripheral effects of thyroid hormones, making them a critical component of acute management.
G. Frequent assessment of vital signs, cardiac rhythm, fluid status, electrolytes, and thyroid hormone levels is essential during thyroid storm. Continuous monitoring allows for early detection of deterioration, rapid intervention, and adjustment of medications, ensuring patient safety and improving outcomes.
H. Patients with thyroid storm often experience dehydration due to hypermetabolism, excessive sweating, vomiting, and tachypnea. IV fluids help restore circulating volume, maintain hemodynamic stability, support renal perfusion, and correct electrolyte imbalances, which are vital in preventing shock or organ dysfunction.
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
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.