During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic with increased oral secretions after receiving edrophonium IV. Vital signs are HR 55, BP 130/78, respiration 12 and saturation of 94%. What intervention should the nurse prepare to do?

Continue to monitor as this is a normal response to the medication

Administration of atropine

Place the patient in the trendelenburg position

Administer diphenhydramine (Benadryl) for the allergic reaction

Answer and Explanation

The Correct Answer is B

A) Continue to monitor as this is a normal response to the medication: The symptoms the patient is experiencing (cramping, diaphoresis, increased oral secretions) are not normal responses to the edrophonium test and suggest a cholinergic crisis rather than a simple reaction to the medication. A cholinergic crisis occurs when there is overmedication with cholinergic drugs, leading to excessive stimulation of the parasympathetic nervous system. While mild effects like slight nausea or dizziness can occur, cramping, diaphoresis, and increased oral secretions indicate toxicity, requiring immediate intervention.

B) Administration of atropine: The symptoms the patient is exhibiting—cramping, diaphoresis, and increased oral secretions—are indicative of cholinergic toxicity. Edrophonium, a cholinesterase inhibitor, is used in the Tensilon test to diagnose myasthenia gravis by temporarily improving muscle strength. However, in some cases, the patient may experience a cholinergic crisis from an overdose of the medication, resulting in excess acetylcholine at synapses, which overstimulates the parasympathetic nervous system. Atropine, an anticholinergic agent, blocks the effects of acetylcholine and is used to reverse these symptoms by reducing the excessive parasympathetic activity (e.g., reducing secretions and improving heart rate).

C) Place the patient in the Trendelenburg position: The Trendelenburg position (head down, feet up) is often used in cases of shock to help increase venous return to the heart. However, it is not appropriate for a cholinergic crisis. The patient’s symptoms are not due to hypotension or shock but are related to an overdose of edrophonium causing parasympathetic overstimulation.

D) Administer diphenhydramine (Benadryl) for the allergic reaction: The symptoms the patient is experiencing (cramping, diaphoresis, increased oral secretions) are not related to an allergic reaction. Diphenhydramine (Benadryl) is an antihistamine used for allergic reactions, such as urticaria or anaphylaxis, but it does not treat cholinergic toxicity.

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Correct Answer is A

Explanation

A) Women should start yearly mammograms at age 40:
Mammography is a key screening tool for breast cancer detection. According to guidelines from the American Cancer Society (ACS) and other leading health organizations, women should begin annual mammograms at age 40. This recommendation applies to average-risk women who are not showing any symptoms of breast cancer. Mammograms are effective in detecting early-stage breast cancer, which is crucial for better treatment outcomes.

B) Women should have a yearly clinical breast examination starting at age 50:
The clinical breast examination (CBE) is a physical exam performed by a healthcare provider to check for breast cancer. However, the recommendation is to have a clinical breast examination every 1-3 years for women in their 20s and 30s and annually for women 40 and older, not just beginning at age 50. It is not necessary to wait until age 50 to start yearly CBEs.

C) Clients should have fecal occult blood test every other year:
The fecal occult blood test (FOBT) is used to detect hidden blood in the stool, which may be a sign of colon cancer. However, this test is not typically performed every other year for all clients. The recommended schedule for colorectal cancer screening depends on risk factors. The American Cancer Society recommends annual FOBT or fecal immunochemical test (FIT) for clients over the age of 45 who are at average risk for colon cancer. More invasive tests, such as colonoscopy, are generally recommended for people at higher risk or after positive results from non-invasive tests like FOBT.

D) Clients should have a colonoscopy at age 40 and every 10 years thereafter:
The recommended age for the first colonoscopy is age 45 for individuals at average risk of colorectal cancer, not 40. Colonoscopies are typically performed every 10 years after the initial screening unless there are risk factors (e.g., family history, genetic conditions) that require earlier or more frequent screenings.

A. Digoxin B. Diltiazem C. Propanolol D. Captopril

Correct Answer is A

Explanation

A) Digoxin:
The client’s symptoms of confusion, vision disturbances (such as yellow halos around lights), and anorexia are all classic signs of digoxin toxicity. Digoxin, a cardiac glycoside, is commonly used in the treatment of heart failure and atrial fibrillation. However, it has a narrow therapeutic index, meaning that even slightly elevated blood levels can lead to toxicity. Other common symptoms of digoxin toxicity include bradycardia (which the client is also experiencing with a pulse of 53 bpm), nausea, and vomiting.

B) Diltiazem:
Diltiazem is a calcium channel blocker used to treat hypertension, angina, and atrial fibrillation. While it can cause bradycardia (as evidenced by the client’s pulse of 53 bpm), vision disturbances and anorexia are not typical side effects of this medication. More common side effects include hypotension, edema, and constipation.

C) Propranolol:
Propranolol is a beta-blocker used to treat hypertension, arrhythmias, and angina, as well as to prevent migraines. Bradycardia is a known side effect of beta-blockers, but vision disturbances and anorexia are not typical of propranolol. Moreover, propranolol can cause hypotension and fatigue but would not be as likely to cause the specific symptoms of confusion and vision changes seen in this client.

D) Captopril:
Captopril is an ACE inhibitor commonly used to treat hypertension and heart failure. Common side effects include hypotension, dizziness, and hyperkalemia, but vision disturbances and anorexia are not typical side effects of captopril. The symptoms the client is experiencing are more specific to digoxin toxicity than to captopril's side effects.

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Naxlex Comprehensive Predictor Exams

A nurse is teaching a class at a community center to a group of young adult, adult, and older adult clients regarding regular screening recommendations for cancer prevention. Which of the following information should the nurse include?

Correct Answer is A

Explanation

Correct Answer is A

Explanation

A nurse is caring for a client that has been recently diagnosed with Guillian-Barre syndrome. What would the nurse consider to be common risk factors associated with Guillain-Barré syndrome (GB5)? (select all that apply)

A nurse is assessing a client who has early symptoms of hypoxia. Which of the following findings should the nurse expect?

A client with history of myasthenia gravis is experiencing prolonged periods of weakness and difficulty breathing. The provider orders an edrophonium [Tensilon] test. Once the dose is administered, the client becomes weaker. The nurse interprets this test result as:

The nurse is preparing discharge teaching for a client with Bell's Palsy. Which of the following is most important to include in the teaching? [Select all that apply)

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