In managing a patient with myasthenia gravis being treated with pyridostigmine, which of the following should the nurse assess for effectiveness of the treatment? Select all that apply.
Presence of gastrointestinal upset such as diarrhea
Decreased fatigue levels reported by the patient
Client's report of discomfort around the injection site
Increased ability to tolerate prolonged speaking without fatigue
Improvement in muscle strength during physical activity
Reduction in respiratory distress or difficulty breathing
Increase in heart rate
Correct Answer : B,D,E,F
Rationale:
A. Gastrointestinal upset is a common side effect of pyridostigmine, not an indicator of treatment effectiveness. While monitoring for adverse effects is important, diarrhea does not reflect whether the medication is improving muscle function.
B. Pyridostigmine enhances neuromuscular transmission, leading to reduced muscle fatigue. A patient reporting less fatigue during daily activities indicates the medication is working effectively.
C. Injection site discomfort is not related to the efficacy of pyridostigmine; it is a local adverse effect. Monitoring for pain is important for patient comfort, but it does not indicate treatment success.
D. Ptosis, dysarthria, and difficulty speaking are common symptoms in myasthenia gravis due to weak facial and respiratory muscles. Improvement in speech endurance reflects enhanced neuromuscular function, signaling effective therapy.
E. Pyridostigmine increases acetylcholine availability at the neuromuscular junction, improving skeletal muscle strength. Observable improvements in mobility or exercise tolerance indicate treatment effectiveness.
F. Respiratory muscles may be affected in myasthenia gravis, and pyridostigmine can enhance respiratory muscle strength, reducing dyspnea or respiratory compromise. This is a critical indicator of therapeutic effectiveness, especially to prevent myasthenic crisis.
G. While pyridostigmine can cause cholinergic side effects such as bradycardia, changes in heart rate are not an indicator of effectiveness. Heart rate monitoring is for safety and side effect management, not therapeutic assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. NSAIDs can increase the risk of methotrexate toxicity by reducing renal clearance, which may lead to dangerous accumulation and increased risk of liver or bone marrow toxicity. Clients are advised to consult their provider before taking any over-the-counter medications.
B. Methotrexate inhibits folate metabolism, which is why folic acid supplementation is often prescribed. However, dietary folate alone is insufficient to prevent toxicity, and clients should follow prescribed folic acid supplementation rather than relying solely on diet.
C. Some vitamins and supplements, especially those containing high doses of folic acid, iron, or other interacting compounds, may interfere with methotrexate’s effectiveness or toxicity profile. Clients should confirm all supplements with their provider.
D. Methotrexate can cause hepatotoxicity, and alcohol consumption further increases this risk. Avoiding alcohol is a key teaching point to minimize liver damage while on therapy.
Correct Answer is A
Explanation
Rationale:
A. Levothyroxine is usually a lifelong therapy for primary hypothyroidism. Stopping the medication once thyroid hormone levels normalize can lead to a return of hypothyroid symptoms and potential complications such as fatigue, bradycardia, and weight gain. Patients must understand that normalization of lab values does not mean the underlying thyroid deficiency is cured.
B. Regular monitoring of TSH and free T4 is essential to ensure the dose is appropriate and to prevent over- or under-replacement. Lab checks are typically done 6–8 weeks after starting or adjusting therapy and periodically thereafter.
C. Consistent daily use is critical because missing doses can lead to fluctuating thyroid hormone levels and recurrence of hypothyroid symptoms.
D. Levothyroxine absorption is maximized on an empty stomach, typically 30–60 minutes before breakfast, and should be taken separately from medications or supplements (like calcium or iron) that can impair absorption.
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