The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms?
Excessive salivation
Respiratory paralysis
Muscle weakness
Muscle spasms
The Correct Answer is C
A) Excessive salivation: Neostigmine (Prostigmin) is a cholinesterase inhibitor, which works by increasing the levels of acetylcholine at neuromuscular junctions. If a dose is missed, excessive salivation can be a side effect of too much acetylcholine activity, but it is not the most immediate symptom in this case. Muscle weakness is a more direct consequence of a missed dose.
B) Respiratory paralysis: While respiratory weakness or paralysis can occur in myasthenia gravis, it is usually associated with a severe form of the disease or if the patient is in a myasthenic crisis. A single missed dose of neostigmine typically does not result in respiratory failure unless the patient is already in a very fragile state.
C) Muscle weakness: Neostigmine helps to improve neuromuscular transmission by inhibiting the breakdown of acetylcholine, which is crucial for muscle contraction. A missed dose would directly lead to a reduction in acetylcholine levels, exacerbating the characteristic muscle weakness of myasthenia gravis. Muscle weakness is the most anticipated symptom when neostigmine is not administered on time.
D) Muscle spasms: Muscle spasms are typically not a symptom of missed neostigmine therapy. Instead, muscle weakness occurs due to impaired neuromuscular transmission. Spasms might occur if there is significant overstimulation of the muscles, but this is more associated with electrolyte imbalances or other neuromuscular issues
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Increase in mental acuity: Beta-adrenergic blockers (beta-blockers) do not directly affect mental acuity. In fact, some beta-blockers may cause side effects like fatigue or drowsiness, which can affect mental sharpness. Beta-blockers primarily focus on cardiovascular effects, not cognitive function, making this an unlikely therapeutic goal for their use.
B) Slowing of gastrointestinal motility: Beta-blockers can reduce sympathetic nervous system activity, which may indirectly affect the gastrointestinal system. However, slowing gastrointestinal motility is not a primary therapeutic goal of beta-blocker therapy. The main action of beta-blockers is in the cardiovascular system, not in regulating GI function.
C) Decreased production in gastric acid: Beta-blockers do not significantly reduce gastric acid production. Medications such as proton pump inhibitors or H2 blockers are typically used for managing gastric acid production or reflux. Beta-blockers focus on reducing the workload of the heart and controlling blood pressure, not on acid secretion.
D) Reduction in the heart rate and blood pressure: The primary therapeutic effect of beta-blockers is the reduction of heart rate (negative chronotropic effect) and blood pressure (due to reduced cardiac output and inhibition of the sympathetic nervous system). This is especially beneficial for managing conditions like hypertension, heart failure, and arrhythmias. It is the most likely goal of beta-blocker therapy prescribed by the provider.
Correct Answer is D
Explanation
A) Reversal of bronchoconstriction: Narcotic antagonists are not used to reverse bronchoconstriction. Bronchoconstriction is typically managed with bronchodilators (such as beta-agonists) or corticosteroids. Narcotic antagonists, such as naloxone, specifically counteract the effects of opioids, not respiratory conditions like bronchoconstriction.
B) Reversal of tachycardia: Narcotic antagonists do not have an effect on reversing tachycardia. Tachycardia may result from various conditions, including stimulant use, dehydration, or heart conditions. Treatment for tachycardia typically involves addressing the underlying cause, such as using beta-blockers for cardiac issues, but not narcotic antagonists.
C) Treatment of alcohol dependence: While certain medications, like disulfiram or acamprosate, are used to treat alcohol dependence, narcotic antagonists are not typically indicated for alcohol dependence. Narcotic antagonists, such as naloxone, are primarily used for opioid overdose or dependence, not for alcohol use disorders.
D) Treatment of narcotic dependence: Narcotic antagonists, such as naloxone, are prescribed in the treatment of narcotic (opioid) dependence. These medications work by blocking the effects of opioids at the receptor sites, thereby preventing the "high" associated with opioid use. They are particularly useful in treating opioid overdoses and can also be used in the management of opioid addiction as part of a comprehensive treatment plan.
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