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?

A) Hypothalamus and the medulla: While the hypothalamus and medulla play critical roles in regulating autonomic functions and overall sympathetic nervous system activity, the primary origin of the sympathetic nervous system's neural impulses comes from the spinal cord, specifically in the thoracic and lumbar regions. The hypothalamus and medulla are involved in coordinating and regulating sympathetic activity rather than being the origin of the impulses themselves.

B) Cranium and sacral area of the spinal cord: The cranium and sacral regions are primarily associated with the parasympathetic nervous system, not the sympathetic nervous system. The parasympathetic nervous system's nerve fibers arise from the brainstem and the sacral region, while the sympathetic fibers originate from the thoracic and lumbar areas.

C) Thoracic and lumbar section of the spinal cord: The sympathetic nervous system originates in the thoracolumbar region of the spinal cord, which includes the thoracic and lumbar segments (T1-L2). These regions house the preganglionic neurons whose axons exit the spinal cord and synapse in sympathetic ganglia, leading to the sympathetic effects on organs and tissues. This makes the thoracic and lumbar sections the correct location for the origin of SNS impulses.

D) Nerve membrane: The nerve membrane, or the cellular membrane of individual neurons, is not the location where impulses originate. The origin of the impulses is in the central nervous system (CNS), specifically in the spinal cord for the sympathetic system, not at the level of the individual nerve membranes.

A) Bradycardia: Bradycardia is a common symptom of a cholinergic crisis. It results from excessive acetylcholine at the neuromuscular junction, which can overstimulate the parasympathetic nervous system, leading to a decrease in heart rate.

B) Rash: A rash is not a typical symptom of a cholinergic crisis. Rash might occur as a side effect of medications or other conditions, but it is not a hallmark feature of a cholinergic crisis in myasthenia gravis.

C) Vomiting: Vomiting is a potential symptom of a cholinergic crisis. It occurs due to the excessive stimulation of the parasympathetic nervous system, which can cause gastrointestinal distress and nausea.

D) Fever: Fever is not typically associated with a cholinergic crisis, but it can occur if there is an underlying infection or other condition. A cholinergic crisis itself usually leads to symptoms like weakness and excessive salivation, not fever.

E) Weakness: Weakness is a hallmark symptom of a cholinergic crisis, as it results from overstimulation at the neuromuscular junction, leading to muscle fatigue and paralysis. This is similar to the symptoms of myasthenia gravis, but in a cholinergic crisis, the weakness is more profound.

F) Drooling: Drooling is another common symptom of a cholinergic crisis. Excessive acetylcholine can lead to excessive salivation due to overstimulation of the parasympathetic nervous system.