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 C
Explanation
A) Feed cells under stress:
The primary function of the homeostasis control systems is not to directly "feed" cells under stress, but to regulate internal balance and ensure all systems are functioning optimally, particularly in response to changes in the environment or internal states. "Feeding" or providing nutrients is a broader metabolic process rather than a direct function of the homeostasis control systems.
B) Act on invading organisms:
While the immune system, which plays a role in defending the body against invading organisms, is a part of overall body regulation, homeostasis itself is more concerned with maintaining internal stability. The control systems of the body regulate physiological processes such as temperature, pH, and fluid balance rather than directly targeting external organisms like bacteria or viruses, which would fall under the immune response.
C) Control vital functions:
Homeostasis control systems are integral in maintaining the body's internal environment, ensuring stability for vital functions such as temperature, heart rate, blood pressure, and respiratory rate. These systems help adjust these functions in response to various internal and external stimuli to maintain optimal conditions for survival, making this the most accurate answer.
D) Shut down the body at death:
While the control systems ultimately cease to function at death, the purpose of homeostasis during life is to maintain the balance of bodily functions, not to cause the cessation of life. The homeostatic mechanisms are about maintaining life and health, preventing "shutdown" until the point of death.
Correct Answer is C
Explanation
A) Suspect worsening of the anxiety disorder:
While it is possible that the patient's anxiety disorder is worsening, the more likely explanation for the reduced effectiveness of lorazepam is the development of drug tolerance. Over time, patients may require higher doses of a medication to achieve the same therapeutic effect, especially with medications like lorazepam that are used chronically.
B) Contact the provider to discuss changing to another benzodiazepine:
Changing to another benzodiazepine might be an option, but it is more likely that tolerance to lorazepam is the cause of the reduced effect, not an issue with the specific drug. Tolerance is common with long-term use of benzodiazepines, and switching drugs may not address the underlying issue. The first step would be to assess the current medication regimen and discuss possible adjustments with the provider.
C) Understand that the patient has developed tolerance to this drug:
Tolerance occurs when the body becomes accustomed to the effects of a medication over time, requiring higher doses to achieve the same therapeutic effect. This is a common phenomenon with benzodiazepines like lorazepam, which are often used for long periods to manage anxiety. As the patient has been taking lorazepam for six months, this reduced effectiveness is likely due to the development of tolerance, rather than a worsening of the anxiety disorder.
D) Notify the provider and discuss increasing the dose of lorazepam:
While increasing the dose of lorazepam could temporarily relieve symptoms, it is not the most appropriate first step. The nurse should first consider the possibility of tolerance and discuss this with the provider before increasing the dose. Long-term increases in benzodiazepine dosages can increase the risk of side effects, dependency, and withdrawal symptoms.
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