The nurse is assisting while a neurologist administers an edrophonium (Tensilon) test to a client with facial weakness and ptosis. If the test is positive for myasthenia gravis, which outcome would the nurse observe?

Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes.

After administration, the client will experience worsening facial weakness and ptosis.

After administration of the medication, there will be no change in the status of the ptosis or facial weakness.

The client will have elimination of symptoms lasting at least 24 hours after the administration of the medication.

Answer and Explanation

The Correct Answer is A

This is the correct expected outcome if the test is positive for myasthenia gravis. Edrophonium works quickly to increase acetylcholine levels, leading to temporary improvement in muscle strength. In a patient with myasthenia gravis, administration of edrophonium typically results in a rapid improvement in symptoms like facial weakness and ptosis within 30 to 60 seconds, with the effects lasting for a few minutes. This brief improvement is indicative of a positive result for myasthenia gravis.
B.A Worsening symptoms after administration of edrophonium are not expected and could indicate an adverse reaction or incorrect diagnosis. In myasthenia gravis, edrophonium typically improves symptoms rather than worsening them.
C. No change in symptoms would be unexpected in the case of myasthenia gravis. If edrophonium is effective, there should be a noticeable improvement in symptoms. If there is no change, it might suggest a diagnosis other than myasthenia gravis or that the test is inconclusive.
D. This outcome is not expected. Edrophonium has a very short duration of action, typically relieving symptoms for only a few minutes. The effects do not last for 24 hours. A longer-lasting improvement might be observed with other treatments for myasthenia gravis, such as anticholinesterase medications like pyridostigmine, but not with edrophonium.

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Correct Answer is D

Explanation

A. Phacoemulsification is a procedure used to remove cataracts from the eye. It involves using ultrasound waves to break up the cloudy lens (cataract) into small fragments, which are then suctioned out. While this procedure is relevant for cataract treatment, it does not address the acute management of angle-closure glaucoma.
B. Extracapsular cataract extraction is a surgical procedure to remove a cataract from the eye by making an incision and extracting the lens in one piece or in large segments. Like phacoemulsification, this procedure is focused on cataract removal and does not directly treat the underlying issue of acute angle-closure glaucoma.
C. A cochlear implant is a device used to provide a sense of sound to individuals with severe hearing loss or deafness. This procedure is unrelated to the treatment of eye conditions or intraocular pressure and therefore is not appropriate for managing primary angle-closure glaucoma.
D. Surgical iridectomy is a procedure specifically aimed at treating angle-closure glaucoma. It involves creating a small hole (iridectomy) in the peripheral iris to allow aqueous humor to flow from the posterior chamber of the eye to the anterior chamber, bypassing the obstructed drainage angle.

A. Black, tarry stool B. Clay-colored stool C. Watery stool D. Bright red blood in the stool

Correct Answer is A

Explanation

A. Black, tarry stool is indicative of blood that has been digested in the upper GI tract. The dark color is due to the action of digestive enzymes on blood.
B. Clay-colored stool is typically associated with biliary obstruction, not upper GI bleeding.
C. Watery stool can be caused by various conditions, including infections, inflammatory bowel diseases, and medications. It is not a specific indicator of upper GI bleeding.
D. Bright red blood in the stool is more likely to be associated with lower GI bleeding, such as from hemorrhoids or anal fissures.

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The nurse is assisting while a neurologist administers an edrophonium (Tensilon) test to a client with facial weakness and ptosis. If the test is positive for myasthenia gravis, which outcome would the nurse observe?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

The nurse is collecting a stool specimen from a client. What stool characteristic indicates to the nurse that the client may have an upper gastrointestinal (GI) bleed?

Correct Answer is A

Explanation

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