Which patient may require a higher-than-expected dose of an opioid analgesic?

Choice A rationale

Myasthenia gravis primarily affects voluntary muscles, especially those involved in breathing and facial movements. Gastrointestinal (GI) and lower extremity muscles are generally not the main muscles affected by this condition. It is an autoimmune disorder that impacts the neuromuscular junction, where nerves communicate with muscles, leading to muscle weakness and fatigue.

Choice B rationale

The central nervous system (CNS), memory, and cognition are not typically impacted by myasthenia gravis. This disorder primarily involves peripheral nervous system issues that affect voluntary muscle control rather than cognitive functions. Myasthenia gravis does not cause alterations in memory or cognition as seen with central nervous system disorders like Alzheimer's disease.

Choice C rationale

Myasthenia gravis notably affects respiratory and facial muscles. The autoimmune attack on acetylcholine receptors leads to muscle weakness, particularly in muscles controlling eye movements, facial expressions, and breathing. Patients may experience difficulty breathing, swallowing, and maintaining an open airway due to this muscle weakness.

Choice D rationale

The cardiovascular system and postural muscles are not commonly affected by myasthenia gravis. This condition involves the neuromuscular junction and leads to fatigue in voluntary muscles, primarily those involved in eye movement, facial expressions, and respiration. Cardiovascular symptoms are not a direct consequence of myasthenia gravis.

Choice A rationale

Administering the medication even if the name of the drug can be clearly read is risky because the rest of the label might contain essential information like dosage, expiration date, and other critical instructions. Administering a medication without complete labeling increases the risk of medication errors.

Choice B rationale

Discarding the entire bottle and contents and obtaining a new bottle is the safest option. It ensures that the nurse is using a medication with a fully intact label, which includes all necessary information to safely administer the medication, such as dosage, route, and expiration date.

Choice C rationale

Asking another nurse to verify the contents of the bottle is not sufficient because the torn and soiled label still lacks complete information. Without all details, there's a risk of administering the wrong dosage or an expired medication.

Choice D rationale

Finding the drug information and making a new label for the bottle is not appropriate because it does not guarantee the accuracy of the dosage or other critical details that were on the original label. It's better to use a completely labeled and verified medication bottle.