Question 1

The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours. The patient's last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action?

A) Assess the patient for signs of ptosis.
B) Notify the provider to discuss an order for intravenous immune globulin (IVIG).
C) Obtain an order for atropine sulfate.
D) Request an order for an extra dose of pyridostigmine.

Accepted Answer

The patient is experiencing cholinergic crisis, which is an adverse effect of pyridostigmine bromide. The symptoms are caused by an excess of acetylcholine. Atropine sulfate is the antidote for cholinergic crisis and will alleviate the symptoms experienced by the patient. Assessing for ptosis may aid in the diagnosis of MG, but it is not the most appropriate action in the current situation. IVIG may be a potential treatment for MG, but it is not the most appropriate action in the current situation. Requesting an extra dose of pyridostigmine is contraindicated in the current situation, as it would worsen the symptoms of cholinergic crisis.

Question 2

A 40-year-old woman is diagnosed with myasthenia gravis, and her provider recommends removal of her thymus gland. She asks the nurse why this would be helpful. The nurse will explain that removal of the thymus gland may:

A) increase binding of acetylcholine (ACh) molecules to ACh receptors.
B) increase the amount of ACh available at neuromuscular junction sites.
C) reduce the number of acetylcholine receptor sites.
D) reduce symptoms of myasthenia gravis following surgery.

Accepted Answer

The thymus gland is involved in the pathogenesis of myasthenia gravis, often through the production of antibodies that attack acetylcholine receptors at the neuromuscular junction, leading to muscle weakness. Removal of the thymus gland (thymectomy) can reduce the production of these antibodies, thereby reducing the symptoms of myasthenia gravis.

Question 3

The nurse is caring for a patient who has recurrent muscle spasms. The provider has ordered metaxalone (Skelaxin) to treat the spasms. The nurse learns that the patient has a history of drug and alcohol abuse. The nurse will contact the provider to discuss switching this patient to which medication?

A) Carisoprodol (Soma)
B) Chlorzoxazone (Parafon forte DSC)
C) Cyclobenzaprine (Flexeril)
D) Methocarbamol (Robaxin)

Accepted Answer

Methylprednisolone (Solu-Medrol) is often used to treat acute MS attacks by reducing inflammation and immune system activity. Mitoxantrone is used for more severe cases and is typically reserved as a second-line agent. Glatiramer acetate (Copaxone) and Interferon-B (IFN-B) are used for long-term management and prevention of MS attacks but are not typically effective for acute attacks.

Question 4

The nurse provides teaching to a patient who will begin taking cyclobenzaprine (Flexeril) to treat acute muscle spasms. Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I may experience dizziness and drowsiness when I take this drug.&#34;&#10;B) &#34;I should not consume alcohol while taking this medication.&#34;&#10;C) &#34;I should take this medication with food to decrease stomach upset.&#34;&#10;D) &#34;I will take this medication for 3 months and then stop taking it.&#34;

Accepted Answer

Cyclobenzaprine is typically prescribed for short-term use (2-3 weeks) to treat acute muscle spasms, and its effectiveness beyond that time period is not well-established. Therefore, the patient should not plan to take the medication for 3 months and should instead follow the prescribed duration of treatment.

Question 5

The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) scheduled to be administered 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms?

A) Excessive salivation
B) Muscle spasms
C) Muscle weakness
D) Respiratory paralysis

Accepted Answer

Neostigmine is a medication used to treat myasthenia gravis by increasing muscle strength. If a scheduled dose is missed, the patient may experience a recurrence of muscle weakness. Excessive salivation (A) and muscle spasms (B) are not typical symptoms of myasthenia gravis or neostigmine use. Respiratory paralysis (D) is a potential side effect of neostigmine overdose or incorrect use, but it is not the expected symptom in this scenario.

Question 6

A patient reports weakness of the extremities and diplopia. The nurse knows that these symptoms are characteristic of which condition?&#10;A) Cerebral palsy (CP)&#10;B) Multiple sclerosis (MS)&#10;C) Myasthenia gravis (MG)&#10;D) Parkinson disease (PD)

Accepted Answer

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. Symptoms of MS can include weakness of the extremities, diplopia, and fatigue.

Question 7

The nurse is caring for a patient who has recurrent muscle spasms. The provider has ordered metaxalone (Skelaxin) to treat the spasms. The nurse learns that the patient has a history of drug and alcohol abuse. The nurse will contact the provider to discuss switching this patient to which medication?

A) Carisoprodol (Soma)
B) Chlorzoxazone (Parafon forte DSC)
C) Cyclobenzaprine (Flexeril)
D) Methocarbamol (Robaxin)

Accepted Answer

Myasthenic crisis is characterized by respiratory distress or failure, as the muscles that control breathing are affected in patients with myasthenia gravis. Therefore, the nurse should be alert to symptoms affecting the respiratory system. Symptoms may include increased difficulty in breathing, shallow respirations, or the need for mechanical ventilation. Other body systems may be affected as well, but respiratory symptoms are most indicative of myasthenic crisis.

Question 8

The nurse is teaching a group of nursing students about multiple sclerosis (MS). Which statement by the nurse is correct?&#10;A) &#34;MS is characterized by degeneration of neurons and nerves in the brain and spinal cord.&#34;&#10;B) &#34;MS is characterized by lesions or plaques on myelin sheaths of nerves.&#34;&#10;C) &#34;MS is characterized by neuritic plaques and neurofibrillary tangles in the CNS.&#34;&#10;D) &#34;MS is characterized by weak muscles and decreased nerve impulses caused by decreased ACh.&#34;

Accepted Answer

MS is characterized by the presence of lesions or plaques on the myelin sheaths of nerve fibers in the brain and spinal cord. This can lead to a variety of symptoms, including weakness, numbness, tingling, and vision problems. The degeneration of neurons and nerves, as well as the presence of neuritic plaques and neurofibrillary tangles, are actually characteristic of other neurological disorders, such as Alzheimer's disease. Decreased ACh is associated with conditions like dementia and Parkinson's disease, but not MS.

Question 9

Which agent listed below is used in surgery to achieve neuromuscular blockade and paralysis?&#10;A) Baclofen (Lioresal)&#10;B) Chlorzoxazone (Parafon forte)&#10;C) Pancuronium bromide (Pavulon)&#10;D) Methocarbamol (Robaxin)

Accepted Answer

Pancuronium bromide is a neuromuscular blocking agent commonly used in surgery to achieve muscle paralysis. Baclofen, chlorzoxazone, and methocarbamol are muscle relaxants but do not produce paralysis.

Question 10

Which of the following is FALSE regarding pyridostigmine bromide (Mestinon)?&#10;A) It is poorly absorbed from the gastrointestinal tract.&#10;B) Overdosing of pyridostigmine can result in cholinergic crisis.&#10;C) Atropine is the antidote for pyridostigmine overdose.&#10;D) Pyridostigmine is a muscarinic receptor antagonist.

Accepted Answer

Pyridostigmine is not a muscarinic receptor antagonist. It is a reversible acetylcholinesterase inhibitor used to treat myasthenia gravis and to reverse the effects of non-depolarizing neuromuscular blocking agents used during surgery.

Question 11

The nurse is preparing to care for a patient who has multiple sclerosis (MS). The nurse learns that the patient receives fingolimod. The nurse knows that which of the following is FALSE about fingolimod?

A) It is used for treatment of relapsing forms of MS
B) It is administered IV
C) Fingolimod treatment requires CBC, ECG and LFT monitoring
D) Diarrhea, headache and nausea are common side effects

Accepted Answer

The answer of The nurse is preparing to care for...

Question 12

The nurse is preparing to administer methocarbamol (Robaxin) to a patient who is experiencing acute muscle spasms. The nurse notes discoloration of the patients urine. What will the nurse do?&#10;A) Administer the next dose of methocarbamol since this is a harmless side effect.&#10;B) Contact the provider to discuss changing to cyclobenzaprine (Flexeril).&#10;C) Obtain an order for a complete blood count to evaluate blood loss.&#10;D) Request an order for liver function tests since this indicates hepatotoxicity.

Accepted Answer

The answer of The nurse is preparing to administer methocarbamol...

Question 13

A patient has symptoms that are characteristic of multiple sclerosis (MS). Which diagnostic tests are likely to be ordered to aid in the diagnosis of this patient?&#10;A) Cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI)&#10;B) CSF proteins and an angiography&#10;C) Serum albumin and a computed tomography (CT) scan&#10;D) Serum anti-acetylcholine antibodies and x-rays

Accepted Answer

The answer of A patient has symptoms that are characteristic...

Question 14

The nurse is performing an admission assessment on a patient who has been taking carisoprodol (Soma) for 3 weeks to treat muscle spasms. The patient reports that the muscle spasms have resolved. The nurse will contact the provider to discuss

A) changing to cyclobenzaprine (Flexeril).
B) continuing the carisoprodol for 1 more week.
C) discontinuing the carisoprodol now.
D) ordering a taper of the carisoprodol.

Accepted Answer

The answer of The nurse is performing an admission assessment...

Question 15

The nurse is caring for a patient who has recurrent muscle spasms. The provider has ordered metaxalone (Skelaxin) to treat the spasms. The nurse learns that the patient has a history of drug and alcohol abuse. The nurse will contact the provider to discuss switching this patient to which medication?

A) Carisoprodol (Soma)
B) Chlorzoxazone (Parafon forte DSC)
C) Cyclobenzaprine (Flexeril)
D) Methocarbamol (Robaxin)

Accepted Answer

The answer of The nurse is caring for a patient...

Question 16

The nurse is performing a health history on a patient who has multiple sclerosis. The patient reports episodes of muscle spasticity and recurrence of muscle weakness and diplopia. The nurse will expect this patient to be prescribed which medication?

A) Methylprednisolone (Solu-Medrol)
B) Mitoxantrone
C) Cyclobenzaprine (Flexeril)
D) Interferon-B (IFN-B)

Accepted Answer

The answer of The nurse is performing a health history...

Deck 21: Drugs for Neuromuscular Disorders and Muscle Spasms