Question 1

A patient experiences severe muscle weakness,and the provider orders edrophonium bromide (Tensilon).The patient begins to show improved muscle strength within a few minutes after administration of this drug.The nurse anticipates the provider will order which drug?

Accepted Answer

In this case,edrophonium is used to diagnose myasthenia gravis.Since symptoms improved with the AChE inhibitor,the patient will benefit from a longer-acting AChE inhibitor such as pyridostigmine.Atropine is given for AChE inhibitor overdose.Edrophonium is very short-acting,so it will not be used for treatment.IVIG is used when other AChE inhibitors fail.

Question 2

The nurse provides teaching to a patient who will begin taking cyclobenzaprine (Flexeril)to treat muscle spasms.Which statement by the patient indicates a need for further teaching?

Accepted Answer

This medication should not be stopped abruptly.Patients may experience dizziness and drowsiness.Alcohol will compound the central nervous system sedative effects.To decrease gastrointestinal upset,the nurse should counsel the patient to take it with food.

Question 3

A patient reports weakness of the extremities and diplopia.The nurse knows that these symptoms are characteristic of which condition?

Accepted Answer

Diplopia and weakness of the extremities are two symptoms of MS.CP is characterized by muscle spasticity.MG involves generalized weakness,especially of facial muscles and respiratory muscles.PD manifests as tremors and difficulty moving and walking.

Question 4

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

Accepted Answer

Muscle relaxants can cause drug dependence and should not be withdrawn abruptly.The nurse should discuss a drug taper.

Question 5

A patient exhibits ptosis of both eyes,and the provider orders edrophonium (Tensilon).The nurse notes immediate improvement of the ptosis.The nurse understands that this patient most likely has which disorder?

Accepted Answer

Improvement of symptoms after administration of edrophonium is diagnostic for myasthenia gravis.

Question 6

The nurse is preparing to administer methocarbamol (Robaxin)to a patient who is experiencing acute muscle spasms.The nurse notes that the patient's urine has turned black.What will the nurse do?

Accepted Answer

Urine may turn green,brown,or black in patients taking methocarbamol,and this is a harmless side effect.There is no need to change medications or order lab tests.

Question 7

The nurse is teaching a group of nursing students about multiple sclerosis (MS).Which statement by the nurse is correct?

Accepted Answer

MS is characterized by lesions on myelin sheaths of nerves.

Question 8

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?

Accepted Answer

Severe muscle weakness,excess salivation,fasciculations of facial muscles,and pupil constriction are the major signs of cholinergic crisis,caused by excess pyridostigmine.The antidote is atropine,so the nurse should obtain an order to give this.Ptosis is sign of myasthenic crisis.IVIG is given to treat symptoms of MG and not used for cholinergic crisis.Giving extra pyridostigmine would increase the symptoms.

Question 9

A client with myasthenia gravis is experiencing a cholinergic crisis.Which symptoms are associated with this condition? (Select all that apply.)

Accepted Answer

Bradycardia,drooling,and weakness can all occur with cholinergic crisis.

Question 10

The nurse is preparing to care for a patient who has myasthenia gravis.The nurse will be alert to symptoms affecting which body system in this patient?

Accepted Answer

Myasthenia gravis causes fatigue and muscular weakness of the respiratory system,facial muscles,and extremities.It does not directly affect the cardiovascular system,CNS,or GI systems.

Question 11

The nurse is caring for a patient who has myasthenia gravis (MG)and is receiving pyridostigmine bromide (Mestinon).The nurse notes ptosis of both eyelids and observes that the patient has difficulty swallowing.What action will the nurse perform next?

Accepted Answer

Overdosing and underdoing of AChE inhibitors have similar symptoms: muscle weakness,dyspnea,and dysphagia.Edrophonium may be used to diagnose MG or to distinguish between myasthenic crisis and cholinergic crisis since it is a very short-acting AChE inhibitor.When given,if the symptoms are alleviated,the cause is myasthenic crisis; if symptoms worsen,it is cholinergic crisis.Since patients can have similar symptoms,the nurse cannot report one or the other to the provider without more information.

Question 12

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?

Accepted Answer

Neostigmine must be given on time to prevent myasthenic crisis,which is characterized by generalized,severe muscle weakness.The other symptoms are characteristic of cholinergic crisis,caused by too much medication.

Question 13

The nurse is preparing to care for a patient who has multiple sclerosis (MS).The nurse learns that the patient receives cyclophosphamide (Cytoxan).The nurse knows that this patient is in which stage of MS?

Accepted Answer

Cyclophosphamide is used to treat MS patients who are in the chronic,progressive phase.

Question 14

The nurse is caring for a patient who has multiple sclerosis.The patient is experiencing an acute attack.Which drug does the nurse anticipate the provider will order?

Accepted Answer

ACTH is given to treat an acute attack of MS.Glatiramer acetate and interferon are used for remission-exacerbation states.Cyclophosphamide is given for chronic,progressive symptoms.

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?

Accepted Answer

Cyclobenzaprine is a muscle relaxant that does not cause drug dependence.The other muscle relaxants can cause drug dependence.

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 taking which medication?

Accepted Answer

This patient is showing signs of remission and exacerbation of MS symptoms.Interferon is used to treat this phase.ACTH is used for acute attacks.Cyclophosphamide is used for chronic,progressive symptoms.Cyclobenzaprine is a centrally acting muscle relaxant that is used for muscle spasms to decrease pain and increase range of motion.

Question 17

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?

Accepted Answer

Laboratory tests that may suggest MS include CSF IgG and MRI.

Question 18

The charge nurse observes a nurse administer undiluted intravenous pyridostigmine bromide (Mestinon)at a rate of 0.8 mg/min.The charge nurse will stop the infusion and perform which action?

Accepted Answer

When given,IV pyridostigmine should be administered undiluted at a rate of 0.5 mg/min and should not be added to IV fluids.It is not necessary to administer atropine,since the patient is not symptomatic of cholinergic crisis.

Question 19

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

Accepted Answer

Myasthenia gravis is an autoimmune disorder involving an antibody response against a subunit of the ACh receptor site.Since the thymus is involved in systemic immunity,it is thought that removing the thymus can inhibit this process.It does not increase binding of ACh molecules to receptors or increase the amount of ACh or reduce the number of ACh receptor sites.

Question 20

Which muscle relaxant is used in surgery as a skeletal muscle relaxant?

Accepted Answer

Pancuronium bromide is used as a depolarizing muscle relaxant during anesthesia.

Quiz 24: Drugs for Neuromuscular Disorders: Myasthenia Gravis, Multiple Sclerosis, and Muscle Spasms

A patient experiences severe muscle weakness,and the provider orders edrophonium bromide (Tensilon) .The patient begins to show improved muscle strength within a few minutes after administration of this drug.The nurse anticipates the provider will order which drug?

The nurse provides teaching to a patient who will begin taking cyclobenzaprine (Flexeril) to treat muscle spasms.Which statement by the patient indicates a need for further teaching?

A patient reports weakness of the extremities and diplopia.The nurse knows that these symptoms are characteristic of which condition?

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 patient exhibits ptosis of both eyes,and the provider orders edrophonium (Tensilon) .The nurse notes immediate improvement of the ptosis.The nurse understands that this patient most likely has which disorder?

The nurse is preparing to administer methocarbamol (Robaxin) to a patient who is experiencing acute muscle spasms.The nurse notes that the patient's urine has turned black.What will the nurse do?

The nurse is teaching a group of nursing students about multiple sclerosis (MS) .Which statement by the nurse is correct?

A client with myasthenia gravis is experiencing a cholinergic crisis.Which symptoms are associated with this condition? (Select all that apply.)

The nurse is preparing to care for a patient who has myasthenia gravis.The nurse will be alert to symptoms affecting which body system in this patient?

The nurse is caring for a patient who has myasthenia gravis (MG) and is receiving pyridostigmine bromide (Mestinon) .The nurse notes ptosis of both eyelids and observes that the patient has difficulty swallowing.What action will the nurse perform next?

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?

The nurse is preparing to care for a patient who has multiple sclerosis (MS) .The nurse learns that the patient receives cyclophosphamide (Cytoxan) .The nurse knows that this patient is in which stage of MS?

The nurse is caring for a patient who has multiple sclerosis.The patient is experiencing an acute attack.Which drug does the nurse anticipate the provider will order?

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?

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 taking which medication?

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?

The charge nurse observes a nurse administer undiluted intravenous pyridostigmine bromide (Mestinon) at a rate of 0.8 mg/min.The charge nurse will stop the infusion and perform which action?

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

Which muscle relaxant is used in surgery as a skeletal muscle relaxant?