A client with myasthenia gravis is prescribed neostigmine. The ...

[dbose]

A client with myasthenia gravis is prescribed neostigmine. The client telephones to report severe abdominal pain for the last 4 hours. Which response by the nurse is the most appropriate?
 
  1. Increase your evening dose of medication. This should resolve your pain.
  2. This is a common side effect that should resolve when you have a bowel movement.
  3. You need to be evaluated immediately for a bowel obstruction.
  4. You are probably constipated. Take a laxative and return to the office in the morning.

Question 2

A client who is suspected to have myasthenia gravis is given a small dose of postoperative medication. The client subsequently develops increased muscle weakness. Which medication should the nurse anticipate administering immediately?
 
  1. A dopamine agonist
  2. A calcium channel blocker
  3. A cholinesterase inhibitor
  4. A sympathetic stimulant

[ririgirl15]

Answer to Question 1

Correct Answer: 3
Rationale 1: Increasing the evening dose of medication could worsen the obstruction.
Rationale 2: Neostigmine can cause some constipation, but should not cause severe abdominal pain.
Rationale 3: Advise the client to be evaluated immediately for a bowel obstruction. Clients with obstructive disorders of the gastrointestinal and urinary tract should not receive this drug because the increased smooth muscle contractions could worsen the condition.
Rationale 4: Advising the client to take a laxative and return to the office in the morning could cause a perforated bowel if the client's bowel is obstructed.
Global Rationale: Advise the client to be evaluated immediately for a bowel obstruction. Clients with obstructive disorders of the gastrointestinal and urinary tract should not receive this drug because the increased smooth muscle contractions could worsen the condition. Increasing the evening dose of medication could worsen the obstruction. Neostigmine can cause some constipation, but should not cause severe abdominal pain. Advising the client to take a laxative and return to the office in the morning could cause a perforated bowel if the client's bowel is obstructed.

Answer to Question 2

Correct Answer: 3
Rationale 1: This would relax the peripheral muscles.
Rationale 2: This would relax cardiac contractility.
Rationale 3: This would increase muscle strength.
Rationale 4: A parasympathetic stimulant would be needed.
Global Rationale: A cholinesterase inhibitor would increase muscle strength. A dopamine agonist would relax peripheral muscles. A calcium channel blocker would relax cardiac contractility. A parasympathetic stimulant, not sympathetic stimulants, would be needed.