A patient who has myasthenia gravis (MG) presents to the ...

[michelleunicorn]

A patient who has myasthenia gravis (MG) presents to the emergency department with abrupt onset of increased muscle weakness and difficulty swallowing. An attempt to distinguish worsening of the MG symptoms from overdose of the patient's prescribed anticholinergic is planned. What medications should the nurse obtain for use in this procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.
 
  1. Donepezil (Aricept)
  2. Pyridostigmine (Mestinon)
  3. Neostigmine (Prostigmin)
  4. Edrophonium (Edrophonium Injectable)
  5. Atropine (Atropine Injectable)

Question 2

Dextran 40 (Gentran 40) has been prescribed for nonemergency infusion. The nurse should plan to take which actions?
 
  1. Start the infusion no faster than 240 mg/min.
  2. Monitor the patient's vital signs continuously during administration.
  3. Monitor for signs of anaphylaxis.
  4. Teach the patient to avoid use of any over-the-counter herbal products.
  5. Discard any portion of the infusion that is not used.

[lindahyatt42]

Answer to Question 1

4,5
Rationale 1: Donepezil (Aricept) is prescribed for the treatment of Alzheimer's disease and would not be used in this situation.
Rationale 2: Pyridostigmine (Mestinon) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication.
Rationale 3: Neostigmine (Prostigmin) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication.
Rationale 4: Edrophonium (Edrophonium Injectable) is given as a test dose. If muscular symptoms improve, the patient is having a myasthenic crisis.
Rationale 5: Atropine (Atropine Injectable) is given if the test results in a cholinergic crisis.

Global Rationale: Edrophonium (Edrophonium Injectable) is given as a test dose. If muscular symptoms improve, the patient is having a myasthenic crisis. Atropine (Atropine Injectable) is given if the test results in a cholinergic crisis. Donepezil (Aricept) is prescribed for the treatment of Alzheimer's disease and would not be used in this situation. Pyridostigmine (Mestinon) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication. Neostigmine (Prostigmin) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication.

Answer to Question 2

1,2,3,5
Rationale 1: Nonemergency infusion should not be faster than 240 mg/min. In an emergency the rate is increased to 1.2 to 2.4 g/min.
Rationale 2: Hypertension may occur, so vital signs must be continuously monitored.
Rationale 3: Some patients are anaphylactic to this drug.
Rationale 4: There is no known herbal or food interaction with this drug.
Rationale 5: There is no preservative in this preparation, so unused portions must be discarded.

Global Rationale: Nonemergency infusion should not be faster than 240 mg/min. In an emergency the rate is increased to 1.2 to 2.4 g/min. Hypertension may occur, so vital signs must be continuously monitored. Some patients are anaphylactic to this drug. There is no preservative in this preparation, so unused portions must be discarded. There is no known herbal or food interaction with this drug.

[michelleunicorn]

Both answers were spot on, thank you once again

[lindahyatt42]

Great! Please up vote