While assessing a patient prior to the administration of ...

[wenmo]

While assessing a patient prior to the administration of neostigmine (Prostigmine) for the treatment of myasthenia gravis, a nurse notices that the patient has greater muscle strength than when assessed 1 hour ago.
 
  The nurse's interpretation of this assessment information is that
  a. the dose needs to be increased.
  b. the medication schedule seems to be effective.
  c. the patient will not require the next scheduled dose.
  d. toxicity is impending.

Question 2

A patient is admitted to the unit with complaints of abdominal pain and a history of myasthenia gravis. During the health history the nurse determines that the patient has been taking neostigmine (Prostigmin).
 
  The nurse should further assess the patient for
  a. bradycardia, diaphoresis, and urinary urgency.
  b. tachycardia, diaphoresis, and urinary retention.
  c. xerostomia, diaphoresis, and mydriasis.
  d. increased gastric motility, mydriasis, and urinary retention.

[kescobar@64]

Answer to Question 1

ANS: B
Important signs of improvement for patients with myasthenia gravis are ease of swallowing and increased ability to raise the eyelids. Increased muscle strength is the desired effect.
There is no indication that the dose needs to be increased. In fact, if the dosage is increased, this could lead the patient to develop a cholinergic crisis.
The patient should continue taking this dose as ordered, because it is producing the desired effect.
The patient is not exhibiting any signs or symptoms of toxicity.

Answer to Question 2

ANS: A
Accumulation of acetylcholine, seen in patients with myasthenia gravis, results in bradycardia, diaphoresis, and urinary urgency. These assessment findings are also a result of the adverse effects of neostigmine.
Tachycardia and urinary retention are not adverse effects of excessive muscarinic stimulation.
Xerostomia and mydriasis are not adverse effects of neostigmine or an accumulation of acetylcholine.
Increased gastric motility, mydriasis, and urinary retention are not adverse effects of neostigmine or an accumulation of acetylcholine.

[wenmo]

Gracias!

[mcarey591]

Excellent