NUR 255 Test 3 Review | QUESTIONS AND ANSWERS
Men usually develop myasthenia C) 50s
gravis (MG) in their s.
Rationale
A)30s Myasthenia gravis normally occurs from ages 20 to 30 in females but presents later
B) 40s in men. Men usually develop MG in their 50s.
C)50s
D) teens
A) Ocular muscles
Rationale
Which muscle group is affected first in ✔Ocular muscles
patients with myasthenia gravis (MG)? Ocular muscles are usually the first to be affected by MG. In most patients, MG
normally does not progress past the ocular muscles.
A)Ocular muscles
B) Facial muscles X - Facial muscles. Trunk muscles, Limb muscles
C) Trunk muscles Facial, Limb, and Trunk muscles are not the first muscle group to be affected.
D) Limb muscles -If the facial muscles are affected, the patient will have impaired expression and
facial mobility.
-If the trunk muscles are impacted, it will cause the patient to fatigue quickly.
-If the limb muscles are impacted, it will cause the patient to fatigue quickly.
, B) Single-fiber electromyography (EMG)
Rationale
Which diagnostic tool is highly sensitive for ✔Single-fiber electromyography (EMG)
diagnosing myasthenia gravis (MG)? A single-fiber EMG is highly effective in diagnosing MG.
A)Chest computed tomography (CT) scan X - Chest computed tomography (CT) scan
B) Single-fiber electromyography A chest CT scan might be done to assess the thymus if a confirmed diagnosis is
(EMG) made. X - History and physical exam
C)History and physical exam A history and physical exam is important in getting baseline information, but it is not
D) Magnetic resonance imaging (MRI) the tool used for a definitive diagnosis.
X - Magnetic resonance imaging (MRI)
An MRI is not useful in diagnosing MG.
D) 1,3,4,5
Which overall goal would the nurse
include in the plan of care for a patient Rationale
with myasthenia gravis (MG)? Select all ✔Restore normal muscle strength
that apply. One, some, or all responses Restoration of normal muscle growth is a goal the nurse should include in the
may be correct. plan of care for the patient with MG.
1) Restore normal muscle strength X - Be aware of cardiac problems
2) Be aware of cardiac problems Myasthenia gravis is a neurologic disease that can cause impaired respiratory
3) Avoid complications function.
4)Maintain quality of life
5) Avoid fatigue ✔Avoid complications
The patient is at risk for injury, and it is important to keep the patient safe.
A) 3,5
B)3,4,5 ✔Maintain quality of life
C) 2 For the patient’s mental well-being, it is important to maintain quality of life as
D) 1,3,4,5 much as possible.
E)All
F) None ✔Avoid fatigue
Symptoms will intensify with fatigue; thus, it is important to prevent fatigue.
D) “Try to adapt your schedule so you aren’t as tired.”
Which response would the nurse
Rationale
provide when caring for a female
✔“Try to adapt your schedule so you aren’t as tired.”
patient with myasthenia gravis who is
Patients with myasthenia gravis should adapt their schedule to include ample rest
angry and depressed and says, “I can’t do
periods and prevent fatigue.
anything for longer than a few
minutes”?
X - “You may need to hire a home health aide.”
The nurse should not recommend a home health aide as the first option.
A)“You may need to hire a home health
aide.”
X - “Why do you feel that you can’t do anything?”
B) “Why do you feel that you
Asking “why” questions is not therapeutic and may cause the patient to become
can’t do anything?”
defensive.
C)“Do you have family at home who can
help you?”
X - “Do you have family at home who can help you?”
D) “Try to adapt your
The nurse should assess the presence of a support system, but that is not the best
schedule so you aren’t as tired.”
response.
, D) 1,2,4,5
Which is an expected outcome in the
patient with myasthenia gravis (MG)? Select Rationale
all that apply. One, some, or all ✔Free of medication side effects
responses may be correct. Avoidance of side effects is important in the management of the patient with MG.
1) Free of medication side effects ✔Achieve optimal muscle function
2) Achieve optimal muscle function Muscle function is important for patient safety.
3) Maintain liquid diet
4) Avoid complications ✔Avoid complications
5) Maintain quality of life If muscle is unable to be maintained, there is risk for complications for the
patient.
A) 3,5
B)2,4,5 ✔Maintain quality of life
C) 3 As disease progresses, it is important to maintain the quality of life appropriate
D) 1,2,4,5 to the disease course.
E)All
F) None X - Maintain liquid diet
Semi-solid foods may be easier for the patient than solids or liquids.
Which clinical manifestation is considered A) Fluctuating weakness of skeletal muscles
the key feature of myasthenia gravis (MG)?
Rationale
A)Fluctuating weakness of skeletal ✔Fluctuating weakness of skeletal muscles
muscles Fluctuating weakness of skeletal muscles is the key feature of MG.
B) Sensory loss X-Sensory loss, Loss of reflexes, Muscle atrophy
C)Loss of reflexes Muscle atrophy is rare in patients with MG. Sensory and Reflex loss do not occur
D) Muscle atrophy with MG.
D) Swallowing and breathing
Rationale:
Which muscle group causes the
✔Swallowing and breathing
most problems for patients with
Muscles used for swallowing and breathing can be affected and may result in
myasthenia gravis (MG)?
aspiration and need for ventilation.
X-Orbital
A)Orbital
Orbital muscles are the first muscles involved in the disease process and often the
B) Facial
only muscles involved.
C) Trunk and limbs
X-Facial
D) Swallowing and breathing
If facial muscles are impacted, expression is
challenged. X-Trunk and limbs
If trunk and limbs are impacted, it may cause fatigue.
, E) All
Which objective data would be collected
when caring for a patient with myasthenia
Rationale
gravis (MG) to assess the severity of the
✔Respiratory rate and depth
disease? Select all that apply. One, some,
Assessment of respiratory rate and depth will help in gauging the severity of MG.
or all responses may be correct.
✔Oxygen saturation
1) Respiratory rate and depth
Assessment of oxygen saturation will help gauge the severity of MG. Knowing
2) Oxygen saturation
baseline will assist in gauging status.
3) Arterial blood gas (ABG) analysis
4)Pulmonary function tests
✔Arterial blood gas (ABG) analysis
5) Cough and gag reflexes
Assessment of ABG will help gauge the severity of MG.
A) 3,5 ✔Pulmonary function tests
B)1,2,3,4 If there is a question of status, assessment of pulmonary function tests will help
C) 3 gauge the severity of MG.
D) 1,2,4,5
E)All ✔Cough and gag reflexes
F) None Assessment of cough and gag reflexes will help gauge the severity of MG.
Weakness may be seen within ___ hour(s) of A) 1
ingestion of an anticholinesterase drug
during an cholinergic crisis.
A) 1
B) 2
C) 3
D) 4
B) Improved strength after intravenous (IV) administration of anticholinesterase
drugs
Rationale
Which clinical manifestation is seen in ✔Improved strength after intravenous (IV) administration of anticholinesterase
patients experiencing a myasthenic crisis? drugs
A patient who is experiencing a myasthenic crisis will exhibit improved strength
A)Increased bronchial secretions after IV administration of anticholinesterase drugs.
B) Improved strength after
intravenous X-Increased bronchial secretions
(IV) administration of anticholinesterase Increased bronchial secretions can occur in patients in a cholinergic crisis in which
drugs there are effects on smooth muscle.
C)Weakness within 1 hour after
ingestion of anticholinesterase drugs X-Weakness within 1 hour after ingestion of anticholinesterase drugs
D) Effects on smooth muscle, A person in a cholinergic crisis will have weakness 1 hour after ingestion of
including pupillary miosis, salivation, anticholinesterase drugs.
diarrhea, nausea, or vomiting
X-Effects on smooth muscle, including pupillary miosis, salivation, diarrhea, nausea,
or vomiting
During a cholinergic crisis, there are effects on smooth muscle.
Men usually develop myasthenia C) 50s
gravis (MG) in their s.
Rationale
A)30s Myasthenia gravis normally occurs from ages 20 to 30 in females but presents later
B) 40s in men. Men usually develop MG in their 50s.
C)50s
D) teens
A) Ocular muscles
Rationale
Which muscle group is affected first in ✔Ocular muscles
patients with myasthenia gravis (MG)? Ocular muscles are usually the first to be affected by MG. In most patients, MG
normally does not progress past the ocular muscles.
A)Ocular muscles
B) Facial muscles X - Facial muscles. Trunk muscles, Limb muscles
C) Trunk muscles Facial, Limb, and Trunk muscles are not the first muscle group to be affected.
D) Limb muscles -If the facial muscles are affected, the patient will have impaired expression and
facial mobility.
-If the trunk muscles are impacted, it will cause the patient to fatigue quickly.
-If the limb muscles are impacted, it will cause the patient to fatigue quickly.
, B) Single-fiber electromyography (EMG)
Rationale
Which diagnostic tool is highly sensitive for ✔Single-fiber electromyography (EMG)
diagnosing myasthenia gravis (MG)? A single-fiber EMG is highly effective in diagnosing MG.
A)Chest computed tomography (CT) scan X - Chest computed tomography (CT) scan
B) Single-fiber electromyography A chest CT scan might be done to assess the thymus if a confirmed diagnosis is
(EMG) made. X - History and physical exam
C)History and physical exam A history and physical exam is important in getting baseline information, but it is not
D) Magnetic resonance imaging (MRI) the tool used for a definitive diagnosis.
X - Magnetic resonance imaging (MRI)
An MRI is not useful in diagnosing MG.
D) 1,3,4,5
Which overall goal would the nurse
include in the plan of care for a patient Rationale
with myasthenia gravis (MG)? Select all ✔Restore normal muscle strength
that apply. One, some, or all responses Restoration of normal muscle growth is a goal the nurse should include in the
may be correct. plan of care for the patient with MG.
1) Restore normal muscle strength X - Be aware of cardiac problems
2) Be aware of cardiac problems Myasthenia gravis is a neurologic disease that can cause impaired respiratory
3) Avoid complications function.
4)Maintain quality of life
5) Avoid fatigue ✔Avoid complications
The patient is at risk for injury, and it is important to keep the patient safe.
A) 3,5
B)3,4,5 ✔Maintain quality of life
C) 2 For the patient’s mental well-being, it is important to maintain quality of life as
D) 1,3,4,5 much as possible.
E)All
F) None ✔Avoid fatigue
Symptoms will intensify with fatigue; thus, it is important to prevent fatigue.
D) “Try to adapt your schedule so you aren’t as tired.”
Which response would the nurse
Rationale
provide when caring for a female
✔“Try to adapt your schedule so you aren’t as tired.”
patient with myasthenia gravis who is
Patients with myasthenia gravis should adapt their schedule to include ample rest
angry and depressed and says, “I can’t do
periods and prevent fatigue.
anything for longer than a few
minutes”?
X - “You may need to hire a home health aide.”
The nurse should not recommend a home health aide as the first option.
A)“You may need to hire a home health
aide.”
X - “Why do you feel that you can’t do anything?”
B) “Why do you feel that you
Asking “why” questions is not therapeutic and may cause the patient to become
can’t do anything?”
defensive.
C)“Do you have family at home who can
help you?”
X - “Do you have family at home who can help you?”
D) “Try to adapt your
The nurse should assess the presence of a support system, but that is not the best
schedule so you aren’t as tired.”
response.
, D) 1,2,4,5
Which is an expected outcome in the
patient with myasthenia gravis (MG)? Select Rationale
all that apply. One, some, or all ✔Free of medication side effects
responses may be correct. Avoidance of side effects is important in the management of the patient with MG.
1) Free of medication side effects ✔Achieve optimal muscle function
2) Achieve optimal muscle function Muscle function is important for patient safety.
3) Maintain liquid diet
4) Avoid complications ✔Avoid complications
5) Maintain quality of life If muscle is unable to be maintained, there is risk for complications for the
patient.
A) 3,5
B)2,4,5 ✔Maintain quality of life
C) 3 As disease progresses, it is important to maintain the quality of life appropriate
D) 1,2,4,5 to the disease course.
E)All
F) None X - Maintain liquid diet
Semi-solid foods may be easier for the patient than solids or liquids.
Which clinical manifestation is considered A) Fluctuating weakness of skeletal muscles
the key feature of myasthenia gravis (MG)?
Rationale
A)Fluctuating weakness of skeletal ✔Fluctuating weakness of skeletal muscles
muscles Fluctuating weakness of skeletal muscles is the key feature of MG.
B) Sensory loss X-Sensory loss, Loss of reflexes, Muscle atrophy
C)Loss of reflexes Muscle atrophy is rare in patients with MG. Sensory and Reflex loss do not occur
D) Muscle atrophy with MG.
D) Swallowing and breathing
Rationale:
Which muscle group causes the
✔Swallowing and breathing
most problems for patients with
Muscles used for swallowing and breathing can be affected and may result in
myasthenia gravis (MG)?
aspiration and need for ventilation.
X-Orbital
A)Orbital
Orbital muscles are the first muscles involved in the disease process and often the
B) Facial
only muscles involved.
C) Trunk and limbs
X-Facial
D) Swallowing and breathing
If facial muscles are impacted, expression is
challenged. X-Trunk and limbs
If trunk and limbs are impacted, it may cause fatigue.
, E) All
Which objective data would be collected
when caring for a patient with myasthenia
Rationale
gravis (MG) to assess the severity of the
✔Respiratory rate and depth
disease? Select all that apply. One, some,
Assessment of respiratory rate and depth will help in gauging the severity of MG.
or all responses may be correct.
✔Oxygen saturation
1) Respiratory rate and depth
Assessment of oxygen saturation will help gauge the severity of MG. Knowing
2) Oxygen saturation
baseline will assist in gauging status.
3) Arterial blood gas (ABG) analysis
4)Pulmonary function tests
✔Arterial blood gas (ABG) analysis
5) Cough and gag reflexes
Assessment of ABG will help gauge the severity of MG.
A) 3,5 ✔Pulmonary function tests
B)1,2,3,4 If there is a question of status, assessment of pulmonary function tests will help
C) 3 gauge the severity of MG.
D) 1,2,4,5
E)All ✔Cough and gag reflexes
F) None Assessment of cough and gag reflexes will help gauge the severity of MG.
Weakness may be seen within ___ hour(s) of A) 1
ingestion of an anticholinesterase drug
during an cholinergic crisis.
A) 1
B) 2
C) 3
D) 4
B) Improved strength after intravenous (IV) administration of anticholinesterase
drugs
Rationale
Which clinical manifestation is seen in ✔Improved strength after intravenous (IV) administration of anticholinesterase
patients experiencing a myasthenic crisis? drugs
A patient who is experiencing a myasthenic crisis will exhibit improved strength
A)Increased bronchial secretions after IV administration of anticholinesterase drugs.
B) Improved strength after
intravenous X-Increased bronchial secretions
(IV) administration of anticholinesterase Increased bronchial secretions can occur in patients in a cholinergic crisis in which
drugs there are effects on smooth muscle.
C)Weakness within 1 hour after
ingestion of anticholinesterase drugs X-Weakness within 1 hour after ingestion of anticholinesterase drugs
D) Effects on smooth muscle, A person in a cholinergic crisis will have weakness 1 hour after ingestion of
including pupillary miosis, salivation, anticholinesterase drugs.
diarrhea, nausea, or vomiting
X-Effects on smooth muscle, including pupillary miosis, salivation, diarrhea, nausea,
or vomiting
During a cholinergic crisis, there are effects on smooth muscle.
