McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach,
11th Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient who has myasthenia gravis. The nurse will be alert to
symptoms affecting which body system which may indicate that the patient has
transitioned to myasthenic crisis?
a. Cardiovascular system
b. Central nervous system (CNS), memory, and cognition
c. Gastrointestinal system (GI) and lower extremity muscles
d. Respiratory system
ANS: D
Patients with myasthenia gravis can progress to severe, generalized muscle weakness
involving the muscles of respiration, such as the diaphragm and intercostal muscles.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity:
Pathophysiology
2. 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
a. increase binding of acetylcholine (ACh) molecules to ACh receptors.
b. increase the amount of ACh available at neuromuscular junction sites.
c. reduce the number of acetylcholine receptor sites.
d. reduce symptoms of myasthenia gravis following surgery.
ANS: D
Thymic hyperplasia and tumors are common in patients with myasthenia gravis (MG).
The thymus gland is involved in systemic immunity that is active during infancy and
early childhood, but the gland normally shrinks during adulthood. Approximately
70% of MG patients have thymic hyperplasia. A thymectomy (removal of the thymus
gland) is most beneficial because it can cause a reduction of symptoms following the
surgery.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: Nursing Intervention: Patient Teaching MSC: NCLEX:
Physiological Integrity: Pathophysiology
,3. The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of
neostigmine scheduled to be administered 1 hour prior was not given. The nurse will
anticipate the patient to exhibit which symptoms?
a. Excessive salivation
b. Muscle spasms/twitching
c. Muscle weakness
d. Abdominal cramping
ANS: C
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.
DIF: Cognitive Level: Understanding (Comprehension) TOP:
Nursing Process: Assessment | Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pathophysiology
4. The nurse is caring for a patient who has myasthenia gravis (MG) and takes
pyridostigmine 60 mg every 4 hours. The patient’s last dose was 45 minutes prior. The
nurse notes respiratory distress, excess salivation, fasciculations of facial muscles, and
pupil constriction. The nurse will perform which action?
a. Assess the patient for signs of ptosis.
b. Notify the provider to discuss an order for intravenous immune globulin (IVIG).
c. Obtain an order for atropine sulfate.
d. Request an order for an extra dose of pyridostigmine.
ANS: C
Respiratory distress, 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 a 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.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
5. Which of the following is FALSE regarding pyridostigmine?
a. It is poorly absorbed from the gastrointestinal tract.
b. Overdosing of pyridostigmine can result in cholinergic crisis.
c. Atropine is the antidote for pyridostigmine overdose.
d. Pyridostigmine is a muscarinic receptor antagonist.
ANS: D
Pyridostigmine is an acetylcholinesterase inhibitor and does not antagonize
, muscarinic receptors. The drug is poorly absorbed from the GI tract. Overdosing with
pyridostigmine results in cholinergic crisis, and atropine is used as an antidote for
pyridostigmine overdose.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
6. A patient reports weakness of the extremities and diplopia. The nurse knows that these
symptoms are characteristic of which condition?
a. Cerebral palsy (CP)
b. Multiple sclerosis (MS)
c. Myasthenia gravis (MG)
d. Parkinson disease (PD)
ANS: B
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.
DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity:
Pathophysiology
7. A patient has symptoms that are characteristic of multiple sclerosis (MS). Which
diagnostic tests are likely to be ordered to aid in the diagnosis?
a. Cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI)
b. CSF proteins and an angiography
c. Serum albumin and a computed tomography (CT) scan
d. Serum anti-acetylcholine antibodies and x-rays
ANS: A
Laboratory tests that may be used to confirm a diagnosis of MS include CSF analysis,
evoked potential (EP) testing, and MRI.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity:
Pathophysiology
8. A patient with multiple sclerosis (MS) is to start treatment with interferon beta-1a. The
presence of which of the following will prompt the nurse to check with the provider?
a. History of diabetes mellitus
b. History of hypertension
c. History of depression and suicidal ideation
d. History of osteoarthritis
, ANS: C
Interferons are associated with contributing to symptoms of depression and suicidal
ideation. For patients with a positive history of depression and suicidal ideation
consideration of alternative therapy is likely prudent. A history of diabetes,
hypertension or osteoarthritis would not preclude the use of interferon therapy.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Assessment MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
9. The nurse provides teaching to a patient who will begin taking cyclobenzaprine to treat
acute muscle spasms. Which statement by the patient indicates a need for further
teaching?
a. “I may experience dizziness and drowsiness when I take this drug.”
b. “I should not consume alcohol while taking this medication.”
c. “I should be careful driving with this medication because it can cause
drowsiness.”
d. “I will take this medication for 3 months and then stop taking it.”
ANS: D
Most centrally acting muscle relaxants used for acute spasms are taken for no longer
than 3 weeks and should be tapered over 1 week to avoid rebound spasms. Patients
may experience dizziness and drowsiness. Alcohol will compound the central nervous
system sedative effects. Patients should be cautioned about driving and operating
machinery while using muscle relaxants.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological
Integrity: Pharmacological and Parenteral Therapies
10. The nurse is performing an admission assessment on a patient who has been taking
carisoprodol 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. changing to cyclobenzaprine.
b. continuing the carisoprodol for 1 more week.
c. discontinuing the carisoprodol now.
d. ordering a taper of the carisoprodol.
ANS: D
Muscle relaxants can result in drug dependence and should not be withdrawn
abruptly. The nurse should discuss a drug taper. Changing to a different muscle
relaxant (cyclobenzaprine) is not recommended since the patient is doing well.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process:
Nursing Intervention MSC: NCLEX: Physiological Integrity:
Pharmacological and Parenteral Therapies
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