Nokea
A client is taking long-term corticosteroids for myasthenia gravis. What teaching is most important?
- A. Avoid others who are ill
- B. Check blood sugars four times a day
- C. Use two forms of contraception
- D. Wear properly fitting socks and shoes
Correct Answer: A
Rationale: Corticosteroids reduce immune function, so clients taking these medications must avoid being exposed to illness. Long-term use can lead to secondary diabetes, but the client would not need to start checking blood glucose unless diabetes had been detected. Corticosteroids do not affect the effectiveness of contraception. While it is important to avoid injury, this is not specific to corticosteroid use.
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A client with myasthenia gravis is prescribed pyridostigmine (Mestinon). What teaching should the nurse plan regarding this medication? (Select all that apply.)
- A. Do not eat a full meal for 45 minutes after taking the drug
- B. Seek immediate care if you develop trouble swallowing
- C. Take this drug on an empty stomach for best absorption
- D. The dose may change frequently depending on symptoms
- E. Your urine may turn a reddish-orange color while on this drug
Correct Answer: A,B,D
Rationale: Pyridostigmine should be given with a small amount of food to prevent GI upset, but the client should wait to eat a full meal due to the potential for aspiration. If difficulty with swallowing occurs, the client should seek immediate attention. The dose can change on a day-to-day basis depending on the client's manifestations. Taking the drug on an empty stomach is not necessary, and the client's urine will not turn reddish-orange.
A client had a nerve laceration repair to the forearm and is being discharged in a cast. What statement by the client indicates a poor understanding of discharge instructions relating to cast care?
- A. I can scratch with a coat hanger
- B. I should feel my fingers for warmth
- C. I will keep the cast clean and dry
- D. I will return to have the cast removed
Correct Answer: A
Rationale: Nothing should be placed under the cast to use for scratching, as this can cause skin damage or infection. The other statements show a good understanding of cast care instructions.
A client is admitted with Guillian-Barr syndrome (GBS). What assessment takes priority?
- A. Bladder control
- B. Cognitive perception
- C. Respiratory system
- D. Sensory functions
Correct Answer: C
Rationale: Clients with GBS have muscle weakness, possibly to the point of paralysis. If respiratory muscles are paralyzed, the client may need mechanical ventilation, so the respiratory system is the priority. The nurse will complete urinary, cognitive, and sensory assessments as part of a thorough evaluation.
A client with myasthenia gravis (MG) asks the nurse to explain the disease. What response by the nurse is best?
- A. MG is an autoimmune problem in which nerves do not cause muscles to contract
- B. MG is an inherited destruction of peripheral nerve endings and junctions
- C. MG is contact-induced paralysis of specific cranial nerves
- D. MG is a viral infection of the dorsal root of sensory nerve fibers
Correct Answer: A
Rationale: MG is an autoimmune disorder in which nerve fibers are damaged, and their impulses do not lead to muscle contraction. MG is not an inherited or viral disorder and does not paralyze specific cranial nerves.
The nurse caring for a client with Guillain-Barr?© syndrome has identified the priority client problem of decreased mobility for the client. What actions by the nurse are best? (Select all that apply.)
- A. Ask occupational therapy to help the client with activities of daily living
- B. Communicate with physical therapy for a consult
- C. Provide the client with information on support groups
- D. Refer the client to a medical social worker or chaplain
- E. Work with speech therapy to design a high-protein diet
Correct Answer: A,B,E
Rationale: Improving mobility and strength involves the collaborative assistance of occupational therapy, physical therapy, and speech therapy for nutritional support. While support groups, social work, or chaplain referrals may be needed, they do not directly help with mobility.