Nokea
A nurse is caring for a client with myasthenia gravis at a health care facility. The client is receiving ambenonium. The nurse suspects that the dosage is insufficient based on assessment of which of the following?
- A. Clenching of the jaw
- B. Muscle spasms
- C. Difficulty breathing
- D. Abdominal cramping
Correct Answer: C
Rationale: The nurse should monitor for difficulty breathing as a symptom of drug underdosage. Clenching of the jaw and muscle spasms are symptoms of drug overdosage. Abdominal cramping may occur in the client who is receiving guanidine.
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A client has been prescribed pyridostigmine for myasthenia gravis. The nurse would be alert for the development of which of the following?
- A. Seizure disorder
- B. Reduction of visual acuity
- C. Abdominal discomfort
- D. Cardiac arrhythmias
Correct Answer: D
Rationale: The nurse should monitor for cardiac arrhythmias as a general adverse reaction in the client. Seizure disorder, reduction of visual acuity, and abdominal discomfort are not pyridostigmine-related adverse reactions. Reduction of visual acuity is related to topical ophthalmics. When the client is receiving bethanechol chloride for urinary retention, the nurse needs to examine for abdominal discomfort, which is an adverse reaction of bethanechol chloride and not pyridostigmine.
Which of the following would the nurse assess before administering ambenonium to a client?
- A. Palpation of the bladder
- B. Palpation of the thyroid
- C. Evidence of muscle weakness
- D. Signs of difficulty breathing
- E. Drooping of eyelids
Correct Answer: C,D,E
Rationale: Ambenonium is used to treat myasthenia gravis. The nurse's preadministration assessment should include assessment for signs of muscle weakness, such as drooling, inability to chew and swallow, drooping eyelids, inability to perform repetitive movements, difficulty breathing, and extreme fatigue.
A nurse is caring for a client with urinary retention who is prescribed bethanechol. The nurse would administer this drug cautiously if the client has which of the following?
- A. Raynaud's disease
- B. Bradycardia
- C. Coronary artery disease
- D. Hyperthyroidism
Correct Answer: B
Rationale: The nurse should administer bethanechol cautiously if a client has bradycardia, hypertension, epilepsy, cardiac arrhythmias, recent coronary occlusion, or megacolon. Cautious use is not necessary if the client has Raynaud's disease, coronary artery disease, or hyperthyroidism.
When conducting client teaching with a client and his family about the prescribed cholinergic therapy for myasthenia gravis, which of the following would be most important to include?
- A. How to adjust dosage
- B. Indications of drug underdosage
- C. The need to monitor blood glucose levels
- D. How to keep a record of response to therapy
- E. The need to wear medical identification
Correct Answer: A,B,D,E
Rationale: Client and family teaching should include signs and symptoms associated with underand overdosage, instructions on how to adjust the dosage up or down, how to keep a record of the response to therapy, and the importance of wearing medical identification. There is no need for the client and family to monitor blood glucose levels.
When assessing a client receiving a cholinergic drug, the nurse would assess the client for increased neuromuscular blocking effects if the client is also receiving which of the following?
- A. Amoxicillin
- B. Tobramycin
- C. Cephalexin
- D. Neomycin
- E. Clarithromycin
Correct Answer: B,D
Rationale: Cholinergic drugs administered concomitantly with aminoglycoside antibiotics, like tobramycin and neomycin, can result in increased neuromuscular blocking effects.