Question

Client: Shiri Koradia is a 33-year-old, female. She moved with her husband from India 10 years ago and has since resided in Queens, New York. She has 2 children: a 6-year-old boy and a 4-year-old girl. Shiri is the primary caregiver for her family and does not work outside the home. She has a 3-month history of complaints of fatigue, exhaustion, and multiple episodes of choking because she did not have the strength to chew the food. Her health care provider was unable to diagnose the problem and told her to rest and eat soft foods that did not require chewing. Her physical condition is affecting her ability to care for her children, and as a result, her mother-in-law has moved into the home to help care for the family.

PLEASE PROVIDE ELABORATE EXPLANATION FOR EACH ANSWER

1. Following an episode of double vision and eyelid drooping, Shiri’s husband brings her back to the health care provider. The provider administers a Tensilon test to help confirm a suspected diagnosis of myasthenia gravis (MG). Which response to the test indicates that Shiri has MG?

a.     No significant change in Shiri’s neurovascular assessment.

b.     Reduced amplitude of electrical stimulation in Shiri’s muscle.

c.     Antiacetylcholine receptor antibodies present in the blood.

d.     A noticeably marked improvement in Shiri’s muscle strength.

2. A health care provider prescribes anticholinesterase pyridostigmine (Mestinon) for Shiri. She asks the nurse “how is medication going to help me?” How should the nurse reply? SELECT ALL THAT APPLY.

a.     The medication increases ability to independently perform activities of daily living (ADLs).

b.     The medication increases tear production for adequate moisture in the eyes.

c.     The medication reduces gastric acid production to aid digestion of food.

d.     The medication eliminates muscle pain to enhance client’s ability to sleep.

e.     The medication prevents the breakdown of acetylcholine, a natural substance, in the body.

3. One month after the office visit, Shiri is admitted to the ED with sudden exacerbation of motor weakness, blurred vision, and diaphoresis. Which further data indicates she is experiencing a cholinergic crisis?

a.     The circulating acetylcholine receptor antibodies test is positive

b.     The symptoms improve when a cholinesterase inhibitor test is administered

c.     The blood pressure and pulse increase after a blood transfusion

d.     The Tensilon test does not show improvement in muscle strength

4. It is determined that Shiri is experiencing a cholinergic crisis, possibly due to an overdose of an anticholinesterase medication. Which nursing diagnosis is a priority?

a.     Impaired swallowing

b.     Chronic pain

c.     Safety risk due to impaired vision

d.     Ineffective airway clearance

Answer 1

Answer:(C) Antiacetylcholine receptor antibodies present in blood.

Answer: (A) & (E) It helps the release of the acetylcholine which retains the normal function of the body.

Answer: (D) The tension test does not show imoroimprov in muscles strength.

Answer: (D) ineffective airway clearance. Because this creates breathing problem which leads to many other problems.