STUVIA 2024/2025
Chapter 21: Drugs for Neuromuscular Disorders
and Muscle Spasms
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.
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.
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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. 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.
The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of
neostigmine (Prostigmin) 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
c. Muscle weakness
d. Respiratory paralysis - ✔✔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.
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The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide
(Mestinon) 60 mg every 4 hours. The patient's last dose was 45 minutes prior. The nurse notes
severe muscle weakness, 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
Severe muscle weakness, 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.
Which of the following is FALSE regarding pyridostigmine bromide (Mestinon)?
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.
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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.
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.
A patient has symptoms that are characteristic of multiple sclerosis (MS). Which diagnostic tests are
likely to be ordered to aid in the diagnosis of this patient?
a. Cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI)
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