A nurse is providing discharge teaching to a client who has generalized myasthenia gravis. Which of the following information should the nurse include?

Encourage the client to eat a large meal in the evening.

Recommend the client eat within 45 min of taking cholinesterase-inhibitor medication.

Recommend the client extend their neck to facilitate swallowing.

Encourage the client to contact an occupational therapist to learn techniques of avoiding aspiration.

Answer and Explanation

The Correct Answer is B

Rationale:
A. Encourage the client to eat a large meal in the evening: Clients with myasthenia gravis experience progressive muscle weakness, especially later in the day. Eating large evening meals increases the risk of fatigue and aspiration because muscle strength is reduced after activity.

B. Recommend the client eat within 45 min of taking cholinesterase-inhibitor medication: Cholinesterase inhibitors, such as pyridostigmine, enhance neuromuscular transmission and improve muscle strength. Eating within 45 minutes of taking the medication ensures optimal swallowing ability and reduces the risk of aspiration by aligning mealtime with peak effect.

C. Recommend the client extend their neck to facilitate swallowing: Extending the neck actually increases the risk of aspiration by opening the airway. Clients should be instructed to flex the neck slightly forward while swallowing to close the airway and promote safe swallowing mechanics.

D. Encourage the client to contact an occupational therapist to learn techniques of avoiding aspiration: While an occupational therapist can provide helpful adaptive techniques, primary aspiration prevention teaching should come directly from the nurse and speech-language pathologist.

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Correct Answer is C

Explanation

Rationale:
A. "I will plan to continue taking this medication for at least 5 years.": Disulfiram therapy is not prescribed for a fixed duration such as 5 years. The length of treatment depends on the client’s motivation and response, typically continuing until long-term abstinence is maintained.

B. "My provider wants me to take this medication for 2 weeks before I try to quit drinking.": Disulfiram must be started only after the client has abstained from alcohol for at least 12 hours, not before quitting. Taking it while alcohol is still in the system can trigger severe reactions such as flushing, nausea, vomiting, and hypotension.

C. "I should avoid over-the-counter medications that contain alcohol.": Even small amounts of alcohol—such as in cough syrups, mouthwash, or sauces—can cause a dangerous disulfiram-alcohol reaction. Clients must avoid all alcohol-containing products.

D. "I will need to get a monthly injection of this medication.": Disulfiram is taken orally, usually once daily, and does not come in injectable form. The injectable medication used for alcohol dependence is naltrexone (Vivitrol).

A. Mottled skin B. Constricted pupils C. Restlessness D. Cheyne-Stokes respirations

Correct Answer is C

Explanation

Rationale:
A. Mottled skin: Mottling is typically a late sign of poor perfusion or approaching death and does not indicate pain. It reflects circulatory changes rather than discomfort requiring analgesia.

B. Constricted pupils: Constricted pupils may result from certain medications or neurological changes, but they are not a reliable indicator of pain. Pupillary changes alone do not guide pain management.

C. Restlessness: Restlessness is a common manifestation of pain in clients receiving palliative care, especially when verbal communication is limited. Administering prescribed pain medication can help alleviate discomfort and improve comfort.

D. Cheyne-Stokes respirations: This irregular breathing pattern occurs in advanced illness or near end-of-life and is not an indicator of pain. It reflects neurological or metabolic changes rather than discomfort requiring analgesia.

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A nurse is providing discharge teaching to a client who has generalized myasthenia gravis. Which of the following information should the nurse include?

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