The nurse is providing education for a client diagnosed with myasthenia gravis (MG) taking pyridostigmine. The nurse understands teaching has been effective when the client states, "I will

use pyridostigmine as needed to relieve symptoms of muscle weakness and fatigue."

be able to crush the sustained release tablet because of difficulty swallowing."

skip a dose if I have symptoms of fatigue to minimize side effects of the medications."

take pyridostigmine 30-60 minutes before meals to improve muscle function."

Answer and Explanation

The Correct Answer is D

A. Use pyridostigmine as needed to relieve symptoms of muscle weakness and fatigue: Pyridostigmine should not be used on an "as-needed" basis, as it is a long-acting medication that works by maintaining a steady level of acetylcholine at the neuromuscular junction. The client needs to take the medication regularly at prescribed intervals, not sporadically, to maintain consistent symptom control. This statement reflects a misunderstanding of the medication's use.

B. Be able to crush the sustained release tablet because of difficulty swallowing: Sustained-release (or extended-release) tablets should not be crushed because doing so can cause the medication to be released too quickly, leading to potential side effects or overdose. If the client has difficulty swallowing, an alternative form of the medication, such as a liquid or split tablet, should be considered. This statement reflects a lack of understanding regarding the proper administration of the medication.

C. Skip a dose if I have symptoms of fatigue to minimize side effects of the medications: Skipping doses of pyridostigmine is not appropriate. The medication should be taken as prescribed, even if the client feels fatigued. Fatigue is a symptom of myasthenia gravis, not necessarily a side effect of the medication. Consistent dosing is important for controlling the disease and preventing worsening of symptoms. Skipping doses can lead to inadequate symptom control and potential exacerbation of weakness.

D. Take pyridostigmine 30-60 minutes before meals to improve muscle function: This statement indicates that the client understands the appropriate use of pyridostigmine for managing myasthenia gravis (MG). Pyridostigmine is an acetylcholinesterase inhibitor that helps improve neuromuscular transmission, and it is typically taken 30-60 minutes before meals. This timing helps optimize muscle strength during the period when the client is eating, as muscle weakness can make swallowing more difficult. By taking the medication before meals, the client is more likely to experience improved muscle function when needed most.

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Correct Answer is D

Explanation

A. Fully compensated respiratory acidosis: Fully compensated respiratory acidosis would involve a low pH (indicative of acidosis), elevated PaCO2 (due to impaired ventilation), and a normal HCO3 level as compensation by the kidneys. The given ABG results show metabolic acidosis with partial respiratory compensation, not respiratory acidosis.

B. Partially compensated respiratory acidosis: In respiratory acidosis, you would expect an elevated PaCO2 (not low, as seen here) and a compensatory increase in HCO3. However, the ABG results show low HCO3 and low PaCO2, indicating that this is metabolic acidosis, not respiratory acidosis.

C. Uncompensated metabolic acidosis: Uncompensated metabolic acidosis would be indicated by a low pH and low bicarbonate (HCO3), with normal PaCO2. Since the PaCO2 is low, this suggests partial respiratory compensation, making this scenario not uncompensated but partially compensated.

D. Partially compensated metabolic acidosis: To interpret these ABG results, let's break down the values:

pH 7.32 (normal range: 7.35–7.45) indicates acidosis, as it is below the normal range.

PaCO2 33 mmHg (normal range: 35–45 mmHg) is low, suggesting that respiratory compensation is occurring to counteract the acidosis. In metabolic acidosis, the lungs typically attempt to blow off CO2 to reduce acid levels, which is why PaCO2 is low here.

HCO3 16 mEq/L (normal range: 22–25 mEq/L) is low, confirming a metabolic acidosis. The low bicarbonate level is characteristic of metabolic acidosis, where the body loses too much bicarbonate or produces too much acid. PaO2 88 mmHg (normal range: 80–95 mmHg) is within the normal range and does not indicate a significant respiratory issue.

A. pH 7.33, PaCO2 35 mmHg, Pa02 78 mmHg, HCO3 20 mEq/L. B. heart rate 80 and respiratory rate 20. C. 02 saturation of at least 94%. D. sodium 135 mg/di. and potassium 4.8 mg/dL.

Correct Answer is C

Explanation

A. pH 7.33, PaCO2 35 mmHg, PaO2 78 mmHg, HCO3 20 mEq/L:
This answer choice indicates respiratory acidosis (pH < 7.35, low bicarbonate), but the goal in acute respiratory failure is not just to adjust the pH alone; the more immediate concern is correcting oxygenation. The PaO2 of 78 mmHg is below the normal range (80-100 mmHg), indicating hypoxemia that should be corrected first. The goal should be to improve PaO2 to acceptable levels (≥80 mmHg) and achieve adequate oxygen saturation. This ABG result does not fully align with the immediate goals of treatment.

B. Heart rate 80 and respiratory rate 20:
While normal vital signs like heart rate and respiratory rate are important, they are not the primary goal of treatment in acute respiratory failure. The focus during ventilator support is to improve oxygenation and ventilation rather than simply achieving normal heart and respiratory rates. In acute respiratory failure, abnormal heart and respiratory rates are often a result of hypoxia or hypercapnia (high CO2), so normalizing oxygenation and carbon dioxide levels is more critical initially.

C. O2 saturation of at least 94%:
The primary goal in acute respiratory failure is to maintain adequate oxygenation. In this context, the goal of ventilator support is to correct hypoxemia (low blood oxygen levels) and restore normal oxygen saturation. A target oxygen saturation of at least 94% is commonly considered appropriate for most patients in acute respiratory failure to ensure that tissues are receiving enough oxygen to prevent organ damage. This is a key aspect of managing respiratory failure and ensuring adequate tissue perfusion. Oxygen saturation below 90% is typically considered to indicate a severe level of hypoxemia, requiring prompt intervention.

D. Sodium 135 mg/dL and potassium 4.8 mg/dL:
While electrolyte levels are important to monitor in any critically ill patient, the main goal of treatment in acute respiratory failure is improving oxygenation and ventilation rather than focusing specifically on normalizing sodium or potassium levels. Correcting imbalances in electrolytes can be part of overall care, but it is not the primary objective in this situation. Oxygenation (as measured by PaO2 and O2 saturation) takes priority over correcting individual electrolytes.

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Arterial Blood Gases
pH	7.35-7.45
PaCO2	35-45mmHg
PaO2	80-100mmHg
HCO3-	22-26 mEq/L
O2 Saturation	>95%
Chemistry
BUN	8-21mg/dl
Creatinine	0.5-1.2mg/dl
Na	135-145 mEq/L
K	3.5-5.3 mEq/L
Cl	97-107 mEq/L
CO2	22-26 mEq/L
Ca	8.2-10.2 mg/dl
Glucose	65-99 mg/dl
Mg	1.7-2.2 mg/dl
PO4	2.5-4.5 mg/dl

The nurse is providing education for a client diagnosed with myasthenia gravis (MG) taking pyridostigmine. The nurse understands teaching has been effective when the client states, "I will

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Correct Answer is C

Explanation

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