Myasthenia gravis NCLEX practice questions for nursing students. Myasthenia gravis is an autoimmune condition where the body attacks the receptors that allow for voluntarily muscle control, which leads to muscle weakness.
In the previous NCLEX review, I explained about other neurological disorders, so be sure to check those reviews out.
As the nurse, it is important to know the pathophysiology of myasthenia gravis, the types of drugs used to treat this condition, differences between myasthenia crisis vs. cholinergic crisis, and the nursing interventions.
Don’t forget to watch the lecture on myasthenia gravis before taking the quiz.
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Myasthenia Gravis NCLEX Questions
1. Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.
A. metabotropic; muscle weakness
B. nicotinic acetylcholine; muscle weakness
C. dopaminergic adrenergic; muscle contraction
D. nicotinic adrenergic; muscle contraction
The answer is B. In myasthenia gravis, either the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system (hence why this disease is considered autoimmune) or antibodies are inhibiting the function of muscle-specific kinase (which is a receptor tyrosine kinase that helps with maintaining and building the neuromuscular junction). Either way this leads to the neurotransmitter acetylcholine from being able to communicate with the muscle fiber to make it contract.
2. You’re educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located?
A. behind the thyroid gland
B. within the adrenal glands
C. behind the sternum in between the lungs
D. anterior to the hypothalamus
The answer is C. The thymus is located anteriorly in the upper part of the chest behind the sternum in between the lungs.
3. A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication?
A. As soon as possible
B. 1 hour after the patient has eaten (at 1300)
C. 1 hour before the patient eats (at 1100)
D. at 1200 right before the patient eats
The answer is C. Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used…hence improving muscle strength.
4. The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis?
A. The patient experiences worsening of the muscle weakness.
B. The patient experiences wheezing along with facial flushing.
C. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears.
D. The patient experiences improved muscle strength.
The answer is D. During a Tensilon test Edrophonium is administered. This medication prevents the breakdown of acetylcholine, which will allow more of the neurotransmitter acetylcholine to be present at the neuromuscular junction….hence IMPROVING muscle strength IF myasthenia gravis is present. Therefore, if a patient with MG is given this medication they will have improved muscle strength.
5. You’re preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?
B. Protamine sulfate
The answer is A. Atropine will help reverse the effects of the drug given during a Tensilon test, which is Edrophonium, in case an emergency arises. Edrophonium is a short-acting cholinergic drug, while atropine is an anticholinergic.
6. Which patient below is MOST at risk for developing a cholinergic crisis?
A. A patient with myasthenia gravis is who is not receiving sufficient amounts of their anticholinesterase medication.
B. A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks.
C. A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery.
D. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.
The answer is D. Remember patients who experience a cholinergic crisis are most likely to because they’ve received too much of their anticholinesterase medications (example Pyridostigmine). However, on the other hand, patients who have received insufficient amount of their anticholinesterase medication or have experienced an illness/stress/surgery are most likely to experience a myasthenia crisis. Both conditions will lead to muscle weakness and respiratory failure but from different causes, which is why a Tensilon test is used to help differentiate between the two conditions.
7. Which meal option would be the most appropriate for a patient with myasthenia gravis?
A. Roasted potatoes and cubed steak
B. Hamburger with baked fries
C. Clam chowder with mashed potatoes
D. Fresh veggie tray with sliced cheese cubes
The answer is C. Patients with MG have weak muscles and this can include the muscles that are used for chewing and swallowing. The patient should choose meal options that require the least amount of chewing and that are easy to swallow. Option C is a thick type of soup and the mashed potatoes are soft….both are very easy to eat and swallow compared to the other options.
8. Select all the signs and symptoms below that can present in myasthenia gravis:
A. Respiratory failure
B. Increased salivation
E. Slurred speech
G. Mask-like appearance of looking sleepy
H. Difficulty swallowing
The answers are A, C, D, E, G, and H.
9. You’re providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition?
B. Cholinesterase medications
The answer is B. These medications are not used to treat MG, but ANTIcholinesterase medications (like Pyridostigmine) are used to treat this condition.
10. You’re a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks?
D. Before bedtime
The answer is B. Patients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day….the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.
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