Nursing Elites

1. A client with a new diagnosis of myasthenia gravis is prescribed pyridostigmine (Mestinon). Which instruction should the nurse include in the client's teaching?

• A. Take the medication with food to prevent gastrointestinal upset.
• B. Take the medication 30 minutes before meals.
• C. Avoid dairy products while taking this medication.
• D. Take the medication at bedtime.

Correct answer: B

Rationale: The correct instruction for a client with myasthenia gravis prescribed pyridostigmine (Mestinon) is to take the medication 30 minutes before meals. This timing is crucial as it helps improve muscle strength for eating and swallowing. By taking the medication before meals, the client can experience enhanced muscle function during mealtime, which is especially important for managing the symptoms of myasthenia gravis. Choices A, C, and D are incorrect. Taking the medication with food may decrease its effectiveness, avoiding dairy products is not necessary, and taking the medication at bedtime does not coincide with the optimal timing for enhancing muscle function during meals.

2. A patient with peptic ulcer disease is prescribed omeprazole. When should the patient take this medication for optimal effectiveness?

• A. With meals
• B. At bedtime
• C. Before meals
• D. After meals

Correct answer: C

Rationale: Omeprazole should be taken before meals to reduce stomach acid production and promote healing of the ulcer. Taking it before meals ensures that the medication can inhibit acid secretion when the stomach is most active in producing acid, thereby maximizing its effectiveness in treating peptic ulcer disease.

3. A 50-year-old man presents with fatigue, arthralgia, and darkening of the skin. Laboratory tests reveal elevated liver enzymes and high serum ferritin levels. What is the most likely diagnosis?

• A. Wilson's disease
• B. Hemochromatosis
• C. Alpha-1 antitrypsin deficiency
• D. Autoimmune hepatitis

Correct answer: B

Rationale: The symptoms of fatigue, arthralgia, and skin darkening, along with elevated liver enzymes and high serum ferritin levels, are characteristic of hemochromatosis, a condition characterized by iron overload. In hemochromatosis, excess iron is deposited in various organs, including the liver, leading to symptoms such as fatigue, joint pain, and skin pigmentation changes. The elevated liver enzymes and high serum ferritin levels seen in this patient further support the diagnosis of hemochromatosis.

4. For a patient with asthma, what is the primary purpose of prescribing salmeterol?

• A. Relieve acute bronchospasm
• B. Prevent asthma attacks
• C. Suppress cough
• D. Thin respiratory secretions

Correct answer: B

Rationale: Salmeterol is classified as a long-acting beta2-agonist, which is used to prevent asthma attacks by providing extended bronchodilation. It is not typically used for immediate relief of acute bronchospasm or for suppressing cough. Additionally, salmeterol does not have the primary purpose of thinning respiratory secretions.

5. The nurse formulates a nursing diagnosis of 'High risk for ineffective airway clearance' for a client with myasthenia gravis. What is the most likely etiology for this nursing diagnosis?

• A. Pain when coughing.
• B. Diminished cough effort.
• C. Thick, dry secretions.
• D. Excessive inflammation.

Correct answer: B

Rationale: The correct answer is B: Diminished cough effort. Clients with myasthenia gravis often experience muscle weakness, including respiratory muscles, which can lead to diminished cough effort. This weakness can result in ineffective airway clearance, putting the client at a high risk. Pain when coughing (choice A) is not directly related to the etiology of ineffective airway clearance in myasthenia gravis. While thick, dry secretions (choice C) and excessive inflammation (choice D) can contribute to airway clearance issues, the primary concern in myasthenia gravis is the muscle weakness affecting cough effort.

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