A patient with myasthenia gravis has been on cholinesterase inhibitor therapy. The patient reports on occasion that she has some difficulty swallowing and periods of fatigue
The patient asks, "What can be done to remedy this?" The nurse's best response would be
a. "You are already on a high dosage of the drug. You will have to cope with these symptoms."
b. "This could mean that the dosage is too high and you should skip every other dose."
c. "Let's discuss some strategies to help you learn to self-adjust the dose in response to your symptoms."
d. "You are developing tolerance to the drug and will need to change to a different class of agents."
ANS: C
To maintain optimal responses, patients occasionally must modify the dosage themselves. To do this, they must be taught to recognize signs of undermedication (difficulty swallowing, ptosis) and signs of overmedication (excessive salivation, diaphoresis).
Telling the patient that she will have to learn to cope with her symptoms without further explanation ignores the patient's need for answers.
The patient most likely is undermedicated, not overmedicated, and therefore should not be told to skip doses.
There is no indication that the patient has developed a tolerance to the drug.
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