A woman sees her primary care provider because of extreme fatigue for the past 2 months; she difficulty lifting even light objects. Her physician suspects myasthenia gravis. Which of the ff. tests should the nurse anticipate to confirm this diagnosis?

Correct Answer: D

Rationale: The Tensilon test is used to confirm the diagnosis of myasthenia gravis, a condition characterized by muscle weakness and fatigue. In this test, the medication Tensilon (also known as edrophonium) is administered intravenously. If the patient has myasthenia gravis, there will be a rapid but temporary improvement in muscle strength after the Tensilon injection. This response helps to differentiate myasthenia gravis from other causes of muscle weakness. The other options mentioned (Mestinon test, pulmonary function studies, and quinine tolerance test) do not specifically confirm the diagnosis of myasthenia gravis.

Correct Answer: A

Rationale: A phenytoin blood level of 35 mcg/ml is considered to be above the therapeutic range (usually 10-20 mcg/ml for phenytoin). At this elevated level, the client is at risk for phenytoin toxicity. Symptoms of phenytoin toxicity include nystagmus (rapid, involuntary eye movements), as well as other symptoms such as confusion, slurred speech, ataxia, and tremors. Tachycardia is not typically associated with phenytoin toxicity. Therefore, the expected symptom in this case would be nystagmus.

Correct Answer: B

Rationale: During a Romberg test, the individual is asked to stand with feet together, arms at sides, and eyes closed. The tester then observes for swaying, losing balance, or arm drifting, which are signs of a positive Romberg test, indicating a potential issue with proprioception or vestibular function. Hypotension (choice A) refers to low blood pressure and is not directly assessed during a Romberg test. Sneezing and wheezing (choice C) are unrelated symptoms. Excessive cerumen in the outer ear (choice D) does not affect the results of a Romberg test focused on balance and proprioception.

Correct Answer: A

Rationale: Meniere's disease is a disorder of the inner ear characterized by the triad of symptoms including hearing loss, vertigo (a spinning sensation), and tinnitus (ringing in the ear). These symptoms can occur episodically and may be associated with a feeling of fullness in the affected ear. Other symptoms such as nausea and vomiting may sometimes accompany the episodes of vertigo, but the classic triad of Meniere's disease consists of hearing loss, vertigo, and tinnitus. Nystagmus, headache, and pain are not typically part of the classic presentation of Meniere's disease.

Correct Answer: C

Rationale: A 6-hour glucose tolerance test would yield the most occlusive diagnostic information about the client's glucose utilization in this case. The elevated blood pressure level of 185 mg/dL two hours after breakfast indicates poor glucose regulation. A glucose tolerance test involves monitoring the client's blood glucose levels over a period of time after ingesting a glucose solution. This test provides a comprehensive assessment of how the body processes glucose, revealing any abnormalities in glucose metabolism beyond fasting levels, such as postprandial (after-meal) glucose spikes and prolonged hyperglycemia. This can help identify conditions like insulin resistance, impaired glucose tolerance, or diabetes, which may not be evident from a fasting blood glucose test alone. Glycosylated hemoglobin (HbA1c) reflects average blood sugar levels over the past 2-3 months and would not provide immediate information about the client's current glucose metabolism. Urine ketones