The client with myasthenia gravis has become increasingly weaker. The physician prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium (Tensilon) is administered. Which of the following would indicate that the client is in cholinergic crisis?

Correct Answer: D

Rationale: Administering edrophonium (Tensilon) to a client with myasthenia gravis helps differentiate between cholinergic crisis and myasthenic crisis. In cholinergic crisis, which is caused by excessive acetylcholine levels due to an overdose of anticholinesterase medications, the client may experience a temporary worsening of symptoms such as muscle weakness, respiratory distress, and other cholinergic effects. This temporary worsening is due to the increase in acetylcholine levels, leading to overstimulation of nicotinic and muscarinic receptors. On the other hand, in myasthenic crisis, which is caused by insufficient acetylcholine at the neuromuscular junction, administering edrophonium would lead to an improvement in muscle weakness. Therefore, if the client experiences a temporary worsening of symptoms after receiving edrophonium, it indicates cholinergic crisis.

Correct Answer: B

Rationale: Mydriatic eye drops are used to dilate or enlarge the pupil. By dilating the pupil, these eye drops allow more light to enter the eye and are often used before eye exams. This dilation also permits aqueous humor to flow around the lens. In contrast, myotic eye drops are used to constrict the pupil, which can increase pressure in the eye. Osmotic eye drops are used to reduce intraocular pressure by drawing fluid out of the eye. Cycloplegic eye drops are used to temporarily paralyze the muscles in the eye, affecting accommodation and pupil size.

Correct Answer: D

Rationale: Checking the glycosylated hemoglobin (HbA1c) level is the most appropriate way to determine the effectiveness of the client's efforts to control type 2 diabetes mellitus over the past few months. HbA1c provides an average of the blood glucose levels over the past 2-3 months, reflecting how well the client has been managing their diabetes. This test is not affected by recent food intake or physical activity, making it a reliable indicator of long-term glucose control. Unlike fasting blood glucose levels or urine glucose levels, which can fluctuate throughout the day, HbA1c gives a more comprehensive view of glucose control and helps guide treatment decisions.

Correct Answer: C

Rationale: In the context of syndrome of inappropriate antidiuretic hormone (SIADH), complications such as hyponatremia and fluid overload can lead to increased volume in the venous system, including the neck veins. Neck vein distention is a sign associated with fluid overload and can be indicative of worsening complications in a client with SIADH. Tetanic contractions are not typical manifestations of complications in SIADH. Weight loss and polyuria are not commonly associated with SIADH due to the increased water retention caused by the syndrome.

Correct Answer: D

Rationale: The anesthesiologist is responsible for transferring the patient to the postanesthesia care unit (PACU) after the surgical incision has been closed and the anesthesia has worn off. The anesthesiologist ensures that the patient is stable and ready for transfer, including assessing vital signs and overall condition. Due to their specialized training in anesthesia and perioperative care, the anesthesiologist is best equipped to manage the transition of care from the operating room to the PACU, where the patient will continue to be monitored closely during the immediate postoperative period.