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: Alpha-fetoprotein (AFP) levels are elevated in maternal serum when a neural tube defect is present due to fetal leakage of AFP into the amniotic fluid and maternal circulation.

Correct Answer: B

Rationale: Severe and extensive hemolysis can lead to the destruction of a large number of red blood cells, causing a significant release of hemoglobin into the bloodstream. This excessive release of hemoglobin can overwhelm the body's ability to clear it, leading to the accumulation of toxic byproducts such as free hemoglobin and heme. These byproducts can lead to various complications, one of which is the potential for causing shock. Shock is a life-threatening condition characterized by inadequate tissue perfusion and oxygen delivery to vital organs due to a systemic vascular response to the circulating toxins and byproducts of hemolysis. It is a severe consequence of extensive hemolysis and requires immediate medical intervention to stabilize the patient.

Correct Answer: D

Rationale: Empyema is a serious infection that requires aggressive treatment with antibiotics. The client must complete the entire course of drug therapy as prescribed by the healthcare provider to ensure that the infection is completely eradicated. Failure to complete the full course of antibiotics can lead to antibiotic resistance and recurrence of the infection. It is crucial to emphasize to the client the importance of adhering to the prescribed treatment regimen to achieve a full recovery and prevent complications.

Correct Answer: D

Rationale: In stable asthmatic patients, additional interventions like systemic steroids or increased beta-agonist doses are not always necessary unless there are signs of exacerbation.