SEMIFINAL EXAM: MEDICAL SURGICAL NURSING Set A

Name: ____Siena Kathleen V. Placino______ Score: ________________

Year and Section: ____BSN-IV____________ Date:__April 25, 2020___

Instruction: Choose the letter of the best answer. Write the letter of the correct answer before
each number. ERASURES and TAMPERED answers are considered wrong.

1. A client with myasthenia gravis is having difficulty in speaking. The speech is dysarthric
and has a nasal tone. The nurse would plan to avoid using which of the following
communication strategies when working with this client
a. Repeating what the client said to verify the message
b. Encouraging the client to speak quickly
c. Using a communication board when necessary
d. Asking yes and no questions when able

2. A client with Bell’s palsy asks a nurse what caused this problem to occur. The nurse’s
response is based on an understanding that the etiology is:
a. Unknown, but possibly includes ischemia, viral infection, or an autoimmune
problem
b. Unknown, but possibly includes long-term tissue malnutrition and cellular hypoxia
c. Primarily genetic in origin, but triggered by exposure to neurotoxins
d. Primarily genetic in origin, but triggered by exposure to meningitis

3. A client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse
inquires during the nursing admission interview whether the client has a history of:
a. Back injury or trauma to the spinal cord
b. Seizures or trauma to the brain
c. Respiratory or gastrointestinal (GI) infection during the previous month
d. Meningitis during the last 5 years

4. A nurse is admitting a client with Guillain-Barre syndrome to the nursing unit. The client
has an ascending paralysis to the level of the waist. Knowing the complications of the
disorder, the nurse brings which of the following items into the client’s room?
a. ECG monitoring electrodes and intubation tray
b. Nebulizer and pulse oximeter
c. Flashlight and incentive spirometer
d. Blood pressure cuff and flashlight

5. A client, recently diagnosed with Bell’s palsy, has many questions about the course of the
disease. The nurse should explain that:
a. Cool compresses decrease facial involvement
b. Pain occurs with transient ischemic attacks
c. Most clients recover within 3 to 5 weeks
d. Body changes will occur with residual effects

6. A client who sustained a spinal cord injury at the T2 level should be assessed for signs of
autonomic dysreflexia because:
a. The injury is above the sixth thoracic vertebra
b. The injury has resulted in loss of all reflexes
c. There has been has a partial Transection of the cord
d. There is a flaccid paralysis of the lower extremities

7. What should the nurse include in the plan of care for a newly admitted client with an
Infratentorial craniotomy for a brain tumor
a. Keep the head of the bed elevated 30-45 degrees and a large pillow under the
client’s head and shoulder
 b. Keep the head of the bed flat with a small pillow under the nape of the neck
c. Assess vital signs and pupils every four hours
d. Flex neck every two hours to prevent stiffness

8. A 36-year-old female reports double vision, visual loss, weakness, numbness of the hands,
fatigue, tremors, and incontinence. On assessment, the nurse notes nystagmus, scanning
speech, ataxia, and slight muscular weakness. Based on these findings, the nurse suspects
the client has:
a. Multiple Sclerosis c. Parkinson’s Disease
b. Amyotrophic lateral sclerosis (ALS) d. myasthenia gravis

9. Which nursing diagnosis is of the highest priority when caring for a client with myasthenia
gravis (MG)?
a. High risk for injury related to muscle weakness
b. Pain
c. Ineffective coping related to illness
d. Ineffective airway clearance related to muscle weakness

10. A client is admitted post craniotomy. Mannitol 4mg IV is ordered every six hours. The nurse
understands the Mannitol is ordered to:
a. Stabilize the blood sugar
b. Decrease cerebral edema
c. Prevent seizures
d. Maintain the integrity of the gastric mucosa

11. A client with a C6 spinal cord injury two months ago now complains of pounding headache.
The pulse is 64 and the blood pressure is 220/110 mmHg. Which of the following actions
should the nurse take first?
a. Check for fecal impaction
b. Elevate the client’s head and lower the legs
c. Notify the physician
d. Give the analgesic as ordered

12. The nurse is evaluating the ability of a client with trigeminal neuralgia to implement the
treatment that has been suggested. Which of the following behaviors by the client will be
most effective in controlling manifestations? The client:
a. Exercises the facial muscles at least twice daily
b. Puts the affected arm through full range of motion daily
c. Avoids extremes in temperature of food and drink
d. Uses proper body mechanics in sitting and bending

13. To maintain airway patency during the acute phase of Cerebrovascular Accident, which of
the following nursing intervention is appropriate?
a. have tracheal suction available at all times
b. thickened all dietary liquids
c. restrict dietary and parenteral fluids
d. place the client in supine position while in bed

14. For a client with Cerebrovascular accident, which of the following criteria must be fulfilled
before the client is fed?
a. speech returns to normal
b. cranial nerve III,IV,VI are intact
c. the client swallows small sips of water with slight coughing
d. the gag reflex returns
15. Stool softeners would be given to a client after a repair of cerebral aneurysm for which of
the following reasons?
a. to prevent straining which increases intracranial pressure
b. to stimulate the bowel due to loss of innervations
c. to prevent the valsalva maneuver which can lead to tachycardia
d. to prevent diarrhea when osmotic diuretics are used

16. A client with subdural hematoma was given Mannitol to decrease intracranial pressure
(ICP). Which of the following results would be best show the mannitol was effective?
a. pupils are 8mm dilated and non reactive
b. urine output increases
c. systolic blood pressure remains at 150mm/Hg
d. blood urea, nitrogen (BUN) creatinine returns to normal

17. A client is newly diagnosed with myasthenia gravis. Client teaching would include which of
the following condition as the cause of this disease?
a. destruction of the acetylcholine receptors causing muscle weakness
b. inability of the basal ganglia to produce sufficient dopamine
c. loss of myelin sheath surrounding the peripheral nerves
d. A post viral illness characterized by ascending paralysis

18. One hour after receiving pyridostigmine bromide (Mestinon), a client report difficulty
swallowing and severe muscle weakness with excessive respiratory secretions. The nurse
notifies the physician and prepares to administer which of the following medication?
a. additional Mestinon c. endrophonium (Tensilon)
b. atropine sulfate d. neostigmine (Prostigmin)

19. Which of the following statements best describes the cause of Parkinson’s disease?
a. degeneration of substania nigra depleting dopamine
b. loss of myelin sheath surrounding the peripheral nerves
c. bleeding into the brainstem resulting in motor dysfunction
d. an autoimmune disorder that destroy acetylcholine receptor sites

20. Which of the following symptoms occurs initially in Parkinson’s disease?

a. Akinesia c. pill rolling movements of hands
b. aspiration of foods d. dementia

21. To evaluate the effectiveness of Levodopa-Carbidopa (Sinemet), a nurse should watch out
for which of the following results?
a. lessened rigidity and tremors c. decreased dyskinesia
b. reduction in short term memory d. improve visual acuity

22. Which of the following pathophsiologic processes are involved in multiple sclerosis?
a. destruction of the brainstem and basal ganglia in the brain
b. degeneration of the nucleus pulposus casing pressure on the spinal cord
c. development of demyelination of myelin sheath, interfering with nerve
transmission
d. chronic inflammation of meninges of the brain and spinal cord

23. Which of the following symptoms commonly occur in the early phase of multiple sclerosis?
a. Diplopia b. hemiparesis c. Grief d. recent memory loss

24. Which of the following nursing interventions takes priority for the client having tonic-clonic
seizure?
a. timing the duration of seizure
b. noting the origin of seizure activity
c. inserting a padded tongue blade to prevent client from biting his tongue
 d. maintaining a patent airway

25. A client with C6 spinal cord injury would most likely have which of the following
symptoms?
a. Quadriplegia b. hemiparesis c. Paraplegia d. aphasia

26. Which of the following signs and symptoms of increased intracranial pressure (ICP) after
head trauma would appear first?
a. Bradycardia c. widened pulse pressure
b. large amount of very dilute urine d. restlessness and confusion

27. A 23 year old client has been hit on the head with a baseball bat. The nurse notes clear fluid
draining from his ears and nose. Which of the following nursing intervention should be done
first?
a. check the fluid for glucose with a dipstick
b. position the client flat in bed
c. suction the nose to maintain airway patency
d. insert nasal and ear packing with sterile gauze

28. When teaching the family of a client with C4 quadriplegia how to suction his tracheostomy,
the nurse includes which of the following instruction?
a. regulate the suction machine to -300 cm suction
b. suction for 10-15 seconds at a time
c. apply suction to the catheter during insertion only
d. Pass the suction catheter into the opening of tracheostomy tube 2-3 cm.

29. Which of the following client on the rehabilitation unit is most likely to develop autonomic
dysreflexia?
a. a client with a high cervical spine injury
b. a client with a stroke
c. a client with brain injury
d. a client with herniated nucleus pulposus

30. During an episode of autonomic dysreflexia in which client becomes hypertensive, the nurse
should perform which of the following interventions?
a. elevate the clients leg c. put the client in high fowlers position
b. put the client flat in bed d. put client in Trendelenburg position

31. A client gas cervical spine injury at the level of C5, which of the following conditions would
the nurse anticipates during the acute phase?
a. The need for mechanical ventilation
b. Movement of only half right or half left of the body
c. Decerebrate posturing
d. Absent of corneal reflex

32. When caring for a client with quadriplegia, which of the following nursing interventions
takes priority?
a. forcing fluids to prevent renal calculi
b. maintaining skin integrity
c. preventing atelectasis
d. obtaining adaptive devices for more independence

33. An unconscious client is receiving mechanical ventilation. Which nursing diagnosis takes
priority?
a. ineffective airway clearance related to inability to expectorate
b. risk for impaired skin integrity related to immobility
c. Imbalance nutrition less than body requirement related to dysphagia
 d. Self care deficit related to unconsciousness

34. An 18 year old client is admitted with a close head injury sustained in a motor vehicle
accident. His intracranial pressure shows an upward trend. Which intervention should the
nurse perform first?
a. administer 1 gm of mannitol (Osmitrol as ordered)
b. reposition the client to avoid neck flexion
c. increase the ventilators respiratory rate to 20 breaths per minute
d. administer 100 mg of Phenobarbital as ordered

35. A 20 year old client who fell approximately 9 meter is unresponsive and breathless. A
cervical spine injury is suspected. How should the first responder open the client airway for
rescue breathing?
a. a. by performing the jaw thrust maneuver
b. by inserting a nasopharyngeal airway
c. by inserting an oropharyngeal airway
d. by performing the head tilt chin lift maneuver

36. When an unconscious client with multiple injuries arrives in the emergency room, which
nursing intervention receives the highest priority?
a. establishing an airway c. stopping bleeding form an open wounds
b. replacing blood loss d. checking for a neck fracture

37. Which postoperative activity does the nurse encourage the client to avoid when there is a
risk for increased intracranial pressure?
a. deep breathing c. turning
b. coughing d. passive range of motion exercise

38. Which of the following describes decerebrate posturing?

a. Back arched, rigid extension of all four extremities
b. Internal rotation and adduction of arms with flexion of elbows, wrists, and fingers
c. Back hunched over, rigid flexion of all four extremities with supination of arms and
plantar flexion of feet
d. Supination of arms, dorsiflexion of the feet

39. In planning the care for a client who has had a posterior Fossa (Infratentorial) craniotomy,
the nurse understands that, when positioning the client, which of the following is
contraindicated?
a. Keeping the client flat on one side of the other
b. Log rolling or turning as a unit when turning
c. Elevating the head of the bed to 30 degrees
d. Keeping the neck in a neutral position

40. Which of the following is contraindicated for a client with seizure precautions?
a. Assessing oral temperature with a glass thermometer
b. Encouraging him to perform his own personal hygiene
c. Allowing him to wear his own clothing
d. Encouraging him to be out of bed

41. What is the priority nursing intervention in the postictal phase of a seizure?
a. Reorient the client to time, person and place
b. Determine the client’s level of sleepiness
c. Position the client comfortably
d. Assess the client’s breathing pattern
42. What is the priority nursing intervention when suctioning an unconscious client to maintain
cerebral perfusion?
a. Hyper-oxygenate before and after suctioning c. Provide oral hygiene
b. Administer analgesics d. Administer diuretic

43. Based on the nurse’s knowledge of thrombolytic therapy, what is the expected outcome of
this drug therapy?
a. Increased vascular permeability c. Vasoconstriction
b. Dissolved emboli d. prevention of hemorrhage

44. Which goal is the most realistic and appropriate for a client diagnosed with Parkinson’s
disease?
a. To maintain optimal body function
b. To cure the disease
c. To stop progression of the disease
d. To begin preparations for terminal care

45. A client with Parkinson’s disease is prescribed Levodopa (L-dopa) therapy. The nurse
determines that the drug is effective when the client experiences an improvement in which
of the following?
a. Mood b. Muscle rigidity c. Appetite d. Alertness

46. When administering a new medication regimen to a client with Parkinson’s disease, the
nurse makes certain that the medication is taken:
a. at the time scheduled c. all at one time
b. at bedtime d. 2 hours before meal time

47. Which intervention should the nurse suggest to help a client with MS avoid episodes of
urinary incontinence?
a. Limit fluid intake to 1000 ml/day
b. Insert an indwelling urinary catheter
c. Establish a regular voiding schedule
d. Administer prophylactic antibiotics, as ordered

48. The nurse determines that Baclofen (Lioresal) is accomplishing its intended purpose for a
client with multiple sclerosis when it achieves which of the following?
a. relieves muscular spasticity c. stimulates the client appetite
b. induces sleep d. reduces the urine bacterial count

49. A client with multiple sclerosis is experiencing bowel incontinence and is starting a bowel a
bowel retraining program. Which strategy is inappropriate?
a. eating a diet high in fiber
b. setting a regular time for elimination
c. limiting fluid intake to 1000 ml per day
d. using an elevated toilet seat when voiding

50. When the nurse performs oral hygiene for an unconscious client, which nursing intervention
is the priority?
a. keep a suction machine available
b. place the client in a prone position
c. wear sterile gloves while brushing the client teeth
d. use gauze wrapped around the fingers to cleans the client gums

51. Which symptom is an early indicator of hypoxia in an unconscious client?

a. Hypotension b. cyanosis c. decreased respiration d. restlessness
52. When interviewing a patient with myasthenia gravis, what statement of the patient support
the signs and symptoms?
a. I have difficulty swallowing my food c. I see black spots
b. I feel dizzy when I stand d. I feel numbness in my hands

53. A patient with Parkinson’s disease was seen in the clinic. The nurse would most likely
assess which of these manifestations?
a. Inequality of the pupils c. numbness of one side of the body
b. Drooping of the eyelids d. pill rolling tremors

54. Dexamethasone may be administered to a client after a brain attack (CVA) to:
a. Reduce intracranial pressure c. Maintain circulatory volume
b. Improve renal blood flow d. Prevent the development of thrombi

55. In the immediate postoperative period after brain surgery, the nurse should assess the client
for:
a. Tachycardia c. constricted pupils
b. decreased level of consciousness d. elevated diastolic pressure

56. A client with a brain attack has dysarthria. Initial nursing care to address this problem
requires provision for:
a. Effective communication c. routine hygienic needs
b. Liquid formula diet d. prevention of aspiration

57. A client is diagnosed as having expressive aphasia. The nurse anticipates that the client will
have difficulty with:
a. Following specific instructions
b. Understanding speech and/or writing
c. Speaking and/or writing
d. Recognizing words for familiar objects

58. The nurse would expect a client with tic douloureux to exhibit:
a. Excruciating facial and head pain c. unilateral muscle weakness
b. Multiple petechiae d. uncontrollable tremors of the eyelid

59. The nurse would expect a client with trigeminal neuralgia (tic douloureux) to demonstrate:
a. Prolonged periods of sleep because of anxiety
b. Hyperactivity because of medications received
c. Exhaustion and fatigue because of extreme pain
d. Excessive talkativeness because of anxiety and apprehension

60. To limit triggering the pain associated with trigeminal neuralgia the nurse should instruct the
client to:
a. chew on the unaffected side c. avoid oral hygiene
b. drink iced liquids d. apply warm compress

61. The nurse should expect a client with an exacerbation of multiple sclerosis to experience:
a. resting tremors b. double vision c. flaccid paralysis d. mental retardation

62. Clients with myasthenia gravis, Guillain-Barre syndrome, or amyotrophic lateral sclerosis
experience:
a. Increased risk for respiratory complications
b. Progressive deterioration until death
c. Deficiencies of essential neurotransmitters
d. Involuntary twitching of small muscle groups
63. A client with myasthenia gravis asks the nurse why the disease has occurred. The nurse
bases the reply on the knowledge that there is:
a. A decreased number of functioning acetylcholine receptors sites
b. A genetic defect in the production of acetylcholine
c. A reduced amount of neurotransmitter acetylcholine
d. An inhibition of the enzyme AChE, leaving the end plates folded

64. During lunch a client with myasthenia gravis, who has been prescribed bed rest, experiences
increased dysphagia. The nurse should first :
a. Call the physician c. administer oxygen
b. raised the head of the bed d. suction the trachea

65. A client with myasthenia gravis continues to become weaker despite treatment with
neostigmine. Edrophonium HCl (Tensilon) is ordered to:
a. Rule out cholinergic crisis c. overcome neostigmine resistance
b. Confirm the diagnosis of myasthenia d. promote a synergistic effect

66. A client with extensive head injuries is brought to the ICU after head injury. The physician
inserts an ICP monitoring device. What is the normal ICP value?
a. 0 mm/Hg c. less than 15 mm/Hg
b. 25-35 mmHg d. 40-50 mm Hg

67. When obtaining the vital signs of a client with multiple traumatic injuries, the nurse detects
bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician
immediately because findings reflects which of the following complication?
a. increased intracranial pressure c. encephalitis
b. shock d. status epilepticus

68. A client with epilepsy is having seizure. During the active seizure phase the nurse should:
a. place the client on his back, remove dangerous objects, insert a bite block
b. place the client on his side, remove dangerous objects, insert a bite block
c. place the client on his back, remove dangerous objects, hold down his arms
d. place the client on his side, remove dangerous objects, protect his head

69. The nurse is administering Neostigmine to a client with Myasthenia Gravis. Which nursing
intervention should the nurse implement?
a. schedule the medication before meals
b. give the medication on an empty stomach
c. warn the client that he will experience dryness of the mouth
d. give medication for complaints of muscle weakness and dysphagia

70. A client is suspected of having amyotrophic lateral sclerosis. To help confirm this disorder,
the nurse expects the physician to order which of the following diagnostic test?
a. Doppler scanning c. Doppler Ultrasonography
b. Electromyography d. APL x-ray

71. A client with amyotrophic lateral sclerosis tells the nurse, “Sometimes I felt so frustrated. I
can’t do anything without help”. This comment best support which of the following nursing
diagnosis?
a. powerlessness c. ineffective denial
b. anxiety d. risk for disuse syndrome

72. A client is hospitalized with Guillain-Barre Syndrome. Which nursing assessment finding is
most significant?
a. warm dry skin c. urine output of 40 ml per hour
b. even, unlabored respiration d. soft, non distended abdomen
73. A client undergoes craniotomy with Supratentorial surgery to remove brain tumor.
Following the operation, how should the nurse position the clients head?
a. elevate no more than 30 degrees c. elevate no more than 10 degrees
b. flat d. turn on the operative side

74. A client is sitting in a chair and begins to have a tonic clonic seizure. The most appropriate
nursing response is to:
a. hold the clients arms still to keep him from hitting anything
b. allow him to remain in a chair but move all objects out of his way
c. carefully move him to a flat surface and turn him on his side
d. place an oral airway on his mouth to maintain a patent airway

75. When communicating with a client who has Receptive aphasia, the nurse should:
a. use a short and simple sentences
b. give the client a writing pad
c. speak loudly and articulate clearly when speaking to the client
d. limit the time for the client to respond

76. A white female client is admitted to an acute care facility with a diagnosis of
Cerebrovascular Accident. Her history reveals bronchial asthma, exogenous obesity and
iron deficiency anemia? Which history finding is a risk factor for CVA?
a. Caucasian race b. female sex c. obesity d. bronchial asthma

77. A client is having a tonic clonic seizure. What should the nurse do first?
a. takes measures to prevent injury
b. place a tongue blade into the clients mouth
c. restrain the clients arms and legs
d. elevate the head of the bed

78. When caring for a client with a nursing diagnosis of impaired swallowing related to
neuromuscular impairment, the nurse should:
a. position the client in a supine position
b. encourage thin liquids for dietary meals
c. encourage the client to remove dentures
d. elevate the head of the bed 90 degrees during meals

79. Which nursing intervention can prevent the client from experiencing autonomic dysreflexia?
a. monitoring the patency of an indwelling urinary catheter
b. place the client in Trendelenburg position
c. assessing laboratory test results as ordered
d. administering oxygen in case of difficulty breathing

80. A nurse is teaching a client with myasthenia gravis about prevention of myasthenic and
cholinergic crises. The nurse tells the client that this is most effectively done by:
a. Doing muscle strengthening exercises
b. Eating large, well balanced meals
c. Doing all chores early in the day while less fatigued
d. Taking medications in time to maintain therapeutic blood levels

81. A client is transferred to the intensive care unit after evacuation of a subdural hematoma.
Which nursing intervention would reduce the client’s risk of increased intracranial pressure
(ICP)?
a. administering a stool softener as prescribed
b. encouraging oral fluid intake
c. suctioning the client once each shift
d. elevating the head of the bed to 90 degrees
82. A client is admitted in a disoriented and restless state after sustaining a concussion during a
car accident. Which nursing diagnosis takes priority in the plan of care?
a. disturb sensory perception (visual)
b. high risk for injury
c. impaired verbal communication
d. self cared deficit: Dressing/grooming

83. If a client experience a Cerebrovascular accident that damage the hypothalamus, the nurse
should anticipate that the client has a problem with:
a. body temperature control c. visual acuity
b. balance and equilibrium d. thinking and reasoning

84. A client is admitted with cervical spine injury sustained during a diving accident. When
planning this client’s care, the nurse should assign highest priority to which nursing
diagnosis?
a. impaired physical mobility
b. disturb sensory perception (tactile)
c. ineffective breathing pattern
d. self care deficit: Grooming/dressing

85. When discussing anticholinesterase agents with a client diagnosed with myasthenia gravis,
the nurse would include which discharge instruction?
a. take the medication 30 min. before activities to obtain peak effects
b. ensure for available bathroom facilities due to increase urinary frequency
c. obtain serum drug level every 3 months
d. take the medication on an empty stomach for better absorption

86. A patient with Parkinson’s disease is taking Bromocriptine (Parlodel). The nurse is aware
that the patient is given this type of drug for which of the following reasons?
a. increase dopamine level in the brain
b. prevents the breakdown of dopamine
c. decrease tremors and rigidity
d. stimulate the release of dopamine from the brain

87. Upon assessment of the client with myasthenia gravis the nurse discovered that the client is
showing signs of cholinergic crisis. Which of the following drug should the nurse anticipate
to give?
a. atropine sulfate c. Bromocriptine (Parlodel)
b. pyridostigmine (Mestinon) d. Edrophonium (Tensilon)

88. A nurse is suctioning the unconscious client with tracheostomy. The nurse should avoid
which of the following actions?
a. keeping a supply of suction catheter at the bedside
b. making sure not to suction for longer than 30 seconds
c. hyperoxygenate the client before, during and after suctioning
d. auscultating breath sounds to determine the need for suctioning

89. A client with spinal cord injury at the level of C5 has a weakened respiratory effort and
ineffective cough and is using accessory neck muscles for breathing. The nurse carefully
monitors the client and formulates which of the following nursing diagnosis?
a. ineffective breathing pattern c. risk for aspiration
b. impaired gas exchange d. risk for injury

90. A client with trigeminal neuralgia asks the nurse what causes the painful episodes associated
with the condition. The nurse response is base on an understanding that the symptoms can
be trigger by which of the following?
a. stimulation of the affected nerve by pressure and temperature
 b. a hypoglycemic effect on the cranial nerve
c. release of catecholamine with infection or stress
d. a local reaction to nasal stuffiness

CRITICAL THINKING

1. Discuss the importance of the following drugs in the management of Parkinson’s disease.
(10 pts)

a. Benztropine Mesylate (Cogentin)

Parkinson’s disease indicates an imbalance of dopamine and acetylcholine.
Benztropine Mesylate (Cogentin), an anticholinergic agent, is used for the
symptomatic treatment of Parkinson’s, with its main mechanism of action blocking
acetylcholine. Thereby helping to decrease muscle stiffness, sweating, and
production of saliva – as well as improve walking ability in people diagnosed with
Parkinson’s. It is also thought that Cogentin helps to increase the availability of
dopamine, and since Parkinson’s disease is defined by depletion of dopamine, this
action increases initiation and smooth control of voluntary muscle movement.

b. Bromocriptine (Parlodel)
Bromocriptine (Parlodel) is a major antiparkinsonism agent because it activates
dopaminergic receptors in the neostriatum of the central nervous system. The main
problem in Parkinson’s disease is decreased levels of dopamine, so by stimulating
dopamine production, dopamine levels in the body will increase, thereby decreasing
the symptoms of Parkinson’s disease.

2. Explain how the following drugs help in the management of myasthenia gravis. (10 pts)

a. Anti-cholinesterase Drugs
Myasthenia gravis is a condition in which antibodies produced by the immune
system attack the neuromuscular junction. This transmission defect results from a
deficiency in release of acetylcholine or a deficiency in number of acetylcholine
receptor sites. Acetylcholine is a crucial chemical messenger that carries signals
between nerve and muscle. An enzyme called acetylcholinesterase breaks down
acetylcholine. Decreased levels of acetylcholine cause the symptoms present in
myasthenia gravis especially muscle weakness and fatigue.
Anti-cholinesterase prevents acetylcholinesterase from breaking down the necessary
acetylcholine for smooth nerve and muscle function, thereby increasing
acetylcholine levels in the body and diminishing the symptoms of myasthenia gravis.

b. Corticosteroids
Since myasthenia gravis is described as an autoimmune disease, where antibodies
from the immune system attack the neuromuscular junction and consequently
depletes the acetylcholine levels in the body, steroids, or corticosteroids can help
because of their immunosuppressant actions. They reduce the production of
antibodies by lessening the activity of the body’s immune system. The
neuromuscular is less damaged by the immune system because of this action and the
root problem of acetylcholine depletion is halted.

DARIO V. SUMANDE, Ph.D,

RN
Instructor