N316B MIDTERM 1 EXAM QUESTIONS
WITH 100% CORRECT ANSWERS |
LATEST VERSION 2025/2026.
Which statements would the nurse include when teaching a client who is considering
medroxyprogesterone injection as a form of hormonal birth control? Select all that apply. One,
some, or all responses may be correct.
-It lasts for 3 months.
-It can cause nausea and vomiting.
-It contains both progestin and estrogen.
-It decreases the risk of age-related loss of bone density.
-Side effects include drowsiness or insomnia and depression.
-The most severe undesirable effects are liver dysfunction and thromboembolic disorders. -
ANS It lasts for 3 months.
*It can cause nausea and vomiting.
*Side effects include drowsiness or insomnia and depression.
*The most severe undesirable effects are liver dysfunction and thromboembolic disorders.
Rationale
Medroxyprogesterone does last for 3 months. It can cause nausea and vomiting, as well as
lethargy or insomnia and depression, although the most undesirable severe effects are liver
dysfunction and thromboembolic disorders, including thrombophlebitis, cerebrovascular
disorder, pulmonary embolism, and retinal thrombosis. Medroxyprogesterone does not contain
both progestin and estrogen; it is progestin-only. Medroxyprogesterone does not decrease the
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,risk of age-related loss of bone density; in fact, it has a black-box warning because it can cause
bone mineral density loss that puts women at higher risk for osteoporosis and bone fractures
later in life.
A client with myasthenia gravis has been receiving neostigmine and asks about its action. Which
information would the nurse consider when formulating a response?
- Stimulates the cerebral cortex
- Blocks the action of cholinesterase
- Replaces deficient neurotransmitters
- Accelerates transmission along neural sheaths - ANS Blocks the action of cholinesterase
Rationale:
Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine, thus prolonging
neurotransmission. Neostigmine's action is at the myoneural junction, not the cerebral cortex.
Neostigmine prevents neurotransmitter breakdown, but it is not a neurotransmitter.
Neostigmine's action is at the myoneural junction, not the sheath.
773) The health care provider prescribes neostigmine for a client with myasthenia gravis. Which
client statement indicates understanding regarding medication management plans?
- 'I must keep the medication in a container in the refrigerator.'
- I should take the medication at the exact time that is listed on the prescription.'
-'I will plan to take the medication between meals.'
-'I expect that the onset of the medication's action will occur several hours after I take it.' -
ANS - I should take the medication at the exact time that is listed on the prescription.'
Rationale:
Neostigmine should be taken as prescribed, usually before meals, to limit dysphagia and
possible aspiration. Keeping neostigmine refrigerated is not necessary; it may be kept at room
temperature. Neostigmine should be taken with milk to prevent gastrointestinal irritation;
usually it is taken about 30 minutes before meals. The onset of the action of neostigmine occurs
45 to 75 minutes after administration; the duration of its action is 2.5 to 4 hours.
2 | Page @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Pyridostigmine bromide is prescribed for a client with myasthenia gravis. The nurse evaluates
that the medication regimen is understood when the client makes which statement?
-'I will take the medication on an empty stomach.'
-I need to set an alarm so I take the medication on time.'
-'It will be important to check my heart rate before taking the medication.'
'-I should monitor for an increase in blood pressure after taking the medication.' - ANS -I
need to set an alarm so I take the medication on time.'
Rationale:
Pyridostigmine is a vital medication that must be taken on time; a missed or late dose can result
in severe respiratory and neuromuscular consequences or even death. Pyridostigmine should
be taken with a small amount of food to prevent gastric irritation. It is unnecessary to take the
pulse rate before taking pyridostigmine. Pyridostigmine may cause hypotension, not
hypertension, which is a sign of cholinergic crisis.
A client with myasthenia gravis is receiving pyridostigmine bromide to control symptoms.
Recently, the client has begun experiencing increased difficulty in swallowing. Which nursing
action is effective in preventing aspiration of food?
-Place a tracheostomy set in the client's room.
-Assess respiratory status after meals.
-Request for the diet to be changed from soft to clear liquids.
-Coordinate mealtimes with the peak effect of the medication. - ANS -Coordinate mealtimes
with the peak effect of the medication.
Rationale
Dysphagia should be minimized during peak effect of pyridostigmine bromide, thereby
decreasing the probability of aspiration. A tracheostomy set is a treatment for, rather than
equipment to prevent, aspiration. Although it is vital that the client's respiratory function be
monitored, assessing the client's respiratory status will not prevent aspiration. There are
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, insufficient data to determine whether changing the diet from soft foods to clear liquids is
appropriate; also, liquids are aspirated more easily than semisolids.
Pyridostigmine is prescribed for a client with myasthenia gravis. Why would the nurse instruct
the client to take pyridostigmine about 1 hour before meals?
-This timing limits first pass metabolism.
-Taking it on an empty stomach increases absorption.
-Taking it before meals decreases gastric irritation.
-Taking it before meals improves the ability to chew. - ANS -Taking it before meals improves
the ability to chew.
Rationale:
Peak action of the medication will occur during meals to promote chewing and swallowing and
prevent aspiration. It should be given with a small amount of food to prevent gastric irritation.
First pass metabolism is a process of metabolism, which is not affected by medication timing.
Absorption is not affected significantly by the presence of food in the stomach. Gastric irritation
is reduced best by the administration of medications with food, not on an empty stomach.
A client presents to the clinic for a follow-up appointment after starting pyridostigmine for
management of myasthenia gravis. Which new client problems are adverse effects of
pyridostigmine? Select all that apply. One, some, or all responses may be correct.
-Respiratory depression
-Increased urinary frequency
-Diplopia
-Muscle twitching
-Diarrhea - ANS -Increased urinary frequency
-Muscle twitching
-Diarrhea
Rationale:
4 | Page @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
WITH 100% CORRECT ANSWERS |
LATEST VERSION 2025/2026.
Which statements would the nurse include when teaching a client who is considering
medroxyprogesterone injection as a form of hormonal birth control? Select all that apply. One,
some, or all responses may be correct.
-It lasts for 3 months.
-It can cause nausea and vomiting.
-It contains both progestin and estrogen.
-It decreases the risk of age-related loss of bone density.
-Side effects include drowsiness or insomnia and depression.
-The most severe undesirable effects are liver dysfunction and thromboembolic disorders. -
ANS It lasts for 3 months.
*It can cause nausea and vomiting.
*Side effects include drowsiness or insomnia and depression.
*The most severe undesirable effects are liver dysfunction and thromboembolic disorders.
Rationale
Medroxyprogesterone does last for 3 months. It can cause nausea and vomiting, as well as
lethargy or insomnia and depression, although the most undesirable severe effects are liver
dysfunction and thromboembolic disorders, including thrombophlebitis, cerebrovascular
disorder, pulmonary embolism, and retinal thrombosis. Medroxyprogesterone does not contain
both progestin and estrogen; it is progestin-only. Medroxyprogesterone does not decrease the
1 | Page @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,risk of age-related loss of bone density; in fact, it has a black-box warning because it can cause
bone mineral density loss that puts women at higher risk for osteoporosis and bone fractures
later in life.
A client with myasthenia gravis has been receiving neostigmine and asks about its action. Which
information would the nurse consider when formulating a response?
- Stimulates the cerebral cortex
- Blocks the action of cholinesterase
- Replaces deficient neurotransmitters
- Accelerates transmission along neural sheaths - ANS Blocks the action of cholinesterase
Rationale:
Neostigmine, an anticholinesterase, inhibits the breakdown of acetylcholine, thus prolonging
neurotransmission. Neostigmine's action is at the myoneural junction, not the cerebral cortex.
Neostigmine prevents neurotransmitter breakdown, but it is not a neurotransmitter.
Neostigmine's action is at the myoneural junction, not the sheath.
773) The health care provider prescribes neostigmine for a client with myasthenia gravis. Which
client statement indicates understanding regarding medication management plans?
- 'I must keep the medication in a container in the refrigerator.'
- I should take the medication at the exact time that is listed on the prescription.'
-'I will plan to take the medication between meals.'
-'I expect that the onset of the medication's action will occur several hours after I take it.' -
ANS - I should take the medication at the exact time that is listed on the prescription.'
Rationale:
Neostigmine should be taken as prescribed, usually before meals, to limit dysphagia and
possible aspiration. Keeping neostigmine refrigerated is not necessary; it may be kept at room
temperature. Neostigmine should be taken with milk to prevent gastrointestinal irritation;
usually it is taken about 30 minutes before meals. The onset of the action of neostigmine occurs
45 to 75 minutes after administration; the duration of its action is 2.5 to 4 hours.
2 | Page @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Pyridostigmine bromide is prescribed for a client with myasthenia gravis. The nurse evaluates
that the medication regimen is understood when the client makes which statement?
-'I will take the medication on an empty stomach.'
-I need to set an alarm so I take the medication on time.'
-'It will be important to check my heart rate before taking the medication.'
'-I should monitor for an increase in blood pressure after taking the medication.' - ANS -I
need to set an alarm so I take the medication on time.'
Rationale:
Pyridostigmine is a vital medication that must be taken on time; a missed or late dose can result
in severe respiratory and neuromuscular consequences or even death. Pyridostigmine should
be taken with a small amount of food to prevent gastric irritation. It is unnecessary to take the
pulse rate before taking pyridostigmine. Pyridostigmine may cause hypotension, not
hypertension, which is a sign of cholinergic crisis.
A client with myasthenia gravis is receiving pyridostigmine bromide to control symptoms.
Recently, the client has begun experiencing increased difficulty in swallowing. Which nursing
action is effective in preventing aspiration of food?
-Place a tracheostomy set in the client's room.
-Assess respiratory status after meals.
-Request for the diet to be changed from soft to clear liquids.
-Coordinate mealtimes with the peak effect of the medication. - ANS -Coordinate mealtimes
with the peak effect of the medication.
Rationale
Dysphagia should be minimized during peak effect of pyridostigmine bromide, thereby
decreasing the probability of aspiration. A tracheostomy set is a treatment for, rather than
equipment to prevent, aspiration. Although it is vital that the client's respiratory function be
monitored, assessing the client's respiratory status will not prevent aspiration. There are
3 | Page @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, insufficient data to determine whether changing the diet from soft foods to clear liquids is
appropriate; also, liquids are aspirated more easily than semisolids.
Pyridostigmine is prescribed for a client with myasthenia gravis. Why would the nurse instruct
the client to take pyridostigmine about 1 hour before meals?
-This timing limits first pass metabolism.
-Taking it on an empty stomach increases absorption.
-Taking it before meals decreases gastric irritation.
-Taking it before meals improves the ability to chew. - ANS -Taking it before meals improves
the ability to chew.
Rationale:
Peak action of the medication will occur during meals to promote chewing and swallowing and
prevent aspiration. It should be given with a small amount of food to prevent gastric irritation.
First pass metabolism is a process of metabolism, which is not affected by medication timing.
Absorption is not affected significantly by the presence of food in the stomach. Gastric irritation
is reduced best by the administration of medications with food, not on an empty stomach.
A client presents to the clinic for a follow-up appointment after starting pyridostigmine for
management of myasthenia gravis. Which new client problems are adverse effects of
pyridostigmine? Select all that apply. One, some, or all responses may be correct.
-Respiratory depression
-Increased urinary frequency
-Diplopia
-Muscle twitching
-Diarrhea - ANS -Increased urinary frequency
-Muscle twitching
-Diarrhea
Rationale:
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