A client with myasthenia gravis on scheduled pyridostigmine reports increasing weakness, abdominal cramping, e…

Question

A client with myasthenia gravis on scheduled pyridostigmine reports increasing weakness, abdominal cramping, excessive salivation, and lacrimation 45 minutes after the last dose. Which assessment finding most strongly supports cholinergic crisis rather than myasthenic crisis?

Accepted Answer

Option 2: Constricted pupils with bradycardia and excess secretions

Cholinergic crisis results from acetylcholinesterase-inhibitor overdose. Muscarinic excess produces SLUDGE (salivation, lacrimation, urination, defecation, GI cramping, emesis) with miosis and bradycardia, typically within 30-60 minutes of a dose. Myasthenic crisis (under-medication) presents with worsening weakness HOURS after a dose and improves with edrophonium. Stress can trigger either crisis and is non-specific.

Answer

Option 1: Ptosis worsening 4 hours after the dose

Answer

Option 3: Improvement in muscle strength after edrophonium

Answer

Option 4: Symptoms triggered by emotional stress

A client with myasthenia gravis on scheduled pyridostigmine reports increasing weakness, abdominal cramping, excessive salivation, and lacrimation 45 minutes after the last dose. Which assessment finding most strongly supports cholinergic crisis rather than myasthenic crisis?

In-depth explanation

Clinical scenario

Key concepts

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A client with myasthenia gravis on scheduled pyridostigmine reports increasing weakness, abdominal cramping, excessive salivation, and lacrimation 45 minutes after the last dose. Which assessment finding most strongly supports cholinergic crisis rather than myasthenic crisis?

In-depth explanation

Clinical scenario

Key concepts

Master the NCLEX-RN with MyMerci