# The emergency nurse reviews serial findings for a client with myasthenia gravis. Which findings require immediate follow-up? Highlight the findings associated with impending myasthenic crisis. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=497292&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question The emergency nurse reviews serial findings for a client with myasthenia gravis. Which findings require immediate follow-up? Highlight the findings associated with impending myasthenic crisis. Nurses' Notes 1315: The emergency nurse assesses a client with myasthenia gravis after a respiratory infection. The client reports that eyelid drooping improves briefly after resting. At 1320, the nurse documents that the single-breath count falls markedly from the earlier assessment. The room is kept cool, and the client reports less fatigue away from direct heat. During conversation, the client can speak only short phrases before taking another breath. The medication record confirms that the usual pyridostigmine schedule was followed today. At 1328, the monitor shows that oxygen saturation remains within the prescribed target range. The client remains alert and follows commands. The nurse hears gurgling and finds that a weak cough cannot clear pooled oral secretions. The limb examination shows that hand strength is unchanged from the client's baseline. The nurse observes that the abdomen moves inward during inspiration as the chest rises. A chest image completed earlier shows no new focal pulmonary opacity, pleural fluid, or lobar collapse. At 1335, the nurse raises the head of the bed, keeps suction available, and calls for immediate airway evaluation. The team prepares ventilatory support while repeating bedside respiratory measurements. ## Explanation A rapidly falling single-breath count, inability to speak full sentences, weak cough with pooled secretions, and paradoxical breathing require follow-up. Oxygen saturation can remain reassuring until respiratory muscle failure is advanced. ## In-depth explanation Quick answer Highlight the falling single-breath count, speech limited to short phrases, weak cough with pooled secretions, and paradoxical breathing. These are direct signs that respiratory and airway muscles may be failing despite a reassuring saturation. Why this is correct Myasthenic crisis causes respiratory failure from muscle weakness. Rapid shallow breathing, poor speech endurance, impaired secretion handling, and paradoxical breathing can appear before oxygen saturation falls, so bedside strength and ventilation assessment drive escalation.[2] Easy analogy or mental picture Picture a bellows that is losing squeezing strength while the oxygen gauge still looks acceptable. The bellows is respiratory muscle power and the gauge is pulse oximetry; the picture explains why strength cues matter but does not replace airway assessment. Memory hook Weak breath, weak voice, weak cough: prepare airway support. NCLEX decision rule When myasthenia gravis is paired with worsening breathing or bulbar weakness, think impending crisis; check speech, cough, secretions, breathing pattern, and bedside respiratory strength without waiting for desaturation. Why the other choices are wrong Improved eyelid opening after rest, stable limb strength, a cool room, prescribed medication timing, and an unchanged chest image do not show the same immediate ventilatory decline. Normal saturation alone cannot clear the client.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]MGFA: Emergency Management for First RespondersMyasthenia Gravis Foundation of America ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. 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