Ch 53

A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response? a. "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants." b. "If you combine baclofen and alcohol you could suffer a severe allergic-type reaction." c. "You're not permitted to drink alcohol while you're taking baclofen." d. "The combination of baclofen and alcohol could depress your nervous system to a dangerous level."

"The combination of baclofen and alcohol could depress your nervous system to a dangerous level."

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide? a. "We'll need to closely monitor your blood sugar levels for the next week." b. "There's a small risk that you might experience some hallucinations in the first few days that you begin taking this drug." c. "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." d. "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time."

"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."

A 36-year-old man has been taking extended-release carbamazepine for 1 year. He is in the clinic every 3 months for follow-up visits, which include a drug blood level. Which of the following carbamazepine blood levels would indicate a potential risk for adverse effects? a. 6 mcg/mL b. 2 mcg/mL c. 15 mcg/mL d. 10 mcg/mL

15 mcg/mL

The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage? a. 6 mcg/mL b. 8 mcg/mL c. 2 mcg/mL d. 4 mcg/mL

2 mcg/mL

A client is receiving phenytoin. The nurse monitors the client's plasma drug level. Which level would alert the nurse to the possibility of toxicity? a. 10 µg/mL b. 18 µg/mL c. 15 µg/mL d. 27 µg/mL

27 mcg/mL

A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions? a. A client who will be discharged on carbamazepine and who requires education b. A client receiving pregabalin who is not responsive to verbal stimuli c. A client being treated with phenobarbital whose blood pressure is 106/69 mmHg d. A client who is anxious about undergoing electroencephalography to investigate a recent absence seizure

A client receiving pregabalin who is not responsive to verbal stimuli

The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence? a. A client receiving ethosuximide for the prevention of absence seizures b. A client with a history of tonic-clonic seizures who takes phenobarbital c. A client with a history of myoclonic seizures who takes valproic acid d. A client receiving IV phenytoin to prevent seizures post-neurosurgery

A client with a history of tonic-clonic seizures who takes phenobarbital

Kate is experiencing status epilepticus. The prescriber orders IV diazepam. What special precautions need to be taken by a nurse to administer IV diazepam? a. Dilute the drug with 5 to 10 mL normal saline. b. Administer the drug in the small veins in the dorsum of the hand or the wrist. c. Administer the drug through an IV pump. d. Administer the drug very slowly, no faster than 5 mg/min.

Administer the drug very slowly, no faster than 5 mg/min.

A client has been admitted to the emergency department and is experiencing tonic-clonic seizures. What intervention should the nurse prioritize? a. Administration of gabapentin PO as prescribed b. Assessment of the client's renal and hepatic function c. Administration of phenytoin IV as prescribed d. Establishing a therapeutic relationship with the client

Administration of phenytoin IV as prescribed

A client is receiving carbamazepine therapy and the client's latest serum level of the drug is 13 mcg/mL. What action is most appropriate? a. Assess the client's renal function b. Contact the provider to request a one-time supplementary dose c. Anticipate a reduction in dosage d. Call an emergency code

Anticipate a reduction in dosage

The nursing instructor is teaching a group of students about drugs used for muscle spasms and cramping. The instructor determines the session is successful when the students correctly choose which instruction as relevant to skeletal muscle relaxants? a. Avoid alcohol or other CNS depressants. b. Take the drug with 6-8 ounces of water. c. Take the drug with food. d. Stay upright for 30 minutes after taking the drugs.

Avoid alcohol or other CNS depressants.

A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered? a. Cyclobenzaprine b. Chlorzoxazone c. Carisoprodol d. Baclofen

Baclofen

The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued, and the client will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration when discontinuing the client's baclofen? a. Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations. b. The client's dose of baclofen should be gradually withdrawn over 4 to 6 weeks to prevent rebound spasticity. c. Carisoprodol will be administered while continuing baclofen until the carisoprodol level is established. d. The client will be prescribed alternate doses of baclofen and carisoprodol over 10 days to prevent symptoms of baclofen withdrawal.

Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations.

After teaching a group of nursing students about the various drugs used to treat musculoskeletal conditions, the instructor determines that the teaching was successful when the students correctly choose which drug as being used to treat osteoporosis? a. Bone resorption inhibitors b. DMARDs c. Uric acid inhibitors d. Skeletal muscle relaxants

Bone resorption inhibitors

The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine? a. Cyclobenzaprine has an effect at the neuromuscular junction b. Cyclobenzaprine acts in the peripheral nervous system c. Cyclobenzaprine is structurally similar to amitriptyline d. Cyclobenzaprine produces an anticholinergic response

Cyclobenzaprine produces an anticholinergic response

The nurse is administering phenytoin to a client who is also receiving a continuous nasogastric enteral feeding and is aware of what possible effect? a. Increasing absorption of the AED b. Precipitating signs of overdosage c. Decreasing the absorption of the AED d. Not affecting absorption of the AED

Decreasing the absorption of the AED

When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include? a. Stimulation of the cerebral cortex b. Promotion of impulse conduction c. Depression of motor nerve output d. Maintenance of cerebellar function

Depression of motor nerve output

For a client with a known heart block (conduction disorder), what medication is contraindicated? a. Dilantin b. Valproic acid c. Theophylline d. Lithium

Dilantin

What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant? a. Do not drive or operate machinery until individual drug effects are known. b. Report increased muscle spasm to the health care provider immediately. c. Drink eight to 10 glasses of water daily to prevent constipation. d. Always take this medication with food to prevent nausea and vomiting.

Do not drive or operate machinery until individual drug effects are known

A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? a. Teach the client how to self-administer subcutaneous injections b. Educate the client about the need to take the pills as scheduled c. Educate the client about taking the medication at the first sign of impending seizure activity d. Establish intravenous access

Educate the client about the need to take the pills as scheduled

Which type of seizures involves a loss of consciousness? a. Generalized seizures b. Motor seizures c. Partial seizures d. Somatosensory seizures

Generalized seizures

Signs and symptoms of what would necessitate discontinuation of dantrolene therapy? a. Hepatic dysfunction b. Visual disturbances c. Urinary retention d. Intermittent gastrointestinal upset

Hepatic dysfunction

A client with multiple sclerosis is experiencing painful muscle spasticity and has been prescribed a centrally acting skeletal muscle relaxant. What should the nurse include in the client's plan of care? a. Monitor for signs and symptoms of bone marrow suppression. b. Provide small meals five times daily rather than three larger meals. c. Implement non-pharmacologic pain relief measures as needed. d. Educate the client about the need to abstain from NSAIDs during treatment.

Implement non-pharmacologic pain relief measures as needed.

A client is receiving allopurinol. Which instruction would be most important for the nurse to include in the client's plan of care? a. Avoidance of direct sunlight b. Liberal fluid intake c. Moderate exercise d. Use of a brace or corset

Liberal fluid intake

What should the nurse include as a possible adverse effect when teaching a client about phenytoin? a. Physical dependence b. Diarrhea c. Liver toxicity d. Increased white blood cell count

Liver toxicity

A client asks the nurse about the cause of idiopathic seizures. What is the nurse's bestresponse? a. Passed from parent to child b. No known cause c. High fever d. Brain injury at birth

No known cause

A client is taking allopurinol for gout. The client exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action? a. Notify the healthcare provider. b. Recommend the client trim fingernails. c. Document the finding as a common side effect. d. Apply a moisturizing lotion.

Notify the healthcare provider.

A client with seizures is prescribed phenytoin. Which assessment should the nurse prioritize? a. Check the client's temperature every 3-4 hours. b. Obtain serum plasma drug levels regularly. c. Evaluate the client's pulse rate and rhythm. d. Assess the client's respiratory rate.

Obtain serum plasma drug levels regularly.

The nurse has completed a teaching with a client prescribed phenytoin daily for seizure activity. The nurse determines the session is successful after the client correctly chooses which potential adverse reaction that can occur if the client misses a dose of medication? a. Nystagmus b. Recurrence of seizures c. CNS depression d. Hypotension

Recurrence of seizures

A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do? a. Titer the dose b. Increase the dose c. Maintain the current dose d. Reduce the dose

Reduce the dose

A nurse is preparing to administer carbamazepine to a client. The nurse should question the health care provider about this order if which disorder is noted in the client's history? a. Hearing impairment b. Respiratory depression c. Renal impairment d. Bipolar disorder

Renal impairment

An older adult client experiencing seizures is prescribed diazepam. Which assessment should the nurse prioritize? a. Blood glucose levels b. Speech quality c. Swallowing ability d. Respiratory rate and depth

Respiratory rate and depth

A client has been prescribed a subcutaneous medication to treat rheumatoid arthritis (RA). The nurse should teach the client to do which? a. Aspirate the syringe before injecting the medication. b. Pinch the skin over the deltoid before injection. c. Rotate sites when administering the injections. d. Pull the skin to the side when injecting to prevent skin irritation.

Rotate sites when administering the injections.

The primary health care provider prescribes adalimumab. The nurse would prepare to administer this drug by which route? a. Orally b. Subcutaneously c. Intravenously d. Intramuscularly

Subcutaneously

A client with a history of partial seizures has been taking lamotrigine for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse's best action? a. Tell the client to take the medication with a high-fat food to minimize adverse effects. b. Tell the client to take no further doses and come be assessed at the clinic immediately. c. Rule out any shortness of breath and inform the client that this adverse effect will resolve with time. d. Recommend that the client take 50 mg diphenhydramine PO and check back tomorrow.

Tell the client to take no further doses and come be assessed at the clinic immediately.

A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason? a. The client's risk for dependence is increased. b. The client is at risk for increased CNS depression. c. The combination may lead to a hypertensive crisis. d. A disulfiram-like reaction can occur.

The client is at risk for increased CNS depression.

The nurse is preparing to administer the next dose of methsuximide to a client experiencing partial seizures. The client remarks about hoping their stomach will do better this time. Which suggestion from the nurse will best assist this client when administering this next dose? a. Immediately before eating a meal b. Daily at bedtime c. First thing in the morning on arising d. With some food or milk

With some food or milk

While writing a care plan for a client newly diagnosed with generalized seizures, the nurse might appropriately choose what nursing diagnosis? a. decreased cardiac output related to autonomic disruption b. chronic confusion related to central nervous system depression c. risk for injury related to gastrointestinal (GI) effects d. altered thought processes related to central nervous system effects

altered thought processes related to central nervous system effects

A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency? a. metaxalone b. carisoprodol c. methocarbamol d. dantrolene

dantrolene

A client newly diagnosed with a seizure disorder has been prescribed valproic acid. When assessing for adverse effects, what assessment should the nurse prioritize? a. assessing the client for signs of respiratory distress b. monitoring the client's liver enzyme levels c. assessing the client's apical heart rate and rhythm d. performing musculoskeletal assessment

monitoring the client's liver enzyme levels

A client with multiple sclerosis asks the nurse to explain why deep tissue massages do not relieve spasticity. The nurse should explain that spasticity is caused by: a. stimulation of "association areas" in the brain; therefore, only nerve blocks will be effective. b. inflammation of the muscles; therefore, NSAIDs may be effective. c. nerve damage in the brain and spinal cord, and it is a permanent condition. d. skeletal muscle trauma and will improve in time.

nerve damage in the brain and spinal cord, and it is a permanent condition

A client is to receive ethotoin. The nurse would expect to administer this drug by which route? a. Intramuscular b. Rectal c. Oral d. Intravenous

oral

The nurse is providing client education for a client newly prescribed a hydantoin antiseizure medication. The nurse has taught the client about the need to taper down the dose of the drug slowly when the provider decides it should be discontinued. What benefit of tapering should the nurse describe? a. improved blood pressure stability b. shorter duration of absence seizures c. reduced risk of cardiac dysrhythmias d. reduced risk of status epilepticus

reduced risk of status epilepticus

A nurse is caring for a client with trigeminal neuralgia at a health care facility. The health care provider has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated in clients with: a. renal impairment. b. hearing impairment. c. respiratory depression. d. nervous breakdown.

renal impairment.

A client is prescribed phenytoin and reports gastrointestinal (GI) upset. The nurse should tell the client to: a. take the medication with meals. b. take the medication two hours after ingesting dairy products. c. take the medication at bedtime. d. ask the health care provider to change the route from oral to injection.

take the medication with meals.