module 2 - muscle relaxants questions

Spinal reflexes are the simplest nerve pathways that monitor movement and posture.

True

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?

Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders. Baclofen is not available over the counter and is prescribed on a scheduled basis, rather than in response to acute symptoms. It is not necessary to stop taking other drugs prior to or during treatment with baclofen.

Which skeletal muscle relaxant is also available in intrathecal form?

Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity.

Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of:

Caution should be used with dantrolene in all patients older than 35 years because of increased risk of potentially fatal hepatocellular disease.

A client comes to the health care provider's office. The client is to receive botulinum toxin. What, if assessed, would suggest to the nurse that the drug administration should be postponed?

Botulinum toxin is administered as an injection and should not be given if there is active infection at the site of the intended injection.

A patient who is receiving chlorzoxazone reports that his urine is somewhat orange in color. Which response by the nurse would be most appropriate?

Chlorzoxazone may discolor the urine causing it to become purple-red to orange when metabolized and excreted. This is an expected effect.

Patients receiving chlorzoxazone (Paraflex) should be cautioned that what will occur with administration?

Chlorzoxazone may discolor urine, becoming orange to purple-red when metabolized and excreted. Patients should be warned about this effect to prevent fears of blood in the urine. Tizanidine has been associated with liver toxicity and hypotension in some patients.

A client sustained a musculoskeletal injury to his left leg that has resulted in occasional spasticity. What should the nurse expect the health care provider to prescribe?

Cyclobenzaprine is used for the treatment of discomfort of acute musculoskeletal conditions. Baclofen is used to treat muscle spasticity associated with neuromuscular diseases. Dantrolene is used to treat upper motor neuron-associated muscle spasticity. Botulinum toxin type B is used to reduce the severity of abnormal head position and neck pain associated with cervical dystonia.

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?

Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.

A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency?

Dantrolene acts directly on skeletal muscle to inhibit muscle contraction. It is used to relieve spasticity in neurologic disorders (e.g., MS, spinal cord injury) and to prevent or treat malignant hyperthermia, a rare but life-threatening complication of anesthesia characterized by hypercarbia, metabolic acidosis, skeletal muscle rigidity, fever, and cyanosis. None of the other medications are prescribed for this emergency.

A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?

Dantrolene is the drug that would be used as prevention and treatment of malignant hyperthermia.

Which medication is classified as an antianxiety medication but is also used to treat muscle spasms?

Diazepam (Valium), a drug widely used as an anxiety agent, also has been shown to be an effective centrally acting skeletal muscle relaxant. It may be advantageous in situations in which anxiety may be precipitating the muscle spasm.

The health care provider orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition?

For most of the skeletal muscle relaxants, safety and effectiveness for use in children 12 years of age and younger have not been established. The drugs should be used only when clearly indicated, for short periods, when close supervision is available for monitoring drug effects (especially sedation), and when mobility and alertness are not required.

Which adverse effect of muscle relaxants is most pronounced when a client is prescribed tizanidine therapy?

Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.

The client is taking baclofen (Lioresal). What would be the most important safety instruction for the nurse to give to this client?

In a client experiencing spasticity, the nurse should advise the client to stop drinking alcohol. Alcohol consumption may increase the adverse effect of sedation, causing sleepiness, dizziness, and blurred vision. The client should not drive or walk after taking the drug; the client should learn to self-administer the drug; and constipation is a concern. However, the most important safety concern is to avoid alcohol.

Which is the drug of choice in children who need to be treated with tetanus?

Methocarbamol is the drug of choice if a child needs to be treated for tetanus(지속 강직성 경련).

A client's migraines are not being adequately controlled by triptans and so the client is preparing to begin treatment with onabotulinumtoxin A. What should the nurse teach the client about this treatment?

Migraine treatment with onabotulinumtoxin A involves a series of injections to the head, neck and shoulders every 12 weeks. The drug is not administered by IM depot and inpatient monitoring is not a necessity. Botulism infection is potential risk but clients are not required to carry a supply of the antitoxin.

A patient has been prescribed methocarbamol (Robaxin) for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which statement by the patient indicates that the patient has an understanding of at least one of the significant side effects of methocarbamol?

One significant side effect of methocarbamol is that it causes urine to be discolored. Central-acting muscle relaxants such as methocarbamol usually cause fatigue and loss of energy along with constipation, not diarrhea. Methocarbamol is not designed to treat tension headaches.

When prescribed dantrolene, what is the most serious adverse effect the client should be instructed about?

The most serious adverse effect of oral dantrolene is fatal hepatitis. Metabolic acidosis, hypercarbia, and renal calculi are not adverse effects of oral dantrolene.

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor:

The nurse will monitor alanine aminotransferase and total bilirubin levels, because a serious adverse effect of dantrolene is drug-induced hepatitis. The nurse will also educate the patient and family concerning signs and symptoms of hepatitis. Prothrombin time and partial thromboplastin time would be monitored for someone taking an anticoagulant, not for someone taking dantrolene. Urine specific gravity is part of a urinalysis and would be used to assess urinary function, which is not affected by dantrolene use. Follicle-stimulating hormone level is important to the female reproductive system and would not be assessed in a male.

A 32-year-old female client is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the client and her husband that the adverse effect that poses the greatest safety risk to the client is:

Tizanidine (Zanaflex) has been associated with hypotension, which could be a safety risk, especially if the client is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.

A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which instruction?

The nurse will need to caution the patient about the adverse effect of photosensitivity, especially considering his work. He should be advised to wear protective clothing and sunglasses and to use sunscreen whenever he is outside on the job site. A complete blood cell count should be done before therapy begins but would not be needed again unless indicated. A nurse must check with the prescriber before advising a patient to decrease a drug dosage. A diet high in protein is not necessary with this drug.