CNS Depressant and Skeletal Muscle Relaxant Therapy

Question 2 of 5 Which statement made by Ms. Wilson regarding cyclobenzaprine indicates further teaching is required by the nurse? "I should avoid taking the cyclobenzaprine and ibuprofen together." "I can take this medication as long as I want." "I should take this medication with food." "I need to taper this medication if I want to stop taking it."

"I can take this medication as long as I want." This statement is incorrect, so further teaching is required by the nurse. Most muscle relaxants are usually taken for no longer than a few weeks, not for as long as the patient wants. Once the muscle spasms diminish, the medication should be tapered and discontinued.

Question 11 of 20 A nurse is providing discharge teaching to a patient prescribed cyclobenzaprine. Which statement would be appropriate to include in the teaching? "Notify your health care provider if you think you might be pregnant." "Finish the entire prescription, even if you feel better." "You may drive 4 hours after you take the medication." "You may take a sleeping pill, if needed, but only if you have 8 hours to sleep."

"Notify your health care provider if you think you might be pregnant." Cyclobenzaprine should be used with caution in patients who are pregnant, so the health care provider should be notified if the patient thinks she might be pregnant.

Question 15 of 20 A patient has been prescribed a skeletal muscle relaxant and asks the nurse, "Why was I told not to drive or participate in activities that require mental alertness while taking this drug?" Which response by the nurse is appropriate? "Sedation is a common side effect of skeletal muscle relaxants." "A decrease in peripheral vision is a side effect of skeletal muscle relaxants." "A decrease in muscle tone is a side effect of skeletal muscle relaxants." "Short-term memory loss is a side effect of skeletal muscle relaxants."

"Sedation is a common side effect of skeletal muscle relaxants." Muscle relaxants have a sedative effect and can cause drowsiness. Patients taking muscle relaxants should avoid driving or participating in activities that require mental alertness. Other medications that cause sedation (opioids, alcohol) should also be avoided.

Question 2 of 3 Cyclobenzaprine exerts an effect within which time span? 30 minutes 1 hour 2 hours 6 to 8 hours

1 hour The onset of action for cyclobenzaprine is 1 hour. This is the time when the patient may begin noticing relief of spasm from the cyclobenzaprine, with a peak effect of between 3 to 8 hours.

Question 3 of 3 Cyclobenzaprine may aid in the relief of muscle spasm for which duration? 1 to 2 hours 3 to 8 hours 12 to 24 hours 36 to 48 hours

12 to 24 hours The duration of action of cyclobenzaprine is 12 to 24 hours. Patients may notice improvement in muscle spasm for up to 24 hours. The medication may be taken more frequently (every 8 hours) for consistent pain/spasm.

Question 4 of 20 Which method would the nurse use to administer cyclobenzaprine to facilitate the greatest amount of absorption? Administer with grapefruit juice Administer with a full meal Administer on an empty stomach Administer intravenously

Administer on an empty stomach Administering the medication on an empty stomach will increase absorption because cyclobenzaprine is absorbed from the GI tract and food acts as a barrier to absorption.

Question 7 of 20 The nurse educates a patient to avoid which drugs while taking muscle relaxants? Select all that apply. Alcohol Ibuprofen Over-the-counter vitamins Kava kava Valerian

Alcohol Kava kava Valerian

Question 20 of 20 Which nursing assessments, if applicable, must be completed before the administration of midazolam? Select all that apply. Allergy history Medication history Auscultation of lung sounds Blood pressure Pregnancy test

Allergy history Medication history Blood pressure Pregnancy test

Question 1 of 5 The nurse plans to provide patient teaching to Ms. Wilson regarding cyclobenzaprine. Which information would the nurse share with Ms. Wilson? Avoid concomitant use with alcohol and other central nervous system (CNS) depressants. Take cyclobenzaprine every 8 hours around the clock. Take cyclobenzaprine every morning before driving to work to increase range of motion in her cervical spine. Take cyclobenzaprine on an empty stomach.

Avoid concomitant use with alcohol and other central nervous system (CNS) depressants. Concomitant use of cyclobenzaprine and alcohol and other CNS depressants may intensify CNS depressant effects of the drug.

Question 19 of 20 Which assessment finding would require the nurse to hold the prescribed midazolam? Heart rate 110 beats/minute Respiratory rate 26/minute Oxygen saturation 93% Blood pressure 90/60 mm Hg

Blood pressure 90/60 mm Hg Midazolam lowers blood pressure, which can lead to orthostatic hypotension, dizziness, falls, and safety risks. The nurse should not administer midazolam to an already hypotensive patient to avoid adverse reactions.

Question 8 of 20 Which side effects of muscle relaxants would the nurse educate a patient about? Select all that apply. Coughing Headache Nausea Tinnitus Amber urine Muscle weakness

Headache Nausea Muscle weakness

Question 18 of 20 The nurse administered midazolam intravenously. Which assessment, if noted by the nurse, would require immediate intervention? Confusion Nausea Blurred vision Cough

Cough Cough may be indicative of bronchospasm, which is an adverse effect of midazolam. The nurse should intervene to ensure the patient's airway is not compromised.

Question 1 of 3 Centrally-acting muscle relaxants relieve muscle spasms and pain through which mechanism? Increase neuron activity in the spinal cord or brain, or decrease neuronal inhibition on the skeletal muscles. Sedate the patient so the spasms and spasticity are decreased. Depress neuron activity in the spinal cord or brain or enhance neuronal inhibition on the skeletal muscles. Increase the hyperactive reflex which blocks the spasms and spasticity.

Depress neuron activity in the spinal cord or brain or enhance neuronal inhibition on the skeletal muscles. Increased stimulation from the cerebral neurons cause hyper-excitable neurons, which leads to increased muscle tone and spasticity. Central-acting muscle relaxants depress the neuron activity in the spinal cord or brain, or enhance the neuronal inhibition on the skeletal muscles.

Question 3 of 5 Which common side effects are associated with centrally-acting muscle relaxants? Select all that apply. Dizziness Drowsiness Bradycardia Hypertension Dyspnea Polydipsia

Dizziness Drowsiness

Question 5 of 20 Use of muscle relaxants is contraindicated in patients with which condition? Brain tumor Diabetes Acromegaly Hepatic disease

Hepatic disease Muscle relaxants are metabolized in the liver; therefore a patient with hepatic disease would not take these medications. A decrease in the metabolism of these medications may lead to toxicity in patients with hepatic disease.

Question 16 of 20 A patient who has received an intravenous (IV) dose of midazolam will be switched to oral (PO) formulation. Which adjustment in dosing does the nurse anticipate? Lower PO dose Higher PO dose No adjustment in dose This medication cannot be given PO

Higher PO dose Midazolam undergoes first-pass metabolism when administered orally, with only 40% to 50% of the medication reaching circulation. A higher dose will be required to achieve the same medication effects.

Question 4 of 5 Which products, if taken concurrently with midazolam, could result in drug interactions? Select all that apply. Kava kava Erythromycin Zolpidem Penicillin Fish oil Atropine

Kava kava Kava kava, if combined with midazolam, may increase central nervous system (CNS) depression. The combination of these two medications should be avoided. Erythromycin Erythromycin, if combined with midazolam, may increase sedative effects. The combination of these two medications should be avoided. Zolpidem Using midazolam with other CNS depressant drugs, (i.e., zolpidem) may increase CNS effects, respiratory depression, and hypotensive effects. The combination of these two medications should be avoided.

Question 2 of 20 The nurse understands that excretion of cyclobenzaprine occurs via which organ system? Kidneys Liver Lungs Skin

Kidneys Cyclobenzaprine is excreted via the kidneys through urine.

Question 6 of 20 A patient who has been taking 5 mg of oral cyclobenzaprine PO tid for 6 weeks asks for a renewal of the prescription. Which information is of concern to the nurse? Length of time patient has been on medication Frequency that the medication is prescribed Dose of the medication that is prescribed Route that current medication is prescribed

Length of time patient has been on medication The nurse would be concerned about the length of time the patient has been on the prescribed muscle relaxant. Patients with acute spasm should be on the medication for no longer than 3 weeks due to the risk for abuse.

Question 3 of 20 Which nursing assessments are important for a patient prescribed cyclobenzaprine? Select all that apply. Level of consciousness Breathing Blood pressure Blood glucose Vision checks

Level of consciousness Breathing Blood pressure

Question 1 of 20 The nurse would monitor which laboratory values for a patient taking cyclobenzaprine? Liver function tests Creatine kinase Serum amylase and lipase Arterial blood gases

Liver function tests Cyclobenzaprine is metabolized in the liver; therefore liver function tests should be monitored. If liver function is impaired, the medication may accumulate to toxic levels.

Question 10 of 20 A patient is complaining of gastrointestinal symptoms when taking a prescribed muscle relaxant. The nurse would recommend which beverage to help alleviate these symptoms? Water Lemonade Milk Tea

Milk Milk can coat the lining of the stomach and can be helpful with a patient who is having gastrointestinal symptoms with muscle relaxants.

Question 17 of 20 Which medication would the nurse instruct an otherwise healthy patient to avoid while taking midazolam? Morphine Loratadine Acetaminophen Aspirin

Morphine The combination of morphine and midazolam can worsen central nervous system (CNS) depression, sedation, and respiratory depression and should be avoided.

Question 12 of 20 The nurse will teach the patient that cyclobenzaprine can relieve which symptoms? Select all that apply. Muscle stiffness Muscle paralysis Localized muscle spasms Pain with range of motion Spasticity caused by myasthenia gravis

Muscle stiffness Localized muscle spasms Pain with range of motion

Question 5 of 5 The nurse would withhold the prescribed midazolam for the patient reporting which condition? Peripheral vascular disease Muscle spasms Acute low back pain Hepatitis B

Question 5 of 5 The nurse would withhold the prescribed midazolam for the patient reporting which condition? Peripheral vascular disease Muscle spasms Acute low back pain Hepatitis B

Question 9 of 20 Which instruction would the nurse provide a patient taking cyclobenzaprine to avoid dizziness and fainting? Select all that apply. Stand slowly from a sitting position Take medication without food Check blood glucose levels Maintain adequate hydration Stop the medication immediately

Stand slowly from a sitting position Maintain adequate hydration

Question 14 of 20 The nurse teaches a patient that a muscle relaxant should not be abruptly stopped based on which rationale? To avoid rebound spasms To prevent heart palpitations To decrease chances of depression associated with chronic pain To prevent permanent nerve damage

To avoid rebound spasms Muscle relaxants should be tapered, rather than stopped abruptly, to avoid rebound spasms. Stopping the medication abruptly may result in increased spasm and continued need for medication.

Question 13 of 20 For which reason should a patient taking cyclobenzaprine report adverse effects to the health care provider? To prevent respiratory depression To decrease prescribed dose To increase prescribed dose To prevent hypertension

To prevent respiratory depression Muscle relaxants cause central nervous system depression, especially at toxic levels. Early identification of side and adverse effects is necessary to prevent respiratory depression.