Chapter 25: Drugs for Muscle Spasm and Spasticity

The client diagnosed with narcolepsy is prescribed methylphenidate (Ritalin), an amphetamine. Which information should the nurse teach the client? 1. Take the medication early in the day. 2. The medication should be taken at bedtime. 3. Keep the medication in a locked cabinet. 4. Notify the HCP if there is a decrease in appetite.

1. Ritalin is a stimulant and should be taken early in the day to prevent insomnia at night.

A primary health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication is going to be administered intrathecally. Which medication would the nurse expect to be prescribed and administered by this route? 1.Baclofen 2.Chlorzoxazone 3.Dantrolene sodium 4.Cyclobenzaprine hydrochloride

1.Baclofen Rationale: Baclofen is a skeletal muscle relaxant that can be administered intrathecally. The other medications are incorrect.

The client diagnosed with insomnia asks the nurse, "Why did my HCP prescribe Ambien CR and tell me to quit taking Tylenol PM?" Which response by the nurse is most appropriate? 1. "Over-the-counter medications are not as good as prescriptions." 2. "Tylenol PM is addicting and you should not take it nightly." 3. "You are concerned your HCP gave you a prescription drug." 4. "Ambien CR will help you get to sleep and stay asleep through the night."

4. "Ambien CR will help you get to sleep and stay asleep through the night."

A nurse is teaching the parents of a child who has attention-deficit/hyperactivity disorder about methylphenidate [Concerta]. Which statement by the child's parents indicates understanding of the teaching? a."The effects of this drug will wear off in 4 to 6 hours." b."The tablet needs to be swallowed whole, not crushed or chewed." c."This medication has fewer side effects than amphetamines." d."We should call the provider if we see parts of the medicine in our child's stools."

b. "The tablet needs to be swallowed whole, not crushed or chewed."

a 24- year old female client is admitted for an elective cholecystectomy. the client is complaining of a severe, pounding headache and vomiting. vital signs are blood pressure 136/88 mm pulse 86 beats.minute, respiratory rate 20 breaths/minute, temperature 99.6 F and pulse ox 96% on room air. The client has a history of migraine headaches, hypertension, and fibro. What will the nurse anticipate? a. Nifedepine 60 mg PO b. Sumatriptan 6 mg SQ c. Ribavirin 100 mg PO d. Proplthiouracil 100 mg PO

b. Sumatriptan 6 mg SQ

A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's heart rate is 110 beats per minute, the respiratory rate is 18 breaths per minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient? a.CNS depression b.Cardiac arrest c.Respiratory failure d.Seizures

d. Seizures

Which diagnostic test should the nurse expect the HCP to monitor for the child diagnosed with attention deficit-hyperactivity disorder (ADHD) who is prescribed methylphenidate (Ritalin), a central nervous stimulant? 1. Complete blood cell count (CBC). 2. Serum potassium and sodium levels. 3. An annual bone density test. 4. Serum methylphenidate level.

1. . Ritalin is metabolized in the liver and excreted by the kidneys. Impaired organ function can increase serum drug levels. The medication may cause leukopenia, anemia, or both. The HCP would order a CBC, differential, and platelet count.

The mother of a 7-year-old child taking methylphenidate (Ritalin), a central nervous stimulant, for attention deficit-hyperactivity disorder (ADHD) calls the pediatric clinic and tells the nurse her daughter has lost 4 pounds in the past 2 weeks. Which action should the nurse implement? 1. Make an appointment for the child to see the HCP. 2. Instruct the mother to discontinue the Ritalin. 3. Explain that this is normal response to the medication. 4. Tell the mother to increase the child's caloric intake.

1. Growth rate may stall in response to nutritional deficiency caused by anorexia. A 4-pound weight loss in 2 weeks is cause for investigation. The child needs to be seen by the HCP.

The client diagnosed with MS is prescribed baclofen. Which data should the nurse assess? Select all that apply. 1. The client's serum baclofen levels. 2. The client's report of urinary urgency. 3. The client's muscle rigidity and range of motion. 4. The client's blood urea nitrogen (BUN) and creatinine levels. 5. The client's muscle spasticity and pain.

1. There is no serum baclofen level. 2. Antispasmodic baclofen (Lioresal) can cause urinary urgency, so this should be assessed. 3. Antispasmodic baclofen (Lioresal) is administered to treat the spasticity associated with MS. The nurse should assess for muscle spasticity, rigidity, movement, and pain to determine the effectiveness of the medication. 4. The medication can affect the liver, but it does not damage the kidneys. 5. Antispasmodic baclofen (Lioresal) is administered to treat the spasticity associated with MS. The nurse should assess for muscle spasticity, rigidity, movement, and pain to determine the effectiveness of the medication.

The nurse has reinforced discharge instructions to a client with multiple sclerosis who is receiving baclofen. Which statement by the client indicates an understanding of the medication? 1."I need to watch for urinary retention." 2."I need to stop the medication if diarrhea occurs." 3."If I develop fatigue, I need to notify the primary health care provider." 4."I need to restrict my fluid intake while I take this medication."

1."I need to watch for urinary retention." Rationale: Baclofen is a central nervous (CNS) depressant. It is not necessary to restrict fluids, but the client would be warned that urinary retention can occur. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary for the client to notify the primary health care provider. Constipation rather than diarrhea is an adverse effect of baclofen. Additionally, the client would be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents.

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder should alert the nurse to contact the primary health care provider (PHCP)? 1.A seizure disorder 2.Hyperthyroidism 3.Diabetes mellitus 4.Coronary artery disease

1.A seizure disorder (Remember, a lowered seizure threshold can occur when baclofen is administered.) Rationale: Clients with a seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

The nurse is caring for a client with muscle spasticity characterized by heightened muscle tone, spasm, and loss of dexterity caused by multiple sclerosis. Which centrally acting skeletal muscle relaxants might be prescribed for this client? Select all that apply. 1.Baclofen 2.Diazepam 3.Ibuprofen 4.Dantrolene 5.Trazadone

1.Baclofen 2.Diazepam 4.Dantrolene Rationale: Baclofen, dantrolene, and diazepam may be prescribed for this client with muscle spasticity. Centrally acting skeletal muscle relaxants are prescribed as an adjunct to rest and physical therapy for relief of discomfort associated with acute, painful musculoskeletal disorders such as multiple sclerosis, cerebral palsy, spinal cord lesions, and CVA. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Trazadone is given for anxiety and depression.

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication? 1.Depresses spinal reflexes 2.Acts directly on the skeletal muscle to relieve spasticity 3.Acts within the spinal cord to suppress hyperactive reflexes 4.Acts on the central nervous system (CNS) to suppress spasms

2. Acts directly on the skeletal muscle to relieve spasticity

A client with multiple sclerosis is receiving baclofen. The nurse monitoring this client should look for which outcome to indicate a primary therapeutic response from the medication? 1.Decreased nausea 2.Decreased muscle spasms 3.Increased muscle tone and strength 4.Increased range of motion of all extremities

2. Decreased muscle spasms

The 8-year-old child is newly diagnosed with attention deficit-hyperactivity disorder (ADHD) and is prescribed methylphenidate (Ritalin), a central nervous stimulant. Which assessment data should the nurse anticipate the HCP obtaining prior to the child starting the medication? 1. An x-ray of the epiphyseal plate. 2. The child's height and weight. 3. An electrocardiogram (EKG). 4. The child's head circumference.

2. The child's baseline height and weight must be obtained because reduction in growth rate is associated with this medication.

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication? 1.Depresses spinal reflexes 2.Acts directly on the skeletal muscle to relieve spasticity 3.Acts within the spinal cord to suppress hyperactive reflexes 4.Acts on the central nervous system (CNS) to suppress spasms

2.Acts directly on the skeletal muscle to relieve spasticity (1, 3, and 4 are all comparable) Rationale: Dantrolene acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. Options 1, 3, and 4 are not actions of the medication.

The nurse is reinforcing discharge instructions to a client receiving baclofen. Which should the nurse include in the instructions? 1.Restrict fluid intake. 2.Avoid the use of alcohol. 3.Stop the medication if diarrhea occurs. 4.Notify the primary health care provider (PHCP) if fatigue occurs.

2.Avoid the use of alcohol. (Recall that baclofen is a CNS depressant) Rationale: Baclofen is a central nervous system (CNS) depressant. The client should be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents. It is not necessary to restrict fluids, but the client should be warned that urinary retention can occur. Constipation rather than diarrhea is an adverse effect of baclofen. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the PHCP if fatigue occurs.

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan? 1.Restrict fluid intake. 2.Avoid the use of alcohol. 3.Stop the medication if diarrhea occurs. 4.Notify the primary health care provider (PHCP) if fatigue occurs.

2.Avoid the use of alcohol. Rationale: Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the PHCP about fatigue.

A client with multiple sclerosis is receiving baclofen. The nurse monitoring this client should look for which outcome to indicate a primary therapeutic response from the medication? 1.Decreased nausea 2.Decreased muscle spasms 3.Increased muscle tone and strength 4.Increased range of motion of all extremities

2.Decreased muscle spasms Rationale: A primary therapeutic response from baclofen is to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases and multiple sclerosis. Baclofen is a skeletal muscle relaxant and acts at the spinal cord level. Increased muscle tone and strength and increased range of motion of all extremities are not directly related to the effects of this medication. Decreased nausea is incorrect.

A client with a history of spinal cord injury is receiving baclofen for muscle spasms. The nurse determines that the client is experiencing a side effect of this medication if the client experiences which sign/symptom? 1.Muscle pain 2.Drowsiness 3.Hypertension 4.Photosensitivity

2.Drowsiness

A client with a history of spinal cord injury is receiving baclofen for muscle spasms. The nurse determines that the client is experiencing a side effect of this medication if the client experiences which sign/symptom? 1.Muscle pain 2.Drowsiness 3.Hypertension 4.Photosensitivity

2.Drowsiness Rationale: Baclofen is a centrally acting skeletal muscle relaxant. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. The other signs/symptoms are incorrect.

The 10-year-old child diagnosed with attention deficit-hyperactivity disorder (ADHD) is taking methylphenidate (Ritalin), a central nervous stimulant. Which assessment data warrants intervention from the pediatric clinic nurse? 1. The child has gained 3 kg in the last month. 2. The child's pulse is 98 and B/P is 100/70. 3. The child has multiple bruises on the arm. 4. The child sits quietly in the examination room.

3. The nurse should further investigate the cause of the bruises because this could be an adverse effect of the medication caused by leukopenia, anemia, or both; it could also be the result of child abuse. Either way, it warrants intervention by the nurse.

A client is receiving a maintenance dose of oral dantrolene sodium for the treatment of spasticity. The nurse reviews the medication record, expecting which dose to be prescribed? 1.50 mg daily 2.100 mg daily 3.100 mg twice daily 4.200 mg four times daily

3.100 mg twice daily Rationale: For treatment of spasticity, dantrolene is administered orally. The initial dosage in adults is 25 mg once daily. The usual maintenance dosage is 100 mg 2 to 4 times daily. If beneficial effects do not develop within 45 days, dantrolene therapy should be discontinued.

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect? 1.Polyuria 2.Diarrhea 3.Drowsiness 4.Muscular excitability

3.Drowsiness

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect? 1.Polyuria 2.Diarrhea 3.Drowsiness 4.Muscular excitability

3.Drowsiness (baclofen is a CNS depressant used to treat muscle spasticity) Rationale: Baclofen is a central nervous system (CNS) depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients should be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

An adult client with severe muscle spasticity is receiving intrathecal baclofen (ITB). The nurse knows that what adverse effects may occur if the medication is suddenly withdrawn. Select all that apply. 1.Fatigue 2.Sedation 3.Seizures 4.Dizziness 5.Hallucinations

3.Seizures 5.Hallucinations

An adult client with severe muscle spasticity is receiving intrathecal baclofen (ITB). The nurse knows that what adverse effects may occur if the medication is suddenly withdrawn. Select all that apply. 1.Fatigue 2.Sedation 3.Seizures 4.Dizziness 5.Hallucinations

3.Seizures & 5.Hallucinations Rationale: Seizures and hallucinations may occur if ITB is suddenly withdrawn. Other centrally-acting skeletal muscular relaxants, such as tizanidine, may cause severe drowsiness and sedation in most clients and may not be effective in reducing spasticity. As an alternative to other centrally-acting skeletal muscular relaxants, intrathecal baclofen (ITB) therapy may be prescribed. This drug is administered through a programmable, implantable infusion pump and intrathecal catheter directly into the cerebrospinal fluid. The pump is surgically placed in a subcutaneous pouch in the lower abdomen. Common adverse effects include sedation, fatigue, dizziness, and possible changes in mental status.

A client is receiving baclofen for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which is a side effect of this medication? 1.Muscle pain 2.Hypertension 3.Slurred speech 4.Photosensitivity

3.Slurred speech Rationale: Slurred speech is a one of the side effects of baclofen. Other side effects include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesia of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence. The other side effects are not related to this medication.

The 7-year-old child newly diagnosed with attention deficit-hyperactivity disorder (ADHD) is prescribed methylphenidate (Ritalin), a central nervous stimulant. Which information should the nurse discuss with the parents? Select all that apply. 1. Take the medication with food. 2. Weigh your child weekly in the morning. 3. Administer the medication at night. 4. Keep a behavior diary on your child. 5. Protect the child from direct sunlight

4. A behavior diary should be kept to chronicle symptoms and response to drug therapy. This diary should be brought to all follow-up visits with the health-care provider.

The 8-year-old child newly diagnosed with attention deficit-hyperactivity disorder (ADHD) is prescribed methylphenidate (Ritalin), a central nervous stimulant. Which statement by the mother indicates the medication teaching has not been effective? 1. "I will keep the medication in a safe place." 2. "I will schedule regular drug holidays for my child." 3. "It may cause my child to have growth restriction." 4. "My child will probably experience insomnia."

4. Insomnia is an adverse reaction to the medication; central nervous stimulants may disrupt normal sleep patterns. This statement indicates the medication teaching has not been effective

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client? 1."You should never stop the medication." 2."It is best that you taper the dose if you intend to stop the medication." 3."It is okay to stop the medication if you think that you can tolerate the muscle spasms." 4."Weakness and fatigue commonly occur and will diminish with continued medication use."

4."Weakness and fatigue commonly occur and will diminish with continued medication use." Rationale: The client should be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.

A patient is admitted to the hospital after several days of vomiting and diarrhea. After an initial bolus of isotonic (0.9%) sodium chloride solution, the prescriber orders dextrose 5% in normal saline (D5NS) with 20 mEq potassium chloride to infuse at a maintenance rate. What should the nurse review before implementing this order? (Select all that apply.) a. Electrocardiogram b. Arterial blood gas levels c. Serum electrolyte levels d. Serum glucose level e. Urine output

A, C, E. Patients receiving potassium should be monitored for cardiovascular toxicity; an ECG before and during administration can help monitor for this adverse effect. Serum electrolyte levels should be reviewed to make sure the patient is not already hyperkalemic. Because potassium is excreted via the kidneys, it is important to determine that renal function is intact. Intravenous potassium should never be given if the patient has not voided. Patients who are hyperkalemic can be treated with sodium bicarbonate to increase pH and insulin to promote uptake of potassium by cells, but it is not necessary to evaluate the blood gas or glucose levels before administering potassium.

A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. A history of peptic ulcers b. Migraine headaches c. Asthma d. A history of kidney stones

A. Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine

A surgical patient is receiving succinylcholine [Anectine] with an inhalation anesthetic. The patient is intubated, has an indwelling urinary catheter, and has ongoing monitoring of vital signs. Which symptom during the perioperative period is cause for concern? a. Elevated temperature b. Increased urine output c. Muscle paralysis d. No response to painful stimuli

A. Combining succinylcholine (a skeletal muscle relaxant) with an inhalation anesthetic increases the risk of malignant hyperthermia. The mechanism is not understood. Temperature elevation can be profound, and cooling measures must be initiated or the condition can be fatal. A decrease in urine output would be a sign of hypotension. Muscle paralysis and lack of response to pain are desired effects of anesthesia.

A patient arrives in the emergency department complaining of muscle weakness and drowsiness. The nurse notes a heart rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 90/50 mm Hg. The electrocardiogram reveals an abnormal rhythm. The nurse will question the patient about which over-the-counter medication? a. Antacids b. Aspirin c. Laxatives d. Potassium supplements

A. Hypermagnesemia can occur when patients are taking magnesium-containing antacids. Symptoms include muscle weakness, sedation, hypotension, and ECG changes. Aspirin would cause metabolic acidosis. Laxatives can contribute to hypokalemia. Potassium supplements would cause hyperkalemia.

A nurse is caring for a patient receiving intrathecal baclofen [Lioresal]. The patient is unresponsive. After asking a coworker to contact the provider, the nurse anticipates performing which intervention? a.Preparing to support respirations b.Administering an antidote to baclofen c.Administering diazepam to prevent seizures d.Obtaining an electrocardiogram

ANS: A An overdose of baclofen can produce coma and respiratory depression, so the nurse would be correct to suspect overdose in this patient. Respiratory support is essential to prevent a fatal outcome. There is no antidote for baclofen overdose. Diazepam would not be indicated, because seizures are not a result of baclofen overdose and may further depress respirations. An electrocardiogram is not indicated for this patient.

A patient with cerebral palsy has severe muscle spasticity and muscle weakness. The patient is unable to take anything by mouth. The nurse is correct to anticipate that which medication will be ordered for home therapy? a.Baclofen [Lioresal] b.Dantrolene [Dantrium] c.Diazepam [Valium] d.Metaxalone [Skelaxin]

ANS: A Baclofen is used to treat muscle spasticity associated with multiple sclerosis, spinal cord injury, and cerebral palsy. It does not reduce muscle strength, so it will not exacerbate this patient's muscle weakness. It can be given intrathecally, via an implantable pump, and therefore is a good choice for patients who cannot take medications by mouth. Dantrolene must be given by mouth or intravenously and so would not be a good option for this patient. It also causes muscle weakness. Diazepam is not the first-line drug of choice. Alternative routes to PO administration are IM, IV, or by rectum. Metaxalone is used to treat localized muscle spasms caused by injury and is not used for cerebral palsy.

A patient with multiple sclerosis needs pharmacologic treatment for spasticity to begin strengthening exercises to improve walking ability. The nurse anticipates that which medication will be ordered for spasticity? a.Baclofen [Lioresal] b.Dantrolene [Dantrium] c.Diazepam [Valium] d.Metaxalone [Skelaxin]

ANS: A Baclofen is used to treat spasms associated with multiple sclerosis. It has no direct muscle relaxant effects, so it does not reduce muscle strength. Dantrolene works well to reduce spasms, but it also has significant effects on muscle strength. Diazepam is not the first-line drug of choice, but it could be used because it does not reduce muscle strength. Metaxalone is not indicated to treat spasms caused by multiple sclerosis.

A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened? a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of aspirin. d. He developed an allergy to the drug.

B. Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction

A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The nurse will expect to provide which therapy? a. Intravenous hypertonic fluids given slowly over several hours b. Intravenous hypotonic fluids administered in stages c. Intravenous isotonic fluids given as a rapid bolus d. Oral electrolyte replacement fluids with potassium

B. Because this patient is experiencing fluid volume loss as the result of excessive sweating, this is most likely hypertonic dehydration, in which loss of water exceeds loss of electrolytes. This should be treated with a hypotonic solution or with fluids that contain no solutes at all. Initial treatment may consist of having the patient drink water. When intravenous therapy is provided, volume replenishment should occur in stages. Hypertonic fluids are used to treat hypotonic contraction, usually caused by excessive sodium loss through the kidneys as the result of diuretic therapy. Isotonic fluids are used to treat isotonic contraction, which is generally caused by vomiting and diarrhea. An oral electrolyte solution would only increase the hypertonicity; if oral rehydration is used in this case, the patient should drink plain water.

A patient arrives in the emergency department after becoming dehydrated. Based on the patient's history, the provider determines that isotonic dehydration has occurred. Which solution will the nurse expect to infuse to treat this patient? a. 0.45% sodium chloride in sterile water b. 0.9% sodium chloride in sterile water c. 3% sodium chloride in sterile water d. 5% dextrose solution

B. Isotonic dehydration should be treated with an isotonic solution of 0.9% NaCl in sterile water. A 0.45% solution or 5% dextrose is used to treat hypertonic dehydration. A 3% NaCl solution is used to treat hypotonic dehydration.

During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103 F (39.4 C). The nurse will prepare for what immediate treatment? a. naltrexone hydrochloride (Narcan) injection, an opioid reversal drug b. dantrolene (Dantrium) injection, a skeletal muscle relaxant c. An anticholinesterase drug, such as neostigmine d. Cardiopulmonary resuscitation (CPR) and intubation

B. Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation

The client presents to the ED reporting a migraine headache. The HCP prescribes sumatriptan. When the nurse enters the room to administer the medication, the client is laughing with his or her significant other. Which intervention should the nurse implement? A. Notify the HCP of the clients drug-seeking behavior B. Ask the client how bad the headache is if they are able to laugh C. Administer the medication after checking for allergies and the ID bracelet D. Discharge the client and recommend taking OTC medications

C. Administer the medication after checking for allergies and the ID bracelet

A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels "so tired." Which explanation by the nurse is correct? a. "Long-term use of this drug results in a sedative effect." b. "If you take the drug every night, this hangover effect will be reduced." c. "These drugs affect the sleep cycle, resulting in daytime sleepiness." d. "These drugs increase the activity of the central nervous system, making you tired the next day."

C. Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and, thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect.

a 17 year old client had one generalized convulsion several hours prior to admission to the medical unit for a neurological workup. Physician's orders include phenytoin 100 mg PO tid & phenobarbital 100 mg PO daily. He tells the nurse; "I can't believe I had a seizure. My mom says she was in the room when it happened, but I don't even remember it." What is the best interpretation A. They indicate an initial denial mechanism, but will begin to remember the seizure later B. Anoxia suffered during the seizure has damaged part of the cerebral cortex C. Inability to remember the seizure is a normal response of a person who has had a seizure D. They are an indication that he would rather not talk about it

C. Inability to remember the seizure is a normal response of a person who has had a seizure

A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to "make it through" the end of the semester and exam week. She is in the university clinic today because she is "exhausted." What nursing diagnosis may be appropriate for her? a. Noncompliance b. Impaired physical mobility c. Sleep deprivation d. Imbalanced nutrition: less than body requirements

C. The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects. Thus, sleep deprivation is the most appropriate nursing diagnosis of those listed.

The client with chronic low back pain has been taking baclofen (Lioresal), a muscle relaxant. Which instruction should the nurse review with the client?A. The medication can cause gastric ulcer formation. B. The client may consume no more than one glass of wine per day. C. The medication must be tapered off when discontinued. D. The client should not take the medication before bedtime.

C. The medication must be tapered off when discontinued.Rationale: Baclofen must be tapered off when being discontinued. Abrupt withdrawal after prolonged use can cause anxiety, agitated behavior, hallucinations, severe tachycardia, acute spasticity, and seizures.

A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention? a. Starting an intravenous infusion of diluted bicarbonate solution b. Administering medications to increase blood pressure c. Implementing measures to maintain the airway and support respirations d. Administrating naloxone (Narcan) as an antagonist

C. There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate.

A patient who is a chronic alcoholic is admitted to the hospital. Admission laboratory work reveals a magnesium level of 1.2 mEq/L. The prescriber orders intravenous magnesium sulfate in a 10% solution at a rate of 10 mL/min. What will the nurse do? a. Administer the IV dose as ordered and have calcium gluconate on hand. b. Administer the IV dose and make preparations for mechanical ventilation. c. Hold the IV dose until the infusion rate has been clarified with the provider. d. Request an order for renal function tests before administering the IV dose

C. This patient has hypomagnesemia and should be given magnesium sulfate intravenously. The percent of magnesium in solution is correct; however, magnesium should not be infused faster than 1.5 mL/min, so the nurse is correct to question the rate of infusion. Calcium gluconate should be available when magnesium is given, but the nurse needs to clarify the rate of infusion first. Mechanical ventilation is necessary with excessive magnesium. Renal function tests are not indicated.

A patient receives a neuromuscular blocking agent as an adjunct to inhalation anesthesia. When caring for this patient, it is important for the nurse to remember that neuromuscular blocking agents: a. cause vagal slowing of the heart. b. increase the required dose of inhalation anesthetics. c. increase the depth of unconsciousness. d. prevent contraction of the diaphragm

D. Neuromuscular blocking agents enhance skeletal muscle relaxation so that the dose of inhalation anesthetics can be reduced to a safer amount. Because these drugs prevent contraction of all skeletal muscles, including the diaphragm, mechanical ventilation is required to support respiration. These agents do not cause vagal slowing of the heart. They reduce the required dose of inhalation agents. They do not affect the level of consciousness

When administering a neuromuscular blocking drug such as pancuronium (Pavulon), the nurse needs to remember which principle? a. It is used instead of general anesthesia during surgery. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It causes sedation and pain relief while allowing for lower doses of anesthetics. d. Artificial mechanical ventilation is required because of paralyzed respiratory muscles

D. Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. In addition, they do not cause sedation or pain relief. They are used along with, not instead of, general anesthesia during surgery

Before a patient receives triptans for the treatment of migraines, the nurse will assess for the presence of which condition, which is a contraindication if present? a. Hypotension b. Renal disease 'c. Liver damage d. Cardiovascular disease

D. Triptans are contraindicated in patients with serious cardiovascular disease because of the vasoconstrictive potential of these medications. The other options are incorrect

A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching? a."I should report insomnia and poor appetite to his provider." b."I will make sure he takes his medication after breakfast every day." c."This drug will make him less impulsive while he's at school." d."This medication will help my child focus so he can learn new behaviors."

c. "This drug will make him less impulsive while he's at school."

A client with multiple sclerosis is receiving dantrolene for relief of muscle spasticity. When would this medication be discontinued if there is no relief of spasticity? 1.10 days 2.2 weeks 3.5 weeks 4.2 months

4.2 months Rationale: Dantrolene is discontinued if no relief of spasticity is achieved in 6 to 8 weeks.

The client is prescribed sumatriptan 6 mg subcutaneously for a migraine headache. The medication comes in 12mg/ml. How many milliliters should the nurse administer?

0.5ml

A primary health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication is going to be administered intrathecally. Which medication would the nurse expect to be prescribed and administered by this route? 1.Baclofen 2.Chlorzoxazone 3.Dantrolene sodium 4.Cyclobenzaprine hydrochloride

1. Baclofen

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test(s) would identify an adverse effect associated with the administration of this medication? 1.Creatinine 2.Liver function tests 3.Blood urea nitrogen 4.Hematological function tests

2.Liver function tests (recall that this medication affects liver function.) Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. Options 1 and 3 are tests that assess kidney function.

The nurse reinforces dietary instructions to a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines the client has understood if the client plans to include which foods in the diet? Select all that apply. 1.Apples 2.Raisins 3.Kiwifruit 4.Bananas 5.Pineapple 6.Canned peaches

2.Raisins 3.Kiwifruit 4.Bananas

The order reads, :Give atomoxetine (Strattera) 0.5mg/kg/day once daily in the morning before school". The child weighs 88 pounds. Identify how many milligrams will be administered per dose

20 mg

The 13-year-old child admitted to the intensive care department diagnosed with an overdose of Ambien CR, a sedative hypnotic, is ordered whole bowel irrigation. Which intervention should the nurse implement? 1. Administer 0.5 L of GoLYTELY every hour. 2. Administer 1.0 L of GoLYTELY every hour. 3. Administer 1.5-2.0 L of GoLYTELY every hour. 4. Administer 2.5-3.0 L of GoLYTELY every hour.

3. 1.5-2.0 L of GoLYTELY is the dose for clients 12 years old or older. Whole bowel irrigation is effective following ingestion of lead, lithium, iron, and sustained-release medications.

The 6-year-old child with attention deficit-hyperactivity disorder (ADHD) is admitted to the pediatric department after having an emergency appendectomy. Which intervention should the nurse implement when administering methylphenidate (Ritalin), a central nervous stimulant to the child? 1. Check the child's glucose level. 2. Administer with a full glass of water. 3. Monitor the child's vital signs. 4. Assess the child's incisional wound.

3. Stimulation of the central nervous system induces the release of catecholamines with a subsequent increase in heart rate and blood pressure. Therefore, the nurse should assess the child's vital signs.

A licensed practical nurse (LPN) is reviewing laboratory results for a client taking dantrolene sodium. The LPN should suggest that the registered nurse notify the primary health care provider if which finding is noted on the laboratory report sheet? 1.Creatinine 0.6 mg/dL 2.Platelet count 290,000 mm3 3.Blood urea nitrogen 9 mg/dL 4.Lactate dehydrogenase (LDH) 600 units/L

4.Lactate dehydrogenase (LDH) 600 units/L Rationale: Dantrolene sodium is a skeletal muscle relaxant. Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, tests of liver function would be performed before treatment and throughout the treatment interval. It is administered in the lowest effective dosage for the shortest time necessary. The LDH level reported is high. The other laboratory results are considered normal.

Baclofen is prescribed for a client with a spinal cord injury who is experiencing muscle spasms, and the nurse prepares a list of the associated side effects of the medication and reviews the list with the client. Which side effect identified by the client indicates a need for further teaching? 1.Tremors 2.Slurred speech 3.Nasal congestion 4.Photosensitivity

4.Photosensitivity Rationale: There is a need for further teaching when the client identifies photosensitivity as a side effect of baclofen. Photosensitivity is not a side effect of this medication. Side effects of baclofen include drowsiness, dizziness, weakness, and nausea. Occasional side effects include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion. Paradoxical central nervous system excitement and restlessness can occur along with slurred speech, tremor, dry mouth, nocturia, and impotence.

The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.) a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin

A, B, D, E. The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin.

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? 'a. "I will take this medication regularly to prevent a migraine headache from occurring." b. "I will take this medication when I feel a migraine headache starting." 'c. "This medication does not reduce the number of migraines I will have." d. "I will keep a journal to record the headaches I have and how the injections are working."

A. Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient's responses to the medication are helpful.

While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide [Lasix], digoxin, and spironolactone [Aldactone]. A diet history reveals the use of salt substitutes. The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient? a. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels. b. Evaluate the patient's urine output and request an order for intravenous potassium. c. Hold the next dose of furosemide and request an order for intravenous magnesium sulfate. d. Request an order for intravenous insulin to help this patient regulate extracellular potassium.

A. This patient is taking a potassium-sparing diuretic and is ingesting dietary potassium in salt substitutes. The patient shows signs of hyperkalemia: confusion, shortness of breath, and tingling of the hands and feet. The cardiac effects can be fatal, especially if a patient also is taking digoxin. The most appropriate first action would be to obtain an ECG and serum electrolyte levels to evaluate the extent of the patient's hyperkalemia. The patient does not need increased potassium. Furosemide is a potassium-wasting diuretic and would be helpful. Magnesium sulfate is not indicated. Until the patient's status has been assessed further, intravenous insulin is not indicated.

The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) a. Narcolepsy b. Depression c. Panic attacks d. Neonatal apnea e. Attention deficit hyperactivity disorder (ADHD) f. Appetite suppression

A.D.E.F. Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks

Which drugs are used to treat spasticity? (Select all that apply.) a.Baclofen [Lioresal] b.Dantrolene [Dantrium] c.Diazepam [Valium] d.Metaxalone [Skelaxin] e.Tizanidine [Flexeril]

ANS: A, B, C Three drugs—baclofen, dantrolene, and diazepam—are used to treat spasticity. Baclofen and diazepam act in the CNS, whereas dantrolene acts directly on skeletal muscles. With the exception of diazepam, drugs used for muscle spasm, such as metaxalone and tizanidine, are not effective for treating spasticity.

A nurse is admitting a patient to the hospital. The patient reports taking oral baclofen [Lioresal] but stopped taking the drug the day before admission. The nurse would be correct to anticipate which adverse effects? a.Weakness and dizziness b.Fatigue and drowsiness c.Seizures and hallucinations d.Respiratory depression and coma

ANS: C Abrupt discontinuation of baclofen is associated with visual hallucinations, paranoid ideation, and seizures. Central nervous system effects of baclofen include weakness, dizziness, fatigue, and drowsiness. Respiratory depression is a result of overdose of baclofen.

Which patient should receive dantrolene [Dantrium] with caution? a.A 20-year-old woman with a spinal cord injury b.A 45-year-old man with a history of malignant hyperthermia c.A 55-year-old woman with multiple sclerosis d.An 8-year-old child with cerebral palsy

ANS: C Dose-related liver damage is the most serious adverse effect of dantrolene and is most common in women older than 35 years. Dantrolene is used to treat spasticity associated with multiple sclerosis, cerebral palsy, and spinal cord injury, so all of these patients would be candidates for this agent. Dantrolene also is used to treat malignant hyperthermia.

A patient with cerebral palsy who has been receiving baclofen [Lioresal] via gastrostomy tube for 3 months is admitted to the hospital for evaluation of new-onset seizures. What may the nurse suspect to be the cause of these seizures? a.Baclofen toxicity b.Common adverse effect of baclofen c.Idiopathic causes related to disease process d.Missed doses of baclofen

ANS: D Baclofen does not appear to cause physical dependence, but abrupt discontinuation has been associated with adverse reactions. Abrupt withdrawal of oral baclofen can cause visual hallucinations, paranoid ideation, and seizures and should be considered when a patient develops these symptoms. Seizures are not a symptom of baclofen toxicity.

A nurse is teaching the parent of a child with spastic quadriplegia about intrathecal baclofen [Lioresal]. Which statement by the parent indicates a need for further teaching? a."I can expect my child to be more drowsy when receiving this medication." b."I should not notice any change in my child's muscle strength." c."I will contact the provider if my child is constipated or cannot urinate." d."If my child has a seizure, I should stop giving the medication immediately."

ANS: D Seizures may occur if oral baclofen is withdrawn abruptly; seizures are not an adverse effect of baclofen. If intrathecal baclofen is stopped abruptly, patients can experience lifethreatening effects, so parents should be advised not to stop the drug abruptly. The central nervous system effects of baclofen include drowsiness and lethargy, so these effects are expected. Baclofen does not reduce muscle strength. It can cause constipation and urinary retention, and patients should be advised to contact their provider so that these conditions can be treated.

Which order for potassium (KCl) would the nurse question? (Select all that apply.) a. NS with 20 mEq KCl to start after patient voids b. NS with 60 mEq KCl for a patient with a serum potassium of 3.2 mEq/L c. K-Dur, 1 tablet daily for a patient in diabetic ketoacidosis d. K-Dur, 1 tablet with a full glass of water e. Potassium chloride, 10 mEq rapid IV push

B, C, E. Patients receiving potassium should not receive potassium in solution diluted at more than 40 mEq/L. Diabetic ketoacidosis causes decreased cellular uptake of potassium, and patients in whom acidosis is present should also receive sodium bicarbonate if they need potassium. IV potassium should not be infused faster than 10 mEq/hr. NS with 20 mEq KCl is an appropriate solution for a patient with intact renal function. Oral potassium should be given with a full glass of water to minimize gastrointestinal (GI) effects.

The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus

B, D, E. Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications.

A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started a. Eye examination b. Height and weight c. Liver studies d. Hearing test

B. Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time.

A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially? a. Give the digoxin and maintain close cardiac monitoring. b. Hold the digoxin and report the laboratory values to the provider. c. Hold the thiazide diuretic and give the digoxin. d. Request an order for an electrocardiogram (ECG).

B. Potassium depletion is common with thiazide diuretics, and hypokalemia is especially dangerous for patients receiving digoxin, because the drug can precipitate a fatal dysrhythmia and digoxin toxicity. The provider should be notified of the serum potassium level so that it can be corrected before the digoxin is administered. Giving the digoxin could produce a fatal adverse effect, so this is not an appropriate course of action. Holding the thiazide diuretic will not correct the potassium deficiency. An ECG is not the initial priority.

A patient has been given succinylcholine (Anectine) after a severe injury that necessitated controlled ventilation. The physician now wants to reverse the paralysis. The nurse would expect to use which drug to reverse the succinylcholine a. valium (Diazepam) b. caffeine c. neostigmine (Prostigmin) d. vecuronium (Norcuron

C. The antidote for neuromuscular blocking drugs is an anticholinesterase drug, such as neostigmine. Neostigmine reverses the effects of neuromuscular blocking drugs. The other drugs listed are not antidotes for neuromuscular blocking drugs

A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that "the least little thing" bothers him now. Which is the correct explanation for this problem? a. These are adverse effects that usually subside after a few weeks. b. The drug must be stopped immediately because of possible adverse effects. c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.

D. Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect.

A child has been taking SD methylphenidate [Ritalin], 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do? a.Ask the prescriber whether this child could be given methylphenidate [Concerta]. b.Contact the prescriber to suggest using a nonstimulant medication. c.Reinforce the need to take all doses as prescribed. d.Suggest drug holidays for the child on weekends.

a. Ask the prescriber whether this child could be given methylphenidate [Concerta].

A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include: a.results of an electrocardiogram (ECG). b.family history of psychosis. c.height and weight. d.renal function.

c. height and weight.