Client with musculoskeletal Medications

645. In the monitoring a clients response to disease modifying anti-rheumatic drugs (DMARDS), which finding would the nurse interpret as acceptable response

1. Symptoms control during periods of emotional stress 2. Normal White blood cell count, platelets and neutrophils counts 3. Radiological findings that show non-progression of joint degeneration 4. An increase range of motion in the affected joints 3 months into therapy

(643.) A nurse is reviewing the record of a client who has been prescribed baclofen (lioresal). Which of the following disorder, if noted in the clients history, would alert the nurse to contact the health care provider?

Answer: 1---Seizure Disorders Rationale:Client with seizure disorder may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may required an increase in the anti convulsive medication

639. A nurse is reinforcing discharge instruction to a client receiving baclofen (lioresal). Which of the following would the nurse include in the instructions?

Answer: 2-- Avoid the use of alcohol Rationale: Baclofen is a central Nervous System depressant. The client should be cautioned against the use of alcohol and other CNS depressant, because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is an adverse effect of baclofen. It is not necessary to restrict fluid, but the client should be warned that urinary retention can occur. Fatigue is related to CNS effect that is most intense during the early phase of therapy and diminished with continued medication use. It is not necessary that the client notify the health care provider if fatigue occurs

641. Dantrolene sodium (Tantrum) is prescribed for a client experiencing flexor spasms, and the client ask the nurse about the action of the medication. The nurse responds, knowing that the therapeutic action of this medication is which of the following

Answer: 2---Acts directly on skeletal muscle to relieve spasticity. Rationale: Dantrium acts directly on skeletal muscle relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decrease the ability of the skeletal muscle to contract

(637). Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse assists in planning care, Knowing that the primary therapeutic effect of this medication is which of the following?

Answer: 2--Decrease Muscle Spasms Rationale: Baclofen is a skeletal muscle relaxant and central nervous system depressant and act at the spinal cord level to decrease the frequency and amplitude of muscle spasms in client with spinal cord injuries or disease and in client with multiple sclerosis

(636). The client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept (Enbrel), it is most important for the nurse to check:

Answer: 2--The white blood cell count and platelet counts Rationale: Infection and pancytopenia are side effect of etanercept (Enbrel). Laboratory studies are performed before and during drug treatment. The appearance of abnormal white blood cell counts and abnormal platelet count can alert the nurse to a potentially life threatening infection. Injection site itching is a common occurrence following administration. A metallic taste with loss of appetite are not common sign of side effects this medication

(638.) A nurse is monitoring a client receiving Baclofen (Lioseral) for side effect related to the medications. Which of the following would indicate that the client is experiencing a side effect?

Answer: 3--Drowsiness 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. Client should be warned about the possible reactions

640. A client with acute muscle spasms has been taking baclofen (lioresal). The client calls the clinic nurse because of continuous feeling of weakness and fatigue and ask the nurse about discontinuing the medication. The nurse should make which appropriate response to the client?

Answer: 4--"Weakness and fatigue commonly occurred will diminished 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 dimes with continued medication use. The client should be instructed never to withdraw or stop the medication abruptly, because abrupt withdrawal can cause visual hallucination, 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

(644.) Cyclobenzaprine (Flexeril) is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client record. Which of the following disorder, If noted in the clients record, Would indicate a need to contact the health care provider regarding the administration of this medication

Answer: Glaucoma Rationale: Because this medication has anticholinergic effect is should be used with caution in clients with a history urinary retention, angle closure glaucoma, and increased intraocular pressure.

(642). A nurse is reviewing the laboratory studies on client receiving dantrolene sodium (Tantrum). Which laboratory test would identify and adverse effect associated with administration of this medication?

Answer: Liver Function Test Rationale:Dose related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function test should be performed before treatment and periodically through out the treatment course. It is administered in the lowest effective dosage for the shortest time necessary.

Baclofen (Lioresal)

Baclofen is used to help relax certain muscles in your body. It relieves the spasms, cramping, and tightness of muscles caused by medical problems such as multiple sclerosis or certain injuries to the spine. Baclofen does not cure these problems, but it may allow other treatment, such as physical therapy, to be more helpful in improving your condition.

Cyclobenzaprine (Flexeril)

Cyclobenzaprine is used short-term to treat muscle spasms. It is usually used along with rest and physical therapy. It works by helping to relax the muscles.

entanercept (Enbrel)

This medication is used alone or in combination with an immunosuppressant (such as methotrexate) to treat certain types of arthritis (such as rheumatoid, psoriatic, juvenile idiopathic, and ankylosing spondylitis), as well as a skin condition called psoriasis. These conditions are caused by an overactive immune system (autoimmune disease). The immune system attacks the body's own healthy cells, causing inflammation in the joints and skin. Treating moderate to severe forms of ankylosing spondylitis (AS), juvenile arthritis, plaque psoriasis, and rheumatoid and psoriatic arthritis. Etanercept may be used alone or with other medicines. It may also be used for other conditions as determined by your doctor.

Dantrolene sodium (Tantrum)

This medication is used to treat muscle tightness and cramping (spasms) caused by certain nerve disorders such as spinal cord injury, stroke, cerebral palsy, and multiple sclerosis. It works by relaxing the muscles. Dantrolene helps reduce muscle pain and stiffness, improves your ability to move around, and lets you do more of your daily activities.

flexor spasms

are involuntary muscle contractions comprising dorsiflexion at the ankle and flexion at the knee and the hip, occurring as a result of nociceptive spinal release reflex. The presence of flexor spasms generally suggests a lesion in the spinal cord.