Pharmacology - Chapter 25: Muscle Relaxants

The nurse is caring for four clients. Which client would have the highest risk for hepatotoxicity from dantrolene?

A 60-year-old woman who is on hormone replacement therapy Response Feedback: If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This combination should be avoided. Nothing indicates that clients taking a cardiac glycoside, an antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with dantrolene therapy.

A 31-year-old female client has been taking dantrolene for several years with good effect. The client has presented to the clinic because she has just had a positive home pregnancy test. In addition to referring the client to her primary care provider, the nurse should provide what teaching?

"You and your care provider will have to carefully consider whether it will be safe for you to continue taking dantrolene." Response Feedback: Dantrolene is not absolutely contraindicated during pregnancy, but the risks versus benefits must be carefully weighed. It would not be withheld for only part of the pregnancy, and it is not a category A medication.

The nurse is giving discharge instructions to a client who just had botulinum toxin type A injections around her eyes. The nurse should caution the client about what potential adverse effects?

-Development of respiratory infections -Flu-like symptoms -Droopy eyelids Response Feedback: Adverse effects associated with use of botulinum toxin type A for cosmetic purposes include headache, respiratory infections, flu-like syndrome, and droopy eyelids in severe cases. Adverse effects do not typically include vision changes of muscle spasms.

After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm?

Application of heat to the affected region Response Feedback: Other measures in addition to drugs should be used to alleviate muscle spasm and pain. The nurse can independently encourage rest of the affected muscle and provide heat applications to increase blood flow to the area to remove the pain-causing chemicals. Deep tissue massage could cause damage and is not an independent nursing action. Similarly, administration of an NSAID requires an order.

The nurse is working with a client who has been prescribed tizanidine for the treatment of muscle spasticity. When monitoring the client's risk for injury, what assessment should the nurse prioritize?

Assessment of the client's blood pressure following administration Response Feedback: Tizanidine has been associated with hypotension, which could be a safety risk especially if the client is also taking an antihypertensive drug. Constipation and headaches are common adverse effects that do not pose as a direct safety risk. Creatinine levels are not normally affected, and these do not pose a safety risk.

A nurse is providing discharge teaching for a client who will be going home on cyclobenzaprine prescribed for acute musculoskeletal pain. What health education should the nurse provide?

Avoid drinking any alcohol until the completion of treatment Response Feedback: Taking cyclobenzaprine with alcohol can cause an increase in central nervous system depression. Vitamin B 6 and acetaminophen are not contraindicated, though this should be discussed with the provider. The effects of CNS depression can be minimized by taking the medication in the evening or at bedtime, if prescribed.

A female client has been experiencing increased muscle spasticity since being diagnosed with multiple sclerosis. What drug is most likely to meet this client's needs?

Baclofen (Lioresal) Response Feedback: Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort associated with painful, acute musculoskeletal conditions.

The nurse is caring for a client who is being discharged horne from the rehabilitation unit. Baciofen 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 baciofen?

Baclofen must be tapered down over one to two weeks to prevent psychoses and hallucinations Response Feedback: If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious adverse effects and would never be done. Four to 6 weeks is unnecessary for the transition.

The nurse is caring for a client who has a disorder of muscle contraction and relaxation. The nurse should prioritize the assessment of what laboratory value?

Calcium Response Feedback:Calcium is released from the sarcoplasmic reticulum, which leads to the binding of calcium with troponin-tropomyosin. This leads to contraction of the muscle fiber. The calcium pump then moves calcium back into the sarcoplasmic reticulum, which leads to relaxation of muscle fiber. Chloride, magnesium, and potassium are not involved in this process.

An older adult with intractable back pain is scheduled to begin taking a centrally acting, skeletal muscle relaxant. What medication is most likely to balance risks and benefits to the client?

Carisoprodol Response Feedback: Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older clients and for those with hepatic or renal impairment. Although the other options may be prescribed, older adults are more likely to experience the adverse effects associated with the drug.

A 3-year-old girl with a diagnosis of spasticity caused by cerebral palsy has been admitted to the unit. The physician has ordered dantrolene to see if it relieves the spasticity in the child's arms and hands. The nurse would schedule this child for what routine screenings?

Central nervous system and gastrointestinal (GI) function Response Feedback: Children prescribed dantrolene should be routinely and regularly screened for central nervous system and gastrointestinal (including hepatic) toxicity. Growth and development should be routinely screened in all children. Renal, respiratory, and CV screening is not indicated.

The nurse is caring for a client who has just been prescribed cyclobenzaprine 100 mg PO t.i.d. What is the nurse's best action?

Contact the prescriber to confirm the dose Response Feedback: The normal daily dosage of cyclobenzaprine is 10 mg taken orally t.i.d., and it can be increased to a maximum of 60 mg/day. As a result, the nurse must clarify this potentially unsafe dose.

General anesthetic has been administered to a surgical client, and the client has begun to exhibit signs and symptoms of malignant hyperthermia. The operating room nurse should prepare to assist with the administration of:

Dantrolene Response Feedback: Indications for dantrolene include control of clinical spasticity resulting from upper motor neuron disorders; preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible clients; IV for management of fulminant malignant hyperthermia. The other drugs are not indicated for treatment of malignant hyperthermia.

A client presents to the clinic to receive a botulinum toxin type A injection in her forehead. The client has adult acne across her forehead. What is the nurse's priority action?

Development of respiratory infections Flu-like symptoms Droopy eyelids Response Feedback: Adverse effects associated with use of botulinum toxin type A for cosmetic purposes include headache, respiratory infections, flu-like syndrome, and droopy eyelids in severe cases. Adverse effects do not typically include vision changes of muscle spasms.

The nurse assesses a newly admitted client and finds the muscle tone in his left leg has sustained muscle contraction and that the client is unable to relax the muscle even when prompted. What is the nurse's most appropriate action?

Document the presence of muscle spasticity Response Feedback: Muscle spasticity is defined as a sustained muscle contraction. Soft and flabby muscle tone is defined as atonic. Phenytoin and diphenhydramine are not used to treat muscle spasticity.

The client reports pain caused by muscle spasms in his back. The nurse assesses the client as being very anxious due to intense psychosocial stressors and notes how the anxiety results in tensing of muscles. What medication would be most effective in treating this client?

Diazepam (Valium) Response Feedback: Adults complaining of muscle spasm pain that may be related to anxiety often respond very effectively to diazepam, which is a muscle relaxant and anxiolytic. Although many drugs, including baclofen, will treat the muscle spasm, diazepam also reduces anxiety. Dantrolene would be better indicated for spasticity than for spasm, and botulinum toxin type B is not prescribed for either anxiety or muscle spasm.

The nurse is caring for a client taking dantrolene on a long-term basis for the treatment of cerebral palsy. The care team is considering a change in the client's medication regimen. How should the therapeutic effects of this drug be best assessed?

Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity. Response Feedback: Periodically discontinue drug for 2 to 4 days to monitor therapeutic effectiveness. A clinical impression of exacerbation of spasticity indicates a positive therapeutic effect and justifies continued use of the drug. It would not be ethical to stress the client; there is no known measurement of spasticity, and the client may not be able to describe how much improvement was felt because it is unlikely all spasticity will be eliminated.

A female client has been taking dantrolene for several years and has now requested a prescription for oral contraceptives from her primary care provider. What is the nurse's best action?

Ensure all members of the care team are aware of the risk for hepatotoxicity Response Feedback:In women, a combination of dantrolene and estrogen seems to affect the liver, thus posing a greater risk of hepatotoxicity. Renal function is a not a priority, nor are the other client's other medications at this time. Education about the risks of pregnancy is relevant, but more so if the client was trying to become pregnant rather than prevent pregnancy.

The nurse is preparing to administer a hospital client's scheduled dose of baclofen 20 mg PO. Prior to administering the medication, the nurse has performed an assessment, which indicated the client's blood pressure is 151/98 mm Hg. What is the nurse's best action?

ITS NOT withhold the medication and reassess the client in 30 to 60 minutes or contact the care provider immediately

When caring for a client taking dantrolene, for what adverse effects should the nurse monitor the client?

Jaundice Fatigue Drowsiness Response Feedback: Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency. Hepatitis and other forms of liver damage could be indicated by the development of jaundice. Adverse effects of dantrolene do not include bradycardia or urinary retention.

A client has been diagnosed with cerebral palsy accompanied by muscle spasticity. The nurse should identify what causative factor of this client's symptoms?

Nerve Damage within the CNS Response Feedback:Muscle spasticity is the result of damage to neurons within the central nervous system (CNS) rather than injury to peripheral structures such as the musculoskeletal system. Serotonin is not involved in the process of muscle contraction and relaxation. The etiology of spasticity is not rooted in neurotransmitter disruptions, even though these may subsequently be affected.

The nurse is caring for a client with an infusing IV who is allowed noting by mouth due to a paralytic ileus. What centrally acting medication could the nurse administer to this client?

Orphenadrine Response Feedback: Only orphenadrine of these options can be given parenterally, either IV or intramuscularly. The other options are available for oral use only.

What clients should the nurse recognize as having a health problem that could result in muscle spasm?

Overstretching a muscle Wrenching a joint Tearing a tendon or ligament

A client with a spinal cord injury has developed central spasticity, and the care provider wishes to administer a muscle relaxant intrathecally. What is the nurse's best action?

Prepare to administer baclofen Response Feedback:Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity. Carisoprodol cannot be delivered in this manner, and there is no obvious reason to question such an order. The client likely needs venous access for other fluids and medications, but it is not necessary for intrathecal administration.

The nurse is observing a client who is labeling the numbers on a drawing of a clock during a neurologic assessment. What should the nurse recognize that the client is using when making precise, intentional movements such as handwriting?

Pyramidal tract Response Feedback: Upper-level controls of muscle activity include the pyramidal tract in the cerebellum, which regulates precise intentional muscle movement, and the extrapyramidal tract in the cerebellum and basal ganglia, which coordinates crude movements, often related to unconscious muscle activity. Broca's area has to do with speech, not movement. The substantia nigra does not control muscle movement.

An older adult with lumbar pain has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize?

Risk for falls related to CNS depression Response Feedback: The CNS depression that results from muscle relaxants creates a significant risk for falls, especially in older adults. Constipation is more likely than diarrhea and fluid imbalances are not anticipated. Cognition changes may occur, but these would be short term during drug therapy, not chronic.

A client with a complex health history has developed severe spasticity. What aspect of the client's status would contraindicate the safe and effective use of dantrolene? The client:

has a history of fatty liver disease. Response Feedback: Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also contraindicated in the following conditions: spasticity that contributes to locomotion, upright position, or increased function, which would be lost if that spasticity was blocked; active hepatic disease (such as fatty liver disease), which might interfere with metabolism of the drug and because of known liver toxicity; and lactation because the drug may cross into breast milk and cause adverse effects in the infant. Diabetes, asthma, and lack of independence do not contraindicate the use of dantrolene.

A client stepped on a rusty nail 2 days ago and is now exhibiting signs of muscle rigidity and contractions. The ED nurse should have which drug available for administration when the client arrives?

methocarbamol Response Feedback: The client is exhibiting signs of tetanus, and methocarbamol is indicated for treatment. Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus.

The nurse admits a child diagnosed with tetanus after stepping on some old barbed wire fencing. What medication should the nurse expect to administer?

methocarbamol Response Feedback: Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene are not recommended for use with children. Cyclobenzaprine is not used for the treatment of tetanus.

What are the simplest nerve pathways in the body?

spinal reflexes Response Feedback: The spinal reflexes are the simplest nerve pathways that monitor movement and posture. Arc reflexes and afferent nerve reflexes are distracters for this question. Spindle gamma loops respond to stretch receptors.

The nurse provides client teaching about chlorzoxazone in preparation for the client's discharge to home. The nurse determines that the client understands potential adverse effects when the client makes what statement?

"My urine might change color when I take this drug." Response Feedback: The client indicates an understanding of adverse effects of this drug by stating that his urine may be discolored while using the drug. Chlorzoxazone may discolor the urine, which will turn orange to purple-red when metabolized and excreted. Clients should be warned about this effect to prevent any fears of blood in the urine. Chlorzoxazone usually causes constipation, not diarrhea. The onset of action is usually within an hour after the drug has been taken. Yellow discoloration of the skin would indicate liver damage or dysfunction, which should be reported immediately.

A female client attends a "Botox party and is injected with botulinum toxin type A to decrease frown lines between her eyebrows. Later that evening, the client is admitted to the emergency department and is distraught because she cannot move her eyebrows. The nurse explains that that toxin causes what?

"The toxin causes muscle paralysis, preventing movement and relieving wrinkles." Response Feedback: Botulinum toxin types A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine, leading to local muscle paralysis. These two drugs are injected locally and used to paralyze or prevent the contractions of specific muscle groups. The action smoothes wrinkles in the area but does not cause muscle death. The effect is temporary and does not cause nerve death. The other options are false statements.

The nurse is caring for a client who is having a pump placed to deliver intrathecal baciofen and another client who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans?

Acute pain related to GI effects of drug Risk for injury related to central nervous system (CNS) effects Disturbed thought processes related to CNS effects Response Feedback: Acute pain related to GI effects of drug, risk for injury related to CNS effects, and disturbed thought processes related to CNS effects all apply to both clients. Disturbed body image may apply to the client having the pump placed, but this is not related to muscle pain. Only the client having the pump placed would need information related to the procedure.

A client with muscle spasticity has begun taking baclofen. What recent assessment findings should the nurse attribute to possible adverse effects?

Client reports frequent urges to void Blood pressure 103/59 mm Hg Client reports light-headedness transitioning from lying to sitting Response Feedback: Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, and urinary frequency. Leukopenia and bradycardia are not associated with baclofen.

A client has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. What drug would the nurse anticipate will be ordered as the drug of choice to manage spasticity associated with neuromuscular diseases?

Dantrolene (Dantrium) Response Feedback: Dantrolene directly affects peripheral muscle contraction and has become important in the management of spasticity associated with neuromuscular diseases. Baclofen, carisoprodol, and botulinum toxin type B are not the drugs of choice for management of spasticity in neuromuscular disease.