Prep-U: Chapter 30
The perioperative nurse is caring for a client who requires an umbilical hernia repair but who has a known family history of malignant hyperthermia. The client has been prescribed dantrolene 2.5 mg/kg IV one hour before surgery. The client weighs 121 lbs. The nurse reconstitutes a single-use vial as per the manufacture's instructions, yielding a solution with a concentration of 50 mg/mL. How many mL of the reconstituted dantrolene solution should the nurse add to the client's bag of intravenous fluid?
2.75 mL
A nurse understands that succinylcholine lasts for approximately how long once it is administered?
4 to 6 minutes
A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered? Cyclobenzaprine Chlorzoxazone Carisoprodol Baclofen
Correct response: Baclofen Explanation: Baclofen is used for the treatment of muscle spasticity associated with spinal cord injuries. Carisoprodol is used for the relief of discomfort of acute musculoskeletal conditions. Chlorzoxazone is used for the relief of discomfort of acute musculoskeletal conditions. Cyclobenzaprine is used for the relief of discomfort of acute musculoskeletal conditions.
The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse nurse prioritize when assessing for therapeutic effects?
Inspection for muscle spasticity and range of motion assessment
An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene?
Malignant hyperthermia
The nurse is caring for a client immediately prior to the administration of anesthesia. The nurse knows that what equipment must be available when the anesthesiologist administers vecuronium?
Mechanical ventilation
A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen?
Risk for Injury related to CNS depression
A surgical client is receiving a neuromuscular junction (NMJ) blocker. The nurse knows that the client cannot move because the client's acetylcholine receptor sites have been stimulated and the drug is remaining in the receptor sites, preventing repolarization. What medication is this client receiving?
Succinylcholine
Which agent would be associated with increased intraocular pressure?
Succinylcholine
Which neuromuscular blocking agent would a nurse expect to have the shortest duration of action?
Succinylcholine
A client is to receive a nondepolarizing NMJ blocker. The client also takes a calcium channel blocker. Which would most likely occur?
The dosage of the NMJ blocker will be less.
When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?
drowsiness
Which adverse effect should the nurse assess for when administering cyclobenzaprine?
drowsiness
A client with a known cardiac history is being prepared for surgery. Safe use of neuromuscular junction blockers can be best promoted by:
ensuring the client does not take his prescribed amlodopine in the days before surgery.
When prescribed dantrolene, what is the most serious adverse effect the client should be instructed about?
hepatitis
Which adverse effect of muscle relaxants is most pronounced when a client is prescribed tizanidine therapy? eczema dark black urine excessive salivation hypotension
hypotension Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.
A client needs further teaching about medication prescribed for muscle spasms and cramping when making which statements?
"I take my medicine with three to four beers each evening."
After teaching a patient about an upcoming procedure that will use a nondepolarizing neuromuscular junction (NMJ) blocking agent, the nurse would recognize a need for further instruction if the patient said:
"I will not be awake during the procedure."
A client has told the nurse that she has been invited to a work colleague's house where she and some of her peers will be able to receive Botox injections. What is the nurse's best response?
"It's safest to have these injections performed under medical supervision."
A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide?
"Make sure to see your health care provider promptly if you develop yellowish skin or eyes."
After teaching a group of students about NMJ blockers, the instructor determines that the students have understood the teaching when they state:
"Most of the drugs do not alter pain perception and consciousness."
A patient recovering from a procedure that involved succinylcholine (Anectine) reports muscle soreness and asks the nurse for an explanation. What will the nurse tell the patient?
"The drug triggers receptors to cause prolonged muscle contraction."
A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response?
"The combination of baclofen and alcohol could depress your nervous system to a dangerous level."
A female patient has expressed anxiety to the nurse surrounding the thought of being awake but unable to move or express pain during surgery. The patient states that she recently saw a movie that addressed this phenomenon and that she is consequently fearful about her impending surgery. How should the nurse reassure this patient?
"The whole surgical team will be monitoring you very closely throughout the procedure to make sure that things like this don't happen."
A client in the clinic complains of depression (secondary to chronic back pain) and of not being able to "get around as good as I used to." The client has just been prescribed a skeletal muscle relaxant. What is the nurse's most therapeutic response?
"Therapy may take weeks or longer before you feel optimal relief."
A patient who is receiving chlorzoxazone reports that his urine is somewhat orange in color. Which response by the nurse would be most appropriate?
"This discoloration sometimes occurs with this drug."
A client who is experiencing lower back pain has been prescribed cyclobenzapine. The nurse should provide what health education in order to ensure safe and effective treatment?
"This will likely make you drowsy, so don't take it before doing anything that would require alertness."
A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide?
"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."
A client is receiving baclofen at 8 AM. The nurse would monitor the client for evidence of maximum effect at which time?
10 AM
A patient receives pancuronium. The nurse would expect the patient to feel the effects of the drug for which duration?
120 to 180 minutes
The nurse is caring for a group of clients who each received a nonpolarizing neuromuscular block agent and understands that which client is most at risk for recurarization?
79-year old male
Which patient is at the greatest risk for developing skin breakdown following a procedure that uses a neuromuscular junction (NMJ) blocking agent?
A 73-year-old man with a history of hypertension
A 13-year-old patient is scheduled to receive pancuronium (Pavulon). Which healthcare provider should administer the medication?
A CRNA trained to use NMJ blockers
The perioperative nurse provides care to a diverse group of clients. Which client is most likely to benefit from the administration of a neuromuscular junction (NMJ) blocker in order to prevent musculoskeletal injury?
A client with major depression who has been scheduled for electroconvulsive therapy (ECT)
After reviewing the events associated with the sliding filament theory of muscle contraction, a group of students demonstrate a need for additional study when they state:
Acetylcholine interacts with muscarinic receptors.
Which patient is at greatest risk for toxicity if given a neuromuscular junction (NMJ) blocking agent?
A patient with chronic azotemia
Which assessment finding indicates that a neuromuscular junction (NMJ) blocking agent is effective?
Absent reflexes
The perioperative nurse is caring for a client who is undergoing abdominal surgery with the inclusion of succinylcholine in the client's anesthesia. The anesthesiologist tells the team that the client is exhibiting signs and symptoms suggestive of malignant hyperthermia. What is the nurse's best action?
Anticipate IV administration of dantrolene
A client has presented to the day surgery unit and will be having a diagnostic procedure that will involve the use of a neuromuscular junction blocker. The client says to the nurse, "Let me get this straight: I won't be able to talk or move my muscles but I'll be awake?" The nurse's response should address the possibility of what nursing diagnosis?
Anxiety related to paralysis
Which statement accurately describes the pharmacodynamics of nondepolarizing neuromuscular junction (NMJ) blocking agents?
Compete with acetylcholine for receptor sites
A client experienced significant muscle pain after receiving an NMJ blocker for a procedure. Which would be most appropriate for the nurse to administer for pain relief?
Aspirin
Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?
Avoid alcohol or other CNS depressants
Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?
Avoid alcohol or other CNS depressants.
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) 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.
In a patient who is to be given vecuronium (Norcuron), anesthesia is induced before neuromuscular blockade is started. What is the reason for this?
Because it helps prevent the patient from undergoing the frightening experience of paralysis and the inability to breathe
A patient has been diagnosed with cervical dystonia. The nurse would expect which medication to be ordered for this patient?
Botulinum toxin type B
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
A patient is experiencing toxicity and prolonged paralysis after using a nondepolarizing neuromuscular junction (NMJ) blocking agent. Which type of medication will be used to reverse this condition?
Cholinesterase inhibitor
After reviewing the various NMJ blockers, a group of students demonstrate understanding of the information when they identify which agent as having the longest duration?
Cisatracurium
When a depolarizing NMJ agent is used, what occurs?
Continuous sustained muscle contraction
Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation? Hydroxychloroquine Baclofen Allopurinol Alendronate
Correct response: Baclofen Explanation: Baclofen is an example of a skeletal muscle relaxant. Allopurinol would be administered to treat gout. Alendronate would be administered to treat osteoporosis. Hydroxychloroquine would be used to treat rheumatoid arthritis.
Question 5 of 5 A client who is experiencing lower back pain has been prescribed cyclobenzapine. The nurse should provide what health education in order to ensure safe and effective treatment? "Make sure to avoid grapefruit juice and fresh grapefruit until treatment is complete." "If you experience sedation, seek care promptly since it could be a sign of a serious drug reaction." "Don't use this for more than five consecutive days to prevent damage to your liver." "This will likely make you drowsy, so don't take it before doing anything that would require alertness."
Correct response: "This will likely make you drowsy, so don't take it before doing anything that would require alertness." Explanation: Cyclobenzaprine causes drowsiness because of CNS depression. There is no absolute prohibition against using the drug for more than five days; it is metabolized in the liver but is not noted to be highly hepatotoxic. Sedation is an anticipated adverse effect, not a sign of a serious drug reaction.
The nurse is preparing to administer a scheduled dose of baclofen and notes that the client's most recent oral temperature was 100.9° (38.3°C). What is the nurse's best action? Perform a focused respiratory assessment Administer the medication as prescribed and monitor the client Hold the baclofen, administer antipyretics as prescribed and reassess the client in one hour Report this assessment finding promptly to the care provider
Correct response: Administer the medication as prescribed and monitor the client Explanation: A fever is not necessarily an indication that the client's baclofen should be held. Administering the drug as prescribed does not pose any clear safety risk in the presence of a fever. The nurse will need to follow up the client's fever, but there is no obvious need to report it.
The nurse is working in collaboration with a nurse anesthetist to assess a preoperative client. When addressing the client's risk for malignant hyperthermia as a result of neuromuscular junction blockers, what assessment should be prioritized? Assessing for a family history of malignant hyperthermia Assessing for a history of febrile seizures in childhood Assessing the client's allergy status Assessing for any history of cytochrome P450 dysfunction
Correct response: Assessing for a family history of malignant hyperthermia Explanation: Family history is the most salient risk factor for malignant hyperthermia. This adverse effect is physiologically unrelated to childhood febrile seizures and does not result from cytochrome P450 dysfunction. Malignant hyperthermia is not a hypersensitivity response.
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 Assessment for headaches following peak blood levels Assessment of bowel sounds and pattern of bowel movements Monitoring the client's creatinine clearance rate
Correct response: Assessment of the client's blood pressure following administration Explanation: 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 direct a safety risk. Creatinine levels are not normally affected, and these do not pose a safety risk.
Which nursing focus is the highest priority for the nurse caring for a patient receiving a neuromuscular junction (NMJ) blocking agent?
Impaired gas exchange
A client taking medication to treat an acute attack of gout should do which of the following? Expect pain relief in two to three weeks. Drink just enough water to swallow the pills. Take the medication an hour before meals. Contact the health care provider if a mild skin rash appears.
Correct response: Contact the health care provider if a mild skin rash appears. Explanation: When using drugs to treat gout, a client should: drink 10 glasses of water a day until the acute attack has subsided; avoid driving or hazardous tasks if drowsiness occurs; notify the health care provider if pain is not relieved in a few days or if a skin rash occurs; take the medication with meals to minimize GI upset.
A clent has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication? Decreased muscle spasms Increased muscle strength Decreased severity and duration of exacerbations Reduction in the appearance of new lesions in magentic resonance imaging (MRI) studies
Correct response: Decreased muscle spasms Explanation: Baclofen, a GABA agonist, is used in the treatment of spasms. It can be administered orally or by intrathecal injection. Avonex and betaseron reduce the appearance of new lesions in MRI studies. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.
The client is taking baclofen. What would be the most important safety instruction for the nurse to give to this client? Discontinue the use of alcohol. Do not walk or drive after taking the drug. Learn to self-administer the drug. Take a laxative when needed.
Correct response: Discontinue the use of alcohol. Explanation: In a client experiencing spasticity, the nurse should advise the client to stop drinking alcohol. Alcohol consumption may increase the adverse effect of sedation, causing sleepiness, dizziness, and blurred vision. The client should not drive or walk after taking the drug; the client should learn to self-administer the drug; and constipation is a concern. However, the most important safety concern is to avoid alcohol.
An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan? Deep breathing and coughing exercises Falls prevention measures Seizure precautions Continuous pulse oximetry
Correct response: Falls prevention measures Explanation: The client's combination of CNS depression from the muscle relaxant and an underlying cognitive deficit creates a risk for falls. This combination is not associated with seizures and will not likely exacerbate the client's COPD; respiratory assessments and interventions would not likely need to be amended.
An older adult is prescribed a skeletal muscle relaxant for reports of neck pain. What is the top priority of care for the nurse to teach the family? Give the medication at the same time each day. Administer the medication with meals. Instruct on how to assess client's pain level. Monitor the client before ambulating.
Correct response: Monitor the client before ambulating. Explanation: Safety is the top priority concern, because skeletal muscle relaxants can cause drowsiness. Administering the medication with meals can reduce GI distress but is not the top priority safety concern. Checking the client's pain level is important but not the top priority safety concern. Giving the medication at the same time each day may help the caregivers remember it, but is not the top priority safety concern.
A client is taking allopurinol for gout. The client exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action? Notify the healthcare provider. Recommend the client trim fingernails. Apply a moisturizing lotion. Document the finding as a common side effect.
Correct response: Notify the healthcare provider. Explanation: A rash while taking allopurinol should be reported to the healthcare provider, because it may precede a serious adverse reaction known as Stevens-Johnson syndrome. Applying a lotion may relieve itching, but notifying the healthcare provider is top priority as a safety precaution. Trimming the fingernails can help prevent further skin damage from scratching, but the healthcare provider needs to be notified as well.
Certain bisphosphonates can be utilized in the treatment of which of the following conditions? (Choose one) Graves' disease Parkinson's disease Huntington's disease Paget's disease
Correct response: Paget's disease Explanation: Certain bisphosphonates can be utilized in the treatment of Paget's disease.
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 Carisoprodol Contact the care provider to question the treatment plan Prepare to administer baclofen Ensure that the client has patent venous access
Correct response: Prepare to administer baclofen Explanation: Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity. Soma 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.
A client has been prescribed a subcutaneous medication to treat rheumatoid arthritis (RA). The nurse should teach the client to do which? Pinch the skin over the deltoid before injection. Aspirate the syringe before injecting the medication. Pull the skin to the side when injecting to prevent skin irritation. Rotate sites when administering the injections.
Correct response: Rotate sites when administering the injections. Explanation: The nurse should teach the client about rotating subcutaneous injection sites. The deltoid is a muscle, not a subcutaneous injection site. Pulling the skin to the side describes the Z-track method used with intramuscular injections. Aspirating is not recommended with subcutaneous injections.
A client's health care provider has prescribed baclofen in an effort to treat neuropathic cancer pain. What education should the nurse prioritize when teaching the client about this new medication? The importance of ensuring safety related to possible sedation The importance of maintaining a sterile central venous catheter The need to maintain a diet that is high in iron and folic acid The importance of regularly scheduled liver function testing
Correct response: The importance of ensuring safety related to possible sedation Explanation: Baclofen carries a risk of CNS depression and a consequent threat to safety. The use of baclofen does not necessitate regular liver function testing or dietary changes. Baclofen is administered orally or intrathecally, not intravenously.
For which patient would cyclobenzaprine not be prescribed for muscle spasms? The patient who underwent a lumbar laminectomy and is having back spasms The patient who strained a quadriceps muscle playing baseball The patient who is having muscle spasms in the left leg after a fracture The patient who is having muscle spasms because of cerebral palsy
Correct response: The patient who is having muscle spasms because of cerebral palsy Explanation: Cyclobenzaprine is used to manage muscle spasms associated with acute musculoskeletal disorders, such as low back strain, muscle tenderness, or movement restriction due to musculoskeletal conditions. It is also used as supportive therapy in patients with tetanus or fibromyalgia. Cyclobenzaprine is ineffective for treating spasticity associated with cerebral or spinal cord disease or in children with cerebral palsy.
A 32-year-old female client is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the client and her husband that the adverse effect that poses the greatest safety risk to the client is: constipation. fatigue. dry mouth. hypotension.
Correct response: hypotension. Explanation: Tizanidine (Zanaflex) has been associated with hypotension, which could be a safety risk, especially if the client is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.
The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine?
Cyclobenzaprine produces an anticholinergic response
A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?
Dantrolene
A patient develops malignant hyperthermia after receiving a NMJ blocker? Which would the nurse expect to be given?
Dantrolene
A patient is being treated for intractable muscle spasticity with a peripherally acting spasmolytic. The nurse should anticipate administering which medication?
Dantrolene
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
A patient receiving succinylcholine (Anectine) experiences malignant hyperthermia. What drug is used to treat this condition?
Dantrolene (Dantrium)
Which medications can be used to treat or prevent malignant hyperthermia?
Dantrolene (Dantrium)
What indicates to the nurse that a patient has recovered from neuromuscular junction (NMJ) blocking anesthesia?
Deep tendon reflexes 2+
Which medication is classified as an antianxiety medication but is also used to treat muscle spasms?
Diazepam (Valium)
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant?
Do not drive or operate machinery until individual drug effects are known.
What is the most important teaching point to emphasize from the plan of care when a client is prescribed a skeletal muscle relaxant?
Do not drive or operate machinery until individual drug effects are known.
A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?
Drowsiness
A client who is scheduled for a diagnostic procedure has learned that the procedure will take place with a neuromuscular junction blocker rather than with a general anesthetic. The nurse should describe what benefit of this approach?
Fewer effects of central nervous system depression
Which concurrent medication promotes prolonged muscle paralysis in a patient receiving rocuronium (Zemuron)?
Gentamicin (Garamycin)
A patient is scheduled for surgery using a neuromuscular junction (NMJ) blocking agent. Which assessment from the patient's history is of greatest priority for the nurse to report to the physician?
Glomerulonephritis
A nurse should review a client's medical conditions prior to administering a dantrolene (Dantrium) as its use is contraindicated in clients with which issues? (Select all that apply.)
Hepatic disease Lactation
Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?
Hepatic dysfunction
Which assessment finding from a patient's history is significant for the nurse to report to the physician before surgery using a neuromuscular junction (NMJ) blocking agent?
Hepatitis
Which adverse effect of a neuromuscular junction (NMJ) blocking agent is the highest priority for the nurse to treat?
Hypotension
Which would a nurse include when describing the action of dantrolene?
Interference with calcium release from the muscles
When caring for a client taking dantrolene, for what adverse effects should the nurse monitor the client? Select all that apply.
Jaundice Fatigue Drowsiness
A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client?
Liver function tests
A nurse assessing a postoperative patient who received a neuromuscular blocking (NMJ) agent during the procedure notes extreme muscle rigidity, pyrexia, and acidosis. What family history predisposed the patient to this event?
Malignant hyperthermia
A client who has multiple sclerosis has experienced a fall and requires open reduction and internal fixation of a femoral fracture. The anesthesiologist has informed the perioperative nurse that the client will be given a neuromuscular junction (NMJ) blocker to facilitate anesthesia. What is the nurse's best action?
Monitor the client's status before, during, and after surgery as per usual protocol.
Which statement best reflects the action of NMJ blockers?
Most do not affect pain perception and consciousness.
The nurse is preparing a patient for an endoscopic procedure that will use a nondepolarizing neuromuscular junction (NMJ) blocking agent. Which condition in the patient's history will require a change in anesthetic medication?
Myasthenia gravis
Based on the nurse's understanding of the adverse effects associated with succinylcholine and the development of muscle pain, the nurse would expect what to be used before administering succinylcholine?
Nondepolarizing NMJ blocker
The nurse is caring for a young adult client in the emergency department (ED) requiring rapid sequence induction and placement on mechanical ventilation. The client has no known allergies; takes no medications, over-the-counter (OTC) drugs, herbals, or alcohol; and has no history of chronic conditions. The nurse administered the prescribed intravenous (IV) succinylcholine. Which best action would the nurse take when the client remains paralyzed 30 minutes after the intubation?
Notify the emergency department health care provider.
The nurse would expect to administer tiludronate to a client with which condition?
Paget disease
A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do?
Reduce the dose
A patient that has a history of glaucoma is to receive a NMJ blocker. Which agent would the nurse identify as being most problematic for this patient?
Succinylcholine
A 40-year-old client with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize for the nursing care plan for this client?
Risk for Injury related to CNS depressant effects
A 6-year-old child has been brought to the emergency department in apparent status asthmaticus. The care team recognizes the need to intubate the client, who is inconsolably agitated. The nurse should anticipate a STAT prescription for what medication?
Succinylcholine
A nurse is monitoring a client closely for malignant hyperthermia because the client received which NMJ blocker?
Succinylcholine
The physician orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition?
When close supervision is available for monitoring drug effects
For which assessment finding will the nurse intervene first when providing postoperative care to a patient who returned to the nursing unit 2 hours after receiving succinylcholine (Anectine)?
Temperature 40 degrees C (104 degrees F)
The operating room nurse has performed an assessment of a preoperative client and the client reports a family history of malignant hyperthermia. The nurse has confirmed with the anesthesiologist that this has been identified. The nurse should anticipate what consequence of this for the client's intraoperative care?
The anesthesiologist will exercise caution when giving the client neuromuscular junction blockers
The nurse is caring for a client who requires surgery following multiple trauma and internal bleeding from a motor vehicle accident. What aspect of this client's health status would contraindicate the use of succinylcholine during surgery?
The client has multiple bone fractures
When reviewing the medical record of a client who is to receive dantrolene, which condition would alert the nurse to the need for close monitoring?
The client has respiratory depression from opioid analgesia
The nurse is collaborating with the anesthetist in the assessment of a client who will soon receive succinylcholine to induce paralysis. What characteristic of this client creates a risk for prolonged paralysis and delayed return of muscle function?
The client is an Alaskan Eskimo
A client is scheduled for surgery, and it is planned that the client will receive pancuronium as an adjunct to general anesthesia. What should the nurse teach the client about this medication?
The client will be unable to move approximately five minutes after receiving the drug.
The nurse can determine that the client taking uric acid inhibitors is drinking enough fluids when which of the following occurs?
The daily urine output is about two liters. Explanation: When taking uric acid inhibitors, the client should drink about 3000 mL per day, and the daily urine output should be about two liters. The client's weekly weight and lip condition are not the best assessments to evaluate adequate fluid intake (prevention of urate stone formation); they are acceptable methods to assess for dehydration.
Nondepolarizing NMJ blockers act as antagonists to acetylcholine at the neuromuscular junction.
True
Nondepolarizing NMJ blockers are metabolized in the serum.
True
When nondepolarizing NMJ blockers are given, histamine is also released, causing wheezing and bronchospasm.
True
A nurse knows that patients with a history of cardiac disorders are at greatest risk for hypotension and dysrhythmias if given which neuromuscular junction (NMJ) blocking agent?
Vecuronium (Norcuron)
A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which instruction?
Wear appropriate clothing and sunscreen whenever he is in direct sunlight
A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which instruction?
Wear appropriate clothing and sunscreen whenever he is in direct sunlight.
The health care provider orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition?
When close supervision is available for monitoring drug effects
a nurse is caring for a client who has been prescribed alendronate for the treatment of postmenopausal osteoporosis. the client informs the nurse that she is also taking antacids for the relief of gastric upset. based on the nurse's knowledge about both drugs, which effect would the nurse anticipate a) decreased effectiveness of alendronate b) increased risk of hypotension c) increased risk of hypoglycemia d) decreased effectiveness of antacids
a) decreased effectiveness of alendronate The nurse should anticipate decreased effectiveness of alendronate in the client due to the interaction between alendronate and antacids. The client should be advised to take alendronate and antacids at different times to promote the therapeutic effects of both medications. Increased risk of hypoglycemia is the effect of the interaction of a uric acid inhibitor with aluminum-based antacids and tolbutamide. Decreased effectiveness of antacids is not the effect associated with the interaction of alendronate and antacids. Increased risk of hypotension is the effect of the interaction of skeletal muscle relaxants with tizanidine.
a client reports that he uses an herbal product to treat his osteoarthritis. which of the following would the nurse most likely expect the client to use a) glucosamine b) kava c) valerian root d) cinnamon
a) glucosamine Glucosamine and chondroitin are herbal products a client might use to treat osteoarthritis. Kava is used in the treatment of anxiety, restlessness, and stress. Valerian root has been used for the treatment of insomnia and anxiety. Cinnamon is known to lower cholesterol, blood sugar, and helps relieve arthritis pain.
A client has been started on cyclobenzaprine. For the duration of treatment with cyclobenzaprine, the nurse should teach the client to eliminate:
alcohol
When reviewing the history of a patient who is to receive succinylcholine, the nurse would expect a prolonged drug action if the patient has a history of:
collagen disease
A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency?
dantrolene
A nurse is working with a 39-year-old client who is experiencing muscle spasms associated with multiple sclerosis. The client reports needing help with basic care The client's health care provider has prescribed baclofen (Lioresal). The nurse and the client agree that an appropriate goal related to helping to maintain self-worth would be to: take medication independently. experience improved motor function. increase self-care in activities of daily living. experience relief of pain.
increase self-care in activities of daily living Explanation: All of the options are goals that the nurse would like the client to achieve. However, the goal related to self-worth would be to increase self-care in activities of daily living. Loss of ability to dress oneself puts the client at risk for decreased self-esteem and feelings of low self-worth.
A patient will be undergoing surgery, during which the anesthesiologist plans to administer vecuronium. The nurse will recognize that the administration of this drug creates a need for:
mechanical ventilation
Adverse effects of dantrolene (Dantrium) include:
potentially fatal hepatitis.
A 71-year-old patient with a history of depression will be receiving vecuronium to prevent trauma during electroconvulsive therapy. Prior to the procedure, the care team must assess the patient's:
renal and hepatic status
A client will undergo an endoscopy with conscious sedation using midazolam. The nurse who is participating in this procedure should monitor the client closely for which sign of adverse reaction?
respiratory depression
A client is about to undergo endoscopy and the nurse is describing the use of a neuromuscular junction blocker to the client, who has asked for detail on the procedure. When providing education to the client, the nurse should describe:
the role of acetylcholine in muscle stimulation.
Spinal reflexes are the simplest nerve pathways that monitor movement and posture.
true
What instructions should a patient scheduled to have a procedure using the neuromuscular junction (NMJ) blocking agent succinylcholine (Anectine) receive? Select all that apply.
• "You may take aspirin for muscle aches after the procedure." • "Tell your primary care physician if you have glaucoma." • "You will not be able to move."
For which patients is use of the nondepolarizing neuromuscular junction (NMJ) blocking agent succinylcholine (Anectine) contraindicated? (Select all that apply.)
• A 19-year-old with a spinal cord injury • A 43-year-old with myasthenia gravis • A 72-year-old with a hip fracture
Which conditions place a patient receiving succinylcholine (Anectine) at high risk for prolonged paralysis after surgery? (Select all that apply.)
• Burns • Cancer • Thyrotoxicosis
A client with gout is receiving allopurinol as part of the treatment plan. Which instruction would the nurse include in the teaching plan for this client? Select all that apply.
• Drinking at least 3 L of fluid per day • Taking the drug with meals • Reporting any evidence of skin rash
The nurse is caring for a client diagnosed with gout. The client is prescribed colchicine and allopurinol. The nurse should perform which assessments? Select all that apply.
• During acute gout attack assess every hour before administering colchicine for improvement of affected joints. • Assess intake and output to ensure at least 2 liters of non-caffeinated fluid intake and at least 3 liters of urine output in 24 hours. • Assess for development of a red rash, hold allopurinol and report it immediately to primary care provider for further orders. • Assess for pain in back, abdomen, or groin, hematuria, and pain upon urination, and presence of fever.
A client will be having surgery imminently and the nurse is aware that the client's anesthesia will be accompanied by the use of a neuromuscular junction (NMJ) blocker. The nurse should anticipate and ensure what assessments and interventions? Select all that apply.
• mechanical ventilation • insertion of an endotracheal tube • continuous cardiopulmonary monitoring
