Chapter 20: Drugs Affecting Muscle Spasm and Spasticity

A patient is admitted to the unit with central spasticity after a severe motor vehicle accident. The doctor plans on placing an intrathecal delivery pump for what medication to treat the central spasticity? Baclofen Flexeril Soma Dantrolene

Baclofen

A patient with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered? Cyclobenzaprine Carisoprodol Chlorzoxazone Baclofen

Baclofen

A 20-year-old female has been diagnosed with multiple sclerosis. Which drug will most likely be prescribed? Cyclobenzaprine (Flexeril) Baclofen (Lioresal) Orphenadrine (Banflex) Metaxalone (Skelaxin)

Baclofen (Lioresal)

The anatomy and physiology instructor is discussing what causes muscle contraction and relaxation. What element is part of the process that causes muscle contraction and relaxation? Chloride Magnesium Calcium Hydrogen

Calcium

When interneurons synapse within the spinal cord, what physiologic adjustments are made? Coordinate balance Adjust response and recovery Adjust to upright position Coordinate movement and position

Coordinate movement and position

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. Report increased muscle spasm to the health care provider immediately. Drink eight to 10 glasses of water daily to prevent constipation. Always take this medication with food to prevent nausea and vomiting.

Do not drive or operate machinery until individual drug effects are known.

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? Administer the medication with meals. Give the medication at the same time each day. Instruct on how to assess client's pain level. Monitor the client before ambulating.

Monitor the client before ambulating.

Which of the following conditions and activities may exacerbate multiple sclerosis (MS)? Range-of-motion (ROM) exercises Pregnancy Urine retention Swimming

Pregnancy

The nurse is caring for a patient who is being discharged home from the rehab unit. The patient is being switched from baclofen to soma for use as an outpatient. What should the nurse instruct the patient about discontinuing baclofen to prevent the development of psychoses and hallucinations? Taper drug over 72 hours. Start the soma right away and you won't experience side effects. Alternate doses of baclofen and soma over 10 days. Taper drug slowly over 1 to 2 weeks.

Taper drug slowly over 1 to 2 weeks.

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. The client's daily fluid intake is 1000 mL. The client's lips are pink and moist. The client gains approximately one pound per week.

The daily urine output is about two liters.

A client with multiple sclerosis asks the nurse to explain why deep tissue massages do not relieve spasticity. The nurse should explain that spasticity is caused by: stimulation of "association areas" in the brain; therefore, only nerve blocks will be effective. nerve damage in the brain and spinal cord, and it is a permanent condition. inflammation of the muscles; therefore, NSAIDs may be effective. skeletal muscle trauma and will improve in time.

nerve damage in the brain and spinal cord, and it is a permanent condition.

Adverse effects of dantrolene (Dantrium) include: potentially fatal hepatitis. severe anemia. incoordination and hypotension. hypoglycemia and hemolytic anemia.

potentially fatal hepatitis.

A client needs further teaching about medication prescribed for muscle spasms and cramping when making which statements? "I made an appointment in two to three weeks to be reevaluated." "I take my medication right after dinner." "I usually lie down for a few minutes after taking my medication." "I take my medicine with three to four beers each evening."

"I take my medicine with three to four beers each evening."

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen? "Even though baclofen is a drug that's available over the counter, it still has the potential to cause serious adverse effects if taken incorrectly." "It's best to avoid taking a dose of baclofen unless your spasticity becomes impossible to manage." "Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply." "You'll likely have to stop taking your other medications for a week to ten days before starting to take baclofen."

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."

A mother brings her 9-year-old son to the clinic for a routine check-up. The 9-year-old has cerebral palsy and is very spastic. The mother asks the nurse what causes the spasticity in her son. What would be the nurse's best reply? "Your son's spasticity is caused by deficiency of the neurotransmitter serotonin." "Your son's spasticity is caused by injury to the musculoskeletal system." "Your son's spasticity is caused by injury to peripheral structures of the CNS." "Your son's spasticity is caused by damage to neurons within the CNS."

"Your son's spasticity is caused by damage to neurons within the CNS."

The nurse is caring for 4 patients. Which patient would have the highest risk for hepatoxicity from dantrolene (Dantrium)? A 32-year-old male who it taking an antipsychotic drug A 65-year-old female who is on hormone replacement therapy A 48-year-old female who is taking an antihypertensive agent An 87-year-old male who is taking a cardiac glycoside

A 65-year-old female who is on hormone replacement therapy b/c combined with estrogen

One of the direct acting muscle relaxants is also used to treat malignant hyperthermia. What drug is used for the treatment of hyperthermia? Orphenadrine Chlorzoxazone Metaxalone Dantrolene

Dantrolene

Which medications can be used to treat or prevent malignant hyperthermia? Methocarbamol (Robaxin) Metaxalone (Skelaxin) Carisoprodol (Soma) Dantrolene (Dantrium)

Dantrolene (Dantrium)

A patient is having surgery to repair a ruptured Achilles tendon. The patient develops severe muscle contractions and hyperthermia. Which medications will be administered? Carisoprodol (Soma) Cyclobenzaprine (Flexeril) Dantrolene sodium (Dantrium) Baclofen (Lioresal)

Dantrolene sodium (Dantrium)

A patient has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the patient is taking baclofen (Lioresal). Which outcome would the nurse expect to be associated with use of this medication? Decreased muscle spasms Reduction in the appearance of new lesions in magentic resonance imaging (MRI) studies Decreased severity and duration of exacerbations Increased muscle strength

Decreased muscle spasms

A patient is administered cyclobenzaprine (Flexeril). Which adverse effect can the nurse expect with this medication? Insomnia Muscle spasms Urinary incontinence Drowsiness

Drowsiness

Muscle spasticity is the result of damage to peripheral structures rather than to injured neurons. False True

False

A patient has been started on dantrolene (Dantrium). What is the most serious adverse effect on which the patient should be instructed? Fatal hepatitis Metabolic acidosis Hypercarbia Renal calculi

Fatal hepatitis

The primary care provider of a patient with a long history of neuropathic pain is considering the addition of gabapentin (Neurontin) to the patient's extensive drug regimen. How will the addition of gabapentin likely influence the other medications that the patient currently receives? The patient will require a 10-day "drug holiday" before taking gabapentin. The patient will need to take gabapentin one hour before or two hours after meals. Gabapentin will not likely interact with any of the patient's other drugs. The patient will need to add calcium supplements to his drug regimen.

Gabapentin will not likely interact with any of the patient's other drugs.

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.) Hypertension Diabetes Atrial fibrillation Hepatic disease Lactation

Hepatic disease Lactation

A patient is taking tizanidine (Zanaflex) to treat spasticity from multiple sclerosis. Which adverse effect of muscle relaxants is most pronounced with this medication? Eczema Dark black urine Hypotension Excessive salivation

Hypotension

Which would a nurse include when describing the action of tizanidine? Interference with calcium release from muscles Inhibition of acetylcholine release Inhibition of presynaptic motor neurons in the CNS Interference with the reflexes causing the spasm

Inhibition of presynaptic motor neurons in the CNS

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? Myocardial ischemia Uncontrolled hypertension Cerebrovascular accident Malignant hyperthermia

Malignant hyperthermia

A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient? Relief from nervous disorder Prevention of convulsion Reduction of muscle spasm Relief from anxiety

Reduction of muscle spasm

The nurse is giving discharge instructions to a patient who just had botox A instructions around their eyes. What adverse effects would the nurse include in the discharge instructions? (Mark all that apply.) Cough Droopy eyelids Diarrhea Respiratory infections Flu-like syndrome

Respiratory infections Flu-like syndrome Droopy eyelids

A male patient who experienced a lower back injury while doing yard work 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 patient's drug regimen? Risk for Injury related to CNS depression Risk for Sexual Dysfunction related to endocrine changes Risk for Ineffective Airway Clearance related to increased secretions and decreased lung function Risk for Impaired Swallowing related to adverse neuromuscular effects

Risk for Injury related to CNS depression

Your client informs you that she has been taking a muscle relaxant. She tells you that she has noted a change in urine color to dark green. You know that the medication she most likely taking is: Soma. Robaxin. Skelaxin. Flexeril.

Robaxin.

When using drugs to treat rheumatoid arthritis (RA), the nurse should tell the client to notify the health care provider if the client experiences which problems? Select all that apply. Itching Fever Blood pressure 122/78 Nausea Sore mouth

Sore mouth Fever Itching Nausea

A patient with severe spasticity sees their physician. The physician orders dantrolene. In what circumstances is the drug dantrolene contraindicated? Spasticity that contributes to upright position, which would be lost if that spasticity were blocked Spasticity that involves both legs Spasticity the involves the arm and the leg on the same side Spasticity that involves the arm and the leg on opposite sides

Spasticity that contributes to upright position, which would be lost if that spasticity were blocked

A patient's physician has prescribed baclofen in an effort to treat the patient's neuropathic cancer pain. What patient education should the nurse prioritize when teaching the patient about this new medication? 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 ensuring safety related to possible sedation The importance of regularly scheduled liver function testing

The importance of ensuring safety related to possible sedation

A patient has been started on methocarbamol (Robaxin). Which of the following is the most important patient teaching intervention on which the nurse should instruct the patient? The medication will cause constipation. The medication will increase coordination. The medication will turn urine green. The medication will cause hypertension.

The medication will turn urine green.

A patient has been started on methocarbamol (Robaxin). Which of the following is the most important patient teaching intervention on which the nurse should instruct the patient? The medication will cause hypertension. The medication will cause constipation. The medication will turn urine green. The medication will increase coordination.

The medication will turn urine green.

For which patient would cyclobenzaprine not be prescribed for muscle spasms? The patient who is having muscle spasms because of cerebral palsy 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 underwent a lumbar laminectomy and is having back spasms

The patient who is having muscle spasms because of cerebral palsy

Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area. False True

True

A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What patient teaching should the nurse provide? "You'll have to come to the hospital daily to be administered this drug." "Make sure to see your doctor promptly if you develop yellowish skin or eyes." "Take an over-the-counter laxative so that you don't get constipated." "You'll find that your muscles will get progressively stronger over the next several weeks."

"Make sure to see your doctor promptly if you develop yellowish skin or eyes."

A nursing student is giving an oral report on multiple sclerosis (MS) to the med-surg class. The student should be able to identify which of the following as a primary symptom most likely to be assessed in a patient with MS? Bradykinesia Dementia Difficulty in coordination Contracture deformities

Difficulty in coordination

Which agent would the nurse identify as also being used to treat tetanus? Tizanidine Methocarbamol Orphenadrine Metaxolone

Methocarbamol

A client taking allopurinol exhibits an "itchy" skin rash on the neck and both arms. What is the nurse's top priority action? Document the finding as a common side effect. Apply a moisturizing lotion. Recommend the client trim fingernails. Notify the health care provider.

Notify the health care provider.

A young women attends a "Botox Party" and is injected with botulinum toxin type A to decrease "frown lines" between her eyebrows. Later that evening, the patient is admitted to the ED and is hysterical because she cannot move her eyebrows. The ED nurse explains that that toxin causes: muscle death, which smoothes wrinkles in the area. muscle relaxation, preventing movement and relieving wrinkles. death to nerves in the area. permanent muscle relaxation, and the muscles will never move again.

muscle relaxation, preventing movement and relieving wrinkles.

A patient has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the patient is taking baclofen (Lioresal). Which outcome would the nurse expect to be associated with use of this medication? Increased muscle strength Decreased muscle spasms Decreased severity and duration of exacerbations Reduction in the appearance of new lesions in magentic resonance imaging (MRI) studies

Decreased muscle spasms