Chapter 21: Drugs for Neuromuscular Disorders and Muscle Spasms

A patient prescribed cyclobenzaprine (Amrix) wants to know why questions are asked about bladder pressure when the medication is needed to treat back muscle spasms. Which adverse effect of cyclobenzaprine should the nurse include in the response? Renal failure Urinary retention Bladder atrophy Neurogenic bladder

Urinary retention Muscle relaxants such as cyclobenzaprine (Amrix) can produce an anticholinergic effect and can lead to urinary retention. The patient should be instructed to report an inability to void, increasing bladder pressure, or pain. Cyclobenzaprine (Amrix) is not known to directly cause renal failure, bladder atrophy, or neurogenic bladder

Which patient suffering from muscle spasms should not receive the direct-acting antispasmodic medication dantrolene sodium (Dantrium)? 1. 20-year-old suffering from a spinal cord injury 2. 57-year-old suffering from congestive heart failure 3. 40-year-old suffering from multiple sclerosis 4. 65-year-old suffering from a cerebral vascular accident

2

A patient with a spinal cord injury asks why cyclobenzaprine (Amrix) is not prescribed for the muscle spasms. Which response should the nurse make? "Cyclobenzaprine acts directly on skeletal muscles and worsens mobility." "Cyclobenzaprine acts directly on skeletal muscles and delays spinal cord healing." "Cyclobenzaprine overdose fatalities are higher when administered to a patient with a spinal cord injury." "Cyclobenzaprine is not effective in treating muscle spasms that result from a spinal cord injury."

"Cyclobenzaprine is not effective in treating muscle spasms that result from a spinal cord injury." Cyclobenzaprine causes muscle relaxation in cases of acute muscle spasticity, but it is not effective in diseases of the brain and spinal cord. Cyclobenzaprine is a centrally acting medication and does not act directly on skeletal muscles. Cyclobenzaprine is generally expected to improve mobility, and the medication is not expected to delay spinal cord healing. Cyclobenzaprine overdoses are generally not fatal; physostigmine (Antilirium) may be given to reverse serious anticholinergic adverse effects.

The physician prescribes cyclobenzaprine (Flexeril) for the patient. When doing medication education, what will the best information of the nurse include? 1. Increase the intake of fiber while taking this medication. 2. Restrict the intake of sodium while taking this medication. 3. Increase the intake of protein while taking this medication. 4. Do not drink any caffeine while taking this medication.

1

The health care provider orders pyridostigmine bromide for a patient. Which assessment will help confirm the therapeutic outcome for this medication? A) ability to walk B) increased muscle strength C) decrease in pain D) clear vision

B) increased muscle strength Pyridostigmine is given to increase muscle strength. It will not actually provide the ability to walk and will not decrease pain or provide clear vision.

The nurse is reviewing a patient's medication history for a patient who has just been prescribed cyclobenzaprine for treatment of back spasms. The nurse plans to contact the health care provider if the patient is taking which of these? A) atorvastatin B) conjugated estrogen C) valerian D) penicillin G procaine

C) valerian

The nurse is asked how dantrolene (Dantrium) affects spastic muscles. Which information should the nurse include in the response? "It blocks calcium release within muscles." "It increases norepinephrine activity by blocking its synaptic reuptake." "It inhibits neuronal activity within the brain and spinal cord." "It depletes dopamine, serotonin, and norepinephrine at nerve terminals."

"It blocks calcium release within muscles." Dantrolene (Dantrium) directly relaxes muscle spasms by interfering with the release of calcium ions from storage areas inside skeletal muscle cells. Cyclobenzaprine (Amrix) increases norepinephrine activity by blocking its synaptic reuptake. Baclofen (Lioresal) inhibits neuronal activity within the brain and spinal cord. Dantrolene does not effect dopamine, serotonin, and norepinephrine at nerve terminals.

A patient prescribed cyclobenzaprine (Amrix) asks why alcoholic beverages cannot be consumed while taking the medication. Which response should the nurse make? "You may become oversedated if you mix cyclobenzaprine with alcohol." "Mixing alcohol with cyclobenzaprine can increase blood pressure." "Alcohol increases the anticholinergic effects of cyclobenzaprine." "Alcohol decreases the effectiveness of cyclobenzaprine."

"You may become oversedated if you mix cyclobenzaprine with alcohol." Cyclobenzaprine (Amrix) should not be combined with alcohol, phenothiazines, or any other central nervous system depressant because additive sedation may occur. Mixing cyclobenzaprine (Amrix) with a monoamine oxidase inhibitor has been linked to a hypertensive crisis. Alcohol dose not increase the anticholinergic effects of cyclobenzaprine (Amrix), nor does it decrease the effectiveness of the medication.

A patient who has been prescribed baclofen (Lioresal) returns to the healthcare provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? 1. Whether the patient has been taking the medication consistently or only when the pain is severe 2. Whether the patient has been consuming alcohol during this time 3. Whether the patient has increased the dosage without consulting the healthcare provider 4. Whether the patient's log of symptoms indicates that the patient is telling the truth

1 Rationale: Muscle relaxers such as baclofen (Lioresal) work best when taken consistently and not prn. Noting consistency of dosing helps to determine the appropriateness of dose, frequency, and drug effects. Options 2, 3, and 4 are incorrect. Consumption of alcohol or increasing the dose of muscle relaxers will increase the risk of sedation and drowsiness. The patient's log of symptoms and drug dose and frequency may assist the provider in determining the therapeutic outcome of the medication. The patient's report of pain or continued spasms should be considered an accurate account.

The nurse teaches the patient with a neuromuscular disorder about nonpharmacological treatment of muscle spasms. What will the best information include? Select all that apply. 1. Application of heat or cold 2. Ultrasound 3. Massage 4. Relaxation techniques 5. Guided imagery

1, 2, 3

A nurse is talking with a patient who has just been prescribed cyclobenzaprine (Flexeril). The nurse would provide additional information if the patient made which statements? Select all that apply. 1. "My wife and I are driving our motor home to the beach tomorrow." 2. "I am going home to mow my lawn." 3. "I take a nap every afternoon." 4. "I just checked out a new book from the library." 5. "I am taking my grandchildren to the zoo tomorrow."

1, 2, 5

Cyclobenzaprine (Amrix) is prescribed for a patient with muscle spasms of the lower back. Which appropriate nursing interventions would be included? (Select all that apply.) 1. Assessing the heart rate for tachycardia 2. Assessing the home environment for patient safety concerns 3. Encouraging frequent ambulation 4. Providing oral suction for excessive oral secretions 5. Providing assistance with activities of daily living, such as reading

1, 2, 5 Rationale: Adverse reactions to cyclobenzaprine include drowsiness, dizziness, dry mouth, rash, blurred vision, and tachycardia. Because the medication can cause drowsiness and dizziness, ensuring patient safety must be a priority. The patient may need assistance with reading or other activities requiring visual acuity if blurred vision occurs. Options 3 and 4 are incorrect. Patients who are experiencing back pain often have orders for limited ambulation until muscle spasms have subsided. Suctioning should not be required related to this drug.

A patient calls the clinic and asks for a refill for a prescription for cyclobenzaprine (Flexeril) that was written a year ago. Which information from the medical record would the nurse draw to the prescriber's attention? Select all that apply. 1. The patient reported drinking wine each day with dinner. 2. The patient has been using nasal saline spray for allergies. 3. The patient was prescribed a MAO inhibitor last month. 4. The patient's blood glucose was elevated at the last visit. 5. The patient had a ulnar fracture repaired a year ago.

1, 3

The patient tells the nurse that she awakens frequently during the night because of leg and foot cramps. What is the best response by the nurse? 1. "Ask your physician for a muscle relaxant." 2. "Increase your intake of vitamin B6." 3. "Take a warm bath before going to bed." 4. "Apply heat to relieve the cramping."

2

A female patient is prescribed dantrolene (Dantrium, Revonto) for painful muscle spasms associated with multiple sclerosis. The nurse is writing the discharge plan for the patient and will include which teaching points? (Select all that apply.) 1. If muscle spasms are severe, supplement the medication with hot baths or showers 3 times per day. 2. Inform the healthcare provider if she is taking estrogen products. 3. Sip water, ice, or hard candy to relieve dry mouth. 4. Return periodically for required laboratory work. 5. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels.

2, 3, 4 Rationale: Dantrolene (Dantrium, Revonto) may cause hepatotoxicity with the greatest risk occurring for women over age 35, and periodic laboratory tests will be required for monitoring. Estrogen taken concurrently with dantrolene may increase this risk. The drug may cause dry mouth and sucking on hard candy, sucking ice chips, or sipping water may help relieve the dryness. Options 1 and 5 are incorrect. Dantrolene may cause erratic blood pressure, including hypotension, and hot baths or showers cause vasodilation, increasing the risk for syncope and falls. The drug may cause photosensitivity and direct exposure to the sun should be avoided.

The nurse is discharging a 72-year-old man who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this patient is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the patient's health care provider? Select all that apply. 1. The dosage amount is too low for the type of injury this patient sustained. 2. Cyclobenzaprine should be used with great caution in those over 65. 3. If taken as directed, the patient would be able to take the medication for 120 days. 4. Cyclobenzaprine is not effective for back pain. 5. Cyclobenzaprine should not be taken with food.

2, 3, 5

Which change is a common adverse effect of cyclobenzaprine (Flexeril)? 1. Alopecia 2. Tongue swelling 3. Drowsiness 4. Hypotension

3

The patient receives dantrolene (Dantrium) for muscle spasticity. Which lab result is a priority for the nurse to assess? 1. Creatinine clearance 2. Serum amylase 3. Hemoglobin and hematocrit 4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

4

A client is prescribed cyclobenzaprine​ (Amrix). For which reason should the nurse question providing this​ medication? A. Takes a monoamine oxidase inhibitor​ (MAOI) B. History of asthma C. Prescription for 14 days D. Age 45 years

A Cyclobenzaprine should not be used within 2 weeks of a monoamine oxidase inhibitor​ (MAOI) therapy because hyperpyretic crisis and convulsions may occur. Cyclobenzaprine can be safety taken by a client who is 45 years old. It is not contraindicated in asthma. The medication should only be taken for 2 to 3 weeks.

A​ client's dose of dantrolene​ (Dantrium) is increased from 25 mg by mouth once daily to 100 mg by mouth twice daily. For which risk should the nurse closely​ monitor? A. Hepatotoxicity B. Muscle excitability C. Increased salivation D. Hyperthermia

A The client is at greater risk for hepatotoxicity as the dose of dantrolene​ (Dantrium) is increased. Dantrolene is used to treat malignant​ hyperthermia, so hyperthermia is not a risk. With increased​ doses, increased muscle relaxation is expected. A potential adverse effect of dantrolene is xerostomia. Next question

The nurse is providing medication instructions to a patient with acute muscle spasms who has been prescribed cyclobenzaprine. Which statement indicates to the nurse that the patient understands the instructions? A) "I plan to take this medication with a glass of milk" B) "cyclobenzaprine should be taken once daily at bedtime" C) "I will only drink one glass of wine per day" D) "I will be able to take this drug with grapefruit juice"

A) "I plan to take this medication with a glass of milk"

A patient taking pyridostigmine develops symptoms of a cholinergic crisis. What action does the nurse anticipate performing next? A) administer atropine B) administer epinephrine C) increase the dose of pyridostigmine D) monitor the patient's blood pressure

A) administer atropine Atropine is the antidote for treating a cholinergic crisis. Administering epinephrine will not be effective nor will increasing the dosage of the pyridostigmine. Monitoring the patient's blood pressure will not alleviate the cholinergic crisis.

A patient newly diagnosed with myasthenia gravis (MG) is started on neostigmine. What is the most important nursing intervention for this patient? A) administer the drug on time B) teach the patient to take the drug with food C) assess the patient's temperature daily D) teach the patient to rise slowly

A) administer the drug on time Neostigmine is an acetylcholinesterase inhibitor with a short half-life. It is administered every 2 to 4 hours and must be given on time to prevent muscle weakness. It is not required to administer the drug with food, and the drug should not affect the patient's temperature nor result in orthostatic hypotension.

The patient is admitted to the emergency department with cholinergic crisis. The nurse anticipates administration of: A) atropine B) baclofen C) edrophonium D) neostigmine

A) atropine Atropine sulfate is an antidote for cholinergic crisis.

A patient is prescribed cyclobenzaprine for relief of muscles spasms. What does the nurse instruct the patient to avoid while taking cyclobenzaprine? A) beer B) coffee C) grape juice D) orange juice

A) beer Alcohol can cause central nervous system depression and should be avoided while taking cyclobenzaprine. There is no need to avoid coffee, grape juice, or orange juice while taking the drug.

The nurse is caring for a patient who is experiencing a myasthenic crisis. What is the primary nursing intervention? A) maintain the patient's airway B) administer atropine C) administer naloxone hydrochloride D) monitor muscle strength

A) maintain the patient's airway Muscle weakness can affect the airway, and maintaining the airway is the primary priority. Asphyxiation is the primary threat to the patient's life; therefore, maintaining the airway is paramount. Neither atropine nor naloxone hydrochloride will alleviate the crisis.

Which instructions will the nurse include in the teaching plan for a patient who is taking pyridostigmine? (Select all that apply) A) pyridostigmine must be taken on time B) take the prescribed dose every other week C) underdosing can result in myasthenic crisis D) overdosing can result in cholinergic crisis E) report the adverse effect of tachycardia to the health care provider

A) pyridostigmine must be taken on time C) underdosing can result in myasthenic crisis D) overdosing can result in cholinergic crisis

The healthcare provider is considering a benzodiazepine for a client because of muscle relaxant properties. Which medication should the nurse expect to be​ prescribed? (Select all that​ apply.) A. Clonazepam​ (Klonopin) B. Tizanidine​ (Zanaflex) C. Lorazepam​ (Ativan) D. Clonidine​ (Catapres) E. Diazepam​ (Valium)

A, C, E Benzodiazepines used for muscle relaxant properties include​ diazepam, lorazepam, and clonazepam. Clonidine and tizanidine are imidazolines and not benzodiazepines. Next question

A client has purchased capsaicin OTC cream to use for muscle aches and pains. What education is most important to give this client? a. Apply with a gloved hand only to the site of pain. b. Apply the medication liberally above and below the site of pain. c. Apply to areas of redness and irritation only. d. Apply liberally with a bare hand to the affected limb.

Answer: a. Apply with a gloved hand only to the site of pain. Rationale: Capsaicin should be applied to the site of pain with a gloved hand to avoid introducing the capsaicin to the eyes or other parts of the body not under treatment. Options b,c, and d are incorrect. Capsaicin should be applied only to the site of pain and never with a bare hand. it should not be applied to irritated or open skin areas and should be discontinued if irritation occurs.

A client has been prescribed clonazepam (Klonopin) for muscle spasms and stiffness secondary to an automobile accident. While the client is taking this drug, what is the nurse's primary concern? a. Monitoring hepatic laboratory work b. Encouraging fluid intake to prevent dehydration c. Assessing for drowsiness and implementing safety measures. d. Providing social services referral for client concerns about the cost of the drug.

Answer: c. Assessing for drowsiness and implementing safety measures. Rationale: Clonazepam (Klonopin) is a benzodiazepine: because it works on the CNS, it may cause significant drowsiness and dizziness. Safety measures should be implemented to prevent falls and injury. Options a,b, and d are incorrect. Benzodiazepines ma cause hepatotoxicity in clients with existing hepatic insufficiency and may be needed for long-term monitoring. This drug was prescribed after a health care provider's assessment and is currently given to treat a potential short-term condition. The drug should not cause dehydration and is available in generic form. If cost is a concern, social service aid may be needed, but the primary concern for the nurse is safety.

A client who has been prescribed baclofen (Lioresal) returns to the health care provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? a. Whether the client has been taking the medication consistently or only when the pain is severe b. Whether the client has been consuming alcohol during this time. c. Whether the client has increased the dosage without consulting the health care provider d. Whether the client's log of symptoms indicates that the client is telling the truth.

Answer: a. Whether the client has been taking the medication consistently or only when the pain is severe Rationale: Muscle relaxers such as baclofen (Lioresal) work best when taken consistently and not prn. Noting consistency of dosing helps to determine the appropriateness of dose, frequency, and drug effects. Options b,c, and d are incorrect. Consumption of alcohol or increasing the dose of muscle relaxers will increase the risk of sedation and drowsiness. The client's log of symptoms and drug dose and frequency may assist the provider in determining the therapeutic outcome of the medication. The client's report of pain or continued spasms should be considered an accurate account.

Cyclobenzaprine (Amrix, Flexeril) is prescribed for a client with muscle spasms of the lower back. Appropriate nursing intervention would include which of the following? (Select all the apply) a. Assessing the heart rate for tachycardia. b. Assessing the home environment for client safety concerns. c. Encouraging frequent ambulation. d. Providing oral suction for excessive oral secretions. e. Providing assistance with ADLs such as reading

Answers: a. Assessing the heart rate for tachycardia b. Assessing the home environment for client safety concerns e. Providing assistance with ADLs such as reading Rationale: Adverse reactions to cyclobenzaprine include drowsiness, dizziness, dry mouth, rash, blurred vision, and tachycardia. Because the medication can cause drowsiness and dizziness, ensuring client safety must be a priority. The client may need assistance with reading or other activities requiring visual acuity if blurred vision occurs. Options c and d are incorrect. Clients who are experiencing back pain often have orders for limited ambulation until muscle spasms have subsided. Suctioning should not be required related to this drug.

A female client is prescribed dantrolene sodium (Dantrium) for painful muscle spasms associated with multiple sclerosis. The nurse is writing the discharge plan for the client and will include which of the following teaching points? (Select all the apply) a. If muscle spasms are severe, supplement the medication with hot baths or showers three times per day. b. Inform the health care provider if she is taking estrogen products. c. Sip water, ice, or hard candy to relieve dry mouth. d. Return periodically for required laboratory work. e. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels.

Answers: b. Inform the health care provider is she is taking estrogen products. c. Sip water, ice, or hard candy to relieve dry mouth d. Return periodically for required laboratory work Rationale: Dantrolene (Dantrium) may cause hepatotoxicity with the greatest risk occurring for women over 35, and periodic laboratory tests will be required for monitoring. Estrogen taken concurrently with dantrolene may increase risk. The drug may cause dry mouth and sucking on hard candy, sucking ice chips, or sipping water may help relieve the dryness. Options a and e are incorrect. Dantrolene may cause erratic blood pressure, including hypotension, and hot baths or showers cause vasodilation, increasing risk for syncope and falls. The drug may cause photo-sensitivity and direct exposure to the sun should be avoided.

A client prescribed cyclobenzaprine​ (Amrix) reports not understanding the importance of moving slowly when getting out of bed each morning. Which adverse effect should the nurse consider when responding to the​ client? A. Bradycardia B. Orthostatic hypotension C. Lower extremity weakness D. Peripheral neuropathy

B Adverse effects of cyclobenzaprine​ (Amrix) are tachycardia and dizziness which could cause orthostatic hypotension.​ Bradycardia, peripheral​ neuropathy, and lower extremity weakness are not common adverse effects of cyclobenzaprine​ (Amrix).

The nurse reviews muscle spasms and muscle spasticity with a new colleague. For which statement should additional teaching be​ provided? A. ​"Clients with muscle spasms generally experience less pain than those with muscle​ spasticity." B. ​"Clients with muscle spasms may have an electrolyte​ imbalance." C. ​"Clients with muscle spasticity have damage to motor areas of the cerebral​ cortex." D. ​"Clients with muscle spasticity usually have greater mobility than those with muscle​ spasms."

B Muscle spasticity usually produces greater impaired mobility and pain than muscle spasms. Spasticity usually results from damage to the motor areas of the cerebral cortex that control muscle movement. Electrolyte imbalances such as​ hypocalcemia, hypokalemia, or dehydration may cause muscle​ spasms, not spasticity.

A patient is beginning to take cyclobenzaprine for treatment of acute back spasms. Which interventions will the nurse include in the care of this patient? (Select all that apply) A) advise the patient to take this drug on an empty stomach B) inform the patient not to abruptly stop taking the muscle relaxant; the dose should be tapered down C) tell the patient to report dizziness and double vision to the health care provider D) advise the patient to avoid alcohol E) taking narcotics at the same time can cause serious side effects

B) inform the patient not to abruptly stop taking the muscle relaxant; the dose should be tapered down C) tell the patient to report dizziness and double vision to the health care provider D) advise the patient to avoid alcohol E) taking narcotics at the same time can cause serious side effects

A mechanically ventilated patient receiving a neuromuscular blocking agent has tearing in the eyes and increased heart rate and blood pressure. What is the nurse's initial action? A) stop the medication; the patient is having an adverse reaction to the medication B) notify the physician; patient's level of sedation is inadequate C) notify the physician; patient's dose of the neuromuscular blocking agent is too high D) document findings and monitor; these effects are expected

B) notify the physician; patient's level of sedation is inadequate Tearing in eyes and increased heart rate and blood pressure are symptoms of increased anxiety and/or pain. A patient receiving a neuromuscular blocking agent cannot move or communicate; thus, the nurse must rely on subtle changes to assess adequate sedation. Simply documenting findings or monitoring will not relieve the patient's symptoms.

A patient with multiple sclerosis is being treated with large doses of corticosteroids. Which nursing diagnosis would be the priority at this time? A) alteration in nutrition: less than body requirements B) risk for infection C) ineffective individual coping D) fatigue

B) risk for infection Suppression of the immune system and risk for infection are two of the many side effects associated with high-dose corticosteroid therapy.

The nurse is caring for a patient with muscle spasticity from multiple sclerosis (MS). Which skeletal muscle relaxant should the nurse expect to be prescribed for this patient? Baclofen (Lioresal) Dantrolene (Dantrium) Incobotulinumtoxin A (Xeomin) Onabotulinum A (Botox)

Baclofen (Lioresal) Baclofen (Lioresal) is structurally similar to the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). It has been used to reduce muscle spasms in patients with MS, cerebral palsy (CP), and spinal cord injury. Dantrolene is indicated for spasms of the head and neck. Incobotulinumntoxin A and onabotulinum A are not used to treat muscle spasticity from multiple sclerosis. previous

A patient has spasticity following a spinal cord injury. The nurse anticipates that which drug will be prescribed to treat the patient's spasticity? A) neostigmine B) ropinirole C) cyclobenzaprine D) pyridostigmine

C) cyclobenzaprine Neostigmine and pyridostigmine are used to treat myasthenia gravis. Ropinirole is used to treat Parkinson's disease.

A nurse is caring for a patient prescribed neostigmine orally. Which instruction will the nurse include in the patient's plan of care? A) administer neostigmine every 8 hours B) monitor for onset of action in 4 hours C) monitor the patient for respiratory depression D) make sure that naloxone hydrochloride is readily available

C) monitor the patient for respiratory depression Neostigmine is a fast-acting AChE inhibitor that, when administered orally, has an onset of action of 0.5 to 1 hour; it is given every 2 to 4 hours. The nurse should monitor the patient for respiratory depression, which is a life-threatening adverse effect. Atropine is the antidote for a cholinergic crisis.

A child with cerebral palsy is ordered to receive baclofen. The nurse is aware that this medication is prescribed to: A) induce sleep and rest B) increase appetite C) reduce muscle spasticity D) increase bowel function

C) reduce muscle spasticity Muscle relaxants are used to decrease a patient's muscular pain and spasticity.

The antidote for Benzodiazepines is what medication below? A. Protamine Sulfate B. Acetylcysteine C. Physostigmine D. Flumazenil E. Fomepizole

D

A client is prescribed cyclobenzaprine​ (Amrix). For which health problem should the nurse question administering this​ medication? A. Osteoarthritis B. Myasthenia gravis C. Gastroenteritis D. Hypothyroidism

D Cyclobenzaprine should be used with caution in clients with myocardial infarction​ (MI), dysrhythmias,​ hypothyroidism, or severe cardiovascular disease. The medication can be safely used in​ osteoarthritis, gastroenteritis, and myasthenia gravis.

A patient with myasthenia gravis comes to the emergency department in respiratory distress. He has been diagnosed with myasthenic crisis. The nurse anticipates administration of which drug? A) diazepam B) baclofen C) edrophonium D) neostigmine

D) neostigmine Neostigmine is a short-acting acetylcholinesterase (cholinesterase) inhibitor which can relieve myasthenic crisis. Edrophonium (Tensilon) is most commonly used to differentiate between myasthenic crisis and cholinergic crisis; diazepam is an anxiolytic, and baclofen is a muscle relaxant.

A patient who received general anesthesia develops malignant hyperthermia. Which medication should the nurse expect to be prescribed for this patient? Dantrolene (Revonta) Clonazepam (Klonopin) Diazepam (Valium) Lorazepam (Ativan)

Dantrolene (Revonta) Malignant hyperthermia is a rare, life-threatening,anesthetic-related disorder that occurs in susceptible patients following the administration of a triggering agent,such as inhaled halogenated volatile anesthetics or succinylcholine.Once triggered, a rapidly progressive hypermetabolic reaction involving sustained muscle contraction occurs with potentially devastating consequences. Treatment of malignant hyperthermia requires rapid administration of dantrolene 1 mg/kg every 4 to 6 hours or alternatively 0.25mg/kg/hr continuous infusion for 24 hours is recommended. Clonazepam, diazepam, and lorazepam are not used to treat malignant hyperthermia.

A patient reports tight, painful leg muscles after exercising at the gym. From which class should the nurse anticipate a medication being prescribed for this patient? Nonsteroidal anti-inflammatory drug (NSAID) Opioid analgesic Benzodiazepine Corticosteroid

Nonsteroidal anti-inflammatory drug (NSAID) Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the firstline drugs for treating minor to moderate pain due to muscle overexertion. Opioid analgesics, benzodiazepines, and corticosteroids are not first-line medications for treating muscle spasms.

An older patient is prescribed a muscle relaxant. Which dietary teaching should the nurse provide this patient? "Consume more seafood." "Consume whole grains." "Consume electrolyte-replacement drinks." "Consume less dietary sodium."

"Consume whole grains." The older adult taking a muscle relaxant is at increased risk of constipation due to slowed peristalsis. Additional fiber may easeconstipation. There is no benefit of increasing consumption of seafood, drinking electrolyte-replacement drinks, or increasing dietary sodium intake while taking the medication.

A patient prescribed dantrolene (Dantrium) asks why a blood specimen is being drawn. Which response should the nurse make? "Dantrolene can increase heart enzyme levels." "Dantrolene can increase the risk for anemia." "Dantrolene can be toxic to the pancreas." "Dantrolene can be toxic to the liver."

"Dantrolene can be toxic to the liver." Liver function tests should be conducted before a patient receives dantrolene (Dantrium) because hepatitis and deaths due to liver failure have occurred in patients taking dantrolene. Liver function tests should be conducted periodically during therapy. Dantrolene is not expected to increase cardiac

A patient is prescribed cyclobenzaprine (Amrix). Which question should the nurse ask when assessing the patient's tolerance to the medication? "Have you experienced insomnia since starting the medication?" "Have you experienced increased salivation since starting the medication?" "Have you experienced bladder pressure since starting the medication?" "Have you experienced increased hair growth since starting the medication?"

"Have you experienced bladder pressure since starting the medication?" Skeletal muscle relaxants can cause an anticholinergic effect and leading to urinary retention. The patient should be instructed to report an inability to void, increasing bladder pressure, or pain. Insomnia, increased salivation, and increased hair growth are not expected to occur when taking skeletal muscle relaxants. Drowsiness and dry mouth are more likely to occur.