Pharm Ch 25 Muscle Relaxants
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." - "You'll have to come to the hospital daily to be administered this drug." - "You'll find that your muscles will get progressively stronger over the next several weeks." - "Take an over-the-counter laxative so that you don't get constipated."
"Make sure to see your health care provider promptly if you develop yellowish skin or eyes."
A client comes to the health care provider's office. The client is to receive botulinum toxin. What, if assessed, would suggest to the nurse that the drug administration should be postponed? - Difficulty swallowing - Recent gastrointestinal upset - Reports of urinary frequency - Infection at the intended site of administration
Infection at the intended site of administration
A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to: - increase fluid intake and self-monitor for decreased urine output. - increase intake of foods that are high in potassium. - avoid drinking alcohol for the duration of treatment. - avoid eating grapefruit or drinking grapefruit juice until treatment is discontinued.
avoid drinking alcohol for the duration of treatment
When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as a common adverse reaction? - Tachycardia - Drowsiness - Dyspnea - Hypertension
drowsiness
A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency? - carisoprodol - dantrolene - methocarbamol - metaxalone
Dantrolene
The nurse is caring for a 59 year-old female client who was diagnosed with multiple sclerosis two years ago. In recent weeks, the client has developed increasing muscle spasticity and the care team is considering the use of dantrolene. What assessment question should the nurse prioritize? - "Have you ever been treated for fibromyalgia?" - "Are you on hormone replacement therapy?" - "Have you had a hysterectomy?" - "At what age did you begin menopause?"
"Are you on hormone replacement therapy?"
Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation? - Alendronate - Allopurinol - Baclofen - Hydroxychloroquine
Baclofen
A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response" - "Please check in again if it doesn't clear up within the next 24 hours." - "It's likely that your chlorzoxazone is reacting with one of your other medications." - "This drug causes your urine to change color, so it's not likely blood that you're seeing." - "There's a risk of that with this particular medication, so you should come be assessed promptly."
"This drug causes your urine to change color, so it's not likely blood that you're seeing."
A client is receiving baclofen at 8 AM. The nurse would monitor the client for evidence of maximum effect at which time? - 12 PM - 10 AM - 9 AM - 11 AM
10 AM
The nurse who is a case manager is overseeing the care of several clients, both inpatient and community-dwelling. Which client is most likely to benefit from the administration of baclofen? - A client with chronic migraines who has not responded to conventional treatment - A client who is undergoing rehabilitation following a spinal cord injury at C7 - A client with longstanding lower back pain from working long hours at a desk - A client with Parkinson's disease who has tremors and gait disturbances affecting quality of life
A client who is undergoing rehabilitation following a spinal cord injury at C7
During surgery to repair a ruptured Achilles tendon, the client develops severe muscle contractions and a dramatic rise in body temperature. Which medication will be administered? - Dantrolene sodium - Baclofen - Carisoprodol - Cyclobenzaprine
Dantrolene sodium
Which medication will inhibit the release of calcium in skeletal muscle cells to minimize the development of muscle contractions? - Dantrolene sodium - Baclofen - Carisoprodol - Cyclobenzaprine
Dantrolene sodium
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? - Insomnia - Drowsiness - Anxiety - Constipation
Drowsiness
The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for? - Muscle spasms - Drowsiness - Urinary incontinence - Insomnia
Drowsiness
The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching? - Hypercarbia - Hepatitis - Renal calculi - Metabolic acidosis
Hepatitis
The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching? - Excessive salivation - Dark black urine - Eczema - Hypotension
Hypotension
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? - Uncontrolled hypertension - Myocardial ischemia - Cerebrovascular accident - Malignant hyperthermia
Malignant hyperthermia
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? - Impaired Swallowing related to increased muscle tone - Risk for Injury related to CNS depressant effects - Altered Nutrition, Less than Body Requirements, related to appetite suppression - Diarrhea related to anticholinergic effects
Risk for injury related to CNS depressant effects
A client's migraines are not being adequately controlled by triptans and so the client is preparing to begin treatment with onabotulinumtoxin A. What should the nurse teach the client about this treatment? - The client will need to carry a supply of the botulism antitoxin for the duration of treatment - The client will receive in intramuscular depot injection once per week - Treatment will involve a series of injections every three months - The client will likely require inpatient monitoring for the first 24 hours after starting treatment
Treatment will involve a series of injections every three months
A client 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 - Decreased severity and duration of exacerbations - Reduction in the appearance of new lesions in magnetic resonance imaging (MRI) studies - Increased muscle strength
Decreased muscle spasms
A client with a recent history of muscle spasticity has been prescribed tizanidine. What finding on the client's most recent laboratory report should prompt the nurse to contact the care provider? - Decline in sodium - Rise in liver enzymes - Decline in neutrophils - Rise in blood urea nitrogen
Rise in liver enzymes
A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor: - alanine aminotransferase and total bilirubin levels. - prothrombin time and partial thromboplastin time. - follicle-stimulating hormone levels. - urine specific gravity.
Alanine aminotransferase and total bilirubin levels
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? - "There's a small risk that you might experience some hallucinations in the first few days that you begin taking this drug." - "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time." - "We'll need to closely monitor your blood sugar levels for the next week." - "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."
"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."
A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which drug would the nurse expect the physician to order? - Methocarbamol - Chlorzoxazone - Dantrolene - Metaxalone
Dantrolene
A patient has been prescribed methocarbamol for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which statement by the patient indicates that the patient has an understanding of at least one of the significant side effects of methocarbamol? - "My urine could be discolored while I take this drug." - "This drug will help my tension headaches." - "I will probably have diarrhea while taking this drug." - "I should have lots of energy while taking this drug."
"My urine could be discolored while I take this drug."
Which skeletal muscle relaxant is also available in intrathecal form? - Baclofen (Lioresal) - Tizanidine (Zanaflex) - Cyclobenzaprine (Flexeril) - Carisoprodol (Soma)
Baclofen (Lioresal)
Which medication is classified as an antianxiety medication but is also used to treat muscle spasms? - Tizanidine (Zanaflex) - Carisoprodol (Soma) - Diazepam (Valium) - Chlorzoxazone (Paraflex)
Diazepam (Valium)
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? - Continuous pulse oximetry - Seizure precautions - Deep breathing and coughing exercises - Falls prevention measures
Falls prevention measures
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." - "You're not permitted to drink alcohol while you're taking baclofen." - "If you combine baclofen and alcohol you could suffer a severe allergic-type reaction." - "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants."
"The combination of baclofen and alcohol could depress your nervous system to a dangerous level."
A client who is experiencing lower back pain has been prescribed cyclobenzaprine. 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." - "Don't use this for more than five consecutive days to prevent damage to your liver." - "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."
"This will likely make you drowsy, so don't take it before doing anything that would require alertness."
Baclofen (Lioresal) is used in the treatment of muscle spasticity associated with which disease processes? (Select all that apply.) - Tetanus - Multiple sclerosis - Spinal cord injury - Muscle rigidity - Quinidine-induced leg cramps
- Multiple sclerosis - Spinal cord injury - Muscle rigidity
Which would a nurse include when describing the action of dantrolene? - Interference with calcium release from the muscles - Inhibition of the release of acetylcholine - Interference with the reflexes causing the spasm - Inhibition of presynaptic motor neurons in central nervous system
Interference with calcium release from the muscles
Which is the drug of choice in children who need to be treated with tetanus? - Carisoprodol (Soma) - Baclofen (Lioresal) - Methocarbamol (Robaxin) - Dantrolene (Dantrium)
Methocarbamol (Robaxin)
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? - Monitor the client before ambulating. - Give the medication at the same time each day. - Instruct on how to assess client's pain level. Administer the medication with meals.
Monitor the client before ambulating
A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient? - Reduction of muscle spasm - Prevention of convulsion - Relief from nervous disorder - Relief from anxiety
Reduction of muscle spasm
When reviewing a client's history, which condition would the nurse identify as contraindicating the use of a centrally acting skeletal muscle relaxant? - Hypertension - Epilepsy - Depression - Rheumatic disorder
Rheumatic disorder
A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider? - The client has gained 1.5 lbs. over the past 48 hours - The client is reluctant to participate in physical therapy this morning, when she is normally highly motivated - The client's most recent laboratory results show an upward trend in AST and ALT levels - The client tells the nurse, "I'm struggling to come to grips with the fact that I'm never going to recover."
The client's most recent laboratory results show an upward trend in AST and ALT levels
Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area. - False - True
True
Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of: - cerebral hemorrhage. - hepatocellular disease. - diabetic ketoacidosis. - congestive heart failure.
hepatocellular disease
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: - skeletal muscle trauma and will improve in time. - inflammation of the muscles; therefore, NSAIDs may be effective. - nerve damage in the brain and spinal cord, and it is a permanent condition. - 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.
