PrepU Ch. 25 & 26 [PathoPharm]
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 Dyspnea Hypertension Tachycardia
Drowsiness
The nurse should anticipate that a client admitted for chronic opioid abuse will be treated with what drug? methadone disulfiram flumazenil naloxone
methadone
Which client would the nurse identify as being opioid naive? one who is psychologically dependent on opioids person who routinely takes opioids individual who is physically dependent on opioids one who does not routinely take opioids
one who does not routinely take opioids
A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?
oral
A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication? Vital signs Glasgow coma scale Subjective assessment Pain scale
Pain scale
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? Increase the dose Titer the dose Reduce the dose Maintain the current dose
Reduce the dose
The client has had a myocardial infarction. The nurse is administering morphine sulfate for the pain. What vital sign would the nurse monitor that directly relates to the use of this narcotic? Pulse Heart rate Temperature Respiratory rate
Respiratory rate
Which medication is classified as an antianxiety medication but is also used to treat muscle spasms? Carisoprodol (Soma) Diazepam (Valium) Tizanidine (Zanaflex) Chlorzoxazone (Paraflex)
Diazepam (Valium)
Patients receiving chlorzoxazone should be cautioned that what will occur with administration? Hypertension Liver toxicity Discoloration of urine Hypotension
Discoloration of urine
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant? Drink eight to 10 glasses of water daily to prevent constipation. Report increased muscle spasm to the health care provider immediately. Always take this medication with food to prevent nausea and vomiting. Do not drive or operate machinery until individual drug effects are known.
Do not drive or operate machinery until individual drug effects are known.
The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine? Increased intracranial pressure Paresthesia in lower extremities Occipital headache Drowiness
Drowiness
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 Constipation Anxiety Drowsiness
Drowsiness
A patient comes to the clinic for a botox injection around her eyes. While making an assessment, the nurse finds that the patient is taking polymyxin for an infection. What would the nurse do first? Document the polymyxin on the chart. Wash her hands. Notify the physician. Prepare the patient for the injection.
Notify the physician.
A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client? CBC and electrolytes Liver function tests Cardiac function tests Hemoglobin and hematocrit
Liver function tests
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 Cerebrovascular accident Uncontrolled hypertension Malignant hyperthermia
Malignant hyperthermia
Which medications are opioids for which naloxone may be given to counter the effects? Meperidine Ibuprofen Acetaminophen Naproxen
Meperidine
A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment? Methadone Tramadol Oxymorphone Oxycodone
Methadone
Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication? Antihypertensive Monoamine oxidase (MAO) inhibitor Antibiotic NSAID
Monoamine oxidase (MAO) inhibitor
A 40-year-old male client with arthritis of the knee joint has been prescribed an analgesic to relieve the pain. Which medication is a narcotic analgesic? Aspirin Morphine Celecoxib Ibuprofen
Morphine
A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what? core body temperature. skin integrity. bowel patterns. urine specific gravity.
bowel patterns.
A history of what medical condition would contraindicate the use of cyclobenzaprine for acute muscle spasms? ransient ischemic attacks (TIA) cardiac dysrhythmias diabetes mellitus chronic obstructive pulmonary disease (COPD)
cardiac dysrhythmias
A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain: codeine. fentanyl. meperidine. hydromorphone
codeine.
While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is: acetaminophen. aspirin. ibuprofen. codeine.
codeine.
A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency? dantrolene metaxalone carisoprodol methocarbamol
dantrolene
Which adverse effect should the nurse assess for when administering cyclobenzaprine? insomnia drowsiness urinary incontinence muscle spasms
drowsiness
A client prescribed dantrolene therapy requires monitoring for what serious adverse effect? hepatitis hypoglycemia hypotension anemia
hepatitis
Which adverse effect of muscle relaxants is most pronounced when a client is prescribed tizanidine therapy? excessive salivation eczema hypotension dark black urine
hypotension
A client has been prescribed morphine 4 - 6 mg IV q4h PRN. The client reports pain rated at 8/10 and the nurse verifies on the MAR that the client has most often required 6-mg doses. The nurse chooses to administer 6 mg. The drug is available in ampules containing 10mg/mL. How many mL should the nurse withdraw and administer?
0.6
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? 2.5 mL 6.05 mL 6.87 mL 2.75 mL
2.75 mL
What would the nurse expect to assess in a client receiving a narcotic for pain relief? Dilation of the pupils Orthostatic hypotension Diarrhea Tachypnea
Orthostatic hypotension
What is a priority nursing assessment of a client prescribed oral sumatriptan? Head to toe assessment Glasgow coma scale Vital signs Urinary output
Vital signs
Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids? hypotension withdrawal symptoms insomnia drowsiness
withdrawal symptoms
Spinal reflexes are the simplest nerve pathways that monitor movement and posture. True False
True
A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which? renal impairment. hypersensitivity to the drug. myocardial infarction. pneumonia.
pneumonia.
Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse is teaching the client upon discharge to avoid alcohol while taking this medication because it can cause which? respiratory depression sedation urinary retention over stimulation of the back muscles kidney pain
respiratory depression
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? "Have you ever received a Botox injection before?" "What effect are you hoping to achieve with the injections? "It's safest to have these injections performed under medical supervision." "These injections have serious side effects so it's best to avoid them."
"It's safest to have these injections performed under medical supervision."
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? "It's best to avoid taking a dose of baclofen unless your spasticity becomes impossible to manage." "You'll likely have to stop taking your other medications for a week to ten days before starting to take baclofen." "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." "Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."
"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."
A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide? "You'll find that your muscles will get progressively stronger over the next several weeks." "Make sure to see your health care provider promptly if you develop yellowish skin or eyes." "Take an over-the-counter laxative so that you don't get constipated." "You'll have to come to the hospital daily to be administered this drug."
"Make sure to see your health care provider promptly if you develop yellowish skin or eyes."
A female client is crying and states that everyone thinks she is a "drug addict," and that no one will listen to her. She states she has abdominal pain and must have something for the pain. What is the best response of the nurse? "Tell me more about your pain." "Your behavior drives our perception." "You do not seem to be in pain right now." "Do you take a lot of pain medication."
"Tell me more about your pain."
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? "You're not permitted to drink alcohol while you're taking baclofen." "The combination of baclofen and alcohol could depress your nervous system to a dangerous level." "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants." "If you combine baclofen and alcohol you could suffer a severe allergic-type reaction."
"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 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." "Don't use this for more than five consecutive days to prevent damage to your liver." "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."
"This will likely make you drowsy, so don't take it before doing anything that would require alertness."
When teaching a client about the safe and effective use of ergotamine in the home setting, what instructions should the nurse provide? "Take this medication at the same time every day to maximize its effectiveness." "This drug may give your urine an orange tint, but this is normal." "When you take the pill, place it under your tongue and then let it dissolve completely." "It's best to take this medication with meals so your stomach doesn't get upset."
"When you take the pill, place it under your tongue and then let it dissolve completely."
A client with myasthenia gravis has been prescribed dantrolene for the treatment of muscle spasticity. What education should the nurse provide to the client? "If you find you're losing your appetite, let me know so we can create a plan." "The care team will follow you closely to ensure that you don't develop a dependence on this medication." "Most clients experience relief from their spasticity for 7 to 10 days following the injection." "You might experience some urinary frequency and urgency. Tell me promptly if it becomes problematic."
"You might experience some urinary frequency and urgency. Tell me promptly if it becomes problematic."
A nurse should recognize the situations when naloxone (Narcan) should be used cautiously. What represents one of those situations? (Select all that apply.) A client with cardiovascular disease A client with an opioid dependency A client with an alcohol dependency A client with chronic obstructive pulmonary disease A client who is pregnant
A client who is pregnant A client with cardiovascular disease A client with an opioid dependency
A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates? Give a dosage only if you think it is necessary. Assess the respiratory rate before giving a dose of opiates. Assess the client's vital signs hourly. Delay the ordered dose if respirations are below 15 bpm.
Assess the respiratory rate before giving a dose of opiates.
The nurse is giving instructions to a client who has just been prescribed sumatriptan for the treatment of migraine headaches. The client will be instructed to take this medication at what time? After other migraine medications have been ineffective Every day at the same time At the onset of migraine symptoms Every 5 minutes until the pain goes away
At the onset of migraine symptoms
Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation? Alendronate Allopurinol Hydroxychloroquine Baclofen
Baclofen
Which skeletal muscle relaxant is also available in intrathecal form? Tizanidine (Zanafelx) Carisoprodol (Soma) Cyclobenzaprine (Flexeril) Baclofen (Lioresal)
Baclofen (Lioresal)
A 3-year-old girl with a diagnosis of spasticity secondary to cerebral palsy has been admitted to the unit. The physician has ordered dantrolene to see if it relieves the spasticity in the child's arms and hands. What would be the priority nursing action? Calculate the correct dosage based on Clark's rule. Wash hands. Prepare the drug for administration. Call the physician and challenge the order.
Call the physician and challenge the order.
The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request? Crushing the medication may precipitate an overdose. The crushed medication can permanently stain teeth. The medication can be very irritating to mucous membranes. Crushing the medication interferes with its absorption.
Crushing the medication may precipitate an overdose.
What factors affect how the patient will experience and respond to pain? Select all that apply. It is a conscious response that the patient has a choice about. Past experience with pain Learned behavior from childhood Cultural expectation about how one should respond to pain
Cultural expectation about how one should respond to pain Past experience with pain Learned behavior from childhood
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 is structurally similar to amitriptyline Cyclobenzaprine acts in the peripheral nervous system Cyclobenzaprine produces an anticholinergic response Cyclobenzaprine has an effect at the neuromuscular junction
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 Baclofen Botulinum toxin type B Methocarbamol
Dantrolene
A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which drug would the nurse expect the physician to order? Methocarbamol Metaxalone Chlorzoxazone Dantrolene
Dantrolene
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 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 female client has been taking dantrolene for several years and has now requested a prescription for oral contraceptives from her primary care provider. What is the nurse's best action? Review each of the other components of the client's current drug regimen Review the client's most recent blood urea nitrogen and creatinine levels, if available Ensure all members of the care team are aware of the risk for hepatotoxicity Educate the client about the risks of taking dantrolene during pregnancy
Ensure all members of the care team are aware of the risk for hepatotoxicity
What action should the nurse take when administering meperidine 75 mg IM every 4 hours to a young adult? Give the medication as prescribed. Call the health care provider for a smaller dose. Administer half the dose. Give the dose by mouth.
Give the medication as prescribed.
Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do these drugs have? Weakness Vomiting Hypotension Dizziness Chronic sleepiness
Hypotension Dizziness Weakness
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? Assessment for seizure activity Inspection for muscle spasticity and range of motion assessment Comparison of fine motor and gross motor skills Bilateral assessment of muscle strength
Inspection for muscle spasticity and range of motion assessment
The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse? Level of consciousness and respiratory rate Pain intensity and blood glucose level Respiratory rate and electrolytes Urine output and pain intensity
Level of consciousness and respiratory rate
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 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 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
When does a client with spinal cord injury-associated spasticity require treatment for this condition? Orthopedic procedures are indicated. Ambulation is possible only with an assistive device. Pain is present in all affected extremities. Safety, mobility, and activities of daily living are impaired.
Safety, mobility, and activities of daily living are impaired.
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 an infected surgical wound The client is 67 years old The client received a blood transfusion less than 24 hours ago The client has respiratory depression from opioid analgesia
The client has respiratory depression from opioid analgesia
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 maintaining a sterile central venous catheter The importance of ensuring safety related to possible sedation The importance of regularly scheduled liver function testing The need to maintain a diet that is high in iron and folic acid
The importance of ensuring safety related to possible sedation
Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area. True False
True
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? Have a complete blood cell count done weekly. Wear appropriate clothing and sunscreen whenever he is in direct sunlight. Eat a high-protein diet. Decrease the dosage if any adverse effect is experienced.
Wear appropriate clothing and sunscreen whenever he is in direct sunlight.
The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function? Slow improvement can be noted throughout the shift. Response is highly individualized based upon client weight. Within one to five minutes, an effect may be seen. Improvement will occur within 30 minutes from the time of administration.
Within one to five minutes, an effect may be seen.
When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide: a return to normal respiratory rate, rhythm, and depth. management of alcohol withdrawal symptoms. alertness and improve memory function. a reduction in the client's rating of their pain.
a return to normal respiratory rate, rhythm, and depth.
