Mod 14- Muscle Relaxants

Question 1

Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?

Answer 1

Avoid alcohol or other CNS depressants.

Question 2

The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects?

Answer 2

Inspection for muscle spasticity and range of motion assessment
Explanation:
Baclofen is prescribed to treat muscle spasticity and/or acute musculoskeletal discomfort

Question 3

The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for?

Answer 3

Drowsiness

Question 4

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?

Answer 4

“You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity.”

Question 5

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?

Answer 5

Treatment will involve a series of injections every three months

Question 6

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?

Answer 6

“It’s safest to have these injections performed under medical supervision.”

Question 7

Which medication is classified as an antianxiety medication but is also used to treat muscle spasms?

Answer 7

Diazepam (Valium)
Explanation:
Diazepam (Valium), a drug widely used as an anxiety agent, also has been shown to be an effective centrally acting skeletal muscle relaxant. It may be advantageous in situations in which anxiety may be precipitating the muscle spasm.

Question 8

Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?

Answer 8

Hepatic dysfunction
Explanation:
Dantrolene therapy must be discontinued at any sign of liver dysfunction.

Question 9

When does a client with spinal cord injury–associated spasticity require treatment for this condition?

Answer 9

Safety, mobility, and activities of daily living are impaired.
Explanation:
In clients with spinal cord injury, spasticity requires treatment when it impairs safety, mobility, and the ability to perform activities of daily living (e.g., self-care in hygiene, eating, dressing, and work or recreational activities).

Question 10

A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?

Answer 10

Dantrolene
Explanation:
Dantrolene is the drug that would be used as prevention and treatment of malignant hyperthermia.

Question 11

Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation?

Answer 11

Baclofen

Question 12

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?

Answer 12

Notify the physician

Question 13

A patient receives intrathecal baclofen at 10 AM. The nurse would expect to see the maximum effect of this drug at approximately what time?

Answer 13

3 PM
Explanation:
Intrathecal baclofen peaks in 4 to 6 hours; in this situation, peak or maximum drug effects would occur around 3 PM.

Question 14

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?

Answer 14

Cyclobenzaprine produces an anticholinergic response
Explanation:
Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.

Question 15

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?

Answer 15

“Make sure that you don’t stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply.”
Explanation:
Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders

Question 16

While most muscle relaxants drugs are central nervous system (CNS) depressants, which medication acts only on the muscle?

Answer 16

dantrolene
Explanation:
Dantrolene is the only skeletal muscle relaxant that acts peripherally on the muscle itself; it inhibits the release of calcium in skeletal muscle cells, thereby decreasing the strength of muscle contraction.

Question 17

T/F: Spinal reflexes are the simplest nerve pathways that monitor movement and posture.

Answer 17

TRUE

Question 18

T/F: Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area.

Answer 18

TRUE

Question 19

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?

Answer 19

Risk for Injury related to CNS depression
Explanation:
The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity.

Question 20

Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of:

Answer 20

hepatocellular disease

Question 21

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?

Answer 21

“The combination of baclofen and alcohol could depress your nervous system to a dangerous level.”

Question 22

A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency?

Answer 22

dantrolene
Explanation:
Dantrolene acts directly on skeletal muscle to inhibit muscle contraction. It is used to relieve spasticity in neurologic disorders (e.g., MS, spinal cord injury) and to prevent or treat malignant hyperthermia, a rare but life-threatening complication of anesthesia characterized by hypercarbia, metabolic acidosis, skeletal muscle rigidity, fever, and cyanosis

Question 23

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?

Answer 23

Drowsiness
Explanation:
The nurse should monitor for drowsiness in the client as the adverse reaction of carisoprodol administration.

Question 24

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?

Answer 24

Decreased muscle spasms

Question 25

The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching?

Answer 25

Hepatitis
Explanation:
The most serious adverse effect of oral dantrolene is fatal hepatitis.

Question 26

Patients receiving chlorzoxazone should be cautioned that what will occur with administration?

Answer 26

Discoloration of urine
Explanation:
Chlorzoxazone may discolor urine, becoming orange to purple-red when metabolized and excreted. Patients should be warned about this effect to prevent fears of blood in the urine.

Question 27

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?

Answer 27

Dantrolene sodium

Question 28

The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching?

Answer 28

Hypotension
Explanation:
Hypotension is the most significant adverse effect of tizanidine.

Question 29

A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which drug would the nurse expect the physician to order?

Answer 29

Dantrolene
Explanation:
Dantrolene is indicated for the control of spasticity resulting from upper motor neuron disorders such as amyotrophic lateral sclerosis

Question 30

A nurse understands that which skeletal muscle relaxants should not be administered to a client with skeletal muscle spasms caused by systemic lupus erythematosus?

Answer 30

Baclofen
Explanation:
A nurse should not administer the skeletal muscle relaxant baclofen (Lioresal) to a client with skeletal muscle spasms caused by systemic lupus erythematosus, as baclofen is contraindicated in skeletal muscle spasms caused by rheumatoid disorders. Cyclobenzaprine is contraindicated in clients with a recent myocardial infarction, cardiac conduction disorders, and hyperthyroidism. In addition, cyclobenzaprine is contraindicated within 14 days of the administration of a monoamine oxidase inhibitor (MAOI). Carisoprodol is used with caution in clients with severe liver or kidney disease and during pregnancy (category unknown) and lactation. Cyclobenzaprine is used cautiously in clients with cardiovascular disease and during pregnancy and lactation (pregnancy category B). Methocarbamol is used for muscle pain relief and stiffness.

Question 31

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?

Answer 31

“This will likely make you drowsy, so don’t take it before doing anything that would require alertness.”

Question 32

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?

Answer 32

When close supervision is available for monitoring drug effects
Explanation:
For most of the skeletal muscle relaxants, safety and effectiveness for use in children 12 years of age and younger have not been established. The drugs should be used only when clearly indicated, for short periods, when close supervision is available for monitoring drug effects (especially sedation), and when mobility and alertness are not required.