NURS 317 Unit 6 Pharm Chapter 25

Question 1

The nurse is preparing to administer a client’s scheduled dose of baclofen and notes that the client’s most recent oral temperature was 100.9° (38.3°C). What is the nurse’s best action?

A) Administer the medication as prescribed and monitor the client.

B) Hold the baclofen, administer antipyretics as prescribed, and reassess the client in 1 hour.

C) Perform a focused respiratory assessment.

D) Report this assessment finding promptly to the care provider.

Answer 1

A) Administer the medication as prescribed and monitor the client.

Rationale:A fever is not necessarily an indication that the client’s baclofen should be held. Administering the drug as prescribed does not pose any clear safety risk in the presence of a fever. The nurse will need to follow up the client’s fever, but there is no obvious need to report it.

Question 2

What client is most likely to benefit from Botox (incobotulinumtoxin A) injections?

A) A client who was diagnosed with myasthenia gravis 18 months ago

B) A client who has chronic lumbar and thoracic pain following a workplace accident

C) A client with cerebral palsy whose upper body spasticity has worsened in recent months

D) A client who suffers debilitating migraines 2 to 3 days per week

Answer 2

D) A client who suffers debilitating migraines 2 to 3 days per week

Rationale:Botox (incobotulinumtoxin A) has been used successfully in some clients with migraines. The injections are not used in the treatment of spasticity, myasthenia gravis, or back pa

Question 3

A client has been prescribed cyclobenzaprine for the treatment of injury-related muscle spasticity. The client asks if it is safe to take ibuprofen while taking cyclobenzaprine. What should the nurse teach the client?

A) “Check with your care provider, but it’s likely not a problem.”

B) “It would probably be unsafe because both drugs are from similar families.”

C) “Confirm with your provider, but it would likely be quite hard on your liver.”

D) “Ask your care provider, but the combination might make you dangerously drowsy.”

Answer 3

A) “Check with your care provider, but it’s likely not a problem.”

Rationale:In most cases, centrally acting skeletal muscle relaxants are not contraindicated with NSAIDs. The client should be encouraged to dialogue with the provider before adding OTC medications to the drug regimen.

Question 4

The pyramidal tract is located primarily within the basal ganglia.

A) FALSE

B) TRUE

Answer 4

A) FALSE

Rationale:The pyramidal tract is located primarily within the CNS. The extrapyramidal tract is composed of cells from the cerebral cortex and from several subcortical areas such as the basal ganglia and cerebellum.

Question 5

Centrally acting skeletal muscle relaxants lyse or destroy the spasm.

A) FALSE

B) TRUE

Answer 5

B) TRUE

Rationale:The centrally acting skeletal muscle relaxants work in the CNS to interfere with the reflexes that are causing the muscle spasm. Because these drugs lyse or destroy spasm, they are often referred to as spasmolytics.

Question 6

A client receives baclofen intrathecally at 8:00 AM. The nurse should expect the client’s serum levels of the drug to peak at what time?

A) 8:30AM

B) 9:00AM

C) 12:00PM

D) 1:00PM

Answer 6

C) 12:00 PM

Rationale:Baclofen, when given intrathecally, peaks in approximately 4 hours; in this situation, peak effect would occur at about 12 PM.

Question 7

The nurse administers a client’s scheduled dose of dantrolene PO at 10 AM. The nurse should expect the duration of action to extend until approximately what time?

A) 2PM

B) 4PM

C) 8PM

D) 10PM

Answer 7

C) 8PM

Rationale:Dantrolene’s duration of action is 8 to 10 hours, so the nurse would expect to see drug effects until 8 PM.

Question 8

A nurse is preparing a teaching plan for a client who is to receive botulinum toxin type A for frown lines. What adverse effects should the nurse inform the client could possibly occur? Select all that apply.

A) Abnormal hair growth

B) Drooping eyelids

C) Respiratory infections

D) Headache

E) Gastrointestinal upset

Answer 8

B) Drooping eyelids
C) Respiratory infections
D) Headache

Rationale:Headache, respiratory infection, and drooping eyelids are possible adverse effects of botulinum toxin type A. Gastrointestinal upset is not associated with the use of botulinum toxin type A. Abnormal hair growth is associated with dantrolene therapy, not botulinum toxin type A.

Question 9

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?

A) Rise in blood urea nitrogen

B) Decline in neutrophils

C) Rise in liver enzymes

D) Decline in sodium

Answer 9

C) Rise in liver enzymes

Rationale:Tizanidine is associated with hepatotoxicity, and any early indication of this phenomenon should be promptly reported.

Question 10

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

A) TRUE

B) FALSE

Answer 10

A) TRUE

Rationale:Muscle spasms often result from injury to the musculoskeletal system—for example, overstretching a muscle, wrenching a joint, or tearing a tendon or ligament. These injuries can cause violent and painful involuntary muscle contractions. It is thought that these spasms are caused by the flood of sensory impulses coming to the spinal cord from the injured area.

Question 11

A client sustained a musculoskeletal injury to their left leg that has resulted in occasional spasticity. What should the nurse expect the healthcare provider to prescribe?

A) Dantrolene

B) Baclofen

C) Cyclobenzaprine

D) Botulinum toxin type B

Answer 11

C) Cyclobenzaprine

Rationale:Cyclobenzaprine is used for the treatment of discomfort of acute musculoskeletal conditions. Baclofen is used to treat muscle spasticity associated with neuromuscular diseases. Dantrolene is used to treat upper motor neuron–associated muscle spasticity. Botulinum toxin type B is used to reduce the severity of abnormal head position and neck pain associated with cervical dystonia.

Question 12

What client is using his or her pyramidal tract to the largest extent?

A) A client who is reaching to flush the toilet

B) A client who is filling out the dietary preferences card for the next day

C) A client who is rising from a sitting to a standing position

D) A client who is walking to the dining room

Answer 12

B) A client who is filling out the dietary preferences card for the next day

Rationale:The pyramidal tract is part of the CNS that controls precise intentional movement such as writing. The other clients’ gross movements would entail less involvement from the pyramidal tract.

Question 12

A client with impaired liver function secondary to hepatitis C requires a centrally acting skeletal muscle relaxant for temporary pain relief. What medication would put the least metabolic burden on the client’s liver?

A) Orphenadrine

B) Diazepam

C) Baclofen

D) Methocarbamol

Answer 12

C) Baclofen

Rationale:Baclofen is not metabolized. The other answer choices are centrally acting skeletal muscle relaxants that are all metabolized by the liver to differing degrees.

Question 13

An older adult client’s healthcare provider believes that the client’s back pain would respond well to a centrally acting skeletal muscle relaxant. The nurse is aware that the client’s glomerular filtration rate has fallen in recent months. Which medication would be most appropriate?

A) Cyclobenzaprine

B) Carisoprodol

C) Chlorzoxazone

D) Baclofen

Answer 13

B) Carisoprodol

Rationale:Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older clients, especially those who have renal or liver dysfunction, because it is considered safer than the other options.

Question 14

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?

A) “You’re not permitted to drink alcohol while you’re taking baclofen.”

B) “It’s best to keep your alcohol intake to a low level when you’re taking muscle relaxants.”

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

D) “If you combine baclofen and alcohol you could suffer a severe allergic-type reaction.”

Answer 14

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

Rationale:The nurse should explain the rationale for avoiding alcohol while taking baclofen. The nurse should ideally promote abstinence rather than low intake. The nurse should avoid giving a prohibition without explaining. This combination does not result in an allergic reaction.

Question 15

A client with muscle spasticity following a back injury has been prescribed tizanidine 8 mg t.i.d. for use on an outpatient basis. When filling this prescription for a 2-week supply, how many 4-mg tablets will the pharmacy provide the client with?
_________ Tabs

Answer 15

84 tabs

Rationale:The client’s doses each consist of 2 tablets (8 mg ÷ 4 mg), and the client takes these three times daily, for a total of 6 tablets per day. Over 14 days, the client will need 84 tablets (6 × 14).

Question 16

What adverse effects would a nurse most likely assess in a client who is receiving a centrally acting skeletal muscle relaxant? Select all that apply.

A) Insomnia

B) Constipation

C) Drowsiness

D) Urinary retention

E) Dry mouth

Answer 16

A) Insomnia
B) Constipation
C) Drowsiness
E) Dry mouth

Rationale:Adverse effects include drowsiness, urinary frequency, constipation, hypotension, insomnia, and dry mouth.

Question 17

A client got a cut on their hand while gardening 1 week ago and now shows signs and symptoms of tetanus. The nurse should anticipate the use of what medication?

A) Orphenadrine

B) Methocarbamol

C) Metaxalone

D) Tizanidine

Answer 17

B) Methocarbamol

Rationale:Only methocarbamol is approved for the treatment of tetanus.

Question 18

A client with a family history of malignant hyperthermia is preparing for bowel resection surgery and has been prescribed dantrolene 2.5 mg/kg IV 1 hour before surgery. The client weighs 185 lbs. The nurse reconstitutes dantrolene to a concentration of 50 mg/mL and should add how many milliliters to the IV minibag? Provide your answer to one decimal place.
____________mL

Answer 18

4.2 mL

Rationale:The client’s weight must first be converted to kilograms by dividing by 2.2. This yields 84.1 kg. The client is to receive 2.5 mg/kg and 2.5 × 84.1 = 210.25 mg. Dividing 210.25 by 50 mg/mL = 4.2 mL.

Question 19

What centrally acting skeletal muscle relaxant could the nurse administer IV?

A) Baclofen

B) Tizanidine

C) Orphenadrine

D) Carisoprodol

Answer 19

C) Orphenadrine

Rationale:Only orphenadrine can be administered IV or IM. Baclofen can be given intrathecally while carisoprodol and tizanidine are only given PO.

Question 20

The nurse reviews the client’s medical record before administering dantrolene. What factors would the nurse identify as placing the client at risk for hepatocellular injury? Select all that apply.

A) She is 39 years old.

B) She visits the gym daily to ride a stationary bicycle.

C) She has been diagnosed with rheumatic arthritis.

D) She takes birth control pills containing estrogen.

E) She is married with three children under 10 years of age.

Answer 20

A) She is 39 years old.
D) She takes birth control pills containing estrogen.

Rationale:In women, a combination of dantrolene and estrogen seems to affect the liver, thus posing a greater risk. Women of all ages may be at increased risk, because those entering menopause may be taking hormone replacement therapy. Clients older than 35 years of age are at increasing risk of liver injury because of the changing integrity of the liver cells that comes with age and exposure to toxins over time. While dantrolene is not indicated for the treatment of muscle spasms associated with rheumatic disorders, it is not a factor that would place the client at risk for hepatocellular injury. Visiting the gym, her marital status, and her children have no bearing on use of this drug.

Question 21

The nurse is assessing a client for possible risk factors for the development of hepatotoxicity with the use of dantrolene. What situations would the nurse identify as requiring cautious use of the drug?

A) Age younger than 30 years

B) Spasticity contributing to locomotion or upright position

C) Cirrhosis

D) Female sex

Answer 21

D) Female sex

Rationale:The risk for hepatocellular disease is increased in women. The risk for hepatocellular disease is increased in all clients over the age of 35 years. The drug is not used cautiously but is contraindicated in clients who have spasticity contributing to locomotion or upright position. Dantrolene is contraindicated, not used cautiously, in clients with hepatic disease.

Question 22

The nurse is caring for a client with an intrathecal catheter in place to treat muscle rigidity. What centrally acting skeletal muscle relaxant could the nurse administer intrathecally?

A) Cyclobenzaprine

B) Carisoprodol

C) Chlorzoxazone

D) Baclofen

Answer 22

D) Baclofen

Rationale:Only baclofen can be administered intrathecally. Carisoprodol, chlorzoxazone, and cyclobenzaprine are only administered orally.

Question 23

Dantrolene is being considered for the treatment of a client’s spasticity. Which aspect of the client’s current health status is most likely to contraindicate the use of this medication?

A) The client’s adherence to drug therapy has been irregular.

B) The client has type 1 diabetes and takes insulin regularly.

C) The client takes opioid analgesics on a regular basis.

D) The client’s spasticity is due to rheumatoid arthritis.

Answer 23

D) The client’s spasticity is due to rheumatoid arthritis.

Rationale:Dantrolene is not used for the treatment of muscle spasms associated with musculoskeletal injury or rheumatic disorders. Diabetes, opioids, and issues with adherence would not necessarily contraindicate the use of dantrolene, though these factors must be addressed.

Question 24

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?

A) The client has an infected surgical wound

B) The client is 67 years old

C) The client has respiratory depression from opioid analgesia

D) The client received a blood transfusion less than 24 hours ago

Answer 24

C) The client has respiratory depression from opioid analgesia

Rationale:Clients with respiratory depression need to be monitored closely because the use of dantrolene can increase muscular weakness and exacerbate the respiratory depression. None of the other listed client factors would necessarily require increased monitoring.

Question 25

Spinal reflexes are the simplest nerve pathways that monitor movement and posture.

A) FALSE

B) TRUE

Answer 25

B) TRUE

Rationale:The spinal reflexes are the simplest nerve pathways that monitor movement and posture. Spinal reflexes can be simple, involving an incoming sensory neuron and an outgoing motor neuron, or more complex, involving interneurons that communicate with the related centers in the brain.

Question 26

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

A) FALSE

B) TRUE

Answer 26

A) FALSE

Rationale:Muscle spasticity is the result of damage to neurons within the CNS rather than injury to peripheral structures.

Question 27

A client comes to the clinic seeking information about having Botox injections to reduce eye wrinkles. What should the nurse teach the client about this treatment?

A) “The effectiveness of Botox injections has been greatly overstated in the media.”

B) “This isn’t a permanent solution. It has to be repeated in 3 months.”

C) “You would need to be sedated so you’re able to stay perfectly still during the injections.”

D) “Some clients have adverse effects of Botox involving muscle spasticity.”

Answer 27

B) “This isn’t a permanent solution. It has to be repeated in 3 months.”

Rationale:Botox injections must be repeated every 3 months. They do not require sedation. Media reports have given much exposure to the treatment, which does have proven effectiveness. Injections do not carry a risk of spasticity.

Question 28

A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered?

A) Cyclobenzaprine

B) Carisoprodol

C) Chlorzoxazone

D) Baclofen

Answer 28

D) Baclofen

Rationale:Baclofen is used for the treatment of muscle spasticity associated with spinal cord injuries. The other answer options are used for the relief of discomfort of acute musculoskeletal conditions.

Question 29

A client who is receiving chlorzoxazone reports that their urine is somewhat orange in color. Which response by the nurse would be most appropriate?

A) “This discoloration sometimes occurs with this drug.”

B) “This drug can temporarily irritate the bladder and cause bleeding.”

C) “We need to discontinue the drug immediately.”

D) “Your kidneys might not be properly getting rid of the drug.”

Answer 29

A) “This discoloration sometimes occurs with this drug.”

Rationale:Chlorzoxazone may discolor the urine, causing it to become purple-red to orange when metabolized and excreted. This is an expected effect and does not require discontinuation of the drug. It is also not a sign of bleeding.