Unit 5: Chapter 25 (Karch 7th Ed) - Muscle Relaxants Flashcards
- The nurse is teaching a class on muscular coordination and explains it is the movement of what
electrolyte that contributes to the process of muscle contraction and relaxation?
A) Calcium
B) Chloride
C) Magnesium
D) Hydrogen
Ans: A
Feedback:
Calcium is released from the sarcoplasmic reticulum, which leads to the binding of calcium with
troponin tropomyosin. This leads to contraction of the muscle fiber. The calcium pump then moves
calcium back into the sarcoplasmic reticulum, which leads to relaxation of muscle fiber. Chloride,
magnesium, and hydrogen are not involved in this process.
- A mother brings her 9-year-old son to the clinic for a routine check up. The 9-year-old boy has cerebral
palsy and is very spastic. The mother asks the nurse what causes the spasticity in her son. What is the
nurse’s best response?
A) Your son’s spasticity is caused by injury to the muscle tissue.
B) Your son’s spasticity is caused by deficiency of a neurotransmitter called serotonin.
C) Your son’s spasticity is caused by damaged sensory neurons.
D) Your son’s spasticity is caused by damaged motor neurons.
Ans: D
Feedback:
Muscle spasticity is the result of damage to neurons within the central nervous system (CNS) rather
than injury to peripheral structures such as the musculoskeletal system. Serotonin is not involved in the
process of muscle contraction and relaxation. Although acetylcholine is released and increases muscle
cell membrane permeability to sodium, which eventually leads to the release of calcium, this process
does play a vital part in muscle contraction and relaxation.
- A nurse is providing discharge teaching for a patient who will be going home on cyclobenzaprine
(Flexeril) prescribed for his acute musculoskeletal pain. The nurse will stress that the patient should
avoid what?
A) Drinking alcohol
B) Taking antiemetics
C) Taking antihistamines
D) Taking antibiotics
Ans: A
Feedback:
Taking cyclobenzaprine with alcohol can cause an increase in central nervous system depression. The
nurse should stress that this combination should be avoided due to possible injury or severe body
system depression that could lead to coma or death. No significant concerns exist with the use of
antiemetics, antihistamines, or antibiotics with this drug.
- The nurse provides patient teaching about chlorzoxazone (Paraflex) in preparation for the patient’s
discharge to home. The nurse evaluates the patient understands potential adverse effects when the
patient makes what statement?
A) This drug can cause diarrhea.
B) My urine may turn orange to purple red while taking this drug.
C) My skin may turn yellow but that will go away when I stop taking the drug.
D) After I take a pill it will take 2 to 3 hours before I feel the effects.
Ans: B
Feedback:
The patient indicates an understanding of adverse effects of this drug by stating that his urine may be
discolored while using the drug. Chlorzoxazone may discolor the urine, which will turn orange to
purple-red when metabolized and excreted. Patients should be warned about this effect to prevent any
fears of blood in the urine. Chlorzoxazone usually causes constipation, not diarrhea. The onset of action
is usually within an hour after the drug has been taken. Yellow discoloration of the skin would indicate
liver damage or dysfunction, which should be reported immediately.
5. The nurse admits a child diagnosed with tetanus. What medication will the nurse expect to administer? A) Methocarbamol (Robaxin) B) Baclofen (Lioresal) C) Dantrolene (Dantrium) D) Diphenhydramine (Benadryl)
Ans: A
Feedback:
Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene
are not recommended for use with children. Diphenhydramine is not indicated for treatment of tetanus.
6. A 20-year-old female patient has been diagnosed with multiple sclerosis. What drug will most likely be prescribed? A) Baclofen (Lioresal) B) Cyclobenzaprine (Flexeril) C) Metaxalone (Skelaxin) D) Orphenadrine (Banflex)
Ans: A
Feedback:
Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as
multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort
associated with painful, acute musculoskeletal conditions
- The nurse is caring for four patients. Which patient would have the highest risk for hepatotoxicity from
dantrolene (Dantrium)?
A) An 87-year-old man who is taking a cardiac glycosideh
B) A 32-year-old man who is taking an antipsychotic drug
C) A 65-year-old woman who is on hormone replacement therapy
D) A 48-year-old woman who is taking an antihypertensive agent
Ans: C
Feedback:
If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This
combination should be avoided. Nothing indicates that patients taking a cardiac glycoside, an
antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with
dantrolene therapy.
8. The nurse alerts the patient to what adverse effect of tizanidine (Zanaflex) that could cause injury? A) Constipation B) Dry mouth C) Fatigue D) Hypotension
Ans: D
Feedback:
Tizanidine has been associated with hypotension, which could be a safety risk especially if the patient
is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse
effects that do not pose a safety risk.
- A young woman attends a Botox Party and is injected with botulinum toxin type A to decrease frown
lines between her eyebrows. Later that evening the patient is admitted to the emergency department and
is hysterical, because she cannot move her eyebrows. The nurse explains that that toxin causes what?
A) The toxin causes muscle death, which smoothes wrinkles in the area.
B) The toxin causes muscle paralysis, preventing movement and relieving wrinkles.
C) The drug is a toxin to nerves in the area.
D) The drug is a permanent muscle relaxant and the muscles will never move again.
Ans: B
Feedback:
Botulinum toxin types A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine, leading to local muscle paralysis. These two drugs are injected locally and
used to paralyze or prevent the contractions of specific muscle groups. The action smoothes wrinkles in
the area, but does not cause muscle death. The effect is temporary and does not cause nerve death. The
other options are false statements
- A patient has stepped on a rusty nail and is exhibiting signs of muscle rigidity and contractions. The
patient’s wife called the emergency department (ED) and the triage nurse told her to bring him in. The
ED nurse will have which drug available for administration when the patient arrives?
A) Carisoprodol (Soma)
B) Cyclobenzaprine (Flexeril)
C) Metaxalone (Skelaxin)
D) Methocarbamol (Robaxin)
Ans: D
Feedback:
The patient is exhibiting signs of tetanus and methocarbamol (Robaxin) is indicated for treatment.
Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus.
- The nurse assesses a newly admitted patient and finds the muscle tone in his left leg has sustained
muscle contraction. How will the nurse document this finding?
A) Tonus
B) Flaccid
C) Atonic
D) Spastic
Ans: D
Feedback:
Muscle spasticity is defined as a sustained muscle contraction. Soft and flabby muscle tone is defined
as atonic. A limp muscle without tone is described as flaccid. The state of readiness, known as muscle
tone (tonus), is produced by the maintenance of some of the muscle fibers in a contracted state.
- A patient comes to the clinic to receive a Botox injection in her forehead. The patient has adult acne
across her forehead. What is the nurse’s priority action?
A) Hold the injection and consult the health care provider.
B) Cleanse the area well with an antibacterial soap.
C) Apply a topical antibiotic after administering the Botox.
D) Provide patient information about post-Botox injection care.
Ans: A
Feedback:
Botulinum toxins should not be injected into any area with an active infection because of the risk of
exacerbation of the infection. As a result, the nurse would hold the injection and consult with the
physician, with the expectation the medication would be held until the acne resolved. Cleansing the
area well, applying a topical antibiotic, and providing information about postinjection care would not
resolve the problem and are not indicated.
- The patient presents to the emergency department with muscle spasms in the back. What types of injury
would the nurse recognize can result in muscle spasm? (Select all that apply.)
A) Overstretching a muscle
B) Wrenching a joint
C) Tearing a tendon or ligament
D) Breaking a bone
E) Exercising too vigorously.
Ans: A, B, C
Feedback:
Muscle spasms often result from injury to the musculoskeletal system (e.g., overstretching a muscle,
wrenching a joint, tearing a tendon or ligament). These injuries can cause violent and painful
involuntary muscle contractions. Breaking a bone or exercising would not cause muscle spasms unless
one of the other options was involved
- The nurse is giving discharge instructions to a patient who just had Botox A injections around her eyes.
What adverse effects would the nurse include in her discharge instructions? (Select all that apply.)
A) Respiratory infections
B) Flu-like syndrome
C) Droopy eyelids
D) Cough
E) Diarrhea
Ans: A, B, C
Feedback:
Adverse effects associated with use of botulinum toxin type A for cosmetic purposes include headache,
respiratory infections, flu-like syndrome, and droopy eyelids in severe cases. Adverse effects do not
include cough or diarrhea.
- A patient with severe spasticity sees his physician. The physician orders dantrolene. In what
circumstances is the drug dantrolene contraindicated?
A) Spasticity that contributes to upright position
B) Spasticity that involves both legs
C) Spasticity that involves the arm and the leg on the same side
D) Spasticity that contributes to mobility
Ans: A
Feedback:
Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also
contraindicated in the following conditions: spasticity that contributes to locomotion, upright position,
or increased function, which would be lost if that spasticity was blocked; active hepatic disease, which
might interfere with metabolism of the drug and because of known liver toxicity; and lactation because
the drug may cross into breast milk and cause adverse effects in the infant. The other options would not
contraindicate the medication.
