Chapter 25- Muscle Relaxants
Content
Chapter 25 Muscle Relaxants
1.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.
2.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.
3.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.
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4.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.
A)
B)
C)
7.The nurse is caring for four patients. Which patient would have the highest risk for
hepatotoxicity from dantrolene (Dantrium)?
An 87-year-old man who is taking a cardiac glycosideh
A 32-year-old man who is taking an antipsychotic drug
A 65-year-old woman who is on hormone replacement therapy
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D)
Ans:
A 48-year-old woman who is taking an antihypertensive agent
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.
9.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.
10.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:
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The patient is exhibiting signs of tetanus and methocarbamol (Robaxin) is indicated for
treatment. Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus.
11.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.
12.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.
13.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.
14.The nurse is giving discharge instructions to a patient who just had Botox A injections
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A)
B)
C)
D)
E)
Ans:
around her eyes. What adverse effects would the nurse include in her discharge
instructions? (Select all that apply.)
Respiratory infections
Flu-like syndrome
Droopy eyelids
Cough
Diarrhea
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.
15.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.
16.Which muscle relaxant was found to be embryotoxic in animal studies?
A)
Carisoprodol (Soma)
B)
Botulinum toxin A (Botox)
C)
Cyclobenzaprine (Flexeril)
D)
Dantrolene (Dantrium)
Ans:
D
Feedback:
Dantrolene crosses the placenta and was found to be embryotoxic in animal studies.
Botulinum toxin A, carisoprodol, and cyclobenzaprine are not known to be embryotoxic.
17.When spinal reflexes involve synapses with interneurons within the spinal cord, what
physiological adjustments are made?
A)
Coordinate movement and position
B)
Adjust response and recovery
C)
Adjust to upright position
D)
Coordinate balance
Ans:
A
Feedback:
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Other spinal reflexes may involve synapses with interneurons within the spinal cord,
which adjust movement and response based on information from higher brain centers to
coordinate movement and position. Spinal reflexes do not adjust response and recovery,
adjust the body to the upright position, or coordinate balance.
18.What are the simplest nerve pathways in the body?
A)
Arc reflexes
B)
Spinal reflexes
C)
Afferent nerve reflexes
D)
Spindle gamma loop
Ans:
B
Feedback:
The spinal reflexes are the simplest nerve pathways that monitor movement and posture.
Arc reflexes and afferent nerve reflexes are distracters for this question. Spindle gamma
loops respond to stretch receptors.
19.The anatomy and physiology instructor is discussing reflex systems with the prenursing
class. What system would the instructor say causes a muscle fiber contraction that
relieves the stretch?
A)
Arch reflex system
B)
Spinal reflex system
C)
Spindle gamma loop system
D)
Stretch receptor system
Ans:
C
Feedback:
A spindle gamma loop system responds to stretch receptors or spindles on muscle fibers
to cause a muscle fiber contraction that relieves the stretch. In this system, nerves from
stretch receptors form a synapse with gamma nerves in the spinal cord, which send an
impulse to the stretched muscle fibers to stimulate their contraction. These reflexes are
responsible for maintaining muscle tone and keeping an upright position against the pull
of gravity and are important in helping venous return when the contracting muscle fibers
massage veins to help move the blood toward the heart. The arch reflex system and the
stretch receptor system are distracters for this question. The spinal reflex system is not the
reflex systems that respond to stretch receptors in the body.
20.A 3-year-old girl with a diagnosis of spasticity caused by 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. The nurse would schedule this child for what
routine screenings?
A)
Central nervous system and gastrointestinal (GI) function
B)
Respiratory and cardiovascular (CV) function
C)
Growth and development
D)
Renal and hepatic function
Ans:
A
Feedback:
Children prescribed dantrolene should be routinely and regularly screened for central
nervous system and gastrointestinal (including hepatic) toxicity. Growth and development
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should be routinely screened in all children. Renal, respiratory, and CV screening is not
indicated.
21.A patient is admitted to the unit with central spasticity after a terrible motor vehicle
accident. The doctor places an intrathecal delivery pump. What medication can be
administered via this route to treat the central spasticity?
A)
Baclofen (Lioresal)
B)
Cyclobenzaprine (Flexeril)
C)
Dantrolene (Dantrium)
D)
Carisoprodol (Soma)
Ans:
A
Feedback:
Baclofen is available in oral and intrathecal forms and can be administered via a delivery
pump for the treatment of central spasticity. Flexeril, dantrolene, and Soma are not
administered intrathecally.
22.Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What
adverse effects do drugs in this class have? (Select all that apply.)
A)
Coronary artery disease
B)
Hypotension
C)
Urinary frequency
D)
Dizziness
E)
Bone marrow suppression
Ans:
B, C, D
Feedback:
Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation,
headache, insomnia, hypotension, nausea, and urinary frequency. Bone marrow
suppression and coronary artery disease are not associated with therapy involving these
drugs.
23.When caring for a patient taking dantrolene, what adverse effects would the nurse
monitor for? (Select all that apply.)
A)
Bradycardia
B)
Hepatitis
C)
Urinary retention
D)
Fatigue
E)
Rash
Ans:
B, D, E
Feedback:
Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea,
hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary
frequency. Adverse effects of dantrolene do not include bradycardia or urinary retention.
24.The nurse is caring for a patient who is having a pump placed to deliver intrathecal
baclofen and another patient who will receive dantrolene as a muscle relaxant. What
nursing diagnosis would be appropriate for both care plans? (Select all that apply.)
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A)
B)
C)
D)
E)
Ans:
Acute pain related to GI effects of drug
Risk for injury related to central nervous system (CNS) effects
Disturbed body image related to muscle pain
Disturbed thought processes related to CNS effects
Deficient knowledge related to procedure
A, B, D
Feedback:
Acute pain related to GI effects of drug, risk for injury related to CNS effects, and
disturbed thought processes related to CNS effects all apply to both patients. Disturbed
body image may apply to the patient having the pump placed, but this is not related to
muscle pain. Only the patient having the pump placed would need information related to
the procedure.
25.The nurse is caring for a patient who is being discharged home from the rehabilitation
unit. Baclofen will be discontinued and the patient will begin taking carisoprodol as an
outpatient. What is the nurse's primary consideration about discontinuing administration
of baclofen?
A)
“Taper drug over 72 hours to reduce dependence on the drug.”
B)
“Alternate doses of baclofen and soma over 10 days to prevent drug withdrawal.”
C)
“Taper drug slowly over 1 to 2 weeks to prevent psychoses and hallucinations.”
D)
“Start carisoprodol immediately while continuing baclofen at full dose to establish
carisoprodol level.”
Ans:
C
Feedback:
If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of
psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious
adverse effects and would never be done.
26.The nurse is caring for a patient receiving intrathecal baclofen via pump while
participating in rigorous rehabilitation therapy. What is the nurse's priority to monitor
related to adverse effects of this drug?
A)
Blood pressure
B)
Pulse pressure
C)
Spasticity
D)
Respiratory status
Ans:
D
Feedback:
The priority to monitor is respiratory status. One of the primary adverse effects of this
drug is central nervous system (CNS) depression. If the patient receives too much
medication, or reaches toxic levels, respiratory rate will decline as the result of excessive
CNS depression and the drug dosage will either be adjusted downward or the drug may
be held until the patient's respirations improve. Monitoring other vital signs including
blood pressure and pulse is indicated but is not the priority.
27.A patient has been diagnosed with multiple sclerosis and experiences spasticity in several
muscle groups. What drug would the nurse anticipate will be ordered as the drug of
choice to manage spasticity associated with neuromuscular diseases?
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A)
B)
C)
D)
Ans:
Dantrolene (Dantrium)
Baclofen (Lioresal)
Carisoprodol (Soma)
Botulinum toxin type B (Myobloc)
A
Feedback:
Dantrolene directly affects peripheral muscle contraction, and has become important in
the management of spasticity associated with neuromuscular diseases. Baclofen,
carisoprodol, and botulinum toxin type B are not the drugs of choice for management of
spasticity in neuromuscular disease.
28.The nurse is caring for a patient taking dantrolene. How would the nurse assess the
therapeutic effects of this drug?
A)
Observe the patient when emotionally stressed to assess for exacerbation of
spasticity.
B)
Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity.
C)
Measure the amount of spasticity before and after administration of medication.
D)
Collect a thorough history to ask the patient any improvement has been noticed.
Ans:
B
Feedback:
Periodically discontinue drug for 2 to 4 days to monitor therapeutic effectiveness. A
clinical impression of exacerbation of spasticity indicates a positive therapeutic effect and
justifies continued use of the drug. It would not be ethical to stress the patient, there is no
known measurement of spasticity, and the patient may not be able to relate how much
improvement was felt because it is unlikely all spasticity will be eliminated.
29.What drug would the nurse expect to administer to the patient experiencing malignant
hyperthermia?
A)
Orphenadrine
B)
Metaxalone
C)
Chlorzoxazone
D)
Dantrolene
Ans:
D
Feedback:
Indications for dantrolene include control of clinical spasticity resulting from upper
motor neuron disorders; preoperatively to prevent or attenuate the development of
malignant hyperthermia in susceptible patients; IV for management of fulminant
malignant hyperthermia. The other drugs are not indicated for treatment of malignant
hyperthermia.
30.What part of the brain does the nurse recognize the patient is using when making precise,
intentional movements?
A)
Pyramidal tract
B)
Substantia nigra
C)
Broca's area
D)
Extrapyramidal tract
Ans:
A
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Feedback:
Upper-level controls of muscle activity include the pyramidal tract in the cerebellum,
which regulates precise intentional muscle movement, and the extrapyramidal tract in the
cerebellum and basal ganglia, which coordinates crude movements related to unconscious
muscle activity. Broca's area has to do with speech, not movement. The substantia nigra
does not control muscle movement.
31.The patient reports pain caused by muscle spasms in his back. The nurse assesses the
patient as being very anxious and notes how the anxiety results in tensing of muscles.
What medication would be most effective in treating this patient?
A)
Baclofen (Lioresal)
B)
Botulinum toxin type B (Myobloc)
C)
Dantrolene (Dantrium)
D)
Diazepam (Valium)
Ans:
D
Feedback:
Adults complaining of muscle spasm pain that may be related to anxiety often respond
very effectively to diazepam, which is a muscle relaxant and anxiolytic. Although many
drugs, including baclofen, will treat the muscle spasm, diazepam also reduces anxiety.
Dantrolene would be better indicated for spasticity than for spasm and botulinum toxin
type B is not prescribed for either anxiety or muscle spasm.
32.What is the drug of choice for an older adult or a patient with hepatic or renal
impairment?
A)
Baclofen
B)
Carisoprodol
C)
Chlorzoxazone
D)
Cyclobenzaprine
Ans:
B
Feedback:
Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older patients
and for those with hepatic or renal impairment. Although the other options may be
prescribed, older adults are more likely to experience the adverse effects associated with
the drug.
33.After administering a centrally acting skeletal muscle relaxant, what other independent
nursing measures might the nurse implement to relieve pain and reduce spasm?
A)
Rest of the affected muscle
B)
Application of cold
C)
Physical therapy
D)
Order of a nonsteroidal anti-inflammatory drug
Ans:
A
Feedback:
Other measures in addition to drugs should be used to alleviate muscle spasm and pain.
The nurse can independently encourage rest of the affected muscle and provide heat
applications to increase blood flow to the area to remove the pain-causing chemicals.
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34.The nurse is caring for a patient with an infusing IV who is allowed noting by mouth due
to a paralytic ileus. What centrally acting medication could the nurse administer to this
patient?
A)
Chlorzoxazone (Paraflex)
B)
Carisoprodol (Soma)
C)
Cyclobenzaprine (Flexeril)
D)
Orphenadrine (Banflex)
Ans:
D
Feedback:
Only orphenadrine (Banflex) of these options can be given parenterally, either IV or
intramuscularly. The other options are available for oral use only.
35.What is the maximum daily dose of cyclobenzaprine (Flexeril) the nurse can administer?
A)
20 mg
B)
30 mg
C)
40 mg
D)
60 mg
Ans:
D
Feedback:
The normal daily dosage of cyclobenzaprine is 10 mg taken orally t.i.d., and it can be
increased to a maximum of 60 mg per day.
Page 11
1.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.
2.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.
3.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.
Page 1
4.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.
A)
B)
C)
7.The nurse is caring for four patients. Which patient would have the highest risk for
hepatotoxicity from dantrolene (Dantrium)?
An 87-year-old man who is taking a cardiac glycosideh
A 32-year-old man who is taking an antipsychotic drug
A 65-year-old woman who is on hormone replacement therapy
Page 2
D)
Ans:
A 48-year-old woman who is taking an antihypertensive agent
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.
9.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.
10.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:
Page 3
The patient is exhibiting signs of tetanus and methocarbamol (Robaxin) is indicated for
treatment. Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus.
11.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.
12.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.
13.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.
14.The nurse is giving discharge instructions to a patient who just had Botox A injections
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A)
B)
C)
D)
E)
Ans:
around her eyes. What adverse effects would the nurse include in her discharge
instructions? (Select all that apply.)
Respiratory infections
Flu-like syndrome
Droopy eyelids
Cough
Diarrhea
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.
15.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.
16.Which muscle relaxant was found to be embryotoxic in animal studies?
A)
Carisoprodol (Soma)
B)
Botulinum toxin A (Botox)
C)
Cyclobenzaprine (Flexeril)
D)
Dantrolene (Dantrium)
Ans:
D
Feedback:
Dantrolene crosses the placenta and was found to be embryotoxic in animal studies.
Botulinum toxin A, carisoprodol, and cyclobenzaprine are not known to be embryotoxic.
17.When spinal reflexes involve synapses with interneurons within the spinal cord, what
physiological adjustments are made?
A)
Coordinate movement and position
B)
Adjust response and recovery
C)
Adjust to upright position
D)
Coordinate balance
Ans:
A
Feedback:
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Other spinal reflexes may involve synapses with interneurons within the spinal cord,
which adjust movement and response based on information from higher brain centers to
coordinate movement and position. Spinal reflexes do not adjust response and recovery,
adjust the body to the upright position, or coordinate balance.
18.What are the simplest nerve pathways in the body?
A)
Arc reflexes
B)
Spinal reflexes
C)
Afferent nerve reflexes
D)
Spindle gamma loop
Ans:
B
Feedback:
The spinal reflexes are the simplest nerve pathways that monitor movement and posture.
Arc reflexes and afferent nerve reflexes are distracters for this question. Spindle gamma
loops respond to stretch receptors.
19.The anatomy and physiology instructor is discussing reflex systems with the prenursing
class. What system would the instructor say causes a muscle fiber contraction that
relieves the stretch?
A)
Arch reflex system
B)
Spinal reflex system
C)
Spindle gamma loop system
D)
Stretch receptor system
Ans:
C
Feedback:
A spindle gamma loop system responds to stretch receptors or spindles on muscle fibers
to cause a muscle fiber contraction that relieves the stretch. In this system, nerves from
stretch receptors form a synapse with gamma nerves in the spinal cord, which send an
impulse to the stretched muscle fibers to stimulate their contraction. These reflexes are
responsible for maintaining muscle tone and keeping an upright position against the pull
of gravity and are important in helping venous return when the contracting muscle fibers
massage veins to help move the blood toward the heart. The arch reflex system and the
stretch receptor system are distracters for this question. The spinal reflex system is not the
reflex systems that respond to stretch receptors in the body.
20.A 3-year-old girl with a diagnosis of spasticity caused by 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. The nurse would schedule this child for what
routine screenings?
A)
Central nervous system and gastrointestinal (GI) function
B)
Respiratory and cardiovascular (CV) function
C)
Growth and development
D)
Renal and hepatic function
Ans:
A
Feedback:
Children prescribed dantrolene should be routinely and regularly screened for central
nervous system and gastrointestinal (including hepatic) toxicity. Growth and development
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should be routinely screened in all children. Renal, respiratory, and CV screening is not
indicated.
21.A patient is admitted to the unit with central spasticity after a terrible motor vehicle
accident. The doctor places an intrathecal delivery pump. What medication can be
administered via this route to treat the central spasticity?
A)
Baclofen (Lioresal)
B)
Cyclobenzaprine (Flexeril)
C)
Dantrolene (Dantrium)
D)
Carisoprodol (Soma)
Ans:
A
Feedback:
Baclofen is available in oral and intrathecal forms and can be administered via a delivery
pump for the treatment of central spasticity. Flexeril, dantrolene, and Soma are not
administered intrathecally.
22.Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What
adverse effects do drugs in this class have? (Select all that apply.)
A)
Coronary artery disease
B)
Hypotension
C)
Urinary frequency
D)
Dizziness
E)
Bone marrow suppression
Ans:
B, C, D
Feedback:
Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation,
headache, insomnia, hypotension, nausea, and urinary frequency. Bone marrow
suppression and coronary artery disease are not associated with therapy involving these
drugs.
23.When caring for a patient taking dantrolene, what adverse effects would the nurse
monitor for? (Select all that apply.)
A)
Bradycardia
B)
Hepatitis
C)
Urinary retention
D)
Fatigue
E)
Rash
Ans:
B, D, E
Feedback:
Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea,
hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary
frequency. Adverse effects of dantrolene do not include bradycardia or urinary retention.
24.The nurse is caring for a patient who is having a pump placed to deliver intrathecal
baclofen and another patient who will receive dantrolene as a muscle relaxant. What
nursing diagnosis would be appropriate for both care plans? (Select all that apply.)
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A)
B)
C)
D)
E)
Ans:
Acute pain related to GI effects of drug
Risk for injury related to central nervous system (CNS) effects
Disturbed body image related to muscle pain
Disturbed thought processes related to CNS effects
Deficient knowledge related to procedure
A, B, D
Feedback:
Acute pain related to GI effects of drug, risk for injury related to CNS effects, and
disturbed thought processes related to CNS effects all apply to both patients. Disturbed
body image may apply to the patient having the pump placed, but this is not related to
muscle pain. Only the patient having the pump placed would need information related to
the procedure.
25.The nurse is caring for a patient who is being discharged home from the rehabilitation
unit. Baclofen will be discontinued and the patient will begin taking carisoprodol as an
outpatient. What is the nurse's primary consideration about discontinuing administration
of baclofen?
A)
“Taper drug over 72 hours to reduce dependence on the drug.”
B)
“Alternate doses of baclofen and soma over 10 days to prevent drug withdrawal.”
C)
“Taper drug slowly over 1 to 2 weeks to prevent psychoses and hallucinations.”
D)
“Start carisoprodol immediately while continuing baclofen at full dose to establish
carisoprodol level.”
Ans:
C
Feedback:
If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of
psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious
adverse effects and would never be done.
26.The nurse is caring for a patient receiving intrathecal baclofen via pump while
participating in rigorous rehabilitation therapy. What is the nurse's priority to monitor
related to adverse effects of this drug?
A)
Blood pressure
B)
Pulse pressure
C)
Spasticity
D)
Respiratory status
Ans:
D
Feedback:
The priority to monitor is respiratory status. One of the primary adverse effects of this
drug is central nervous system (CNS) depression. If the patient receives too much
medication, or reaches toxic levels, respiratory rate will decline as the result of excessive
CNS depression and the drug dosage will either be adjusted downward or the drug may
be held until the patient's respirations improve. Monitoring other vital signs including
blood pressure and pulse is indicated but is not the priority.
27.A patient has been diagnosed with multiple sclerosis and experiences spasticity in several
muscle groups. What drug would the nurse anticipate will be ordered as the drug of
choice to manage spasticity associated with neuromuscular diseases?
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A)
B)
C)
D)
Ans:
Dantrolene (Dantrium)
Baclofen (Lioresal)
Carisoprodol (Soma)
Botulinum toxin type B (Myobloc)
A
Feedback:
Dantrolene directly affects peripheral muscle contraction, and has become important in
the management of spasticity associated with neuromuscular diseases. Baclofen,
carisoprodol, and botulinum toxin type B are not the drugs of choice for management of
spasticity in neuromuscular disease.
28.The nurse is caring for a patient taking dantrolene. How would the nurse assess the
therapeutic effects of this drug?
A)
Observe the patient when emotionally stressed to assess for exacerbation of
spasticity.
B)
Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity.
C)
Measure the amount of spasticity before and after administration of medication.
D)
Collect a thorough history to ask the patient any improvement has been noticed.
Ans:
B
Feedback:
Periodically discontinue drug for 2 to 4 days to monitor therapeutic effectiveness. A
clinical impression of exacerbation of spasticity indicates a positive therapeutic effect and
justifies continued use of the drug. It would not be ethical to stress the patient, there is no
known measurement of spasticity, and the patient may not be able to relate how much
improvement was felt because it is unlikely all spasticity will be eliminated.
29.What drug would the nurse expect to administer to the patient experiencing malignant
hyperthermia?
A)
Orphenadrine
B)
Metaxalone
C)
Chlorzoxazone
D)
Dantrolene
Ans:
D
Feedback:
Indications for dantrolene include control of clinical spasticity resulting from upper
motor neuron disorders; preoperatively to prevent or attenuate the development of
malignant hyperthermia in susceptible patients; IV for management of fulminant
malignant hyperthermia. The other drugs are not indicated for treatment of malignant
hyperthermia.
30.What part of the brain does the nurse recognize the patient is using when making precise,
intentional movements?
A)
Pyramidal tract
B)
Substantia nigra
C)
Broca's area
D)
Extrapyramidal tract
Ans:
A
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Feedback:
Upper-level controls of muscle activity include the pyramidal tract in the cerebellum,
which regulates precise intentional muscle movement, and the extrapyramidal tract in the
cerebellum and basal ganglia, which coordinates crude movements related to unconscious
muscle activity. Broca's area has to do with speech, not movement. The substantia nigra
does not control muscle movement.
31.The patient reports pain caused by muscle spasms in his back. The nurse assesses the
patient as being very anxious and notes how the anxiety results in tensing of muscles.
What medication would be most effective in treating this patient?
A)
Baclofen (Lioresal)
B)
Botulinum toxin type B (Myobloc)
C)
Dantrolene (Dantrium)
D)
Diazepam (Valium)
Ans:
D
Feedback:
Adults complaining of muscle spasm pain that may be related to anxiety often respond
very effectively to diazepam, which is a muscle relaxant and anxiolytic. Although many
drugs, including baclofen, will treat the muscle spasm, diazepam also reduces anxiety.
Dantrolene would be better indicated for spasticity than for spasm and botulinum toxin
type B is not prescribed for either anxiety or muscle spasm.
32.What is the drug of choice for an older adult or a patient with hepatic or renal
impairment?
A)
Baclofen
B)
Carisoprodol
C)
Chlorzoxazone
D)
Cyclobenzaprine
Ans:
B
Feedback:
Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older patients
and for those with hepatic or renal impairment. Although the other options may be
prescribed, older adults are more likely to experience the adverse effects associated with
the drug.
33.After administering a centrally acting skeletal muscle relaxant, what other independent
nursing measures might the nurse implement to relieve pain and reduce spasm?
A)
Rest of the affected muscle
B)
Application of cold
C)
Physical therapy
D)
Order of a nonsteroidal anti-inflammatory drug
Ans:
A
Feedback:
Other measures in addition to drugs should be used to alleviate muscle spasm and pain.
The nurse can independently encourage rest of the affected muscle and provide heat
applications to increase blood flow to the area to remove the pain-causing chemicals.
Page 10
34.The nurse is caring for a patient with an infusing IV who is allowed noting by mouth due
to a paralytic ileus. What centrally acting medication could the nurse administer to this
patient?
A)
Chlorzoxazone (Paraflex)
B)
Carisoprodol (Soma)
C)
Cyclobenzaprine (Flexeril)
D)
Orphenadrine (Banflex)
Ans:
D
Feedback:
Only orphenadrine (Banflex) of these options can be given parenterally, either IV or
intramuscularly. The other options are available for oral use only.
35.What is the maximum daily dose of cyclobenzaprine (Flexeril) the nurse can administer?
A)
20 mg
B)
30 mg
C)
40 mg
D)
60 mg
Ans:
D
Feedback:
The normal daily dosage of cyclobenzaprine is 10 mg taken orally t.i.d., and it can be
increased to a maximum of 60 mg per day.
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