Chapter 21 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 21

Question 1

Type: MCMA

The nurse teaches a class about muscle movement to a group of patients who have neuromuscular disorders. What will the best plan of the nurse include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Body movement depends on an intact spinal cord.

2. Body movement depends on proper functioning of muscles.

3. Body movement depends on intact nerves.

4. Body movement depends on proper endocrine functioning.

5. Body movement depends on the level of consciousness.

Correct Answer: 2,3

Rationale 1: Body movement depends on intact nerves and on proper functioning of muscles. Body movement does not depend on the level of consciousness. Body movement does not depend on an intact spinal cord. Body movement does not depend on proper endocrine functioning.

Rationale 2: Body movement depends on intact nerves and on proper functioning of muscles. Body movement does not depend on the level of consciousness. Body movement does not depend on an intact spinal cord. Body movement does not depend on proper endocrine functioning.

Rationale 3: Body movement depends on intact nerves and on proper functioning of muscles. Body movement does not depend on the level of consciousness. Body movement does not depend on an intact spinal cord. Body movement does not depend on proper endocrine functioning.

Rationale 4: Body movement depends on intact nerves and on proper functioning of muscles. Body movement does not depend on the level of consciousness. Body movement does not depend on an intact spinal cord. Body movement does not depend on proper endocrine functioning.

Rationale 5: Body movement depends on intact nerves and on proper functioning of muscles. Body movement does not depend on the level of consciousness. Body movement does not depend on an intact spinal cord. Body movement does not depend on proper endocrine functioning.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-1

Question 2

Type: MCMA

The nurse teaches the patient with a neuromuscular disorder about nonpharmacological treatment of muscle spasms. What will the best information include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Application of heat or cold

2. Ultrasound

3. Massage

4. Relaxation techniques

5. Guided imagery

Correct Answer: 1,2,3

Rationale 1: Nonpharmacological treatment of muscle spasms includes application of heat or cold, ultrasound, and massage. Guided imagery is not a nonpharmacological treatment for muscle spasms. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms.

Rationale 2: Nonpharmacological treatment of muscle spasms includes application of heat or cold, ultrasound, and massage. Guided imagery is not a nonpharmacological treatment for muscle spasms. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms.

Rationale 3: Nonpharmacological treatment of muscle spasms includes application of heat or cold, ultrasound, and massage. Guided imagery is not a nonpharmacological treatment for muscle spasms. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms.

Rationale 4: Nonpharmacological treatment of muscle spasms includes application of heat or cold, ultrasound, and massage. Guided imagery is not a nonpharmacological treatment for muscle spasms. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms.

Rationale 5: Nonpharmacological treatment of muscle spasms includes application of heat or cold, ultrasound, and massage. Guided imagery is not a nonpharmacological treatment for muscle spasms. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-2

Question 3

Type: MCSA

The patient is started on a medication to treat a neuromuscular disorder. What does the nurse teach as the primary therapeutic goal of the medication?

1. To stop the patients muscle spasms

2. To improve the patients appearance

3. To promote exercise in the patient

4. To allow the patient increased independence

Correct Answer: 4

Rationale 1: The therapeutic goals of pharmacotherapy include minimizing pain and discomfort, increasing range of motion, and improving the patients ability to function independently. Stopping muscle spasms can be achieved, but this is not the primary goal. Promoting exercise is not a goal. Improving the patients appearance is not a goal.

Rationale 2: The therapeutic goals of pharmacotherapy include minimizing pain and discomfort, increasing range of motion, and improving the patients ability to function independently. Stopping muscle spasms can be achieved, but this is not the primary goal. Promoting exercise is not a goal. Improving the patients appearance is not a goal.

Rationale 3: The therapeutic goals of pharmacotherapy include minimizing pain and discomfort, increasing range of motion, and improving the patients ability to function independently. Stopping muscle spasms can be achieved, but this is not the primary goal. Promoting exercise is not a goal. Improving the patients appearance is not a goal.

Rationale 4: The therapeutic goals of pharmacotherapy include minimizing pain and discomfort, increasing range of motion, and improving the patients ability to function independently. Stopping muscle spasms can be achieved, but this is not the primary goal. Promoting exercise is not a goal. Improving the patients appearance is not a goal.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-3

Question 4

Type: MCSA

The patient receives dantrolene (Dantrium) for muscle spasticity. Which lab result is a priority for the nurse to assess?

1. Creatinine clearance

2. Serum amylase

3. Hemoglobin and hematocrit

4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

Correct Answer: 4

Rationale 1: Dantrolene (Dantrium) can cause hepatitis; the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the priority laboratory tests for the nurse to assess. Dantrolene (Dantrium) does not affect hemoglobin or hematocrit; these laboratory tests are not a priority to assess. Dantrolene (Dantrium) does not significantly affect renal function; the creatinine clearance test isnt a priority laboratory test to assess. Dantrolene (Dantrium) does not affect pancreatic function; the serum amylase isnt a priority laboratory test to assess.

Rationale 2: Dantrolene (Dantrium) can cause hepatitis; the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the priority laboratory tests for the nurse to assess. Dantrolene (Dantrium) does not affect hemoglobin or hematocrit; these laboratory tests are not a priority to assess. Dantrolene (Dantrium) does not significantly affect renal function; the creatinine clearance test isnt a priority laboratory test to assess. Dantrolene (Dantrium) does not affect pancreatic function; the serum amylase isnt a priority laboratory test to assess.

Rationale 3: Dantrolene (Dantrium) can cause hepatitis; the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the priority laboratory tests for the nurse to assess. Dantrolene (Dantrium) does not affect hemoglobin or hematocrit; these laboratory tests are not a priority to assess. Dantrolene (Dantrium) does not significantly affect renal function; the creatinine clearance test isnt a priority laboratory test to assess. Dantrolene (Dantrium) does not affect pancreatic function; the serum amylase isnt a priority laboratory test to assess.

Rationale 4: Dantrolene (Dantrium) can cause hepatitis; the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the priority laboratory tests for the nurse to assess. Dantrolene (Dantrium) does not affect hemoglobin or hematocrit; these laboratory tests are not a priority to assess. Dantrolene (Dantrium) does not significantly affect renal function; the creatinine clearance test isnt a priority laboratory test to assess. Dantrolene (Dantrium) does not affect pancreatic function; the serum amylase isnt a priority laboratory test to assess.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-4

Question 5

Type: MCSA

The patient receives dantrolene (Dantrium). A consulting physician orders hydroxyzine (Vistaril) for the patient and he begins taking it. What will the best assessment by the nurse reveal?

1. Confusion

2. Hypertension

3. Respiratory depression

4. Delirium

Correct Answer: 3

Rationale 1: Dantrolene (Dantrium) and hydroxyzine (Vistaril) are both central nervous system (CNS) depressants, and the patient needs to be assessed for respiratory depression. Hypertension would not result from the use of these two medications. Confusion would not result from the use of these two medications. Delirium would not result from the use of these two medications.

Rationale 2: Dantrolene (Dantrium) and hydroxyzine (Vistaril) are both central nervous system (CNS) depressants, and the patient needs to be assessed for respiratory depression. Hypertension would not result from the use of these two medications. Confusion would not result from the use of these two medications. Delirium would not result from the use of these two medications.

Rationale 3: Dantrolene (Dantrium) and hydroxyzine (Vistaril) are both central nervous system (CNS) depressants, and the patient needs to be assessed for respiratory depression. Hypertension would not result from the use of these two medications. Confusion would not result from the use of these two medications. Delirium would not result from the use of these two medications.

Rationale 4: Dantrolene (Dantrium) and hydroxyzine (Vistaril) are both central nervous system (CNS) depressants, and the patient needs to be assessed for respiratory depression. Hypertension would not result from the use of these two medications. Confusion would not result from the use of these two medications. Delirium would not result from the use of these two medications.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-7

Question 6

Type: MCSA

The physician has ordered dantrolene (Dantrium) for a patient. What is a priority assessment by the nurse prior to administering this medication?

1. Does the patient have gastric ulcer disease?

2. Does the patient have cardiovascular disease?

3. Does the patient have gallbladder disease?

4. Is the patient pregnant or lactating?

Correct Answer: 4

Rationale 1: Dantrolene (Dantrium) is a Pregnancy Category C drug, so pregnancy should be assessed prior to administration. Gastric ulcer disease is not a contraindication to receiving dantrolene (Dantrium). Gallbladder disease is not a contraindication to receiving dantrolene (Dantrium). Cardiovascular disease is not a contraindication to receiving dantrolene (Dantrium).

Rationale 2: Dantrolene (Dantrium) is a Pregnancy Category C drug, so pregnancy should be assessed prior to administration. Gastric ulcer disease is not a contraindication to receiving dantrolene (Dantrium). Gallbladder disease is not a contraindication to receiving dantrolene (Dantrium). Cardiovascular disease is not a contraindication to receiving dantrolene (Dantrium).

Rationale 3: Dantrolene (Dantrium) is a Pregnancy Category C drug, so pregnancy should be assessed prior to administration. Gastric ulcer disease is not a contraindication to receiving dantrolene (Dantrium). Gallbladder disease is not a contraindication to receiving dantrolene (Dantrium). Cardiovascular disease is not a contraindication to receiving dantrolene (Dantrium).

Rationale 4: Dantrolene (Dantrium) is a Pregnancy Category C drug, so pregnancy should be assessed prior to administration. Gastric ulcer disease is not a contraindication to receiving dantrolene (Dantrium). Gallbladder disease is not a contraindication to receiving dantrolene (Dantrium). Cardiovascular disease is not a contraindication to receiving dantrolene (Dantrium).

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-4

Question 7

Type: MCSA

The physician prescribes cyclobenzaprine (Flexeril) for the patient. When doing medication education, what will the best information of the nurse include?

1. Increase the intake of fiber while taking this medication.

2. Restrict the intake of sodium while taking this medication.

3. Increase the intake of protein while taking this medication.

4. Do not drink any caffeine while taking this medication.

Correct Answer: 1

Rationale 1: Cyclobenzaprine (Flexeril) has anticholinergic properties and can cause constipation, so the patient should increase the intake of fiber while taking this medication. There is no need to limit sodium. There is no need to limit caffeine. There is no need to increase protein.

Rationale 2: Cyclobenzaprine (Flexeril) has anticholinergic properties and can cause constipation, so the patient should increase the intake of fiber while taking this medication. There is no need to limit sodium. There is no need to limit caffeine. There is no need to increase protein.

Rationale 3: Cyclobenzaprine (Flexeril) has anticholinergic properties and can cause constipation, so the patient should increase the intake of fiber while taking this medication. There is no need to limit sodium. There is no need to limit caffeine. There is no need to increase protein.

Rationale 4: Cyclobenzaprine (Flexeril) has anticholinergic properties and can cause constipation, so the patient should increase the intake of fiber while taking this medication. There is no need to limit sodium. There is no need to limit caffeine. There is no need to increase protein.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-6

Question 8

Type: MCSA

The patient receives dantrolene (Dantrium) for treatment of muscle spasms following a spinal cord injury. What is the best outcome for this patient?

1. Patient will have stabilized vital signs.

2. Patient will have and improved self-concept.

3. Patient will sleep without pain.

4. Patient will have increased bladder tone.

Correct Answer: 3

Rationale 1: Decreasing muscle spasms will help prevent pain that can interfere with sleep. This medication relaxes muscles, but it will not increase bladder tone. Stabilization of vital signs is not an expected effect of this medication. Relief of muscle spasms may help with self-concept, but this is not a direct effect of the drug.

Rationale 2: Decreasing muscle spasms will help prevent pain that can interfere with sleep. This medication relaxes muscles, but it will not increase bladder tone. Stabilization of vital signs is not an expected effect of this medication. Relief of muscle spasms may help with self-concept, but this is not a direct effect of the drug.

Rationale 3: Decreasing muscle spasms will help prevent pain that can interfere with sleep. This medication relaxes muscles, but it will not increase bladder tone. Stabilization of vital signs is not an expected effect of this medication. Relief of muscle spasms may help with self-concept, but this is not a direct effect of the drug.

Rationale 4: Decreasing muscle spasms will help prevent pain that can interfere with sleep. This medication relaxes muscles, but it will not increase bladder tone. Stabilization of vital signs is not an expected effect of this medication. Relief of muscle spasms may help with self-concept, but this is not a direct effect of the drug.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-5

Question 9

Type: MCSA

The patient tells the nurse that she awakens frequently during the night because of leg and foot cramps. What is the best response by the nurse?

1. Ask your physician for a muscle relaxant.

2. Increase your intake of calcium.

3. Take a warm bath before going to bed.

4. Apply heat to relieve the cramping.

Correct Answer: 2

Rationale 1: A lack of calcium is a major cause of muscle cramps. It is premature to ask the physician for a muscle relaxant. Applying heat will relax the muscles, but will not prevent cramping. Taking a warm bath will relax the muscles, but will not prevent cramping.

Rationale 2: A lack of calcium is a major cause of muscle cramps. It is premature to ask the physician for a muscle relaxant. Applying heat will relax the muscles, but will not prevent cramping. Taking a warm bath will relax the muscles, but will not prevent cramping.

Rationale 3: A lack of calcium is a major cause of muscle cramps. It is premature to ask the physician for a muscle relaxant. Applying heat will relax the muscles, but will not prevent cramping. Taking a warm bath will relax the muscles, but will not prevent cramping.

Rationale 4: A lack of calcium is a major cause of muscle cramps. It is premature to ask the physician for a muscle relaxant. Applying heat will relax the muscles, but will not prevent cramping. Taking a warm bath will relax the muscles, but will not prevent cramping.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-7

Question 10

Type: MCSA

The patient receives dantrolene (Dantrium). Which medication would the nurse evaluate as being contraindicated with dantrolene (Dantrium)?

1. Verapamil (Calan)

2. Insulin

3. Clarithromycin (Biaxin)

4. Methylphenidate (Concerta)

Correct Answer: 1

Rationale 1: Verapamil (Calan) is a calcium channel blocker; combining this with dantrolene (Dantrium) could lead to cardiovascular collapse. There isnt any contraindication to the use of dantrolene (Dantrium) and insulin. There isnt any contraindication to the use of dantrolene (Dantrium) and methylphenidate (Concerta). There isnt any contraindication to the use of dantrolene (Dantrium) and clarithromycin (Biaxin).

Rationale 2: Verapamil (Calan) is a calcium channel blocker; combining this with dantrolene (Dantrium) could lead to cardiovascular collapse. There isnt any contraindication to the use of dantrolene (Dantrium) and insulin. There isnt any contraindication to the use of dantrolene (Dantrium) and methylphenidate (Concerta). There isnt any contraindication to the use of dantrolene (Dantrium) and clarithromycin (Biaxin).

Rationale 3: Verapamil (Calan) is a calcium channel blocker; combining this with dantrolene (Dantrium) could lead to cardiovascular collapse. There isnt any contraindication to the use of dantrolene (Dantrium) and insulin. There isnt any contraindication to the use of dantrolene (Dantrium) and methylphenidate (Concerta). There isnt any contraindication to the use of dantrolene (Dantrium) and clarithromycin (Biaxin).

Rationale 4: Verapamil (Calan) is a calcium channel blocker; combining this with dantrolene (Dantrium) could lead to cardiovascular collapse. There isnt any contraindication to the use of dantrolene (Dantrium) and insulin. There isnt any contraindication to the use of dantrolene (Dantrium) and methylphenidate (Concerta). There isnt any contraindication to the use of dantrolene (Dantrium) and clarithromycin (Biaxin).

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 21-6

Question 11

Type: MCSA

The patient receives dantrolene (Dantrium) intravenously (IV). What will a priority assessment by the nurse include?

1. Assessing the patients urinary output

2. Assessing the patients blood glucose

3. Assessing the patients breath sounds

4. Assessing the patients intravenous (IV) site

Correct Answer: 4

Rationale 1: Dantrolene (Dantrium) intravenous (IV) solution has a high pH and is very irritating to tissue. The nurse should assess for infiltration of the intravenous (IV) site. Dantrolene (Dantrium) does not affect the patients blood glucose. Dantrolene (Dantrium) does not affect the patients breath sounds. Dantrolene (Dantrium) does not affect the patients urinary output.

Rationale 2: Dantrolene (Dantrium) intravenous (IV) solution has a high pH and is very irritating to tissue. The nurse should assess for infiltration of the intravenous (IV) site. Dantrolene (Dantrium) does not affect the patients blood glucose. Dantrolene (Dantrium) does not affect the patients breath sounds. Dantrolene (Dantrium) does not affect the patients urinary output.

Rationale 3: Dantrolene (Dantrium) intravenous (IV) solution has a high pH and is very irritating to tissue. The nurse should assess for infiltration of the intravenous (IV) site. Dantrolene (Dantrium) does not affect the patients blood glucose. Dantrolene (Dantrium) does not affect the patients breath sounds. Dantrolene (Dantrium) does not affect the patients urinary output.

Rationale 4: Dantrolene (Dantrium) intravenous (IV) solution has a high pH and is very irritating to tissue. The nurse should assess for infiltration of the intravenous (IV) site. Dantrolene (Dantrium) does not affect the patients blood glucose. Dantrolene (Dantrium) does not affect the patients breath sounds. Dantrolene (Dantrium) does not affect the patients urinary output.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-7

Question 12

Type: MCSA

Which of the following lists of treatment options would be considered optimal for treating a muscle spasm with an unknown cause?

1. Anti-inflammatory agents, casting, and ultrasound

2. Analgesics, antibiotics, and heat application

3. Analgesics, muscle relaxants, and massage

4. Anti-inflammatory agents, immobilization, and fluid and electrolyte replacement

Correct Answer: 3

Rationale 1: Muscle spasms can be treated with a variety of pharmacologic and non-pharmacologic methods. When the cause is unknown, a more general approach is indicated, such as analgesics, muscle relaxants, and massage. Antibiotics and casting are not indicated for muscle spasms. Fluid and electrolyte replacement can be indicated, if determined to be the cause.

Rationale 2: Muscle spasms can be treated with a variety of pharmacologic and non-pharmacologic methods. When the cause is unknown, a more general approach is indicated, such as analgesics, muscle relaxants, and massage. Antibiotics and casting are not indicated for muscle spasms. Fluid and electrolyte replacement can be indicated, if determined to be the cause.

Rationale 3: Muscle spasms can be treated with a variety of pharmacologic and non-pharmacologic methods. When the cause is unknown, a more general approach is indicated, such as analgesics, muscle relaxants, and massage. Antibiotics and casting are not indicated for muscle spasms. Fluid and electrolyte replacement can be indicated, if determined to be the cause.

Rationale 4: Muscle spasms can be treated with a variety of pharmacologic and non-pharmacologic methods. When the cause is unknown, a more general approach is indicated, such as analgesics, muscle relaxants, and massage. Antibiotics and casting are not indicated for muscle spasms. Fluid and electrolyte replacement can be indicated, if determined to be the cause.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-2

Question 13

Type: MCSA

Which statement about skeletal muscle relaxants is correct?

1. They inhibit upper motor neuron activity within the central nervous system.

2. They work primarily by stimulating the peripheral nervous system.

3. They increase the amount of neurotransmitter within the muscles.

4. They stimulate motor activity within the brainstem.

Correct Answer: 1

Rationale 1: The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression.

Rationale 2: The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression.

Rationale 3: The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression.

Rationale 4: The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-6

Question 14

Type: MCSA

The nurse identifies a patient with a repeating pattern of muscle contraction of the leg for 5 seconds followed by 2 seconds of relaxation as experiencing

1. a clonic spasm.

2. a tonic spasm.

3. spasticity.

4. dystonia.

Correct Answer: 1

Rationale 1: Clonic muscle spasms involve multiple, rapidly repeated contractions. Tonic spasms involve a single prolonged contraction. Spasticity involves a continuous state of contraction, and dystonia is a chronic neurological disorder that can cause spasticity.

Rationale 2: Clonic muscle spasms involve multiple, rapidly repeated contractions. Tonic spasms involve a single prolonged contraction. Spasticity involves a continuous state of contraction, and dystonia is a chronic neurological disorder that can cause spasticity.

Rationale 3: Clonic muscle spasms involve multiple, rapidly repeated contractions. Tonic spasms involve a single prolonged contraction. Spasticity involves a continuous state of contraction, and dystonia is a chronic neurological disorder that can cause spasticity.

Rationale 4: Clonic muscle spasms involve multiple, rapidly repeated contractions. Tonic spasms involve a single prolonged contraction. Spasticity involves a continuous state of contraction, and dystonia is a chronic neurological disorder that can cause spasticity.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-7

Question 15

Type: MCSA

Which of the following is a common adverse effect of cyclobenzaprine (Flexeril)?

1. Alopecia

2. Tongue swelling

3. Drowsiness

4. Hypotension

Correct Answer: 3

Rationale 1: All centrally acting agents have the potential to cause sedation. Tongue swelling is serious, but rare. Tachycardia is possible, but would likely lead to hypertension, not hypotension. Alopecia is not an associated adverse effect.

Rationale 2: All centrally acting agents have the potential to cause sedation. Tongue swelling is serious, but rare. Tachycardia is possible, but would likely lead to hypertension, not hypotension. Alopecia is not an associated adverse effect.

Rationale 3: All centrally acting agents have the potential to cause sedation. Tongue swelling is serious, but rare. Tachycardia is possible, but would likely lead to hypertension, not hypotension. Alopecia is not an associated adverse effect.

Rationale 4: All centrally acting agents have the potential to cause sedation. Tongue swelling is serious, but rare. Tachycardia is possible, but would likely lead to hypertension, not hypotension. Alopecia is not an associated adverse effect.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-6

Question 16

Type: MCSA

Which statement describes the primary difference between centrally acting muscle relaxants and direct-acting antispasmodics?

1. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents stimulate neurons of central nervous system.

2. Centrally acting agents stimulate neurons of the central nervous system, while direct-acting agents stimulate neurons of the peripheral nervous system.

3. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles.

4. Centrally acting agents stimulate the central nervous system, while direct-acting agents inhibit neuronal conduction of the central nervous system.

Correct Answer: 3

Rationale 1: Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles.

Rationale 2: Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles.

Rationale 3: Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles.

Rationale 4: Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-5

Question 17

Type: MCSA

Which of the following patients suffering from muscle spasms should not receive the direct-acting antispasmodic medication dantrolene sodium (Dantrium)?

1. 20-year-old suffering from a spinal cord injury

2. 57-year-old suffering from congestive heart failure

3. 40-year-old suffering from multiple sclerosis

4. 65-year-old suffering from a cerebral vascular accident

Correct Answer: 2

Rationale 1: Dantrolene sodium (Dantrium) is contraindicated in patients with cardiac, pulmonary, and hepatic problems. It is indicated for spinal cord injury, strokes, and multiple sclerosis.

Rationale 2: Dantrolene sodium (Dantrium) is contraindicated in patients with cardiac, pulmonary, and hepatic problems. It is indicated for spinal cord injury, strokes, and multiple sclerosis.

Rationale 3: Dantrolene sodium (Dantrium) is contraindicated in patients with cardiac, pulmonary, and hepatic problems. It is indicated for spinal cord injury, strokes, and multiple sclerosis.

Rationale 4: Dantrolene sodium (Dantrium) is contraindicated in patients with cardiac, pulmonary, and hepatic problems. It is indicated for spinal cord injury, strokes, and multiple sclerosis.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-6

Question 18

Type: MCSA

Spasticity is most commonly caused by damage to what area of the body?

1. Cerebral cortex

2. Peripheral nerves

3. Brainstem

4. Spinal cord

Correct Answer: 1

Rationale 1: Spasticity usually results from damage to the motor area of the cerebral cortex.

Rationale 2: Spasticity usually results from damage to the motor area of the cerebral cortex.

Rationale 3: Spasticity usually results from damage to the motor area of the cerebral cortex.

Rationale 4: Spasticity usually results from damage to the motor area of the cerebral cortex.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 21-1

Question 19

Type: MCSA

Which statement is correct in regard to the muscle relaxant botulinum toxin type B (Myobloc)?

1. It can be classified as a cholinergic agonist.

2. Increased muscle strength is often seen within a couple of weeks.

3. It can take 6 months for the effects to be seen.

4. In high doses, it is poisonous, causing the same symptoms food poisoning does.

Correct Answer: 4

Rationale 1: Botulinum toxin type B (Myobloc) is toxic in high doses. Clostridium botulinum is the bacteria responsible for food poisoning. The drug works by blocking the release of acetylcholine from cholinergic nerve terminals. It generally takes 6 weeks to see the effects, and they only last for 36 months. Patients taking this drug generally experience muscle weakness, not strength.

Rationale 2: Botulinum toxin type B (Myobloc) is toxic in high doses. Clostridium botulinum is the bacteria responsible for food poisoning. The drug works by blocking the release of acetylcholine from cholinergic nerve terminals. It generally takes 6 weeks to see the effects, and they only last for 36 months. Patients taking this drug generally experience muscle weakness, not strength.

Rationale 3: Botulinum toxin type B (Myobloc) is toxic in high doses. Clostridium botulinum is the bacteria responsible for food poisoning. The drug works by blocking the release of acetylcholine from cholinergic nerve terminals. It generally takes 6 weeks to see the effects, and they only last for 36 months. Patients taking this drug generally experience muscle weakness, not strength.

Rationale 4: Botulinum toxin type B (Myobloc) is toxic in high doses. Clostridium botulinum is the bacteria responsible for food poisoning. The drug works by blocking the release of acetylcholine from cholinergic nerve terminals. It generally takes 6 weeks to see the effects, and they only last for 36 months. Patients taking this drug generally experience muscle weakness, not strength.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-6

Question 20

Type: MCMA

A patient tells the nurse, I have been reading about using castor oil as a treatment for muscle cramping. Do you know anything about that? How should the nurse respond to this question?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Why dont you ask the doctor about whether it works or not?

2. I think you take a tablespoon twice a day.

3. The castor oil should be warmed before use.

4. Soak a flannel cloth with the castor oil and apply it to your muscle.

5. You must wear gloves when handling castor oil.

Correct Answer: 3,4

Rationale 1: The nurse should be prepared to discuss pharmaceutical and nonpharmaceutical methods of symptom management, including complementary and alternative therapies. There is no reason to defer to the health care provider.

Rationale 2: Castor oil is used as a topical application when it is used for muscle cramping.

Rationale 3: Warming the castor oil has the added benefit of warming the muscle tissue, which helps to relieve discomfort.

Rationale 4: The flannel cloth absorbs the castor oil and holds it on the skin. The flannel also holds in the warmth of the oil.

Rationale 5: There is no indication that contact between castor oil and the hands is detrimental.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-2

Question 21

Type: MCMA

A patient who has cerebral palsy is beginning to experience spasticity of the muscles in the upper arm. Which medications would the nurse question if prescribed for this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Metaxalone (Skelaxin) dosed three times a day

2. Chlorzoxazone (Parafon Forte) dosed four times a day

3. Carisoprodol (Soma) dosed three times a day

4. Intrathecal baclofen (Lioresal)

5. Tizanidine (Zanaflex) dosed twice a day

Correct Answer: 1,2,5

Rationale 1: Metaxalone (Skelaxin) is ineffective in the treatment of spasticity-related neurologic disorders.

Rationale 2: Chlorzoxazone (Parafon Forte) is ineffective in the treatment of spasticity related to neurodegenerative disorders.

Rationale 3: Carisoprodol (Soma) is effective in relieving the pain, muscle spasms, and spasticity associated with cerebral palsy and is dosed three times a day.

Rationale 4: Baclofen (Lioresal) is effective in reducing muscle spasticity and can be delivered intrathecally.

Rationale 5: Tizanidine (Zanaflex) is used for muscle spasticity but has a short half-life and must be dosed every 6?8 hours.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-3

Question 22

Type: MCMA

The parents of a 2-year-old who has cerebral palsy are only now beginning to accept that their child will have a permanent disability. The nurse has been instructing the parents about the treatment for the spasticity their child is experiencing. Which statements by the parents indicate that the nurse should plan additional teaching sessions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. At some point, our child may require surgery to correct this spasticity.

2. As long as we continue our childs medications, the spasticity can be controlled.

3. Our physical therapy sessions should focus on flexing our childs muscles.

4. We should repeat the exercises several times with each muscle group.

5. It is best to give our child a rest from physical therapy by skipping 1 week a month.

Correct Answer: 2,3,5

Rationale 1: Surgery is sometimes necessary in these cases, so this statement reflects accurate knowledge.

Rationale 2: Medication alone is generally not enough to control spasticity in these children. The parents need additional teaching.

Rationale 3: The physical therapy sessions for spasticity focus on muscle stretching, not flexion. The parents need additional teaching.

Rationale 4: Repetitive motion exercises are beneficial in reducing and controlling spasticity. The parents have expressed accurate knowledge.

Rationale 5: Physical therapy should be routine and consistent in order to reduce or control spasticity. These parents need additional teaching.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 21-2

Question 23

Type: MCMA

The patients health care provider prescribed dantrolene sodium (Dantrium) 25 mg daily for the treatment of neck spasms secondary to spinal cord injury. The patient reports that the medication is not working, even though it has been 45 days since the medication was started. What changes in this patients plan of care would the nurse anticipate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Increase in the dosage frequency to twice a day

2. Discontinuation of the medication

3. Increase in the frequency of hepatic function tests

4. Change to a different medication

5. Addition of succinylcholine (Anectine) to the patients medications

Correct Answer: 2,4

Rationale 1: If no therapeutic effect of the medication is noted after 45 days of treatment, increasing the dosage in not indicated.

Rationale 2: If there has been no therapeutic effect from the dantrolene after 45 days of therapy, the medication should be discontinued.

Rationale 3: Simply increasing the frequency of liver tests will not prevent damage to the liver.

Rationale 4: Since there have been no therapeutic effects from this medication, a different medication is indicated.

Rationale 5: Succinylcholine (Anectine) is a drug used during surgery, not on an outpatient basis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 21-6

Question 24

Type: MCMA

The patient tells the nurse, The doctor is going to start me on Botox for the muscle spasms in my neck. Ive always wanted to try that. It will make me look younger. What information should the nurse provide to this patient regarding onabotulinumtoxinA (Botox)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Once you start on the medication, it may take a week or so before you notice a change in your skin.

2. Be certain you take the medication with a full glass of water because it can be hard on your kidneys.

3. There are many different uses for that drug, depending on how it is administered.

4. You may have to have additional treatments with the medication in a few months.

5. You should be aware that side effects of the medication can occur hours or weeks after your treatment.

Correct Answer: 3,4,5

Rationale 1: OnabotulinumtoxinA (Botox) in this patients case will not change the skin.

Rationale 2: OnabotulinumtoxinA (Botox) is administered by injection into the muscle.

Rationale 3: OnabotulinumtoxinA (Botox) has many clinical indications. Action depends on the area where the medication is administered.

Rationale 4: The effects of onabotulinumtoxinA (Botox) generally last from 3 to 6 months.

Rationale 5: Side effects of onabotulinumtoxinA (Botox) may not occur immediately upon administration, and the patient should watch for their development for several hours to weeks later.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-6

Question 25

Type: MCMA

The nurse is discharging a 72-year-old man who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this patient is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the patients health care provider?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The dosage amount is too low for the type of injury this patient sustained.

2. Cyclobenzaprine should be used with great caution in those over 65.

3. If taken as directed, the patient would be able to take the medication for 120 days.

4. Cyclobenzaprine is not effective for back pain.

5. Cyclobenzaprine should not be taken with food.

Correct Answer: 2,3

Rationale 1: The dosage of 10 mg three times daily is standard.

Rationale 2: The adverse reactions from cyclobenzaprine include confusion, hallucinations, and cardiac events, which are more common in patients over 65.

Rationale 3: The manufacturer recommends that treatment not extend beyond 3 weeks or 21 days.

Rationale 4: Cyclobenzaprine is not effective for muscle spasm due to spinal cord injury, but is useful in the treatment of back pain from muscle strain.

Rationale 5: The drug may be taken with food or milk if gastric upset occurs.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 21-6

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E

Copyright 2014 by Pearson Education, Inc.

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