Chapter 45: Drugs Used to Treat the Muscular System My Nursing Test Banks

Chapter 45: Drugs Used to Treat the Muscular System

Test Bank

MULTIPLE CHOICE

1. A patient who has undergone a lengthy surgical procedure under general anesthesia is unable to breathe on his own following the procedure. Which drug will the nurse expect to be administered as an antidote to the neuromuscular-blocking agent?

a.

Dantrolene (Dantrium)

b.

Neostigmine methylsulfate (Prostigmin)

c.

Ether

d.

Baclofen (Lioresal)

ANS: B

Neostigmine methylsulfate is an antidote to neuromuscular-blocking agents. Additional measures to implement include artificial respirations with oxygen and atropine sulfate for bradycardia and hypotension. Dantrolene is a direct-acting skeletal muscle relaxant given for the treatment of neuroleptic malignant syndrome associated with the use of antipsychotic agents. Ether is a general anesthetic. Baclofen is a skeletal muscle relaxant.

DIF: Cognitive Level: Application REF: pp. 724-725 OBJ: 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

2. What is the reason for paraplegic patient to receive baclofen (Lioresal)?

a.

It interrupts reflexes at the level of the spinal cord.

b.

It acts directly on the skeletal muscles to reduce spasticity.

c.

It interrupts transmission of impulses from motor nerves to muscles at the skeletal neuromuscular junction.

d.

It produces generalized mild weakness of skeletal muscles and decreases the force of reflex muscle contractions.

ANS: A

Baclofen is a gamma aminobutyric acid derivative that interrupts polysynaptic reflexes at the level of the spinal cord. Baclofen does not appear to act directly on the skeletal muscles. Interrupting transmission of impulses from motor nerves to muscles at the skeletal neuromuscular junction is the mechanism of action of neuromuscular-blocking agents. Producing generalized mild weakness of skeletal muscles and decreasing the force of reflex muscle contractions is the mechanism of action of dantrolene.

DIF: Cognitive Level: Comprehension REF: pp. 722-723 OBJ: 2 | 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. A patient taking antipsychotic medication for schizophrenia is admitted with a temperature of 106 F. The admitting diagnosis is neuroleptic malignant syndrome resulting from antipsychotic medication. Which drug is indicated in treatment of this condition?

a.

Edrophonium (Tensilon)

b.

Dantrolene (Dantrium)

c.

Baclofen (Lioresal)

d.

Metaxalone (Skelaxin)

ANS: B

Dantrolene, a direct acting skeletal muscle relaxant, is used to treat neuroleptic malignant syndrome associated with the use of antipsychotic agents. Edrophonium is an antidote for neuromuscular-blocking agents. Baclofen is a skeletal muscle relaxant used for the treatment of muscle spasticity resulting from multiple sclerosis (MS) and cerebral palsy. Metaxalone is used for muscle spasms.

DIF: Cognitive Level: Comprehension REF: p. 723 OBJ: 2 | 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. In the intensive care unit, the nurse is taking care of a patient who is on a ventilator and is receiving succinylcholine (Anectine). Which is a priority nursing diagnosis for this patient?

a.

Pain

b.

Disturbed body image

c.

Risk for injury

d.

Self care deficit

ANS: A

Pain is the highest priority, according to Maslows hierarchy of needs. Succinylcholine, a neuromuscular-blocking agent, is used to paralyze muscles while a patient is on a ventilator. Neuromuscular-blocking agents do not relieve pain. Disturbed body image is not a priority for this situation, although it does apply. Risk for injury and self care deficit are not as great of priorities for this situation.

DIF: Cognitive Level: Application REF: pp. 724-725 OBJ: 1 | 5

TOP: Nursing Process Step: Diagnosis

MSC: NCLEX Client Needs Category: Physiological Integrity

5. The patients family asks why neuromuscular blocking agents are used before electroconvulsive therapy. Which explanation by the nurse is most accurate?

a.

They stimulate respirations while therapy is delivered.

b.

They prevent aspiration of respiratory secretions during the therapy.

c.

They decrease intracranial pressure resulting from therapy.

d.

They reduce the risk of injury during therapy.

ANS: D

Neuromuscular-blocking agents are used before electroconvulsive therapy to paralyze the skeletal muscles and reduce the risk of fractures during therapy. Neuromuscular-blocking agents do not stimulate respiration, prevent aspiration, or affect intracranial pressure.

DIF: Cognitive Level: Application REF: pp. 724-725 OBJ: 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

6. Which laboratory values will the nurse review prior to beginning medication therapy for skeletal and muscle disorders?

a.

Sodium, magnesium, and chloride

b.

C-reactive protein (CRP), human leukocyte antigen (HLA), and liver function tests

c.

Arterial blood gases (ABGs), complete blood count (CBC), and electrolytes

d.

Glucose, high density lipoproteins (HDL), and prothrombin time (PT)

ANS: B

Examine laboratory reports associated with the disease process present (e.g., calcium, phosphorus, lupus testing, rheumatoid factor, uric acid level, CRP, HLA, aldolase, aspartate, creatine kinase). Electrolytes, trace minerals, ABGs, CBC, electrolytes, glucose, HDL, and PT are not associated with this disease process.

DIF: Cognitive Level: Application REF: p. 719 OBJ: 1 | 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

7. Which medication will be prescribed for a patient complaining of muscle spasms resulting from a back injury?

a.

Acetaminophen (Tylenol)

b.

Morphine sulfate

c.

Bethanechol (Urecholine)

d.

Cyclobenzaprine (Flexeril)

ANS: D

Cyclobenzaprine is a centrally acting skeletal muscle relaxant, which is a group of drugs used to relieve acute muscle spasms. Their exact mechanism of action is unknown, except that they depress central nervous system (CNS) function. All the centrally acting skeletal muscle relaxants produce some degree of relaxation, and health care providers maintain that the benefits from the sedative effects may exceed the benefits from actual muscle relaxation. Acetaminophen, morphine, and bethanechol do not relieve skeletal muscle spasms.

DIF: Cognitive Level: Comprehension REF: pp. 721-722 OBJ: 2

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. Which symptoms will be most important for the nurse to assess for early signs of respiratory distress in the patient who has been given a neuromuscular-blocking agent?

a.

Nasal flaring and retraction of intercostal muscles

b.

Dyspnea, increased respiratory rate, and cyanosis

c.

Restlessness, anxiety, and lethargy

d.

Pallor, stridor, and diaphoresis

ANS: C

The signs of restlessness, anxiety, lethargy, decreased mental alertness, and headache are early, subtle clues to respiratory distress. Retractions, flaring, dyspnea, hyperventilation, cyanosis, pallor, stridor, and diaphoresis are not early signs of respiratory distress.

DIF: Cognitive Level: Application REF: p. 719 OBJ: 4 | 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

9. Which common adverse effects occur with neuromuscular-blocking agents?

a.

Fever

b.

Flushing

c.

Nausea

d.

Ataxia

ANS: B

Neuromuscular-blocking agents cause histamine release, which may cause bronchospasm, bronchial and salivary secretions, flushing, edema, and urticaria. Ensure that the airway is patent and that secretions are suctioned regularly to prevent obstruction. Report evidence of bronchospasm, edema, and urticaria immediately. Neuromuscular-blocking agents do not commonly cause fever, nausea, or ataxia.

DIF: Cognitive Level: Comprehension REF: p. 725 OBJ: 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. Which assessment is most important for the nurse to obtain when a patient is being treated with a neuromuscular-blocking agent?

a.

Skin assessment for rash and urticaria

b.

Blood pressure assessment for orthostatic hypotension

c.

Respiratory assessment for patent airway

d.

Assessment for fluid volume overload

ANS: C

Histamine release caused by these drugs may produce increased salivation. In patients who are paralyzed or who have incomplete return of control over swallowing, coughing, and deep breathing, these secretions may obstruct the airway. Histamines are not likely to produce rash or urticaria related to the administration of neuromuscular-blocking agents. Patients on neuromuscular-blocking agents are generally kept on bed rest and not subject to orthostatic hypotension. Neuromuscular-blocking agents do not cause fluid volume overload.

DIF: Cognitive Level: Application REF: p. 724 OBJ: 4 | 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

11. Which drug interaction may occur when an aminoglycoside or tetracycline is given in conjunction with neuromuscular-blocking agents?

a.

Deep sedation

b.

Decreased effectiveness of antibiotics

c.

Increased neuromuscular-blocking activity

d.

Sensitivity to antibiotics and possible allergic reaction

ANS: C

Question antibiotic orders that prescribe aminoglycosides or tetracycline when neuromuscular blockers have been used. These drugs may potentiate the neuromuscular blocking activity. This combination of medications would not cause deep sedation. Neuromuscular-blocking agents do not decrease the effectiveness of antibiotics or increase sensitivity to antibiotics.

DIF: Cognitive Level: Comprehension REF: p. 725 OBJ: 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

12. A patient taking a neuromuscular blocking agent is assessed to have a heart rate of 120 and blood pressure of 80/50. The nurse will anticipate the physician writing an order for:

a.

ABGs.

b.

blood glucose level.

c.

CBC.

d.

liver function tests.

ANS: A

Patients taking neuromuscular-blocking agents should be monitored closely for clinical signs of hypoxia and hypercapnia (tachycardia, hypotension, cyanosis). ABG levels may be determined to confirm the clinical observations. Blood glucose levels, CBC, and liver function tests would not be indicated with these symptoms.

DIF: Cognitive Level: Analysis REF: p. 719 OBJ: 4 | 5

TOP: Nursing Process Step: Assessment, Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. The nurse receives a conscious patient from the postoperative unit after administration of a neuromuscular blocker. Once the patients vital signs are stable, the best position for the nurse to assist the patient into is _____ position.

a.

Sims

b.

semi-Fowlers

c.

supine

d.

prone

ANS: B

Patients can usually cough better in a semi-Fowlers or high Fowlers position; therefore, depending on the situation and stability of the patients vital signs, elevating the head of the bed may assist coughing and breathing. Sims, supine, and prone are not the best positions for a patient postoperatively.

DIF: Cognitive Level: Application REF: p. 720 OBJ: 1 | 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

MULTIPLE RESPONSE

14. Patients with which conditions must be carefully assessed to determine whether they would tolerate treatment with a neuromuscular-blocking agent? (Select all that apply.)

a.

Pregnancy

b.

Hepatic disease

c.

Pulmonary disease

d.

Renal disease

e.

Neurologic disorders

f.

Psychiatric disorders

ANS: B, C, D, E

Patients with hepatic disease, pulmonary disease, renal disease, and neurologic disorders such as myasthenia gravis, spinal cord injury, or MS must be fully evaluated to assess their ability to tolerate neuromuscular-blocking agents. Neuromuscular-blocking agents can usually be used safely with the pregnant patient and the psychiatric patient.

DIF: Cognitive Level: Application REF: pp. 724-725 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

15. The nurse is examining a patient in the emergency department whose chief complaint is a dislocated shoulder. Which assessment data are needed to evaluate the patient? (Select all that apply.)

a.

Details related to the mechanism of injury

b.

Degree of impairment

c.

Pain level

d.

Inspection of the affected part for swelling, capillary refill, bruising, redness, localized tenderness, deformities, and paresthesia

e.

Elevation of the affected extremity

ANS: A, B, C, D

Important nursing assessment of a musculoskeletal injury includes mechanism of injury, degree of impairment, pain level, and obvious deformity and neurovascular assessment. Elevating the affected extremity would exacerbate the pain and deformity of the injury.

DIF: Cognitive Level: Application REF: p. 721 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. An employee at a factory has not been to work because of low back muscle spasms. His wife contacts the occupational health nurse to report that her spouse is on a centrally acting skeletal muscle relaxant and is having problems with sleepiness. Based on the medication action, what will the nurse tell her? (Select all that apply.)

a.

The health care provider should be notified because these drugs are contraindicated in the treatment of low back pain.

b.

Your husband should avoid activities requiring alertness, such as driving or operating power equipment.

c.

I need additional and specific information regarding the amount of your husbands sedation.

d.

I will review baseline laboratory studies, discuss your husbands status with the health care provider, and call you back.

e.

Sedation is an adverse effect of these medications and tends to resolve with continued therapy.

ANS: B, C, D, E

Patients should be instructed to avoid activities that require alertness, such as driving or operating heavy machinery, for safety. When obtaining patient information regarding adverse effects, additional information may be needed to fully assess the degree of adverse effects the patient may be experiencing. Review of baseline liver and kidney function and CBC laboratory data is necessary. Centrally acting skeletal muscle relaxants are used to relieve acute muscle spasm. They act on the CNS, and sedation may be an adverse effect associated with usage. This tends to be mild and will resolve with continued use. These drugs are indicated for the treatment of low back pain.

DIF: Cognitive Level: Application REF: p. 721 OBJ: 1 | 2 | 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

17. Why are neuromuscular-blocking agents used? (Select all that apply.)

a.

Alleviation of pain

b.

Reducing the use and adverse effects of general anesthetics

c.

Easing endotracheal intubation and prevent laryngospasm

d.

Producing amnesia during painful procedures

e.

Decreasing muscular activity in electroshock therapy

ANS: B, C, E

Neuromuscular-blocking agents are used to produce adequate muscle relaxation during anesthesia to reduce the use (and adverse effects) of general anesthesia, ease endotracheal intubation and prevent laryngospasm, and decrease muscular activity in electroshock therapy. Neuromuscular-blocking agents have no effect on the pain threshold, memory, or consciousness.

DIF: Cognitive Level: Application REF: pp. 724-725 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. When assessing a patient for signs and symptoms of early respiratory depression immediately after leaving the postoperative area, the nurse will be alert for signs of what? (Select all that apply.)

a.

Restlessness

b.

Anxiety

c.

Lethargy

d.

Increased mental alertness

e.

Cyanosis

ANS: A, B, C

Early signs of diminished ventilation include restlessness, anxiety, lethargy, decreased mental alertness, and headache. Increased mental alertness is not an early sign of respiratory depression. Cyanosis is a late sign of respiratory complications.

DIF: Cognitive Level: Application REF: p. 719 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

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