A
Which information should the nurse include in the education of the body movement for a
client with a neuromuscular disorder?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. 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.
2,3
1. Body movement does not depend on an intact spinal cord as portions of the body move
even if the spinal cord is damaged.
2. Body movement depends on proper functioning of muscles.
3. Body movement depends on intact nerves.
4. Body movement does not depend on proper endocrine functioning.
A client has been prescribed dantrolene (Dantrium). Which question should the nurse ask
the client?
1. "Do you have a history of gastric ulcer disease?"
2. "Do you have a history of psoriasis?"
3. "Do you have a history of gallbladder disease?"
4. "Are you currently pregnant?"
4
1. Gastric ulcer disease is not contraindicated with dantrolene.
2. Psoriasis is not contraindicated with dantrolene.
3. Gallbladder disease is not contraindicated with dantrolene.
4. The patient should be assessed for pregnancy because dantrolene is a Pregnancy Category C.
Which is the nurse's priority assessment when monitoring a client receiving dantrolene
(Dantrium) intravenously?
1. Urinary output
2. Blood glucose
3. Breath sounds
4. Intravenous site
4
1. Dantrolene does not affect urinary output.
2. Dantrolene does not affect blood glucose.
3. Dantrolene does not affect the breath sounds.
4. Dantrolene intravenous solution has a high pH and is very irritating to tissue. The nurse
should assess for infiltration of the intravenous (IV) site.
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 the central nervous system.
2. Centrally acting agents stimulate neurons of the central nervous system, while directacting
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.
3
1. Direct-acting agents do not work at the level of the neuromuscular junction and skeletal muscles.
2. Centrally acting agents inhibit the neurons in the central 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 inhibit neurons of the central nervous system.
The nurse has provided discharge teaching for a client who had an abobotulinumtoxinA
(Dysport) injection. Which symptoms should the nurse instruct the client to immediately
report?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Chest pain
2. Urinary retention
3. Heart palpitations
4. Difficulty swallowing
5. Eye spasm
1,2,4
1. Angina is an adverse effect of this medication.
2. Loss of bladder control is an adverse effect associated with onabotulinumtoxinA (Botox).
3. Dysrhythmias may occur.
4. Difficulty swallowing may occur.
5. OnabotulinumtoxinA (Botox) is used to treat eye spasm.
The nurse is preparing to provide education about the nonpharmacological treatment of
muscle spasms for a client with a neuromuscular disorder. Which information should the
nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Application of heat or cold
2. Ultrasound
3. Massage
4. Relaxation techniques
5. Guided imagery
1,2,3
1. Nonpharmacological treatment of muscle spasms includes application of heat or cold.
2. Nonpharmacological treatment of muscle spasms includes ultrasound.
3. Nonpharmacological treatment of muscle spasms includes massage.
4. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms.
5. Guided imagery is not a nonpharmacological treatment for muscle spasms.
The nurse is preparing to provide education for a client prescribed cyclobenzaprine (Amrix).
Which information should the nurse include in the education?
1. Increase the intake of fiber.
2. Restrict the intake of sodium.
3. Increase the intake of protein.
4. Avoid the use of caffeine.
1
1. Cyclobenzaprine has anticholinergic properties and can cause constipation, so the client should increase the intake of fiber while taking this medication.
2. There is no need to limit sodium.
3. There is no need to increase protein.
4. There is no need to limit caffeine.
Which should the nurse include in the plan of care for the client that has received baclofen
(Lioresal)?
1. Fall precautions
2. Intake and output
3. Fluid restriction
4. Dietary restrictions
1
1. Fall precautions should be implemented for a patient receiving baclofen. Common side
effects of baclofen include drowsiness, dizziness, weakness, and fatigue.
2. It is not necessary to monitor the intake and output for a patient prescribed baclofen.
3. It is not necessary to restrict the fluid for a patient prescribed baclofen. The patient
should increase the fluid intake to 2 L per day to prevent constipation.
4. It is not necessary to implement dietary restrictions for a patient prescribed baclofen.
The patient should be instructed to increase the intake of dietary fiber to prevent
constipation.
For which client experiencing muscle spasms is direct-acting antispasmodic medication
dantrolene sodium (Dantrium) contraindicated?
1. A 20-year-old with a spinal cord injury
2. A 57-year-old with congestive heart failure
3. A 40-year-old with multiple sclerosis
4. A 65-year-old with a cerebral vascular accident
2
1. Dantrolene sodium is indicated for the treatment of a spinal cord injury.
2. Dantrolene sodium is contraindicated in clients with cardiac, pulmonary, and hepatic problems.
3. Dantrolene sodium is indicated for the treatment of multiple sclerosis.
4. Dantrolene sodium is indicated for the treatment of strokes.
The nurse has provided parental education of the treatment plan for the spasticity their 2-
year-old is experiencing. Which statements by the parents indicate additional teaching is
required?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "At some point, our child may require surgery to correct this spasticity."
2. "As long as we continue our child's medications, the spasticity can be controlled."
3. "Our physical therapy sessions should focus on flexing our child's 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."
2,3,5
1. Surgery is sometimes necessary in these cases, so this statement reflects accurate knowledge.
2. Medication alone is generally not enough to control spasticity.
3. The physical therapy sessions for spasticity focus on muscle stretching, not flexion.
4. Repetitive motion exercises are beneficial in reducing and controlling spasticity. The parents have expressed accurate knowledge.
5. Physical therapy should be routine and consistent in order to reduce or control
spasticity
Which should the nurse understand is the primary therapeutic goal for the use of
pharmacotherapy in the treatment of a neuromuscular disorder?
1. Stop the client's muscle spasms
2. Improve appearance
3. Promote the ease of exercise
4. Promote independence
4
1. Stopping muscle spasms can be achieved, but this is not the primary goal.
2. Improving the client's appearance is not a primary goal.
3. Promoting the ease of exercise is not a primary goal.
4. The therapeutic goals for the use pharmacotherapy in the treatment of neuromuscular disorders is to promote independence by minimizing pain and discomfort, increase the range of motion, and improve the client's ability to function.
The nurse is creating a plan of care for a client prescribed cyclobenzaprine experiencing
muscle spasms. Which outcome should the nurse anticipate?
1. Stabilized vital signs
2. Improved self-concept
3. Uninterrupted sleep
4. Increased bladder tone
3
1. Cyclobenzaprine is not used to stabilize vital signs.
2. Relief of muscle spasms may help with self-concept, but this is not the primary
indication for the prescription.
3. Cyclobenzaprine is prescribed to decrease muscle spasms and promote comfort which will enhance sleep.
4. Cyclobenzaprine does not increase bladder tone.
A client asks the nurse how skeletal muscle relaxants work. Which response should the
nurse provide the client?
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."
1
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.
2. Stimulation of the peripheral nervous system is not the mechanism of action of muscle relaxants.
3. Muscle relaxants do not increase the amount of neurotransmitter.
4. Muscle relaxants do not stimulate motor activity in the brainstem.
Which area of the body when damaged commonly results in spasticity?
1. Cerebral cortex
2. Peripheral nerves
3. Brainstem
4. Spinal cord
1
1. Spasticity usually results from damage to the motor area of the cerebral cortex.
2. Spasticity is not likely to occur with damage to peripheral nerves.
3. Spasticity usually results from damage to the motor area of the cerebral cortex.
4. Spasticity is not likely to occur after damage to the spinal cord.
A client prescribed cyclobenzaprine (Amrix) one week prior for the treatment of neck
spasms reports the medication is not working. Which statements should the nurse provide
the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "You will need to increase the frequency of the dosage."
2. "You should discontinue the prescription."
3. "It is important you continue to take the prescription."
4. "You may require a different prescription."
5. "Let's discuss some nonpharmacological techniques that can be used with the
prescription."
3,5
1. Increasing the dosage frequency is not indicated.
2. The full therapeutic effect of the prescription may take one week or longer; the patient should not be instructed to discontinue their prescription.
3. The full therapeutic effect of the prescription may take one week or longer.
4. It is not necessary for the patient to change prescriptions; the full therapeutic effect of the prescription may take one week or longer.
5. The full therapeutic effect of the prescription may take one week or longer, therefore, nonpharmacologic measures may be needed until the full effect of the prescription is noted
Which lab result is a priority for the nurse to assess for a client who is prescribed dantrolene
(Dantrium)?
1. Creatinine clearance
2. Serum amylase
3. Hemoglobin and hematocrit
4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
4
1. Dantrolene (Dantrium) does not significantly affect renal function; the creatinine clearance test isn't a priority laboratory test to assess.
2. Dantrolene (Dantrium) does not affect pancreatic function; the serum amylase isn't a priority laboratory test to assess.
3. Dantrolene (Dantrium) does not affect hemoglobin or hematocrit; these laboratory tests are not a priority to assess.
4. Dantrolene (Dantrium) can cause hepatitis; the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the priority laboratory tests for the nurse to assess.
A client tells the nurse they are awakened during the night with leg and foot cramps. Which
response should the nurse provide the client?
1. "You may need a muscle relaxant."
2. "Increase your intake of vitamin B6."
3. "Take a warm bath before going to bed."
4. "Apply heat to relieve the cramping."
2
1. It is premature for a muscle relaxant.
2. Oral therapy with vitamin B6 may reduce the intensity and duration of leg muscle
cramping.
3. Taking a warm bath will relax the muscles but will not prevent cramping.
4. Applying heat will relax the muscles but will not prevent cramping.
The nurse observes the repeated pattern of muscle contraction of a client's leg for 5
seconds followed by 2 seconds of relaxation. Which terminology should the nurse use to
document the finding?
1. Clonic spasm
2. Tonic spasm
3. Spasticity
4. Dystonia
1
1. Clonic muscle spasms involve multiple, rapidly repeated contractions.
2. Tonic spasms involve a single prolonged contraction.
3. Spasticity involves a continuous state of contraction.
4. Dystonia is a chronic neurological disorder that can cause spasticity.
The educator is reviewing botulinum toxin type B (Myobloc) with a nurse. Which should the
educator include in the discussion?
1. Classified as a cholinergic agonist.
2. The therapeutic effect can last up to a year.
3. It can take 6 months to experience the therapeutic effect.
4. High doses are toxic causing food poisoning.
4
1. The prescription works by blocking the release of acetylcholine from cholinergic nerve terminals.
2. Therapeutic effects typically only last for 3-6 months.
3. It generally takes 6 weeks to experience the therapeutic effect.
4. Botulinum toxin type B is toxic in high doses. Clostridium botulinum is the bacterium responsible for food poisoning.
A client prescribed onabotulinumtoxinA (Botox) for muscle spasms states to the nurse, "This
prescription will also make my face look younger." Which information should the nurse
provide the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. 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 need 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."
3,4,5
1. OnabotulinumtoxinA (Botox) in this patient's case will not change the skin.
2. OnabotulinumtoxinA (Botox) is administered by injection into the muscle.
3. OnabotulinumtoxinA (Botox) has many clinical indications. Action depends on the area where the medication is administered.
4. Repeated doses of onabotulinumtoxinA (Botox) are often required.
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.
A client is experiencing muscle discomfort resulting from weight lifting. Which prescription
should the nurse anticipate will be included in the treatment?
1. Baclofen (Lioresal)
2. Clonazepam (Klonopin)
3. Ibuprofen
4. Clonidine (Catapres)
3
1. Baclofen is a skeletal muscle relaxant and is not the first line treatment for minor to moderate pain due to muscle overexertion.
2. Clonazepam is a benzodiazepine and is not the first line treatment for minor to moderate pain due to muscle overexertion.
3. Ibuprofen is a nonsteroidal anti-inflammatory that is the first line of treatment for minor to moderate pain due to muscle overexertion.
4. Clonidine is an imidazoline that is not the first line treatment for minor to moderate pain due to muscle overexertion.
The nurse is reviewing the prescription history for a client prescribed dantrolene
(Dantrium). Which prescription should concern the nurse?
1. Verapamil (Calan)
2. Insulin
3. Clarithromycin (Biaxin)
4. Methylphenidate (Concerta)
1
1. Verapamil is a calcium channel blocker; combining verapamil with dantrolene places the
patient at risk for cardiovascular collapse.
2. Insulin is not contraindicated with use of dantrolene.
3. Clarithromycin is not contraindicated with the use of dantrolene.
4. Methylphenidate is not contraindicated with the use of dantrolene.
Which common adverse effect of cyclobenzaprine (Amrix) should the nurse include when
educating the client?
1. Alopecia
2. Tongue swelling
3. Drowsiness
4. Hypotension
3
1. Alopecia is not an associated adverse effect.
2. Tongue swelling is serious, but rare.
3. All centrally acting agents have the potential to cause sedation.
4. Tachycardia is possible but would likely lead to hypertension, not hypotension.
A client asks the nurse, "Can you tell me how capsaicin works to treat muscle pain?" Which
statement should the nurse include in the response?
1. "Stimulates the body to produce endorphins that block the pain signal."
2. "Decreases the sensation of pain by interfering with the chemical messengers."
3. "Decreases the activity of the chemicals that stimulate muscle contraction."
4. "Interferes with the muscles ability to isometrically contract."
2
1. Capsaicin does not stimulate the production of endorphins.
2. Capsaicin also known as cayenne, chili pepper, paprika, or red pepper, has been used as a remedy for minor muscle pain or tension. Capsaicin diminishes the chemical
messengers that travel through the sensory nerves, thereby decreasing the sensation of pain.
3. Capsaicin does not decrease the activity of the chemicals that stimulate muscle contractions.
4. Capsaicin does not interfere with the muscles ability to isometrically contract
nurse is preparing to discharge an older adult prescribed cyclobenzaprine (Flexeril) 10
mg three times per day. The prescription is written for 90 tablets and with three refills
available. Which information should the nurse recognize requires collaboration with the
healthcare provider?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. 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 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.
2,3,5
1. The dosage of 10 mg three times daily is standard.
2. The adverse reactions from cyclobenzaprine include confusion, hallucinations, and cardiac events, which are more common in patients over 65.
3. The manufacturer recommends that treatment not extend beyond 3 weeks or 21 days.
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.
5. The drug may be taken with food or milk if gastric upset occurs.