chapter 21 drugs for neuromuscular disorders Flashcards


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1

A patient on Beta-interferon for multiple sclerosis is at risk for what?

infections

2

Beta-interon Beta -1a should not be given to

People with alcoholism and bone transplants

Beta-interferon A will be metabolized in liver

3

Beta-interferon side effects

Side effect Sucidal Idealation, depression, autoimmune hepatitis, neutropenia, change in behavior from depression to joining in activities to giving away posessions, talking about death and dying then not taking about it.

4
  • A patient is prescribed cyclobenzaprine for relief of muscles spasms. What does the nurse instruct the patient to avoid while taking cyclobenzaprine?
  1. Beer
  1. Coffee
  1. Grape juice
  1. Orange juice
  1. Beer. Alcohol can cause central nervous system depression and should be avoided while taking cyclobenzaprine. There is no need to avoid coffee, grape juice, or orange juice while taking the drug.

5
  • A patient newly diagnosed with myasthenia gravis (MG) is started on neostigmine. What is the most important nursing intervention for this patient?
  1. Administer the drug on time.
  1. Teach the patient to take the drug with food.
  1. Assess the patient’s temperature daily.
  1. Teach the patient to change positions slowly.
  1. Administer the drug on time. Neostigmine is an acetylcholinesterase inhibitor with a short half-life. It is administered every 2 to 4 hours and must be given on time to prevent muscle weakness. It is not required to administer the drug with food, and the drug should not affect the patient’s temperature nor result in orthostatic hypotension.

6
  • The health care provider orders pyridostigmine bromide for a patient. Which assessment will help confirm the therapeutic outcome for this medication?
  1. Ability to walk
  2. Increased muscle strength
  3. Decrease in pain
  4. Clear vision

2. Increased muscle strength. Pyridostigmine is given to increase muscle strength. It will not actually provide the ability to walk and will not decrease pain or provide clear vision.

7
  • A patient taking pyridostigmine develops symptoms of a cholinergic crisis. What priority action does the nurse anticipate performing?
  1. Administer atropine.
  1. Administer epinephrine.
  1. Increase the dose of pyridostigmine.
  1. Monitor the patient’s blood pressure.
  1. Atropine is the antidote for treating a cholinergic crisis. Administering epinephrine will not be effective nor will increasing the dosage of the pyridostigmine. Monitoring the patient’s blood pressure will not alleviate the cholinergic crisis.

8
  • The nurse is caring for a patient who is experiencing a myasthenic crisis. What is the primary nursing intervention?
  1. Maintain the patient’s airway.
  2. Administer atropine.
  3. Administer naloxone hydrochloride
  4. Monitor muscle strength.
  1. Maintain the patient's airway. Muscle weakness can affect the airway, and maintaining the airway is the primary priority. Asphyxiation is the primary threat to the patient’s life; therefore, maintaining the airway is paramount. Neither atropine nor naloxone hydrochloride will alleviate the crisis.

9
  • A nurse is caring for a patient prescribed neostigmine orally. Which instruction should the nurse include in the patient’s plan of care?
  1. Administer neostigmine every 8 hours.
  2. Monitor for onset of action in 4 hours.
  3. Monitor the patient for respiratory depression.
  4. Make sure that naloxone hydrochloride is readily available.

3. Monitor the patient for respiratory depression. Neostigmine is a fast-acting AChE inhibitor that, when administered orally, has an onset of action of 0.5 to 1 hour; it is given every 2 to 4 hours. The nurse should monitor the patient for respiratory depression, which is a life-threatening adverse effect. Atropine is the antidote for a cholinergic crisis.

10
  • A mechanically ventilated patient receiving a neuromuscular blocking agent has tearing in the eyes and increased heart rate and blood pressure. What is the nurse’s initial action?
  1. Stop the medication; the patient is having an adverse reaction to the medication.
  2. Notify the physician; patient’s level of sedation is inadequate.
  3. Notify the physician; patient’s dose of the neuromuscular blocking agent is too high.
  4. Document findings and monitor; these effects are expected.

Notify the physician; patient’s level of sedation is inadequate. Tearing in eyes and increased heart rate and blood pressure are symptoms of increased anxiety and/or pain. A patient receiving a neuromuscular blocking agent cannot move or communicate; thus, the nurse must rely on subtle changes to assess adequate sedation. Simply documenting findings or monitoring will not relieve the patient’s symptoms.

11
  • The nurse is caring for a patient who has been diagnosed with multiple sclerosis. The health care provider opts to include baclofen as part of this patient’s treatment regimen. The nurse recognizes that this is an appropriate medication for this patient because the drug will treat which symptom?
  1. Muscle deterioration
  2. Muscle spasticity
  3. Muscle aching
  4. Muscle wasting

Muscle spasticity Baclofen is a muscle relaxant that is used to treat the spasticity of the muscles that occurs with multiple sclerosis. It does not specifically address muscle aching nor deterioration of muscle tissue.

12
  • The patient has been prescribed tizanidine and complains of experiencing a dry mouth. What is the nurse’s priority action?
  1. Notify the health care provider; this is indicative of an anaphylactic reaction.
  2. Monitor the patient closely for additional unexpected side effects of the drug.
  3. Notify the pharmacist; the patient may be receiving too high a dosage of the drug.
  4. Instruct the patient to use sugar-free lozenges to moisten his mouth.

Instruct the patient to use sugar-free lozenges to moisten his mouth.

Dry mouth is an expected side effect of treatment with tizanidine and should not be considered to be indicative of anaphylactic reaction or an overdosage of the drug.

13
  • The patient is scheduled to receive a dose of pancuronium bromide prior to undergoing tracheal intubation. The nurse recognizes that this is an appropriate choice for the patient because pancuronium is which type of drug?
  1. Anxiolytic
  2. Antispasticity drug
  3. Central acting muscle relaxant
  4. Nondepolarizing muscle relaxant

Nondepolarizing muscle relaxant The drug is a neuromuscular blocking agent that functions as a nondepolarizing muscle relaxant and thus is appropriate to be used prior to tracheal intubation.

14
  • The nurse would anticipate which route of administration for the monoclonal antibody Alemtuzumab?
  1. Subcutaneous
  2. Oral
  3. Intramuscular
  4. Intravenous

Intravenous

Alemtuzumab is a monoclonal antibody that requires a daily IV dose of 12 mg for 5 consecutive days, and in 12 months, an additional 12-mg dose for 3 consecutive days.

15

The next day, the patient's pain medication is changed from morphine sulfate to hydromorphone. Which statement regarding hydromorphone does the nurse identify as being true?

A. Hydromorphone must be administered intravenously.

B. Hypertension is a common side effect.

C. Physical dependence does not occur with hydromorphone therapy.

D. Hydromorphone is more potent than morphine.

D. Hydromorphone is more potent than morphine.

16

The nurse assesses a patient receiving morphine via PCA pump. The patient has a respiratory rate of 6 breath/min. The nurse anticipates administration of which of the following drugs?

A. Naloxone

B. Sumatriptan

C. Nalbuphine

D. Hydromorphone

A. Naloxone

17

The nurse identifies which of the following as a common side effect/ adverse effect of morphine therapy?

A. Diarrhea

B. Hypertension

C. Urinary retention

D. Tachypnea

C. Urinary retention

18

A patient received morphine sulfate for severe pain. The nurse assesses the patient 20 minutes later. What is the best indication that the medication has been effective?

A. Patient verbalizes pain relief.

B. Patient has an increase heart rate.

C. The patient is resting.

D. The patient has an increase I blood pressure.

A. Patient verbalizes pain relief.

19

When the nurse explains the pathophysiology of myasthenia graves to a patient, which is the best explanation?

A. Degeneration of cholinergic neurons and a deficit in a acetylcholine lead to neuritic plaques and neurofibrillary tangles.

B. A decreased amount of acetylcholine to cholinergic receptors produces weak muscles and reduced nerve impulses.

C. Myelin sheaths of nerve fibers in the brain and spinal cord develop lessons or plaques affecting the nervous system.

D. An imbalance of dopamine and acetylcholine leads to degeneration of neurons in midbrain and extrapyramidal motor tracts.

B. A decreased amount in acetylcholine to cholinergic receptors produces weak muscles and reduced nerve impulses.

20

The nurse is teaching a patient recently diagnosed with multiple sclerosis about the disease. Which statement is not correct concerning multiple sclerosis?

A. The disease has periods of exacerbations followed by periods of remissions.

B. Goals of treatment are to decrease the inflammation in the nervous system.

C. Patients experience muscle weakness, fatigue, vision and emotional problems.

D. Multiple sclerosis is an autoimmune disorder that causes plaque to develop.

B. Goals of treatment are to decreased the inflammation in the nervous system.

21

A patient with multiple sclerosis is having muscle spasticity. The nurse anticipates which drug will prescribed to treat the patient's spasticity?

A. Neostigmine

B. Ropinirole

C. Cyclobenzaprine

D. Pyridostigmine

C. Cyclobenzaprine.

A centrally acting muscle relaxant. For short term Muscle spasms.

relieves muscle spasms through a central action, possibly at the brainstem level. No direct action on the neuromuscular junction or the muscle involved.

22

The nurse anticipates that the health care provider will prescribe which medication to treat a patient with relapsing remitting multiple sclerosis?

A. Ambenonium

B. Pyridostigmine

C. Mitoxantrone

D. Glatiramer acetate

D. Galatiramer Acetate

Ambenonium was used to treat myasthenia gravis, it was discontinue in 2012 by the manufacturer. Pryridostigmine acetylcholinserace inhibitor used to treat Myasthenia gravis.

Mitoxantrone is used to treat secondary progressive MS and primary progressive ms. carries a BB warning Bone marrow suppression, cardiac toxicity extravasation with IM doses. Also requires an experienced clinician for administration.

23

Which disorder may result in muscle spasms?

cerebral palsy

multiple sclerosis

myasthenia gravis

spinal cord injuries

cerebrovascular accident

cerebral palsy

multiple sclerosis

myasthenia gravis

spinal cord injuries

cerebrovascular accident

24

Which statement is true regarding Pyridostigmine?

A. It has a long half life

B. It requires once a day dosing

C. It's over dose causes a cholinergic crisis

D. It is absorbed more through the GI tract.

C. It's over dose causes a cholinergic crisis

It has a short half life, poorly absorbed through the GI tract, and it is administered several times per day

25

The nurse is caring for a patient experiencing a myasthenic crisis. What is the nurses highest priority?

A. Administer Atropine

B. monitor muscle strength

C. maintain patients airway

D. Administer Naloxone hydrochloride

C. maintain patients airway

26

How would a nurse explain skeletal muscle spasticity to a patient?

A. Spasticity result in a decrease of muscle tone

B. depressed neuron activity in the spinal cord causes muscle spasticity

C. muscular hyperactivity causes muscle contraction that result in spasticity

D. spasticity occurs with increased myelination in nerves that regulate muscle tone

C. muscular hyperactivity causes muscle contraction that result in spasticity

Spasticity results from increased muscle tone from hyper-excitable neurons. Spasticity is a result of demyelination that occurs in nerves that regulate muscle tone. pg. 246

27

Which drug is preferred for anesthesia before intubation?

A. propofol

B. Midazolam

C. Succinylcholine

D. Deemedetomidine

C. Succinylcholine

Used for neuromuscular blockade during surgical procedures for muscular relaxation and used to allow endotracheal intubation.

BB warning: not for children, infants, hyperkalemia, rhabdomyolysis

pg. 247

28

which pathophysiological change occurs due to the autoimmune disorder Multiple Sclerosis?

A. Thymatic Hyperplasia

B. Destruction of acetylcholine receptor sites

C. Destruction of myelin sheath of nerve fibers

D. Impaired transmission of messages at the neuromuscular joint

C. Destruction of myelin sheath of nerve fibers

Multiple sclerosis is a neuromuscular autoimmune disorder that attacks the myelin sheath of nerve fibers, causing lesions known as plaques. pg. 239

29

Which medication is used in the diagnosis of myasthenia gravis?

A. Neostigmine

B. Pyridostigmine

C. Edroponium

D. ciprofloxacin

A. Neostigmine

pyridostigmine is used to control Myasthenia gravis. Ciprofloxacin is used in exacerbated Myasthenia Gravis.

Pg. 240

30

The patient is to receive a does of Pancuronium bromide before endotracheal intubation. The nurse recognizes that this drug is an appropriate choice for this patient because Pancuronium is what?

A. Anxiolytic

B. Antispasticity drug

C. Centrally acting muscular relaxant

D. nondepolarizing muscle relaxant

D. nondepolarizing muscle relaxant

pg. 248

31

Baclofen is included in the treatment regimen of patients with multiple sclerosis to treat which symptom?

A. muscle spasticity

B. muscle waisting

C. muscle aching

D. muscle deterioration

A. muscle spasticity

32

which is a treatment classification of multiple sclerosis? Select all that Apply

A. relapsing remitting

B. primary progressive

C. Gradual progressive

D. Progressive relapsing

E. Secondary progressive

A. B. D. E.

pg. 242

33

Which medication is used to treat spasticity?

A. Baclofen

B. Diazepam

C. Mupirocin

D. Beclomethazone

A. Baclofen

pg. 246

34

A patient is in cholinergic crisis due to an overdose of pyridostigmine. Which medication acts as an antidote for pyridostigmine?

A. Neostigmine

B. Azathioprine

C. Endrophonium

D. Atropine Sulfate

D. Atropine Sulfate

pg. 241

35

Which intervention does the nurse include in the plan of care for a patient with Myasthenia gravis who has been prescribed a cholinergic medication?

A. Discourage the patient from drinking fruit juice

B. Administer medication 30 min. before meals

C. remind patient to avoid beats and high fiber foods

D. Provide patient with dark green leafy veg. throughout the day

B. Administer medication 30 min. before meals

Because patient with Myasthenia gravis have a hard time swallowing.

pg. 242

36

A patient in which condition benefits from Dimethyl fumarate administration?

A. Myasthenia crisis

B. Myasthenia gravis

C. relapsing forms of Multiple sclerosis

D. Chronic progressive phase of Multiple sclerosis

C. relapsing forms of Multiple sclerosis

pg. 244

37

Which medication is used to differentiate muscle weakness associated with myasthenic crisis and cholinergic crisis in a patient undergoing treatment for myasthenia gravis?

A. Phenotoin

B. Neostigmine

C. Azathriopine

D. Pyridostigmine

B. Neostigmine

Myasthenia gravis is treated with Acetylcholinesterase inhibitors. An overdose may result in a cholinergic crisis, and an under dose will result in myasthenia crisis.

Pg. 240

38

The patient is being treated with fingoligmod. Which disorder does the nurse suspect this patient to have?

A. multiple sclerosis

B. Gillian-Barre' syndrome

C. Amyotrophic multiple sclerosis

D. Parkinson's disease and dementia

A. multiple sclerosis

it is the only oral drug for relapsing Multiple sclerosis

pg. 244

39

The patient with multiple sclerosis participates in rehab and takes baclofen. The nurse suspects that the baclofen interferes with rehab because it causes.

A. Gastrointestinal upset

B. impairing coordinating movement

C. increasing pain with activity

D. producing drowsiness, lethargy, and blurred vision

D. producing drowsiness, lethargy, and blurred vision

pg. 247

40

Which factor may trigger myasthenia gravis? select all that apply

A. Trauma

B. pregnancy

C. Tachycardia

D. hypotension

E. emotional stress

A. trauma, B. pregnancy, E. emotional stress

along with Surgery, hypokalemia, Menes, and alcohol intake

pg. 239

41

At which time does a nurse instruct a patient to take pyridostigmine?

A. with meals

B. after meals

C. before meals

D. on an empty stomach

C. Before meal

42

The HCP prescribes a medication to a patient with muscle pain and spasms. On a follow up visit, the patient reports green colored urine. Which medication is this patient taking?

A. Mitoxantrone

B. Ambenonium

C. Chlorzoxazone

D. succinylclorine

C. Chlorzoxazone. May cause green to black colored urine.

pg. 247

43

Which medication does the nurse anticipate to be administered to the patient after induction of anesthesia to ensure the procedure is performed safely?

A. Diazepam

B. Vecuronuim

C. Dantrolene sodium

D. orphanadrine citrate

B. Vecuronuim

This medication is a nondepolarizing muscle relaxant that is used in with anesthesia.

44

A nurse is caring for a patient prescribed neostigmine (Prostigmin) orally. Which instruction will the nurse include in the patient's plan of care?
Administer neostigmine every 8 hours.
Monitor for onset of action in 4 hours.
Monitor the patient for respiratory depression.
Make sure that naloxone hydrochloride (Narcan) is readily available.

Monitor the patient for respiratory depression.

Neostigmine (Prostigmin) is a fast-acting AChE inhibitor that, when administered orally, has an onset of action of 0.5 to 1 hour; it is given every 2 to 4 hours. The nurse should monitor the patient for respiratory depression, which is a life-threatening adverse effect. Atropine is the antidote for a cholinergic crisis.

45

A mechanically ventilated patient receiving a neuromuscular blocking agent has tearing in the eyes and increased heart rate and blood pressure. What is the nurse's initial action?
Stop the medication; the patient is having an adverse reaction to the medication.
Notify the physician; patient's level of sedation is inadequate.
Notify the physician; patient's dose of the neuromuscular blocking agent is too high.
Document findings and monitor; these effects are expected.

Notify the physician; patient's level of sedation is inadequate.

Tearing in eyes and increased heart rate and blood pressure are symptoms of increased anxiety and/or pain. A patient receiving a neuromuscular blocking agent cannot move or communicate; thus, the nurse must rely on subtle changes to assess adequate sedation. Simply documenting findings or monitoring will not relieve the patient's symptoms.

46

The patient has been prescribed tizanidine (Zanaflex) and complains of experiencing a dry mouth. What is the nurse's highest priority action?
Notify the health care provider; this is indicative of an anaphylactic reaction.
Monitor the patient closely for additional unexpected side effects of the drug.
Notify the pharmacist; the patient may be receiving too high a dosage of the drug.
Instruct the patient to use sugar-free lozenges to moisten his mouth.

Instruct the patient to use sugar-free lozenges to moisten his mouth.

47

A patient is diagnosed with multiple sclerosis. The primary health care provider prescribes intramuscular administration of 30 mcg of an interferon once per week to the patient. Which is the interferon most likely prescribed to the patient?

1
Interferon beta-1a (Avonex)
2
Interferon alfa-n3 (Alferon-N)
3
Interferon alfacon-1 (Infergen)
4
Interferon gamma-1b (Actimmune)

Interferon beta-1a (Avonex)

Interferon beta-1a (Avonex) is the interferon most likely prescribed in the treatment of multiple sclerosis. It is administered intramuscularly at a dose of 30 mcg once per week. Interferon alfa-n3 (Alferon-N) is an interferon used in the treatment of condylomataacuminata. It is given intralesionally 250,000 units (0.05 mL) into the base of each wart twice per week. Interferon alfacon-1 (Infergen) is an interferon used in the treatment of chronic hepatitis C. It is given at 9 mcg three times per week subcutaneously. Interferon gamma-1b (Actimmune) is an interferon used in the treatment of chronic granulomatous disease and osteopetrosis. It is given subcutaneously (50 mcg/m2) three times per week for body surface area more than 0.5 m2.

48

What should the nurse advise a patient who is prescribed cyclobenzaprine (Amrix)? Select all that apply.
A
"Avoid the consumption of alcohol."
B
"Avoid administration of anesthetics."
C
"Avoid consumption of barbiturates.
D
"Avoid administration of aminoglycosides."
E
"Avoid consumption of tricyclic antidepressants."

A, C, E

Cyclobenzaprine (Amrix) is a medication that acts as a central nervous system (CNS) depressant. The consumption of alcohol during the course of cyclobenzaprine therapy may result in severe CNS depression; therefore, the nurse should advise the patient who is prescribed cyclobenzaprine to avoid alcohol consumption. Concomitant administration of barbiturates and cyclobenzaprine may result in coma. The administration of tricyclic antidepressants along with cyclobenzaprine may also cause severe CNS depression; therefore, these medications should not be prescribed concurrently. Anesthetics and aminoglycosides do not interact with cyclobenzaprine and can be safely prescribed together.

49

A transplant patient taking glatiramer acetate (Copaxone) therapy inquires about the correct dosage of the medicine. What is the correct dosage to be administered?
1
1 mg/kg IV/PO
2
20 mg Subcut
3
1 g IV/PO
4
0.03 to 0.05 mg/kg/day IV

20 mg Subcut

Glatiramer acetate (Copaxone) is administered subcutaneously as 20 mg once daily. One mg per kg 24 hours preoperatively as bolus injection is the dosage of daclizumab (Zenapax). One gm twice daily IV or PO is the dosage for mycophenolate mofetil (CellCept) and 0.03 to 0.05 mg/kg/day as continuous IV infusion is the dosage for tacrolimus (Prograf).

50

A primary health care provider has prescribed neostigmine (Prostigmin) to a patient who has myasthenia gravis. During a follow-up visit, the nurse finds that symptoms of myasthenia gravis still persist in the patient. Which medication should the nurse expect the primary health care provider to prescribe?
A
Methocarbamol (Robaxin)
B
Dantrolene sodium (Dantrium)
C
Ambenonium chloride (Mytelase)
D
Edrophonium chloride (Tensilon)

Ambenonium chloride (Mytelase)

The persistence of symptoms of myasthenia gravis (MG) after administration of neostigmine (Prostigmin) indicates that the patient is not responding to the medication. The nurse should expect the primary health care provider to prescribe ambenonium chloride (Mytelase) in the treatment of MG, because it is a long-acting acetylcholinesterase inhibitor. Methocarbamol (Robaxin) is used to treat muscle spasms and tetanus. Dantrolene sodium (Dantrium) is used to treat muscle spasms associated with spinal cord injuries, multiple sclerosis, and other neurological disorders. Edrophonium chloride (Tensilon) is used to distinguish between myasthenia crisis and cholinergic crisis. It is also used to diagnose MG.

51

Which medication is beneficial for a patient in the chronic progressive phase of multiple sclerosis?
1
Diazepam (Valium)
2
Cyclophosphamide (Cytoxan)
3
Dantrolene sodium (Dantrium)
4
Pancuronium bromide (Pavulon)

Cyclophosphamide (Cytoxan)

Multiple sclerosis is an autoimmune disorder that attacks the myelin sheath of nerve fibers in the brain and spinal cord, and causes lesions. Cyclophosphamide (Cytoxan) is an immunosuppressant that is used to treat the chronic progressive phase of multiple sclerosis. Diazepam (Valium) is a muscle relaxant that is used to relieve muscle spasms associated with paraplegia and cerebral palsy. Dantrolene sodium (Dantrium) is a muscle relaxant that is used for chronic neurologic disorders and spinal cord injuries. Pancuronium bromide (Pavulon) is used in surgery for relaxation

52

The nurse is caring for a patient with myasthenia gravis (MG) who has been prescribed pyridostigmine bromide (Mestinon). During a follow-up visit, the patient reports symptoms of increased salivation, sweating, and extreme muscle weakness. Which medication should the nurse expect the primary health care provider to prescribe?
A
Phenytoin (Dilantin)
B
Methocarbamol (Robaxin)
C
Atropine sulfate (Atropisol)
D
Edrophonium chloride (Tensilon)

Atropine sulfate (Atropisol)

Pyridostigmine bromide (Mestinon) is used in the treatment of myasthenia gravis (MG), because it increases the amount of the neurotransmitter acetylcholine available to stimulate the receptors. Increased availability of neurotransmitters facilitates transmission of signals from and to the brain and promotes muscular function. Signs such as increased salivation, sweating, and severe muscle weakness indicate an overdose of pyridostigmine bromide; therefore, atropine sulfate (Atropisol) should be prescribed to the patient, because it acts to reverse the effects of pyridostigmine bromide. The administration of phenytoin (Dilantin) may result in myasthenic crisis; however, phenytoin is not used in the treatment of MG and would not be prescribed. Methocarbamol (Robaxin) is used to treat muscle spasms that are associated with tetanus.

53

The primary health care provider has prescribed cyclobenzaprine (Amrix) to a patient who has muscle spasms. After reviewing the patient's medical history, the nurse requests the primary health care provider to revise the prescription. Which finding would most likely be the rationale for the nurse's action? Select all that apply.
A
The patient has asthma.
B
The patient has peptic ulcers.
C
The patient has hyperthyroidism.
D
The patient has hepatic impairment.
E
The patient has narrow-angle glaucoma.

hyperthyroidism and glaucoma

The administration of cyclobenzaprine (Amrix) may cause hypertension and tachycardia in a patient who has hyperthyroidism. This medication may also cause an increase in intraocular pressure and is therefore contraindicated in patients who have narrow-angle glaucoma. Pyridostigmine (Mestinon) may not be administered in patients who have conditions such as asthma, peptic ulcers, and hepatic impairment, because the medication may aggravate these conditions.

54

Which medication is used as an antidote for the nerve gas soman?

A. Diazepam

B. Carisoprodol

C. Neostigmine

D. Pyridostigmine

D. Pyridostigmine

Pg. 241

55

A patient with a history of stroke has been prescribed dantrolene. The nurse includes which intervention in the plan of care? Select all that apply

A. Monitoring liver enzyme levels in the patient

B. instructing the patient to stop the medication after a week

C. Observing the patient for side effects related to the central nervous system

D. Keeping atropine sulfate readily available for the patient

E. administering the medication in intravenous undiluted form at a rate of 0.5 mg/ min

A. Monitoring liver enzyme levels in the patient

C. Observing the patient for side effects related to the central nervous system

dantrolene is used to treat muscle spasticity in Pt who had a stroke. This med is not usually used for more than 3 weeks. Dantrolene is admin orally. dose 25 mg/ day which would gradually be increased.

pg. 247

56

The nurse conducts preoperative teaching with the patient scheduled to undergo a laparotomy who will receive pancuronium during the procedure. Which explantation does the nurse give for the admin of pancuronium?

A. It will maintain a stable blood pressure

B. it will reduce upper respiratory secretion

C. It will keep the heartbeat slow and regular

D. It will relax the abdominal muscles for the surgery

D. It will relax the abdominal muscles for the surgery

Pancuronium is a neuromuscular blocking agent that is used during surgery to relax muscles for exposure of the surgical site and for intubation, and mechanical ventilation. It acts by blocking Acetylcholine. pg. 248

57

The patient who has been administered a neuromuscular drug has severe muscle paralysis. Which med does the nurse expect the health care provider to prescribe for this condition?

A. Isoflurant

B. Dantrolene

C. Sevoflurant

D. Pyridostigmine

D. Pyridostigmine

Pyridostigmine Blocks the action of neuromuscular blocking drugs and reverses muscle paralysis.

pg 240

58

Before administering the first dose of pyridostigmine to the patient with myasthenia gravis, the nurse reviews the patients medical history and notes the patient has asthma. The nurse reports this finding to the HCP and anticipates which instructions?

A. Elevate the patient's bed while sleeping

B. Discontinue administering pyridostigmine

C. Administer pyridostigmine intramuscularly

D. Teach deep breathing exercises to the patient

B. Discontinue administering pyridostigmine

Cholinergic drugs such as pyridostigmine should not be administered to the patient with asthma because it will worsen the asthma symptoms. pg. 241

59

Which is an adverse effect of cyclobenzaprine? Select all that Apply

A. Seizures

B. dyspnea

c. Angioedema

D. Bronchospasm

E. Myocardial infarction

A. Seizures, C. angioedema, E. Myocardial infarction

60

Which is the goal of treatment with glatiramer acetate in the patient diagnosed with Multiple Sclerosis?

A. Slowing the progression of MS

B. Relieving the symptoms of MS

C . Increasing antibody production

D. Reducing edema at the site of demyelination

A. Slowing the progression of MS

Glatiramer acetate is an immunomodulator used to slow the progression of MS. pg. 242

61

Which symptom is suspected in the patient after an acetylcholinesterase inhibitor overdose?

A. Mydriasis

B. Tachycardia

C. Constipation

D. Fasciculation

D. Fasciculation

Fasciculation- involuntary muscle twitching pg 240

62

relapsing remitting MS

A. may have relapse, remissions, and plateaus

B. Relapse with full recovery and residual deficits

C. Clear acute relapses with or without full recovery

D. Will have slowly worsening symptoms with no relapses or remission

B. Relapse with full recovery and residual deficits

63

Primary progressive MS

A. may have relapse, remissions, and plateaus

B. Relapse with full recovery and residual deficits

C. Clear acute relapses with or without full recovery

D. Will have slowly worsening symptoms with no relapses or remission

D. Will have slowly worsening symptoms with no relapses or remission

64

Secondary progressive MS

A. may have relapse, remissions, and plateaus

B. Relapse with full recovery and residual deficits

C. Clear acute relapses with or without full recovery

D. Will have slowly worsening symptoms with no relapses or remission

A. may have relapse, remissions, and plateaus

65

Progressive relapsing MS

A. may have relapse, remissions, and plateaus

B. Relapse with full recovery and residual deficits

C. Clear acute relapses with or without full recovery

D. Will have slowly worsening symptoms with no relapses or remission

C. Clear acute relapses with or without full recovery

66

Muscle relaxant drugs suppress the _____________ reflex and are prescribed for muscle spasms that do not respond to _____________ drugs or other forms of therapy.

hyperactivity, antiinflammatory

67

Baclofen, dantrolene, and tizanidine are some drug to ___________ pain and ____________ mobility for hyperexcitable, spastic muscles.

Decrease, increase

68

A patient with multiple sclerosis is being treated with large doses of corticosteroids. Which nursing diagnosis would be the priority at this time?

A. Alteration in nutrition: Less than body requirements

B. Risk for infection

C. Ineffective individual coping

D. Fatigue

B. Risk for infection

69

A child with cerebral palsy is ordered to receive baclofen. The nurse is aware that this medications prescribed to

A. induce sleep and rest

B. increase appetite

C. reduce muscle spasticity

D. increase bowel function

C. reduce muscle spasticity

70

The health care provider has prescribed phenytoin to the patient who has undergone neurosurgery. Which complication may phenytoin precipitate in the patient?

A. Bradycardia

B. Hypotension

C. Cholinergic crisis

D. Myasthenic crisis

D. Myasthenic crisis

Phenytoin is used to prevent seizures that may occur after neurosurgery. Phenytoin inhibits sodium channels and causes myasthenic crisis.

71

Which instruction does the nurse give to the patient who is prescribed pyridostigmine?

A. seek medical help for nausea and vomiting

B. Ask for help to change positions or to stand

C. Take the medication 30 minutes after eating

D. Lower the dose if the usual does results in drooping eyelids

A. Seek medical help for nausea and vomiting

72

Which instruction would the nurse provide a patient with a history of glaucoma who is prescribed diazepam?

A. This medication may make you hyperactive

B. If you have kidney disease, this medication might make it worse

C. You take this medication by dissolving the pill under your tongue

D. We need to call your HCP because of your history

D. We need to call your HCP because of your history

73

The nurse instructs the patient who is prescribe diazepam to avoid which supplement? Select all that apply

A. Garlic

B. Ginger

C. Valerian

D. Aloe

E. Kava Kava

C. Valerian, E. Kava Kava

74

The patient who has paraplegia reports muscle spasms. The nurse contacts the HCP to report these findings and advocate for which medication?

A. Diazepam

B. Mupirocin

C. Azathioprine

D. Beclomethasone

A. Diazepam

75

The nurse advises the patient prescribed cyclobenzaprine to avoid which substance? Select all

A. Alcohol

B. Anesthetics

C. Barbiturates

D. Aminoglycosides

E. Tricyclic antidepressants

A. Alcohol, C. Barbiturates, E. Tricyclic Antidepressants

76

Which instruction would the nurse provide a patient prescribed methocarbamol?

A. You should cut down the amount of alcohol you drink

B. You may take your prescribed oxycodone when you experience pain

C. It is Ok to continue taking your sleeping pills while you are on this medication

D. Do not drive or operate machinery until you know how this medication affects you

D. Do not drive until you know how this med affects you

Methocarbamol is a centrally acting muscle relaxant given to decrease muscle spasms

77

The patient with muscle spasms is prescribed orphenadrine citrate. Which condition, if present in the patient's medical history, prompts the nurse to hold the dose and contact the HCP?

A. Asthma

B. Peptic ulcers

C. Hyperthyroidism

D. Narrow angle glaucoma

D. Narrow angle glaucoma

Orphenadrine increases IOP

78

The patient receives an agonist for acetylcholine receptors during surgery. This type of drug works by preventing the action potential in the motor neuron because it binds to the receptors in place of which neurotransmitter?

A. serotonin

B. Dopamine

C. Acetylcholine

D. Norepinephrine

C. Acetylcholine

79

The patient with myasthenia gravis has been admitted to the emergency department with dehydration due to excessive vomiting. The function of which system is the nurse's priority concern?

A. Renal

B. Cardiac

C. Neurologic

D. Respiratory

D. Respiratory

80

The patient reports to the clinic complaining of double vision. On further assessment, the nurse finds that the patient has dysarthria, as well. The nurse suspects which diagnosis will be made?

A. Multiple sclerosis

B. Cholinergic crisis

C. Myasthenic crisis

D. Myasthenia Gravis

D. Myasthenia Gravis

81

The patient undergoing tracheostomy is administered a nondepolarizing muscle relaxant before surgery. Which instruction does the nurse anticipate to receive from the health care provider immediately after surgery?

A. Administer atracurium

B. Administer pyridostigmine

C. avoid suctioning to the patient

D. administer an intravenous bolus of normal saline

B. Administer pyridostigmine