chapter 21 drugs for neuromuscular disorders Flashcards

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

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

Beta-interferon side effects

• 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

• 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.

• 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

• 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.

• 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.

• 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.

• 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.

• 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

• 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.

• 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

• The nurse would anticipate which route of administration for the monoclonal antibody Alemtuzumab?

1. Subcutaneous
2. Oral
3. Intramuscular
4. Intravenous

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.

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

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

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.

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.

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.

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

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

Which disorder may result in muscle spasms?

cerebral palsy

multiple sclerosis

myasthenia gravis

spinal cord injuries

cerebrovascular accident

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.

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

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

Which drug is preferred for anesthesia before intubation?

A. propofol

B. Midazolam

C. Succinylcholine

D. Deemedetomidine

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

Which medication is used in the diagnosis of myasthenia gravis?

A. Neostigmine

B. Pyridostigmine

C. Edroponium

D. ciprofloxacin

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

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

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

Which medication is used to treat spasticity?

A. Baclofen

B. Diazepam

C. Mupirocin

D. Beclomethazone

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

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

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

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

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

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

Which factor may trigger myasthenia gravis? select all that apply

A. Trauma

B. pregnancy

C. Tachycardia

D. hypotension

E. emotional stress

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

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

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

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.

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.

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.

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)

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 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

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)

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)

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)

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.

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

A. Diazepam

B. Carisoprodol

C. Neostigmine

D. Pyridostigmine

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

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

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

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

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

A. Seizures

B. dyspnea

c. Angioedema

D. Bronchospasm

E. Myocardial infarction

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

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

A. Mydriasis

B. Tachycardia

C. Constipation

D. Fasciculation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A. Alcohol

B. Anesthetics

C. Barbiturates

D. Aminoglycosides

E. Tricyclic antidepressants

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

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

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

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

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

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