Ch.12 CNS, Depressants, and Muscle Relaxants (Exam 1)

A patient is admitted to the hospital with a diagnosis of benzodiazepine overdose. The nurse anticipates the health care provider will prescribe which antidote for benzodiazepine overdose?

A. Naloxone

B. Naltrexone

C. Nalmefene

D. Flumazenil

D. Flumazenil

Which nursing diagnosis is appropriate for a patient who has just been administered a sedative-hypnotic drug?

A. Risk for infection

B. Deficient knowledge

C. Imbalanced nutrition

D. Risk for injury and falls

D. Risk for injury and falls

A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes before arrival. The nurse can anticipate that which drug will be prescribed?

A. Ipecac syrup

B. Naloxone

C. Flumazenil

D. Charcoal

D. Charcoal

Which statement is accurate for the nurse to use when teaching a patient the difference between a sedative and hypnotic effect of a drug?

A. "There really is no difference; the terms are used interchangeably."

B. "Whereas sedative drugs induce sleep, hypnotic drugs induce a state of hypnosis."

C. "Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses."

D. "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time."

C. "Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses."

The health care provider prescribes dantrolene to a patient immediately after surgery. The nurse is aware this medication is used to treat what condition?

A. Delirium tremens

B. Respiratory arrest

C. Tonic-clonic seizure

D. Malignant hyperthermia

D. Malignant hyperthermia

An intravenous dose of midazolam has been prescribed for a patient before a colonoscopy. What does the nurse teach the patient is the most common adverse effect of this medication?

A. Amnesia

B. Dry mouth

C. Chest pain

D. Constipation

A. Amnesia

The nurse would monitor an older adult patient prescribed a benzodiazepine for treatment of insomnia for which potential adverse effect?

A. Red rash

B. Unsteady gait

C. Muscle spasms

D. Shortness of breath

B. Unsteady gait

When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information?

A. These medications have little effect on the normal sleep cycle.

B. Using this medication may cause drowsiness the next day.

C. It is safe to drive while taking this medication.

D. These drugs are safe to use with alcohol.

B. Using this medication may cause drowsiness the next day.

Barbiturates have a low therapeutic index. How does the nurse interpret this?

A. Low doses are not therapeutic.

B. The toxic range is narrow.

C. They are habit forming.

D. The effective, safe dosage range is narrow.

D. The effective, safe dosage range is narrow.

Which statement regarding muscle relaxants does the nurse identify as being accurate?

A. Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.

B. Cyclobenzaprine (Flexeril) produces little sedation.

C. Patients taking muscle relaxants are at a high risk of developing hypertension.

D. Patients taking muscle relaxants should be told to stop taking the medication if they feel sleepy.

A. Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.

Centrally-acting muscle relaxants relieve muscle spasms and pain through which mechanism?

A. Increase neuron activity in the spinal cord or brain, or decrease neuronal inhibition on the skeletal muscles.

B. Sedate the patient so the spasms and spasticity are decreased.

C. Depress neuron activity in the spinal cord or brain or enhance neuronal inhibition on the skeletal muscles.

D. Increase the hyperactive reflex which blocks the spasms and spasticity.

C. Depress neuron activity in the spinal cord or brain or enhance neuronal inhibition on the skeletal muscles.

Cyclobenzaprine exerts an effect within which time span?

A. 30 minutes

B. 1 hour

C. 2 hours

D. 6 to 8 hours

B. 1 hour

Cyclobenzaprine may aid in the relief of muscle spasm for which duration?

A. 1 to 2 hours

B. 3 to 8 hours

C. 12 to 24 hours

D. 36 to 48 hours

C. 12 to 24 hours

The nurse plans to provide patient teaching regarding cyclobenzaprine. Which information would the nurse share?

A. Avoid concomitant use with alcohol and other central nervous system (CNS) depressants.

B. Take cyclobenzaprine every 8 hours around the clock.

C. Take cyclobenzaprine every morning before driving to work to increase range of motion in her cervical spine.

D. Take cyclobenzaprine on an empty stomach.

A. Avoid concomitant use with alcohol and other central nervous system (CNS) depressants.

Which statement made by the patient regarding cyclobenzaprine indicates further teaching is required by the nurse?

A. "I should avoid taking alcohol with cyclobenzaprine."

B. "I can take this medication as long as I want."

C. "I should take this medication with food."

D. "I need to taper this medication if I want to stop taking it."

B. "I can take this medication as long as I want."

Which common side effects are associated with centrally-acting muscle relaxants? Select all that apply.

A. Dizziness

B. Drowsiness

C. Bradycardia

D. Hypertension

E. Dyspnea

F. Polydipsia

A. Dizziness

B. Drowsiness

Which products, if taken concurrently with midazolam, could result in drug interactions?

Select all that apply.

A. Kava kava

B. Erythromycin

C. Zolpidem

D. Penicillin

E. Fish oil

F. Atropine

A. Kava kava

B. Erythromycin

C. Zolpidem

The nurse would withhold the prescribed midazolam for the patient reporting which condition?

A. Peripheral vascular disease

B. Muscle spasms

C. Acute low back pain

D. Hepatitis B

D. Hepatitis B

The nurse would monitor which laboratory values for a patient taking cyclobenzaprine?

A. Liver function tests

B. Creatine kinase

C. Serum amylase and lipase

D. Arterial blood gases

A. Liver function tests

The nurse understands that excretion of cyclobenzaprine occurs via which organ system?

A. Kidneys

B. Liver

C. Lungs

D. Skin

A. Kidneys

Which nursing assessments are important for a patient prescribed cyclobenzaprine?

Select all that apply.

A. Level of consciousness

B. Breathing

C. Blood pressure

D. Blood glucose

E. Vision checks

A. Level of consciousness

B. Breathing

C. Blood pressure

Which method would the nurse use to administer cyclobenzaprine to facilitate the greatest amount of absorption?

A. Administer with grapefruit juice

B. Administer with a full meal

C. Administer on an empty stomach

D. Administer intravenously

C. Administer on an empty stomach

Use of muscle relaxants is contraindicated in patients with which condition?

A. Brain tumor

B. Diabetes

C. Acromegaly

D. Hepatic disease

D. Hepatic disease

A patient who has been taking 5 mg of oral cyclobenzaprine PO tid for 6 weeks asks for a renewal of the prescription. Which information is of concern to the nurse?

A. Length of time patient has been on medication

B. Frequency that the medication is prescribed

C. Dose of the medication that is prescribed

D. Route that current medication is prescribed

A. Length of time patient has been on medication

The nurse educates a patient to avoid which drugs while taking muscle relaxants?

Select all that apply.

A. Alcohol

B. Ibuprofen

C. Over-the-counter vitamins

D. Kava kava

E. Valerian

A. Alcohol

D. Kava kava

E. Valerian

Which side effects of muscle relaxants would the nurse educate a patient about?

Select all that apply.

A. Coughing

B. Headache

C. Nausea

D. Tinnitus

E. Amber urine

F. Muscle weakness

B. Headache

C. Nausea

F. Muscle weakness

Which instruction would the nurse provide a patient taking cyclobenzaprine to avoid dizziness and fainting?

Select all that apply.

A. Stand slowly from a sitting position

B. Take medication without food

C. Check blood glucose levels

D. Maintain adequate hydration

E. Stop the medication immediately

A. Stand slowly from a sitting position

D. Maintain adequate hydration

A patient is complaining of gastrointestinal symptoms when taking a prescribed muscle relaxant. The nurse would recommend which beverage to help alleviate these symptoms?

A. Water

B. Lemonade

C. Milk

D. Tea

C. Milk

A nurse is providing discharge teaching to a patient prescribed cyclobenzaprine. Which statement would be appropriate to include in the teaching?

A. "Notify your health care provider if you think you might be pregnant."

B. "Finish the entire prescription, even if you feel better."

C. "You may drive 4 hours after you take the medication."

D. "You may take a sleeping pill, if needed, but only if you have 8 hours to sleep."

A. "Notify your health care provider if you think you might be pregnant."

The nurse will teach the patient that cyclobenzaprine can relieve which symptoms?

Select all that apply.

A. Muscle stiffness

B. Muscle paralysis

C. Localized muscle spasms

D. Pain with range of motion

E. Spasticity caused by myasthenia gravis

A. Muscle stiffness

C. Localized muscle spasms

D. Pain with range of motion

For which reason should a patient taking cyclobenzaprine report adverse effects to the health care provider?

A. To prevent respiratory depression

B. To decrease prescribed dose

C. To increase prescribed dose

D. To prevent hypertension

A. To prevent respiratory depression

The nurse teaches a patient that a muscle relaxant should not be abruptly stopped based on which rationale?

A. To avoid rebound spasms

B. To prevent heart palpitations

C. To decrease chances of depression associated with chronic pain

D. To prevent permanent nerve damage

A. To avoid rebound spasms

A patient has been prescribed a skeletal muscle relaxant and asks the nurse, "Why was I told not to drive or participate in activities that require mental alertness while taking this drug?" Which response by the nurse is appropriate?

A. "Sedation is a common side effect of skeletal muscle relaxants."

B. "A decrease in peripheral vision is a side effect of skeletal muscle relaxants."

C. "A decrease in muscle tone is a side effect of skeletal muscle relaxants."

D. "Short-term memory loss is a side effect of skeletal muscle relaxants."

A. "Sedation is a common side effect of skeletal muscle relaxants."

A patient who has received an intravenous (IV) dose of midazolam will be switched to oral (PO) formulation. Which adjustment in dosing does the nurse anticipate?

A. Lower PO dose

B. Higher PO dose

C. No adjustment in dose

D. This medication cannot be given PO

B. Higher PO dose

Which medication would the nurse instruct an otherwise healthy patient to avoid while taking midazolam?

A. Morphine

B. Loratadine

C. Acetaminophen

D. Aspirin

A. Morphine

The nurse administered midazolam intravenously. Which assessment, if noted by the nurse, would require immediate intervention?

A. Confusion

B. Nausea

C. Blurred vision

D. Cough

D. Cough

Which assessment finding would require the nurse to hold the prescribed midazolam?

A. Heart rate 110 beats/minute

B. Respiratory rate 26/minute

C. Oxygen saturation 93%

D. Blood pressure 90/60 mm Hg

D. Blood pressure 90/60 mm Hg

Which nursing assessments, if applicable, must be completed before the administration of midazolam?

Select all that apply.

A. Allergy history

B. Medication history

C. Auscultation of lung sounds

D. Blood pressure

E. Pregnancy test

A. Allergy history

B. Medication history

D. Blood pressure

E. Pregnancy test

When providing education to the patient on the use of a benzodiazepine medication, the nurse will include which information?

A.These medications have little effect on the normal sleep cycle.

B.Using this medication may cause drowsiness the next day.

C.It is safe to drive while taking this medication.

D.These drugs are safe to use with alcohol.

B.Using this medication may cause drowsiness the next day.

Barbiturates have a low therapeutic index. How does the nurse interpret this?

A.Low doses are not therapeutic.

B.The toxic range is narrow.

C.They are habit forming.

D.The effective, safe dosage range is narrow.

D.The effective, safe dosage range is narrow.

An older adult patient taking multiple medications has a barbiturate added to his medication regimen. When administering a barbiturate to an older adult, what should the nurse expect?

A.A decrease in dosages of the other medications

B.The patient will experience increased amounts of REM sleep

C.To administer half of the usual dose of the barbiturate

D.Total relief of anxiety

C.To administer half of the usual dose of the barbiturate

Which statement regarding muscle relaxants does the nurse identify as being accurate?

A.Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.

B.Cyclobenzaprine (Flexeril) produces little sedation.

C.Patients taking muscle relaxants are at high risk of developing hypertension.

D.Patients taking muscle relaxants should be told to stop taking the medication if they feel sleepy.

A.Baclofen (Lioresal) is available as an injectable form for use with an implantable pump device.

The patient asks, "Is there anything I have to worry about when taking Kava?" The best response by the nurse is:

A."Kava is a natural product which has no side effects."

B."You need a prescription to take Kava."

C."No worries, Kava is recommended for patients with depression."

D."It is best to inform your health care provider of any additional medication or supplements you plan to take to check for interactions that may be harmful."

D."It is best to inform your health care provider of any additional medication or supplements you plan to take to check for interactions that may be harmful."

The patient tells the nurse that his friend has been taking valerian for a long period of time and that he isn't feeling so well. The patient asks the nurse what the adverse effects of valerian are.

What adverse effect with valerian would the nurse discuss with the patient?

A.Insomnia

B.Yellow skin

C.Bruising

D.Increased appetite

A.Insomnia

What is Dantrolene used for?

A. To treat muscle spasms caused by multiple sclerosis

B. To reverse opioid overdose

C. To treat malignant hyperthermia

D. To reduce anxiety and sedation

C. To treat malignant hyperthermia

What is the most important safety concern when administering Dantrolene to a patient?

A. Risk of respiratory depression

B. Risk of liver toxicity

C. Risk of acute kidney failure

D. Risk of hypotension

B. Risk of liver toxicity

What assessment finding requires immediate intervention for a patient receiving Dantrolene?

A. Mild muscle weakness

B. Elevated liver enzymes

C. Drowsiness

D. Nausea

B. Elevated liver enzymes

What is Flumazenil used for?

A. To reverse benzodiazepine effects

B. To treat opioid overdose

C. To manage anxiety disorders

D. To induce sedation before procedures

A. To reverse benzodiazepine effects

What is the most important safety concern when administering Flumazenil to a patient?

A. Risk of respiratory depression

B. Risk of severe hypotension

C. Risk of seizures

D. Risk of liver toxicity

C. Risk of seizures

What assessment finding requires immediate intervention for a patient who has received Flumazenil?

A. Mild nausea

B. Anxiety

C. Seizure activity

D. Drowsiness

C. Seizure activity

What drug class does Flumazenil belong to?

A. Opioid antagonist

B. Benzodiazepine antagonist

C. Skeletal muscle relaxant

D. Barbiturate antagonist

B. Benzodiazepine antagonist

What drug class does Dantrolene belong to?

A. Centrally acting muscle relaxant

B. Nonsteroidal anti-inflammatory drug (NSAID)

C. Skeletal muscle relaxant (direct-acting)

D. Acetylcholinesterase inhibitor

C. Skeletal muscle relaxant (direct-acting)

What are sedatives?

Drugs that have an inhibitory effect on the CNS; reduce nervousness, excitability, and irritability.

What are hypnotics?

Drugs that cause sleep, much more potent than sedatives.

What are sedative-hypnotics?

Dose dependent; low doses calm the CNS without inducing sleep, high doses calm the CNS to the point of causing sleep.

What are the three classes of sedative-hypnotics?

1. Barbiturates

2. Benzodiazepines (often end in pam)

3. Miscellaneous drugs

Which statement best explains how benzodiazepines produce their effects in the body?

A. Benzodiazepines block dopamine receptors, leading to sedation and muscle relaxation

B. Benzodiazepines bind to benzodiazepine receptors and enhance the activity of GABA, the brain's primary inhibitory neurotransmitter

C. Benzodiazepines directly activate opioid receptors to decrease anxiety D. Benzodiazepines inhibit serotonin reuptake to promote muscle relaxation

B. Benzodiazepines bind to benzodiazepine receptors and enhance the activity of GABA, the brain's primary inhibitory neurotransmitter

Why are barbiturates no longer commonly used?

- Habit forming, low therapeutic index, many adverse effects

- Benzodiazepines are safer

What is the primary therapeutic action of skeletal muscle relaxants?

A. To decrease inflammation in joints

B. To relieve pain associated with skeletal muscle spasms

C. To reverse neuromuscular blockade

D. To improve muscle strength

B. To relieve pain associated with skeletal muscle spasms

Skeletal muscle relaxants resemble which neurotransmitter and enhance its sedative effects?

A. Dopamine

B. Serotonin

C. Acetylcholine

D. Gamma-aminobutyric acid (GABA)

D. Gamma-aminobutyric acid (GABA)

Skeletal muscle relaxants are most effective when used in combination with which intervention?

A. Opioid therapy

B. Corticosteroids

C. Physical therapy

D. Surgical intervention

C. Physical therapy

Which adverse effect is associated with skeletal muscle relaxants due to their effects on the CNS and skeletal muscles?

A. Hypertension

B. Muscle rigidity

C. Drowsiness

D. Hyperreflexia

C. Drowsiness

If skeletal muscle relaxants are taken with other CNS depressants, which nursing intervention is a priority?

A. Monitor blood glucose levels

B. Maintain an adequate airway

C. Encourage ambulation

D. Administer diuretics

B. Maintain an adequate airway

What drug class does Baclofen belong to?

A. Benzodiazepine

B. Centrally acting skeletal muscle relaxant

C. Barbiturate

D. Opioid agonist

B. Centrally acting skeletal muscle relaxant

What is the primary use of Baclofen?

A. Treatment of insomnia

B. Relief of muscle spasticity

C. Induction of anesthesia

D. Seizure control

B. Relief of muscle spasticity

What is the most important safety concern when administering Baclofen?

A. Risk of liver failure

B. Risk of respiratory depression

C. Risk of severe hypertension

D. Risk of hypoglycemia

B. Risk of respiratory depression

Which assessment finding requires immediate intervention for a patient taking Baclofen?

A. Mild dizziness

B. Muscle weakness

C. Respiratory rate of 8 breaths per minute

D. Fatigue

C. Respiratory rate of 8 breaths per minute

What drug class does Zolpidem (Ambien) belong to?

A. Benzodiazepine

B. Barbiturate

C. Non-benzodiazepine sedative-hypnotic

D. Antidepressant

C. Non-benzodiazepine sedative-hypnotic

What is the primary use of Zolpidem?

A. Treatment of anxiety disorders

B. Short-term treatment of insomnia

C. Muscle relaxation

D. Seizure control

B. Short-term treatment of insomnia

What is the most important safety concern with Zolpidem?

A. Risk of renal failure

B. Risk of complex sleep behaviors

C. Risk of hypotension

D. Risk of constipation

B. Risk of complex sleep behaviors

Which assessment finding requires immediate intervention for a patient taking Zolpidem?

A. Mild morning drowsiness

B. Difficulty falling asleep

C. Reports of sleep-driving

D. Headache

C. Reports of sleep-driving

What drug class does Diazepam belong to?

A. Barbiturate

B. Benzodiazepine

C. Opioid

D. Skeletal muscle relaxant

B. Benzodiazepine

What is a primary use of Diazepam?

A. Treatment of insomnia only

B. Anxiety, muscle spasms, and seizure disorders

C. Induction of general anesthesia

D. Treatment of chronic pain

B. Anxiety, muscle spasms, and seizure disorders

What is the most important safety concern when administering Diazepam?

A. Risk of liver toxicity

B. Risk of respiratory depression

C. Risk of hypertension

D. Risk of hyperglycemia

B. Risk of respiratory depression

Which assessment finding requires immediate intervention for a patient taking Diazepam?

A. Mild sedation

B. Dizziness

C. Respiratory rate of 8 breaths per minute

D. Fatigue

C. Respiratory rate of 8 breaths per minute

What drug class does Lorazepam (Ativan) belong to?

A. Barbiturate

B. Benzodiazepine

C. Sedative-hypnotic

D. Antipsychotic

B. Benzodiazepine

What is a primary use of Lorazepam?

A. Treatment of insomnia

B. Anxiety, acute agitation, and seizure activity

C. Muscle spasticity

D. Chronic pain management

B. Anxiety, acute agitation, and seizure activity

What is the most important safety concern when administering Lorazepam?

A. Risk of kidney failure

B. Risk of respiratory depression

C. Risk of arrhythmias

D. Risk of hyperthermia

B. Risk of respiratory depression

Which assessment finding requires immediate intervention for a patient taking Lorazepam?

A. Drowsiness

B. Mild confusion

C. Respiratory rate of 10 breaths per minute

D. Oxygen saturation of 88%

D. Oxygen saturation of 88%

What drug class does Phenobarbital belong to?

A. Benzodiazepine

B. Opioid

C. Barbiturate

D. Sedative-hypnotic

C. Barbiturate

What is a primary use of Phenobarbital?

A. Treatment of insomnia

B. Seizure control

C. Anxiety management

D. Muscle relaxation

B. Seizure control

What is the most important safety concern when administering Phenobarbital?

A. Risk of hypertension

B. Risk of respiratory depression

C. Risk of hyperglycemia

D. Risk of infection

B. Risk of respiratory depression

Which assessment finding requires immediate intervention for a patient taking Phenobarbital?

A. Mild sedation

B. Dizziness

C. Respiratory rate of 6 breaths per minute

D. Fatigue

C. Respiratory rate of 6 breaths per minute