Chapter 21: Drugs for Neuromuscular Disorders and Muscle Spasms
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 11th
Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient who has myasthenia gravis. The nurse will be alert to
symptoms affecting which body system which may indicate that the patient has transitioned to
myasthenic crisis?
a. Cardiovascular system
b. Central nervous system (CNS), memory, and cognition
c. Gastrointestinal system (GI) and lower extremity muscles
d. Respiratory system
ANS: D
Patients with myasthenia gravis can progress to severe, generalized muscle weakness
involving the muscles of respiration, such as the diaphragm and intercostal muscles.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology
2. A 40-year-old woman is diagnosed with myasthenia gravis, and her provider recommends
removal of her thymus gland. She asks the nurse why this would be helpful. The nurse will
explain that removal of the thymus gland may
a. increase binding of acetylcholine (ACh) molecules to ACh receptors.
b. increase the amount of ACh available at neuromuscular junction sites.
c. reduce the number of acetylcholine receptor sites.
d. reduce symptoms of myasthenia gravis following surgery.
ANS: D
Thymic hyperplasia and tumors are common in patients with myasthenia gravis (MG). The
thymus gland is involved in systemic immunity that is active during infancy and early
childhood, but the gland normally shrinks during adulthood. Approximately 70% of MG
patients have thymic hyperplasia. A thymectomy (removal of the thymus gland) is most
beneficial because it can cause a reduction of symptoms following the surgery.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pathophysiology
3. The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of
neostigmine scheduled to be administered 1 hour prior was not given. The nurse will
anticipate the patient to exhibit which symptoms?
a. Excessive salivation
b. Muscle spasms/twitching
c. Muscle weakness
d. Abdominal cramping
ANS: C
Neostigmine must be given on time to prevent myasthenic crisis, which is characterized by
generalized, severe muscle weakness. The other symptoms are characteristic of cholinergic
crisis, caused by too much medication.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment | Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pathophysiology
4. The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine 60
mg every 4 hours. The patient’s last dose was 45 minutes prior. The nurse notes respiratory
distress, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse
will perform which action?
a. Assess the patient for signs of ptosis.
b. Notify the provider to discuss an order for intravenous immune globulin (IVIG).
c. Obtain an order for atropine sulfate.
d. Request an order for an extra dose of pyridostigmine.
ANS: C
Respiratory distress, excess salivation, fasciculations of facial muscles, and pupil constriction
are the major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is
atropine, so the nurse should obtain an order to give this. Ptosis is a sign of myasthenic crisis.
IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra
pyridostigmine would increase the symptoms.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. Which of the following is FALSE regarding pyridostigmine?
a. It is poorly absorbed from the gastrointestinal tract.
b. Overdosing of pyridostigmine can result in cholinergic crisis.
c. Atropine is the antidote for pyridostigmine overdose.
d. Pyridostigmine is a muscarinic receptor antagonist.
ANS: D
Pyridostigmine is an acetylcholinesterase inhibitor and does not antagonize muscarinic
receptors. The drug is poorly absorbed from the GI tract. Overdosing with pyridostigmine
results in cholinergic crisis, and atropine is used as an antidote for pyridostigmine overdose.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A patient reports weakness of the extremities and diplopia. The nurse knows that these
symptoms are characteristic of which condition?
a. Cerebral palsy (CP)
b. Multiple sclerosis (MS)
c. Myasthenia gravis (MG)
d. Parkinson disease (PD)
ANS: B
Diplopia and weakness of the extremities are two symptoms of MS. CP is characterized by
muscle spasticity. MG involves generalized weakness, especially of facial muscles and
respiratory muscles. PD manifests as tremors and difficulty moving and walking.
DIF: Cognitive Level: Remembering (Knowledge)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology
7. A patient has symptoms that are characteristic of multiple sclerosis (MS). Which diagnostic
tests are likely to be ordered to aid in the diagnosis?
a. Cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI)
b. CSF proteins and an angiography
c. Serum albumin and a computed tomography (CT) scan
d. Serum anti-acetylcholine antibodies and x-rays
ANS: A
Laboratory tests that may be used to confirm a diagnosis of MS include CSF analysis, evoked
potential (EP) testing, and MRI.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology
8. A patient with multiple sclerosis (MS) is to start treatment with interferon beta-1a. The
presence of which of the following will prompt the nurse to check with the provider?
a. History of diabetes mellitus
b. History of hypertension
c. History of depression and suicidal ideation
d. History of osteoarthritis
ANS: C
Interferons are associated with contributing to symptoms of depression and suicidal ideation.
For patients with a positive history of depression and suicidal ideation consideration of
alternative therapy is likely prudent. A history of diabetes, hypertension or osteoarthritis
would not preclude the use of interferon therapy.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. The nurse provides teaching to a patient who will begin taking cyclobenzaprine to treat acute
muscle spasms. Which statement by the patient indicates a need for further teaching?
a. “I may experience dizziness and drowsiness when I take this drug.”
b. “I should not consume alcohol while taking this medication.”
c. “I should be careful driving with this medication because it can cause drowsiness.”
d. “I will take this medication for 3 months and then stop taking it.”
ANS: D
Most centrally acting muscle relaxants used for acute spasms are taken for no longer than 3
weeks and should be tapered over 1 week to avoid rebound spasms. Patients may experience
dizziness and drowsiness. Alcohol will compound the central nervous system sedative effects.
Patients should be cautioned about driving and operating machinery while using muscle
relaxants.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is performing an admission assessment on a patient who has been taking
carisoprodol for 3 weeks to treat muscle spasms. The patient reports that the muscle spasms
have resolved. The nurse will contact the provider to discuss
a. changing to cyclobenzaprine.
b. continuing the carisoprodol for 1 more week.
c. discontinuing the carisoprodol now.
d. ordering a taper of the carisoprodol.
ANS: D
Muscle relaxants can result in drug dependence and should not be withdrawn abruptly. The
nurse should discuss a drug taper. Changing to a different muscle relaxant (cyclobenzaprine)
is not recommended since the patient is doing well.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. The nurse is teaching a group of nursing students about multiple sclerosis (MS). Which
statement by the nurse is correct?
a. “MS is characterized by depletion of dopamine in neurons and nerves in the brain
and spinal cord.”
b. “MS is characterized by lesions or plaques on myelin sheaths of nerves.”
c. “MS is characterized by neuritic plaques and neurofibrillary tangles in the CNS.”
d. “MS is characterized by weak muscles and decreased nerve impulses caused by
decreased ACh.”
ANS: B
MS is characterized by lesions or plaques on myelin sheaths of nerves.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
12. The nurse is caring for a patient who has multiple sclerosis (MS). The patient is experiencing
an acute attack and reports sudden onset of blindness in one eye. Which drug does the nurse
anticipate the provider will order?
a. IV methylprednisolone
b. Mitoxantrone
c. Glatiramer acetate
d. Interferon-B
ANS: A
IV methylprednisolone (a corticosteroid) is given to treat an acute attack of MS. Glatiramer
acetate, interferon products, and mitoxantrone are given chronically to prevent worsening of
symptoms.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
13. The nurse is performing a health history on a patient who has multiple sclerosis (MS) who
will be started on a new therapy. The patient asks about a medication he heard about on TV
that can cause a life threatening viral infection in the CNS. The nurse recognizes that he is
referring to which of the following medications?
a. Siponimod
b. Mitoxantrone
c. Glatiramer acetate
d. Natalizumab
ANS: D
Natalizumab has a black box warning for risk of leukoencephalopathy.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14. The nurse is preparing to care for a patient who has multiple sclerosis (MS). The nurse learns
that the patient receives fingolimod. The nurse knows that which of the following is FALSE
about fingolimod?
a. It is used for treatment of relapsing remitting MS (RRMS).
b. It is administered IV.
c. Fingolimod treatment requires CBC, ECG and LFT monitoring.
d. Diarrhea and headache are common side effects.
ANS: B
Fingolimod is orally administered. It is used to treat RRMS. Common side effects include
diarrhea and headache, and treatment requires monitoring of CBC, ECG and LFTs.
DIF: Cognitive Level: Remembering (Knowledge)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
15. Which agent listed below is used in surgery to achieve neuromuscular blockade and paralysis?
a. Baclofen
b. Chlorzoxazone
c. Pancuronium bromide
d. Methocarbamol
ANS: C
Pancuronium bromide is used as a muscle relaxant as adjunct to anesthesia. Baclofen is used
for muscle spasms caused by MS or spinal cord injury. Chlorzoxazone and methocarbamol
are used for acute muscle spasms.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
16. The nurse is preparing to administer chlorzoxazone to a patient who is experiencing acute
muscle spasms. The nurse notes discoloration of the patient’s urine. What will the nurse do?
a. Administer the next dose of chlorzoxazone since this is a harmless side effect.
b. Contact the provider to discuss changing to cyclobenzaprine.
c. Obtain an order for a complete blood count to evaluate blood loss.
d. Request an order for liver function tests since this indicates hepatotoxicity.
ANS: A
Urine discoloration can occur in patients taking chlorzoxazone, and this is a harmless side
effect. There is no need to change medications or order lab tests.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment | Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
1. A client with myasthenia gravis is experiencing a cholinergic crisis. Which symptoms are
associated with this condition? (Select all that apply.)
a. Bradycardia
b. Rash
c. Vomiting
d. Fever
e. Drooling
f. Weakness
ANS: A, C, E, F
Bradycardia, vomiting, drooling, and weakness can all occur with cholinergic crisis.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies