MILESTONE - PAIN, FEVER, & MUSCULOSKELETAL

MILESTONE - PAIN, FEVER & MUSCULOSKELETAL

Multiple Choice

A client is being started on tramadol therapy for pain management after a back injury. When educating this client on tramadol therapy, what is the priority?

• The client cannot drink alcohol while taking tramadol.

• The client cannot smoke cigarettes while taking tramadol.

• The client needs to increase the intake of calcium-rich foods.

• The client needs to avoid additional over-the-counter cough syrups.

RATIONALE

• Tramadol is similar to an opioid analgesic.

• The client taking tramadol needs to not consume alcoholic beverages while taking this medication because it further depresses the central nervous system (CNS).

• Cigarette smoking does not adversely affect tramadol; however, the client would be discouraged from smoking and encouraged to join a smoking-cessation program for general health reasons.

• The client may need increased calcium, but this is not because of tramadol.

• The client can take cough syrup with this medication.

Multiple Choice

A client with muscle aches and a diagnosis of rheumatism has been given a prescription for capsaicin topical cream. The nurse determines that the client understands the use of the medication if the client makes which statement?

• "The medication will act as a local analgesic."

• "The medication acts by decreasing muscle spasms."

• "The medication will cause redness, flaking, and the skin to peel."

• "A heating pad would be put on the area after applying the medication."

RATIONALE

• Capsaicin is used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia.

• It is one of a group of products known as rubs or liniments, which contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants.

• The skin would not become red, flaky, or peel; if this occurs, the primary health care provider would be notified.

• The medication does not act systemically.

• A heating pad would not be applied because it could cause skin irritation or burning.

Multiple Choice

A client is taking large doses of acetylsalicylic acid for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication?

• Dizziness, sore throat, and purpura

• Gastrointestinal upset and dizziness

• Tinnitus, hearing loss, dizziness, and ataxia

• Gastrointestinal bleeding, ecchymosis, and dizziness

RATIONALE

• Ototoxicity can occur as a result of the administration of acetylsalicylic acid.

• Signs and symptoms of tinnitus, hearing loss, dizziness, and ataxia reflect damage to the eighth cranial nerve, the organ of hearing and balance.

• Purpura and ecchymosis are caused by prolonged bleeding but not ototoxicity.

• Gastrointestinal bleeding and upset may be caused by acetylsalicylic acid irritation but are not symptoms of ototoxicity.

Multiple Choice

Diclofenac is prescribed for a client with osteoarthritis. Which medication, if noted on the client's record, would alert the nurse to consult with the primary health care provider (PHCP)?

• Phenytoin

• Primidone

• Acetaminophen

• Warfarin sodium

RATIONALE

• Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID).

• Interactions may occur with the use of anticoagulants, and the nurse would consult with the PHCP about a potential medication interaction if an anticoagulant is prescribed.

• Phenytoin and primidone are anticonvulsant medications, and acetaminophen is a nonopioid analgesic.

• These medications are not contraindicated with diclofenac.

Multiple Choice

The nurse notes that a client taking ergotamine tartrate is having the intended effects of therapy if the client states relief from which symptom?

• Cough

• Diarrhea

• Backache

• Headache

RATIONALE

• Ergotamine tartrate is used to stop an ongoing migraine attack; it also is used to treat cluster headaches.

• The other options are unrelated to the use of this medication.

Multiple Choice

A client with vascular headaches is taking ergotamine. The home health nurse would periodically assess him or her for which finding?

• Hypotension

• Constipation

• Dependent Edema

• Cool, Numb Fingers & Toes

RATIONALE

• Ergotamine can produce vasoconstriction.

• The nurse periodically assesses for hypertension; cool, numb fingers and toes; muscle pain; and nausea and vomiting.

• This medication does not cause hypotension, constipation, or dependent edema.

Multiple Choice

A client has been prescribed codeine sulfate. The nurse has given the client instructions for its use. The nurse concludes that the client understands the instructions if the client verbalizes to self-assess for which side effect?

• Excitability

• Rapid Pulse

• Constipation

• Excessive Urination

RATIONALE

• The client is taught about side and adverse effects that could occur with the use of codeine sulfate.

• The most common side effects include drowsiness, confusion, hypotension, nausea and vomiting, and constipation.

• Adverse effects include bradycardia, respiratory depression, and urinary retention.

Multiple Choice

The nurse would question a prescription for which medication in the client concurrently receiving tramadol?

• Beta Blockers

• Histamine H2 Antagonists

• Calcium Channel Blockers

• Monoamine Oxidase Inhibitors (MAOIs)

RATIONALE

• Tramadol can precipitate a hypertensive crisis if combined with an MAOI.

• The combination is contraindicated.

• Its use is not contraindicated with beta blockers, histamine H2 antagonists, or calcium channel blockers.

Multiple Choice

On admission the client tells the nurse that sumatriptan is prescribed. Based on this information, which question would the nurse ask the client?

• "Do you have frequent earaches?"

• "Do you experience sinus headaches?"

• "Have you had migraine headaches?"

• "Are you allergic to pollen or molds?"

RATIONALE

• Sumatriptan is used to treat migraine headaches.

• This medication constricts blood vessels around the brain and reduces substances in the body that can trigger headache pain.

• Earaches, sinus headaches, and allergies to pollen or mold are not treated with this medication.

Multiple Choice

Meperidine hydrochloride is prescribed for a client with pain. What would the nurse monitor for as a side or adverse effect of this medication?

• Diarrhea

• Bradycardia

• Hypertension

• Urinary retention

RATIONALE

• Side and adverse effects of meperidine include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention; therefore, the remaining options are incorrect.

Multiple Select

The nurse is caring for a client who underwent an open reduction internal fixation to the right hip. When administering opioid analgesics for pain, the nurse would instruct the client that which are side and adverse effects of opioid analgesics? Select all that apply.

• Sedation

• Diarrhea

• Constipation

• Increased pain level

• Respiratory depression

RATIONALE

• Side and adverse effects of opioids include constipation, sedation, and respiratory depression.

• Diarrhea is not a side effect. The pain level should decrease, not increase.

Multiple Choice

A client reports frequent use of acetaminophen for relief of headaches and other discomforts. The nurse would evaluate which diagnostic data to determine whether the client is at risk for toxicity?

• Chest x-ray

• Electrocardiogram

• Liver function studies

• Upper gastrointestinal x-ray results

RATIONALE

• In adults, overdose of acetaminophen causes liver damage.

• In addition, clients with liver disorders are at a higher risk of experiencing hepatotoxicity with chronic acetaminophen use.

• Options 1, 2, and 4 are not associated with acetaminophen overdose.

Multiple Select

Allopurinol has been prescribed for a client with a diagnosis of gout. The nurse develops a list of instructions for the client regarding the use of this medication. Which measures would be included on the list? Select all that apply.

• Increase fluid intake.

• Take the medication with food.

• Consume items to maintain an alkaline urine.

• Return to the health care clinic for liver and renal function tests.

• Take vitamin C daily to enhance the effects of the medication.

RATIONALE

• The client taking allopurinol needs to be instructed to return to the clinic for monitoring of liver and renal function studies, particularly during the first month of therapy because of the risk of hepatotoxicity and nephrotoxicity.

• The client would take the medication with food and needs to maintain an adequate fluid intake.

• The client needs to be instructed to maintain an alkaline urine

• and to avoid large doses of vitamin C.

Multiple Choice

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder?

• Myxedema

• Kidney disease

• Hypothyroidism

• Diabetes mellitus

RATIONALE

• Colchicine is used with caution in older clients, debilitated clients, and clients with cardiac, kidney, or gastrointestinal disease.

• The disorders in options 1, 3, and 4 are not concerns with administration of this medication.

Multiple Choice

Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions on administration of the medication. Which instruction would the nurse provide?

• Take the medication at bedtime.

• Take the medication in the morning with breakfast.

• Lie down for 30 minutes after taking the medication.

• Take the medication with a full glass of water after rising in the morning.

RATIONALE

• Precautions need to be taken with the administration of alendronate to prevent gastrointestinal adverse effects (especially esophageal irritation) and to increase absorption of the medication.

• The medication needs to be taken with a full glass of water after rising in the morning.

• The client would not eat or drink anything for 30 minutes following administration and needs to not lie down after taking the medication.

Multiple Choice

Cyclobenzaprine is prescribed for a client for muscle spasms, and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the primary health care provider about the administration of this medication?

• Glaucoma

• Emphysema

• Hypothyroidism

• Diabetes mellitus

RATIONALE

• Because cyclobenzaprine has anticholinergic effects, it would be used with caution in clients with a history of urinary retention, glaucoma, and increased intraocular pressure.

• Cyclobenzaprine would be used only for a short time (2 to 3 weeks).

• The conditions in options 2, 3, and 4 are not a concern with this medication.

Multiple Select

A client with gout has begun to take allopurinol. The nurse informs the client that which medication may also be necessary during the beginning phase of medication therapy with allopurinol? Select all that apply.

• Naproxen

• Colchicine

• Oxycodone

• Indomethacin

• Hydromorphone

RATIONALE

• Clients beginning medication therapy with allopurinol may also have to take colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs) because of the risk of an acute gouty attack after first starting allopurinol.

• Colchicine and NSAIDs help to prevent the acute gouty attack from occurring.

• Oxycodone and hydromorphone are opioid analgesics and do not assist in preventing an attack.

Multiple Choice

A client with multiple sclerosis is receiving baclofen. The nurse assessing the client monitors for which finding as an indication of a primary therapeutic response to the medication?

• Decreased nausea

• Decreased muscle spasms

• Increased muscle tone and strength

• Increased range of motion of all extremities

RATIONALE

• Baclofen is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases or with multiple sclerosis.

• Increased muscle tone and strength and increased range of motion of all extremities are not directly related to the effects of this medication.

• Decreased nausea is an incorrect option.

Multiple Choice

The nurse is providing medication instructions to a client with multiple sclerosis receiving baclofen. Which information would the nurse include in the instructions?

• Watch for urinary retention as a side effect.

• Stop taking the medication if diarrhea occurs.

• Restrict fluid intake while taking this medication.

• Notify the primary health care provider if fatigue occurs.

RATIONALE

• Baclofen, a skeletal muscle relaxant, also is a central nervous system (CNS) depressant, which can cause urinary retention.

• The client would not restrict fluid intake.

• Constipation, rather than diarrhea, is an adverse effect of baclofen.

• Fatigue is a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use.

• It is not necessary to notify the primary health care provider if fatigue occurs.

Multiple Choice

A client with muscle spasms in the lumbar area of the spine has been started on cyclobenzaprine. The nurse would monitor for which most frequent side effect of the medication?

• Weakness

• Confusion

• Excitability

• Drowsiness

RATIONALE

• The most common side effects of cyclobenzaprine are drowsiness, dizziness, and dry mouth.

• This medication is a centrally acting skeletal muscle relaxant used in the management of muscle spasm due to a variety of conditions.

• Weakness, confusion, and excitability are less frequent central nervous system effects of cyclobenzaprine.

Multiple Choice

The primary health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication will be administered intrathecally. Which medication would the nurse expect to be prescribed and administered by this route?

• Baclofen

• Chlorzoxazone

• Dantrolene sodium

• Cyclobenzaprine hydrochloride

RATIONALE

• Baclofen is the skeletal muscle relaxant that can be administered intrathecally, which means within the spinal column.

• Therefore, the remaining options are incorrect.

Multiple Choice

A client is receiving baclofen for muscle spasms because of a spinal cord injury. Which side/adverse effect related to this medication would the nurse monitor the client for?

• Muscle pain

• Hypertension

• Slurred speech

• Photosensitivity

RATIONALE

• Side/adverse effects of baclofen include drowsiness, dizziness, weakness, and nausea.

• Others include headache, paresthesias of the hands and feet, constipation or diarrhea, anorexia, hypotension, confusion, and nasal congestion.

• Paradoxical central nervous system excitement and restlessness can occur, along with slurred speech, tremor, dry mouth, nocturia, and impotence.

Multiple Choice

The nurse asks a nursing student about the uses of the medication dantrolene. The nursing student correctly states that dantrolene is used to manage hypermetabolism of skeletal muscle that occurs in which condition?

• Low back pain

• General anesthesia

• Malignant hyperthermia

• Hyperplasia of the prostate

RATIONALE

• Dantrolene is a skeletal muscle relaxant.

• It is used to manage fulminant hypermetabolism of skeletal muscle that occurs in malignant hyperthermia crisis.

• Dantrolene relieves symptoms of malignant hyperthermia by blocking calcium release.

• It is not used for the conditions noted in options 1, 2, or 4.

Multiple Choice

Dantrolene sodium is prescribed for the client experiencing flexor spasms. The client asks the nurse how the medication is going to help. The nurse replies that this medication acts in which way?

• Depresses the spinal reflexes causing the spasms

• Acts on the central nervous system to suppress spasms

• Acts directly on the skeletal muscle to relieve the spasms

• Acts within the spinal cord to suppress excess reflex activity

RATIONALE

• Dantrolene sodium acts directly on skeletal muscle to relieve muscle spasticity.

• The primary action is the suppression of calcium release from the sarcoplasmic reticulum.

• This in turn decreases the ability of the skeletal muscle to contract.

• The other options are incorrect actions.