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Dive into this comprehensive quiz focusing on neuromuscular disorders and their pharmacological treatments. This set explores the pathophysiology, clinical signs, and nursing management of conditions like myasthenia gravis, multiple sclerosis, and muscle spasticity, alongside the safe administration of key medications. Whether you're prepping for exams or reinforcing clinical knowledge, these scenario-based questionsโwith โ correct answers and clear rationalesโhelp solidify critical thinking and boost your confidence in managing complex neurological patients.
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1. When the nurse explains the pathophysiology of myasthenia gravis to a patient, which is the best explanation? A. Degeneration of cholinergic neurons and a deficit in acetylcholine lead to neuritic plaques and neurofibrillary tangles โ 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 lesions or plaques D. An imbalance of dopamine and acetylcholine leads to degeneration of neurons in midbrain and extrapyramidal motor tasks 2. 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 and remissions โ B. Goals of treatment are to decrease the inflammation in the nervous system C. Patients experience muscle weakness, vision problems, and fatigue D. Multiple sclerosis is an autoimmune disorder that causes plaque to develop in the spinal cord 3. A patient has spasticity following a spinal cord injury. The nurse anticipates that which drug will be prescribed to treat the patient's spasticity? A. Neostigmine B. Ropinirole โ C. Cyclobenzaprine D. Pyridostigmine 4. 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 โ D. Glatiramer Acetate
5. The nurse is providing medication instructions to a patient with acute muscle spasms who has been prescribed cyclobenzaprine. Which statement indicates understanding? โ A. I plan to take this medication with a glass of milk B. Cyclobenzaprine should be taken once daily at bedtime C. I will only drink one glass of wine per day D. I will be able to take this drug with grapefruit juice 6. Which instructions will the nurse include in the teaching plan for a patient who is taking pyridostigmine? (Select all that apply) โ A. Pyridostigmine must be taken on time B. Take the prescribed dose every other day โ C. Underdosing can result in myasthenic crisis โ D. Overdosing can result in cholinergic crisis E. Report the adverse effect of tachycardia to the health care provider 7. A patient is beginning to take cyclobenzaprine for treatment of acute back spasms. Which interventions will the nurse include? (Select all that apply) A. Advise the patient to take this drug on an empty stomach โ B. Inform the patient not to abruptly stop taking the muscle relaxant. The dose should be tapered down. โ C. Tell the patient to report dizziness and double vision to the health care provider โ D. Advise the patient to avoid alcohol โ E. Taking narcotics at the same time can cause serious side effects 8. The nurse reviews a patientโs medications before giving cyclobenzaprine for back spasms. Which medication should raise concern? A. Atorvastatin B. Conjugated estrogen
A. Angiography B. CT scan โ C. Magnetic resonance imaging (MRI) D. Myelogram
14. A patient receiving pyridostigmine is prescribed an antibiotic. Which medication should the nurse question? A. Histamine2 blocker B. Propranolol C. Cephalosporin โ D. Tetracycline 15. A patient with MS asks how azathioprine and interferon-B will help. What is the nurse's best response? A. "These medications will help form new neurons and axons." B. "They will improve muscle strength." โ C. "They will reduce spasticity and improve muscular movement." D. "They will stop the progression of the disease." 16. A patient with MS experiences muscle spasms. How do centrally acting muscle relaxants help? A. They affect mu receptors to decrease pain โ B. They decrease pain and increase range of motion C. They decrease inflammation of peripheral nerves D. They speed conduction to improve flexibility 17. A patient is prescribed methocarbamol (Robaxin) for post-MVC spasms. Which side effects should be discussed? (Select all that apply) โ A. Brown urine B. Diarrhea โ C. Drowsiness D. Increased appetite
E. Tachycardia F. Urinary retention
18. Which medication order should the nurse question before administering? A. Dantrolene sodium (Dantrium) for a 50-year-old with muscle spasms โ B. Diazepam (Valium) for a 60-year-old who also has glaucoma C. Edrophonium (Tensilon) for a 30-year-old undergoing diagnosis D. Chlorzoxazone (Parafon Forte DSC) for a 33-year-old with muscle trauma 24. Myasthenic Crisis Results from: underdosing Severe muscle weakness โ may involve diaphragm and intercostal muscles Triggers include:
๏ท Infection ๏ท Emotional stress ๏ท Menses , pregnancy ๏ท Surgery, trauma ๏ท Hypokalemia , alcohol intake ๏ท Medication interactions โ Improves after edrophonium and neostigmine
25. Cholinergic Crisis Results from: overdosing Occurs within 30 to 60 minutes of taking anticholinesterase meds Symptoms: โ Severe muscle weakness โ Possible respiratory paralysis and bronchospasm โ Abnormal pupil constriction (miosis)
โ Have atropine ready as antidote โ If MG: Improvement seen within 30โ60 seconds , lasting 4โ5 minutes
29. Patients Not Responding to AChE Inhibitors โ Prednisone โ Plasma exchange โ IVIG (Intravenous immune globulin) โ Immunosuppressive drugs (Azathioprine) 30. Multiple Sclerosis (MS) โ Pathophysiology โ Autoimmune disorder โ Attacks myelin sheath in brain and spinal cord โก Causes lesions or plaques Characteristics: โ Remissions and exacerbations โ Weakness โ Spasticity in extremities โ Diplopia 31. MS โ Diagnosis โ No specific diagnostic test โ Labs: ๏ท Elevated Immunoglobulin G in CSF ๏ท Increased IgG/albumin ratio ๏ท Multiple lesions on MRI
32. MS โ Treatment โ Immunomodulators : First-line, slow disease & prevent relapses โ Immunosuppressants โ Sphingosine 1-phosphate receptor modulators โ Monoclonal antibodies โ Corticosteroids : Reduce edema and acute inflammation 33. Skeletal Muscle Relaxants โ Centrally acting : Relieve spasm & spasticity , sedative effect Examples: ๏ท Carisoprodol ๏ท Methocarbamol ๏ท Metaxalone โ Direct-acting : Dantrolene โ reduces spasm pain & improves ROM 34. Muscle Relaxants โ Contraindications & Side Effects โ Severe renal, liver, or heart disease โ Use with CNS depressants (barbiturates, opioids, ETOH, sedatives, TCA) โ Side Effects: ๏ท Drowsiness, muscle weakness ๏ท Dizziness, dry mouth, GI upset ๏ท Photosensitivity ๏ท Liver toxicity
โ Side effects: ๏ท Anticholinergic effects ๏ท Drowsiness, dizziness ๏ท Headache, fever, GI distress , erectile dysfunction โ Contraindications: ๏ท MAOIs within 14 days ๏ท Cardiac dysfunction ๏ท Glaucoma
39. Cyclobenzaprine โ Nursing Interventions โ Do not drive or operate machinery โ Not used >3 weeks โ Avoid ETOH & CNS depressants โ Caution in pregnancy/nursing โ Take with food โ Monitor LFTs & vital signs โ Do not stop abruptly 40. Which system is most affected in myasthenia gravis? A. Cardiovascular B. CNS C. GI โ D. Respiratory system and facial muscles 41. Why is thymectomy helpful in MG? A. Increases ACh binding
B. Increases ACh levels C. Reduces ACh receptors โ D. Reduces autoimmune destruction of ACh receptors
42. Missed neostigmine dose โ expected symptom? A. Salivation B. Spasms โ C. Muscle weakness D. Respiratory paralysis 43. Patient on pyridostigmine shows cholinergic signs (drooling, fasciculations). Action? A. Assess ptosis B. IVIG โ C. Obtain order for atropine D. Extra dose of pyridostigmine 44. Ptosis + difficulty swallowing on pyridostigmine โ action? A. Atropine โ B. Edrophonium test (Tensilon) C. Report cholinergic crisis D. Report myasthenic crisis 45. Edrophonium improves muscle strength โ whatโs next? A. Atropine B. Edrophonium
50. The nurse is caring for a patient who has recurrent muscle spasms. The provider has ordered metaxalone (Skelaxin). The patient has a history of drug and alcohol abuse. The nurse should contact the provider to recommend switching to: A. Carisoprodol (Soma) B. Chlorzoxazone (Parafon forte DSC) โ C. Cyclobenzaprine (Flexeril) D. Methocarbamol (Robaxin) 51. Patient teaching for cyclobenzaprine (Flexeril). Which statement 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 take this medication with food to decrease stomach upset." โ D. "I will take this medication for three weeks and then stop taking it." 52. Patient reports that muscle spasms have resolved after 3 weeks on carisoprodol (Soma). The nurse should: A. Change to cyclobenzaprine B. Continue Soma for 1 more week C. Discontinue Soma now โ D. Order a taper of the carisoprodol 53. Correct statement about multiple sclerosis (MS): A. MS is degeneration of neurons and nerves in brain/spinal cord โ B. MS is characterized by lesions or plaques on myelin sheaths of nerves C. MS involves neurofibrillary tangles and neuritic plaques D. MS is caused by low acetylcholine
54. MS patient in acute attack. Anticipated drug order: โ A. Adrenocorticotropic hormone (ACTH) B. Cyclophosphamide (Cytoxan) C. Glatiramer acetate (Copaxone) D. Interferon-B (IFN-B) 55. MS patient with muscle spasticity, weakness, and diplopia. Expected treatment: A. ACTH B. Cytoxan C. Cyclobenzaprine โ D. Interferon-B (IFN-B) 56. MS patient receiving cyclophosphamide (Cytoxan) is in which phase? A. Acute attack โ B. Chronic, progressive C. End-stage D. Remission-exacerbation 57. Which muscle relaxant is used during surgery? A. Baclofen B. Chlorzoxazone โ C. Pancuronium bromide (Pavulon) D. Methocarbamol