The nurse is administering the muscle relaxant baclofen PO to a client diagnosed with multiple sclerosis. Which intervention should the nurse implement?
Evaluate muscle strength every 4 hours.
Advise the client to move slowly and cautiously when rising and walking.
Ensure the client knows to stop baclofen before using other antispasmodics.
Monitor intake and output every 8 hours.
The Correct Answer is B
A. Evaluate muscle strength every 4 hours: While assessing muscle strength is important in clients with multiple sclerosis, it does not need to be done this frequently unless the client is unstable. Baclofen may cause weakness, but routine assessments every 4 hours are excessive for stable patients.
B. Advise the client to move slowly and cautiously when rising and walking: Baclofen can cause dizziness, sedation, decreased muscle tone and orthostatic hypotension, particularly in the early stages of treatment. Educating the client to change positions carefully helps reduce the risk of falls and injury.
C. Ensure the client knows to stop baclofen before using other antispasmodics: Baclofen should not be stopped abruptly due to the risk of withdrawal symptoms like hallucinations or seizures. Combining different antispasmodic medications can increase the risk of adverse effects such as excessive sedation or muscle weakness. Medication changes therefore should only be made under the supervision of the healthcare provider.
D. Monitor intake and output every 8 hours: Baclofen does not typically affect renal function or fluid balance significantly. Monitoring intake and output is not a standard intervention specific to baclofen administration unless there is another underlying condition.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Statins, such as atorvastatin: Statins primarily lower cholesterol and have no significant interaction with sildenafil that would cause an urgent safety concern. Although monitoring for muscle-related side effects is important with statins, it is not the priority here.
B. Analgesics, such as acetaminophen: Acetaminophen is generally safe and does not interact dangerously with sildenafil. There is no immediate concern related to combining these two medications.
C. Anticoagulants, such as warfarin: There is a potential for increased bleeding risk when sildenafil is combined with anticoagulants, but this is generally not an acute, life-threatening interaction requiring immediate determination before other more critical concerns.
D. Nitrates, such as nitroglycerin: Taking sildenafil with nitrates can cause profound, life-threatening hypotension. Both sildenafil and nitrates can cause vasodilation, and their combined use can lead to a dangerous and potentially fatal drop in blood pressure. This combination is absolutely contraindicated, and the nurse must immediately assess whether the client uses any nitrate medication to prevent a serious adverse event.
Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}
Explanation
24 hrs: Insulin glargine provides a steady, basal level of insulin for about 24 hours after injection. It is specifically designed for once-daily dosing to maintain blood glucose stability throughout the day and night.
15 mins: Fifteen minutes is too soon for insulin glargine to start working. This onset time is typical for rapid-acting insulins like lispro or aspart, not for long-acting basal insulins like glargine.
1 hr: Insulin glargine begins to work slowly after administration, with an onset typically around 1 hour. It does not act immediately like rapid insulins but instead gradually lowers blood glucose over an extended time.
48 hrs: A duration of 48 hours is too long for insulin glargine. Its therapeutic window is designed to last about 24 hours, supporting once-daily dosing without significant overlapping or stacking effects if scheduled correctly.
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