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.

Answer and Explanation

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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Free Nursing Study Resources

Correct Answer is C

Explanation

A. "I should take this medication only when I am having an asthma attack.": Montelukast is not intended for acute asthma attacks. It is a maintenance medication taken daily to reduce airway inflammation and prevent symptoms, not to treat attacks in progress.

B. "This medication will stop an asthma attack immediately.": Montelukast does not act quickly enough to treat acute bronchospasm. Short-acting beta-agonists like albuterol are used for immediate relief during an asthma attack, not leukotriene modifiers.

C. "I will take the tablet every evening to control my asthma.": Montelukast is prescribed as a daily maintenance therapy, typically taken in the evening to help control chronic asthma symptoms and to reduce the frequency and severity of exacerbations over time.

D. "I will not need to use my inhalers twice a day when I start this medicine.": Even after starting montelukast, clients often still need to use inhaled corticosteroids or other maintenance inhalers. Montelukast is an adjunct therapy, not a replacement for inhaled medications.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}

Explanation

Oral carbohydrates: The client is not currently hypoglycemic; in fact, the blood glucose is elevated at 279 mg/dL. Oral carbohydrates are typically given to treat low blood glucose, not high glucose. Administering carbohydrates here would worsen hyperglycemia.

Insulin lispro: The client’s blood glucose is significantly elevated and requires correction. Insulin lispro is a rapid-acting insulin designed to lower high blood glucose quickly, making it the correct medication to administer while monitoring closely for improvement.

Insulin glargine: Although the client is prescribed insulin glargine once daily, she has already received her dose earlier this morning before surgery. Giving another dose now would risk insulin stacking and dangerous hypoglycemia later, so it is not safe to administer at this point.

A bolus of IV fluids: The client is showing signs of early dehydration — thirst and low urine output — likely due to hyperglycemia-induced osmotic diuresis. Administering a bolus of IV fluids will help restore circulating volume, prevent further dehydration, and support tissue perfusion.

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The nurse is administering the muscle relaxant baclofen PO to a client diagnosed with multiple sclerosis. Which intervention should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with chronic asthma receives a prescription for montelukast, a leukotriene modifier. Which statement by the client indicates to the nurse that medication teaching was effective?

Correct Answer is C

Explanation

Patient Data Exhibits Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. According to the information gathered in the nurse's assessment, the nurse should prepare to give the client dropdown and dropdown

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}

Explanation

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Patient Data Exhibits Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. The nurse should expect for the insulin lispro to start working at dropdown and to peak at dropdown to dropdown

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