Chapter 40: Muscle Relaxants

Chapter 40: Muscle Relaxants

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The primary care nurse practitioner (NP) is seeing a patient who reports chronic lower back pain. The patient reports having difficulty sleeping despite taking ibuprofen at bedtime each night. The NP should prescribe:

ANS:  D

Cyclobenzaprine (Flexeril) is indicated for chronic low back pain and provides an added benefit of aiding sleep, which is a common problem among patients with back pain. The other medications are used for acute lower back pain.

DIF:    Cognitive Level: Applying (Application)                           REF:   443

2. A patient reports having an acute onset of low back pain associated with lifting a heavy object the day before. Besides advising the patient to rest and apply ice, the primary care NP should prescribe:

ANS:  D

NSAIDs and acetaminophen are first-line analgesic treatments for low back pain. Opioids are used for severe low back pain. The other two medications are not first-line treatments.

DIF:    Cognitive Level: Applying (Application)                           REF:   444

3. A patient who was in a motor vehicle accident has been treated for lower back muscle spasms with metaxalone (Skelaxin) for 1 week and reports decreased but persistent pain. A computed tomography scan is normal. The primary care NP should:

ANS:  B

Physical therapy may be used as an injury begins to heal. This patient is experiencing improvement of symptoms, so physical therapy may now be helpful. Ice and rest are useful in the first 24 to 48 hours after injury. Diazepam is used on a short-term basis only. Opioid analgesics are used for severe pain.

DIF:    Cognitive Level: Applying (Application)                           REF:   444

4. A patient with lower back pain and right-sided sciatica has taken an NSAID and a TCA for 1 week. The patient reports some decrease in pain but is experiencing increased tingling and numbness of the right leg. The primary care NP should:

ANS:  A

Acute episodes of low back pain should be treated with an analgesic for 1 to 2 weeks. A muscle relaxant is used to treat spasms. Patients with sciatica should be treated for 6 weeks. If a neurologic deficit progresses, MRI should be ordered. Physical therapy is not indicated until serious injury is ruled out. A neurology consultation is necessary in urgent conditions and conditions with bilateral neurologic findings. The TCA may be continued, but the progression of symptoms necessitates radiologic evaluation.

DIF:    Cognitive Level: Applying (Application)                           REF:   444