All serious medical conditions are ruled out, and J.C. is diagnosed with lumbar strain. The nurse practitioner (NP) orders a physical therapy consultation to develop a home stretching and back-strengthening exercise program and a dietary consultation for
weight reduction. J.C. is given prescriptions for cyclobenzaprine (Flexeril) 10 mg tid× 3 days only, and celecoxib (Celebrex) 100 mg/day for 3 months. He receives
the following instructions: heat applications to the lower back for 20 to 30 minutes four times a day (using
moist heat from heat packs or hot towels), no twisting or unnecessary bending, and no lifting more than
10 pounds. J.C. is instructed to rest his back for 1 or 2 days, getting up only now and then to move around
to relieve muscle spasms in his back and strengthen his back muscles. He is given a written excuse to
stay off work for 5 days and, when he returns to work, specifying the limitation of lifting no more than 10
pounds for 3 months. He is instructed to contact his primary care provider if the pain gets worse.
J.C. looks at the prescription for cyclobenzaprine (Flexeril) and states, "I'm glad you didn't
give me that Valium. They gave me Valium last time and that stuff knocked me out." How
would you respond to J.C.?
Why do you think that cyclobenzaprine was prescribed instead of diazepam (Valium)?
J.C. states, "Well, I'm glad I'll still be able to take my sleeping pill." True or False? Explain.
The skeletal muscle relaxant cyclobenzaprine might also cause extreme drowsiness, as well as
dizziness and blurred vision. He needs to change position slowly to avoid orthostatic hypotension.
General instructions also include to avoid driving and using sharp objects until the response to the
drug is known, but he is to stay off work for 5 days and in bed for the first 1 to 2 days.
• Cyclobenzaprine is a centrally acting skeletal muscle relaxant. There is no evidence that muscle
relaxants help when used for more than 1 week.
• Diazepam is a sedative hypnotic, anticonvulsant, and muscle relaxant. It is a Schedule IV drug
because of the risk for abuse.
False! You need to remind him that skeletal muscle relaxants, such as Flexeril, cannot be taken with
other central nervous system (CNS) depressants such as sleeping pills (hypnotics), sedatives, or
alcohol, because increased CNS depression and mental confusion might result.
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A patient with a T2 injury is in spinal shock. The nurse will expect to observe what assessment finding?
A) Absence of reflexes along with flaccid extremities B) Positive Babinski's reflex along with spastic extremities C) Hyperreflexia along with spastic extremities D) Spasticity of all four extremities
The nurse is caring for a dying client who becomes very agitated. What is the nurse's best response?
a. Use music therapy to promote relaxation. b. Increase the dose of intravenous opioids. c. Provide a second antipsychotic medica-tion. d. Assess the client for urinary retention.
Although all other joints return to their normal prepregnancy state, those in the parous woman's feet do not. The new mother may notice a permanent increase in her shoe size
1. True 2. False
Before taking a patient's blood pressure, a nurse should do which of the following? Select all that apply
1. Review the graphic sheet to identify how high to inflate the cuff. 2. Ask the patient if there is a reason to not take the blood pressure on either arm. 3. Change the ear pieces of the stethoscope. 4. Assess the patient's peripheral pulses. 5. Lower the bed to its lowest position.