91Qw/exp no ans list tho-*LOOK OVER* Ch20: Anxiolytic and Hypnotic Agents PrepU

The nurse is assessing a breastfed infant at a well-child visit and determines the child is lethargic and losing weight. Which assessment question should the nurse prioritize? Select all that apply.

"Are you currently taking any medications?" The nurse should inquire if the mother is taking any medications, specifically benzodiazepines, such as alprazolam, chlordiazepoxide, and lorazepam. When taken by a breastfeeding mother they can result in lethargy and weight loss in the infant. The other questions might be appropriate if the mother is not using benzodiazepines to further assess the infant and determine the cause of the lethargy and weight loss.

A nursing student indicates the need for further instruction on barbiturates when stating:

"I can give the client in pain a barbiturate and this will help the client sleep." Barbiturates have little or no analgesic actions, so the nurse does not give these drugs if the client has pain and cannot sleep. Barbiturates when given in the presence of pain may cause restlessness, excitement, and delirium. They do have adverse effects, as do all drugs.

The healthcare provider has prescribed alprazolam (Xanax) for a client. After the nurse has taught the client about this medication. The nurse confirms that the client understands the drug's action when the client makes which statement?

"I may be a little drowsy at first when I start taking this medication." The client may experience drowsiness as Xanax is a benzodiazepine that exerts a tranquilizing effect. Mild drowsiness or sedation is a frequent, early adverse reaction. A rash is not expected when taking a benzodiazepine such as Xanax and may be a sign of an allergic reaction. The client is more likely to experience a tranquilizing effect as benzodiazepines exert their effect by potentiating the effects of gamma-aminobutyric acid (GABA). Antianxiety drugs are commonly prescribed to treat convulsions or seizures, not cause them. A seizure or convulsion can be a serious withdrawal symptom.

A client's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The client asks the nurse what likely prompted the health care provider to change the medication. What is the nurse's best response?

"Long-term use of benzodiazepines can result in dependency." Although benzodiazepines are effective anxiolytics, long-term use is associated with concerns over tolerance, dependency, withdrawal, lack of efficacy for treating the depression that often accompanies anxiety disorders, and the need for multiple daily dosing with some agents. They do not cause insomnia, convulsions, or depression.

A 70-year-old male client asks why he is receiving a lower dose of zaleplon than his son. As part of the nurse's teaching plan, which explanation will the nurse give this client?

"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults." In older adults, most non-benzodiazepines are metabolized more slowly, and half-lives are longer than in younger adults. Exceptions are lorazepam and oxazepam, whose half-lives and dosages are the same for older adults as for younger ones. The recommended initial dose of zaleplon or zolpidem is 5 mg, one half of the initial dose recommended for younger adults. Dosages of eszopiclone should also be reduced for older adults, beginning with 1 mg initially, not to exceed 2 mg at bedtime.

A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response?

"This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities." Drugs used to treat anxiety are called antianxiety, or anxiolytic, drugs. Long-term use of benzodiazepines, such as Xanax, can result in physical or psychological dependence. Due to the risk of dependence, benzodiazepines are used for short-term anxiety relief. Due to the risk of dependence, anxiolytics are classified as schedule IV contolled substances. Therefore, anxiolytics require a prescription. Anxiolytic drugs exert their tranquilizing effect by blocking certain neurotransmitter sites.

If diazepam is administered intravenously, when will its onset of action be observed?

1 to 5 min Intravenous diazepam is administered intravenously to decrease seizure activity and has a 1- to 5-minute onset of action. This information makes all the remaining options incorrect.

A client receives an oral dose of diazepam at 4:00 PM. The nurse would expect to see the maximum effect of this drug at approximately which time?

5:30 PM Diazepam peaks in approximately 1 to 2 hours, so the maximum effect of the drug would be seen between 5 and 6 PM.

The nurse should notify the healthcare provider for which client to clarify a prescription of lorazepam?

A client 67 years of age with acute narrow-angle glaucoma Administering antianxiety drugs is contraindicated in clients with known hypersensitivities, psychoses, and acute narrow-angle glaucoma. Alprazolam and lorazepam are both benzodiazepines. Cross sensitivity is likely to occur. Benzodiazepines are contraindicated during pregnancy (category D) and labor. Pregnancy is not a likely concern for the post-menopausal client. Hypertension is not a contraindication to benzodiazepine use.

A nursing student is confused about the difference between a sedative and a hypnotic drug. The student demonstrates a need for further instruction when making which statement?

A hypnotic produces a relaxing effect, while a sedative induces drowsiness. A hypnotic is a drug that induces drowsiness or sleep. A sedative is a drug that produces a relaxing, calming effect. Sedatives are usually given during daytime hours and, although they may make the patient drowsy, they usually do not produce sleep.

How should the nurse explain the major difference between normal and abnormal anxiety?

Abnormal anxiety is prolonged and impairs normal function. Anxiety is usually responsive to drug therapy. Although there is no clear boundary between normal and abnormal anxiety, when anxiety is severe or prolonged and impairs the ability to function in usual activities of daily living, it is called an anxiety disorder. Insomnia, prolonged difficulty in going to sleep, or staying asleep long enough to feel rested, is the most common sleep disorder. Situational anxiety is a normal response to a stressful situation. Symptoms may be quite severe, but they usually last only 2 to 3 weeks.

A client is experiencing acute anxiety and the nurse has received an order for diazepam 4 mg PO STAT. What is the nurse's best action?

Administer the medication as prescribed This order is within expected parameters for dose and route, so there is no obvious need to contact the prescriber. Flumazenil, not flurazepam, is the antidote for benzodiazepine overdose.

A client informs the nurse that he plans on discontinuing the prescribed lorazepam (Ativan) he has been taking for the past four months. What is the nurse's best action in response to this client's statement?

Advise the client to contact his healthcare provider about tapering off the medication. Long-term use of benzodiazepines, such as Ativan, may result in physical dependence. When discontinuing benzodiazepine, a gradually decreasing dosage schedule (tapering) should be used. Merely documenting the client's plan does not address the need for the client to taper off the medication. Rather than continuing the current dose and then abruptly stopping, the client should taper off the medication slowly. The onset of withdrawal symptoms usually occurs within one to 10 days after discontinuing the drug.

Anxiolytic drugs can be used in the management of which conditions? (Select all that apply.)

Alcohol withdrawal Seizures Panic attacks Anxiolytic drugs can be used in the management of anxiety disorder, panic attacks, pre-anesthetic sedation, muscle relaxation, convulsions, seizures, and alcohol withdrawal.

Which are examples of benzodiazepine antianxiety drugs? (Select all that apply.)

Alprazolam (Xanax) Chlordiazepoxide (Librium) Lorazepam (Ativan)

A male client's anxiety is interfering with his ability to perform basic activities of daily living and return to work. The nurse expects that which diagnosis will probably be made by his health care provider?

Anxiety disorder Although there is no clear boundary between normal and abnormal anxiety, when anxiety is severe or prolonged and impairs the ability to function in usual activities of daily living, it is called an anxiety disorder.

What might occur if a client inadvertently receives a benzodiazepine intra-arterially?

Arteriospasm Intra-arterial administration of benzodiazepines would result in arteriospasm and gangrene. CNS depression, blurred vision, and urinary retention are adverse effects associated with benzodiazepines in general.

The nurse obtains the following vital signs on a client: BP 160/85, P 90, RR 24. The client is recently divorced and reports taking alprazolam for the past seven weeks but stopped the medication yesterday. What is the nurse's first action?

Ask the client about experiencing increased anxiety, difficulty concentrating, or tremors. The nurse needs to further assess the cause of the client's elevated vital signs. Because the client has been taking an antianxiety medication and has recently discontinued the drug, the client may be suffering from withdrawal symptoms. Symptoms of benzodiazepine withdrawal include increased anxiety, difficulty concentrating, tremors, and sensory disturbances. The onset of withdrawal symptoms usually occurs within one to 10 days after discontinuing the drug. Increased blood pressure is not a normal, or expected, finding after discontinuing Xanax and may be a sign of increased anxiety and withdrawal. The nurse should further assess for signs of withdrawal, then notify the health care provider. Documenting the client's vital signs and advising the charge nurse is appropriate, but the first action is to further assess the cause of abnormal vital signs.

The client is experiencing pain. The nurse questions the health care provider's order to administer barbiturates to this client for what reason?

Barbiturates can cause paradoxical excitement Barbiturates should not be administered to clients with acute or chronic pain because it can cause paradoxical excitement and mask other symptoms. There is no indication that barbiturates make pain more severe. There is no known risk of tachypnea and they are not contraindicated with NSAIDs.

The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize?

Blood pressure Hypotension is a possible effect when barbiturates are given IV and is more common than hypoxia. Bleeding is not associated with intravenous barbiturate use. Anaphylaxis would be a serious but rare occurrence.

What should the nurse's pre-administration assessment for a client receiving a sedative or hypnotic include? (Select all that apply.)

Blood pressure Pulse Respiratory rate The nurse's pre-administration assessment for a client receiving a sedative or hypnotic should include blood pressure, pulse, and respiratory rate.

What should the nurse's pre-administration physical assessment for the administration of an anxiolytic include? (Select all that apply.)

Blood pressure Pulse Respiratory rate Weight The nurse's pre-administration physical assessment for the administration of an anxiolytic should include blood pressure, pulse, respiratory rate, and weight.

The nurse is doing a physical assessment on admission of a client diagnosed with elevated blood pressure due to anxiety. What are the most important physical assessments for a nurse to perform? Select all that apply.

Blood pressure Respiratory rate Skin temperature and color During the intake exam, a focused physical assessment for anxiety should include checking blood pressure, pulse, respiratory rate, and weight. Physiologic manifestations of anxiety can include increased blood pressure and pulse rate, increased rate and depth of respiration, and increased muscle tension. An anxious client may have cool and pale skin. Bowel sounds and hair texture would not be as important as assessing blood pressure, respiratory rate, and skin temperature for the client who is anxious.

Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety?

Buspirone

A client with a high-pressure job temporarily requires an anxiolytic that has no sedative properties. What medication is most likely to meet this client's needs?

Buspirone Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and central nervous system relaxing effects. Diphenhydramine is an antihistamine that can be sedating.

A nurse is caring for a client who is prescribed barbiturates. The nurse would assess the client for which of the following? Select all that apply.

CNS depression Mood alteration Hypnosis The nurse should monitor the client for CNS depression, mood alteration, and hypnosis, which are effects of barbiturates. Palpitation and somnolence are adverse effects of estazolam, which is a benzodiazepine.

A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse?

Client is diagnosed with hepatitis C. Sedatives and hypnotics should be used cautiously in lactating clients and in clients with hepatic or renal impairment, habitual alcohol use, and mental health problems. The client with hepatitis C requires immediate follow-up, because the prescribing provider may need to change the medication and/or the dose of this medication due to liver impairment. A history of a bladder infection is not a great cause of concern for renal impairment. One drink per day is not as concerning as the client diagnosed with hepatitis C, especially since the client recently quit consuming alcohol beverages. A history of miscarriage is not a contraindication for taking sedatives or hypnotics; however, the pregnant or lactating woman should not take these medications.

The nurse should not administer sedatives or hypnotic drugs to which client?

Comatose client The nurse should not administer these drugs to comatose clients, those with severe respiratory problems, those with a history of habitual drug and alcohol use, or pregnant or lactating women. The nurse could safely administer sedatives or hypnotics to a client with a history of asthma as long as the client is not having an acute attack. A woman of childbearing age can receive sedatives or hypnotics after it is confirmed she is not currently pregnant. An egg allergy is not a contraindication to sedative or hypnotic administration.

An older adult client is prescribed a sedative for the treatment of insomnia. The nurse would suspect that the client is experiencing an adverse reaction to the drug based on assessment of which of the following?

Confusion The nurse should look for signs of confusion in the elderly client when monitoring the effects of the administered drug. Headache, stress, and anxiety are causes of insomnia.

The nurse is providing health education to a client who has been prescribed a barbiturate. The nurse should describe what mechanism of action?

Depression of the cerebral cortex Barbiturates depress the cerebral cortex. Benzodiazepines make GABA more effective leading to the anxiolytic effect. Barbiturates do not affect action potentials. Barbiturates depress motor output.

A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine?

Diazepam

Which information should be included in the teaching plan of a client who is taking a sedative for a diagnosis of insomnia? Select all that apply.

Do not drive or operate heavy machinery while taking the medication. Do not drink alcoholic beverages 2 hours before or within 8 hours after taking the drug. Information included on the teaching plan focuses on how the medication produces a therapeutic response and that the sleep pattern is improved. The medication can impair the mental and physical abilities required for performing potentially dangerous tasks such as driving a vehicle or operating heavy machinery. The client should avoid tea or coffee before bedtime but is allowed to drink them during the day. Avoiding alcoholic beverages 2 hours before or within 8 hours after taking the medication is recommended. Calling the prescriber is appropriate but waiting 2 weeks is too long. The medication should be taken one hour before bedtime.

Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?

Falls Clients taking benzodiazepines, especially older adult clients, are at high risk for falls and should be counseled on fall prevention measures. Constipation can occur at any time in the elderly due to the lack of fluid or fiber intake. Benzodiapine use does not indicate high risk for heart failure or hepatic failure.

Eszopiclone is thought to react with norepinephrine to achieve its action.

False Eszopiclone is thought to react with GABA sites near benzodiazepine receptors.

Which benzodiazepine would a nurse expect to administer as a hypnotic?

Flurazepam Flurazepam would be used as a hypnotic. Lorazepam, diazepam, and alprazolam would be use as anxiolytics.

A patient who was on benzodiazepine antianxiety drug therapy intends to discontinue the treatment. What should the nurse suggest regarding continuation of the medication?

Gradually decrease dosage schedule. The nurse should suggest the patient gradually decrease the dosage schedule to avoid withdrawal symptoms. It is not advisable for the nurse to suggest avoiding medication, increasing the dosage, or continuing scheduled medication.

A nurse is caring for an elderly patient undergoing antianxiety treatment. The patient is to be administered antianxiety drugs parenterally. What precautions should be taken by the nurse?

Have resuscitative equipment ready. The nurse should have resuscitative equipment ready because elderly patients may experience apnea and cardiac arrest during the treatment. Providing fiber-rich food and plenty of fluids is not a precautionary measure during the parenteral administration of the drug. The need for a blood transfusion would not arise during the treatment.

A nurse is preparing to administer an anxiolytic to a client. What would be most appropriate for the nurse to do before administering the drug?

Have the client void It would be appropriate to have the client void before administering the medication to reduce the client's risk for injury if the client attempts to get out of bed after the drug is given. Raising the side rails, instituting a bowel program, and dimming the lights would be appropriate after giving the drug.

Which action by the new nurse would alert the charge nurse that more education is needed for the new nurse, after administering an anxiolytic to a client?

Having the client walk to the bathroom Having the client walk to the bathroom would be appropriate before administering the drug to reduce the client's risk for injury. Raising the side rails would be appropriate after administering an anxiolytic. Placing the call light within reach would be appropriate after administering an anxiolytic. Dimming the lights would be appropriate after administering an anxiolytic.

A nurse should recognize which as common early reactions caused by anxiolytics? (Select all that apply.)

Headache Sedation Light-headedness Dizziness Common early reactions caused by anxiolytics include mild drowsiness, sedation, light-headedness, dizziness, and headache.

A nurse should be cautious administering sedatives and hypnotics to which clients? (Select all that apply.)

Hepatic impairment Renal impairment Mental health problems Habitual alcohol use A nurse should be cautious administering sedatives and hypnotics to clients with hepatic or renal impairment, habitual alcohol use, mental health problems, and those clients who are lactating.

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetadine and a sedative to calm the client. What should the nurse be concerned about?

Increase sedative effect An increased sedative effect may occur when a sedative is given with cimetidine for gastric upset. The other options do not play a role in providing the best care for the client.

A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam?

Induces sleep Flurazepam induces sleep. Adrenergic drugs help to relieve stress. Analgesics are used to ease pain. Circulation can be improved by exercising.

The medication nurse knows that when benzodiazepines are used with opioid analgesics, the analgesic dose should be adjusted in which way?

It should be reduced initially and increased gradually. When benzodiazepines are used with opioid analgesics, the analgesic dose should be reduced initially and increased gradually to avoid excessive CNS depression.

A nurse is caring for a patient whose physician has ordered a benzodiazepine sedative-hypnotic. The nurse knows that most of these drugs are used with caution in patients with which disorders?

Liver disease Benzodiazepines undergo hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects.

The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse's best response?

Monitor for increased signs of confusion or forgetfulness. Recent studies link the chronic use of benzodiazepines by those over 65 years of age to a greater chance of developing dementia. Antianxiety drugs are not known to cause kidney or liver damage but should be used cautiously in elderly clients, and in clients with impaired liver function or impaired kidney function. Antianxiety drugs more likely can cause muscle relaxation than rigidity. A symptom of withdrawal from antianxiety drugs is muscle tension.

The nurse should include which client teaching points when discussing the use of sedatives or hypnotics, and interactions with other drugs? (Select all that apply.)

Opioid analgesics should be used cautiously. Alcohol use can increase sedative effects. Alcohol use and opioid analgesics can increase the sedative effects of sedatives and hypnotics. Antidepressants increase sedative effects, so the doses do not usually need to be increased. All antihistamines can increase sedative effects. Phenothiazines increase sedative effects and do not usually result in hyperactivity.

A nurse is caring for a patient with insomnia. For which type of patient should the nurse exercise caution when administering sedatives and hypnotics?

Patients who are lactating The nurse should exercise caution while administering sedatives and hypnotics to lactating patients. Patients with heart trouble, hypertension, and gastrointestinal problems are not contraindicated in the use of sedatives and hypnotics.

After reviewing the various drugs that are classified as barbiturates, a student demonstrates understanding when identifying which as the prototype?

Phenobarbital Phenobarbital is considered the prototype barbiturate.

A patient admitted to the health care facility for insomnia related to stress is prescribed a sedative. What intervention should the nurse perform to promote the effects of the sedative?

Provide back rubs The nurse must provide back rubs to the patient to promote the effects of the sedative. Providing plenty of fluids and fiber-rich foods are measures taken to prevent constipation. Providing beverages does not help to promote the effect of the sedatives.

A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform?

Provide respiratory assistance The nurse must provide respiratory assistance to the patient showing symptoms of barbiturate toxicity. Providing assistance with movement, supportive care, and a safe environment are suggested for patients at risk for injury due to drowsiness or impaired memory.

Which interventions should be included in a nursing diagnosis of risk for injury for client who has received a hypnotic? Select all that apply.

Raise the siderails of the bed. Advise client to call for assistance. Observe the client for 1 to 2 hours after the medication administration to evaluate the effect of the drug. Risk of injury is an appropriate nursing diagnosis for a client who has received a hypnotic. Raise the side rails of the bed and advise the client to remain in bed and to call for assistance if it is necessary to get out of bed. Observe the client for 1 to 2 hours after the medication is administered to evaluate the effect of the drug.

A client appears very drowsy at bedtime and is difficult to arouse. The client is receiving halcion 0.25 mg PO at bedtime. Based on these findings, what would be the best nursing diagnosis for this client?

Risk for injury Based on the data, the best nursing diagnosis would be risk for injury related to drowsiness. The dose of the halcion appears to be too much for this client and it is making him difficult to rouse. There is not enough data to state Risk for skin breakdown as this client may be fully ambulatory and active without this medication. There is no indication of Risk for altered elimination nor Ineffective individual coping.

A client is ordered to receive diazepam as part of the treatment for status epilepticus. The client has an intravenous (IV) infusion running, which is being used to administer another drug for seizure control. The IV line is in the client's left arm. Which action by the nurse would be most appropriate?

Start another IV line in the client's right arm. When giving diazepam intravenously, it should not be mixed in solution with any other drugs. Therefore, it would be best to start an intravenous line in another area, such as the opposite arm, so that the client can receive the full benefits of both drugs. Notifying the prescriber that the diazepam cannot be given or waiting until the other drug is completed before giving the diazepam is inappropriate. Adding it to the current infusion is inappropriate because potentially serious drug-drug interactions can occur.

What are sedatives and hypnotics used to treat? (Select all that apply.)

Status epilepticus Preoperative sedation Insomnia Sedatives and hypnotics are used in the treatment of insomnia, convulsions, status epilepticus, seizures, and preoperative and conscious sedation.

Three days after discontinuing diazepam with medical guidance, an older adult continues to demonstrate impaired memory and confusion. The nurse should consider what possible explanation for the client's current status?

The adverse effects of benzodiazepines can persist for several days after stopping the drug. Both therapeutic effects and adverse effects of diazepam are more likely to occur after 2 or 3 days of therapy than initially. Such effects accumulate with chronic usage and persist for several days after the drug is discontinued. Hypersensitivity and decreased liver function are unlikely. Benzodiazepines do not cause permanent changes in cognition.

If a pregnant client has taken a benzodiazepine during pregnancy, what would be the biggest concern?

The infant may experience withdrawal symptoms during the postnatal period. Women taking barbiturates and benzodiazepines should be warned of the potential risk to the fetus so that contraception methods may be instituted. A child born to a mother taking a benzodiazepine may experience withdrawal during the postnatal period.

Respiratory distress is a contraindication for the use of barbiturates.

True Other contraindications to barbiturates are latent or manifest porphyria, which may be exacerbated; marked hepatic impairment or nephritis, which may alter the metabolism and excretion of these drugs; and respiratory distress or severe respiratory dysfunction, which could be exacerbated by the CNS depression caused by these drugs.

A male client is admitted to the emergency department via ambulance. He is attempting to pull out his IV line, exhibiting symptoms of agitation, and thrashing about. The physician orders a benzodiazepine-type sedative. What information is needed prior to administration of the drug?

Whether the client is experiencing drug intoxication or withdrawal Some clients become acutely agitated or delirious and need sedation to prevent their injuring themselves by thrashing about, removing tubes and intravenous (IV) catheters, and so forth. Some physicians prefer a benzodiazepine type sedative, whereas others may use haloperidol. Before giving either drug, causes of delirium (e.g., drug intoxication or withdrawal) should be identified and eliminated if possible.

A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that:

a dose adjustment should be made if these symptoms persist. If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist. If the drug is stopped immediately, withdrawal symptoms may occur. Intravenous administration or continuing the same dosage and medication would not help relieve ataxia or confusion in the patient.

What classification of over-the-counter (OTC) medications is often used by clients as treatment for insomnia?

antihistamines People use over-the-counter medications as sleep aids; these medications include antihistamines alone or in combination with pain relievers.

A client is prescribed midazolam in combination with an opioid in the preoperative phase of a laparoscopic cholecystectomy. What does the administration of midazolam assist in minimizing?

anxiety Midazolam provides preoperative sedation, which assists in minimizing anxiety. It does not reduce secretions, increase blood pressure, or reduce muscle tone.

A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The client asked the nurse how this medication will affect his job. The nurse would advise him how?

avoid driving until he is aware of the adverse effects. Drowsiness, sedation, and ataxia may occur when the drug is started, but these effects should disappear once the client becomes accustomed to the drug. The nurse must advise the client to avoid driving or performing any other tasks that require mental alertness and concentration until the effects of the drug are known. Lorazepam does not have prolonged effects after cessation of therapy, so the nurse would not advise the client to change his profession. The client should avoid driving until the drug effects are known, instead of avoiding driving only at night or for 2 hours after drug consumption.

A client is receiving a barbiturate intravenously. The nurse would monitor the client for:

bradycardia When given intravenously, barbiturates can result in bradycardia, hypotension, hypoventilation, respiratory depression, and laryngospasm. Bleeding is not associated with barbiturate therapy.

What aspect of a client's health is most likely to cause insomnia?

chronic pain Chronic pain is commonly associated with insomnia. Diabetes, obesity, and hypothyroidism are not normally associated with insomnia.

A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon. The nurse will be sure to ask if the patient is taking:

cimetidine The nurse will assess for cimetidine use. Cimetidine greatly increases the level of circulating zaleplon and could cause toxic effects in the patient. Secobarbital is a barbiturate, and oxycodone and meperidine are narcotics that would not be used with lorazepam because the combinations may depress respiratory drive, create severe hypotension or bradycardia, and substantially alter level of consciousness.

Which condition will place the client prescribed a benzodiazepine at risk for toxicity?

decreased albumin Clients with liver disease are at risk for adverse effects with drugs that are highly bound to plasma proteins. Neither increased calcium nor decreased potassium will have a direct impact on benzodiazepine toxicity. The normal bicarbonate will not contribute to benzodiazepine toxicity.

In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?

decreased cardiac workload Antianxiety and sedative-hypnotic drugs are often useful in critically ill clients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase level of consciousness (LOC).

When providing health education for a client, the nurse should cite what significant risk associated with the adverse effects of benzodiazepines?

dependence Benzodiazepines carry a significant risk for dependence. They do not cause suicidality, personality changes, or insomnia.

A child diagnosed with night terrors is prescribed a benzodiazepine agent. What increased risk should the child be monitored for?

development of mood disorders Children may be more sensitive to its effects of this drug, namely mood and/or mental changes. Hepatotoxicity, insomnia, and dependence are not among the most common adverse effects.

What is the prototype for the classification of drugs referred to as benzodiazepines?

diazepam Diazepam is the prototype benzodiazepine. High-potency benzodiazepines such as alprazolam, lorazepam, and clonazepam may be more commonly prescribed due to their greater therapeutic effects and rapid onset of action.

A nurse has noted that a newly admitted client has been taking ramelteon for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug?

difficulty falling asleep at night Ramelteon, the newest oral nonbenzodiazepine hypnotic, has received FDA approval for the long-term treatment of insomnia characterized by difficulty with sleep onset. Ramelteon is not effective in managing any of the other suggested sleep-related issues.

A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client?

eszopiclone Eszopiclone (Lunesta) is a newer medication commonly prescribed to treat insomnia. Phenytoin (Dilantin) is an anticonvulsive that depresses the brain's sensory areas located in the motor cortex. Loratadine (Claritin) is an antihistamine that causes the least amount of drowsiness in this class of drugs. Norepinephrine (levarterenol, Levophed) is a potent sympathetic neurotransmitter. Its primary action is to increase blood pressure as a result of vasoconstriction of peripheral blood vessels.

An older adult client is diagnosed with generalized anxiety disorder. The use of benzodiazepines in this client population creates a specific need for which intervention?

falls risk assessment Adverse effects of benzodiazepines may include contributing to falls and other injuries unless clients are carefully monitored and safeguarded. Seizures, dysrhythmias, and sexual dysfunction are not characteristic adverse effects.

The nurse's pre-administration assessment for a client receiving a sedative or hypnotic should include blood pressure, pulse, and respiratory rate.

hypotension The nurse must monitor the patient for hypotension, which is one of the symptoms of barbiturate toxicity. Restlessness, euphoria, and confusion are withdrawal symptoms seen in the use of sedatives and hypnotics.

The etiology of anxiety involves which physiological process?

increased activation of the autonomic nervous system Clinical manifestations of anxiety include overactivity of the autonomic nervous system, such as dyspnea, palpitations, tachycardia, sweating, dry mouth, dizziness, nausea, and diarrhea. Somatotropin is not directly involved, and the adrenal cortex is not suppressed during times of anxiety. The parasympathetic nervous system is not stimulated during times of anxiety.

A client who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by:

increasing the effects of the neurotransmitter GABA. Like all benzodiazepines, lorazepam increases the effects of GABA, which has an inhibitory effect on the CNS. However, none of the benzodiazepines act like GABA or increase the amount of GABA present. MAOIs inhibit monoamine oxidase and tricyclic antidepressants primarily affect serotonin and norepinephrine levels. SSRIs increase the availability of serotonin in the synapses.

When administering benzodiazepines, which medication should be considered the drug of first choice?

lorazepam Lorazepam is probably the benzodiazepine of first choice. The drug provides rapid tranquilization of clients experiencing agitation. Administered intravenously, it reduces nausea and vomiting as well as anxiety and induces procedural amnesia. Lorazepam has a slow onset of action (5 to 20 minutes) because of delayed brain penetration but an intermediate to prolonged duration.

A male client tells the nurse that he has been taking an herbal supplement to aid with insomnia. What herbal supplement is the client taking?

melatonin Melatonin is used for short-term treatment of insomnia. Drowsiness may occur within 30 minutes after taking the supplement and the drowsiness may persist for an hour or more. Ginkgo is used to improve memory and brain function and enhance circulation to the brain, heart, limbs, and eyes. Saw palmetto is used for prostate infections. St. John's wort is used for depression.

A nurse has been taught to observe for adverse reactions whenever administering a medication. One non-nervous system reaction after giving a sedative is:

nausea Adverse nervous system reactions associated with sedatives and hypnotics are dizziness, drowsiness, and headache. A common GI reaction is nausea.

A decrease in dosage of a prescribed benzodiazepine most likely would be necessary if a client was also taking:

oral contraceptive The effects of benzodiazepines are increased when taken with oral contraceptives, necessitating a change in dosage of the benzodiazepine. The effects of benzodiazepines are decreased when taken with theophylline and ranitidine, which might result in the need for an increased dosage of the benzodiazepine. Alcohol should not be used with benzodiazepines because the combination increases the risk of CNS depression.

A nurse should not administer secobarbital to a patient with insomnia caused by:

pain Barbiturates have no analgesic action and, when given in the presence of pain, may cause restlessness, excitement, and delirium; therefore, the use of barbiturates in patient with pain-related insomnia is not recommended.

One week ago, a 74-year-old was started on a benzodiazapine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication?

paradoxical excitement When beginning drug therapy with a sedative or benzodiazepine to treat anxiety, the older client may experience an effect that is the opposite of intended. This effect is known as paradoxical excitement, whereby the client is wide awake and hyperactive rather than calm and relaxed.

The nurse gives a 68-year-old client diphenhydramine to help the client sleep the night before surgery. At midnight, the nurse notes the client is awake and agitated. What pharmacologic principle would be the cause of this reaction?

paradoxical excitement, which is the opposite reaction than what was expected Drug-induced behavioral changes often affect the older adult. Sometimes, they occur unexpectedly. For example, when beginning drug therapy with a sedative or a benzodiazepine to treat anxiety, the older client may experience an effect that is the opposite of the intended effect. This effect is known as paradoxical excitement, where the client is wide awake and hyperactive rather than calm and relaxed. In all probability the nurse did not give the wrong medication, unless she did not follow proper technique when administering it. Delayed gastric emptying has an effect on decreased absorption but may actually increase distribution because of the prolonged transit time in the bowel. The blood-brain barrier is less effective in the older adult, but the nurse would expect a more pronounced effect, not a decreased effect.

A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for:

respiratory disturbances and partial airway obstruction. A priority assessment would be for respiratory disturbances and partial airway obstruction. These adverse effects usually occur when a high dose of the drug is given prior to a procedure. Ataxia and confusion are also adverse effects of lorazepam, but are seen mostly in older adults. Leukopenia and diplopia are not adverse effects specific to intravenous administration but are general hematologic and ophthalmic adverse effects that can occur in anyone of any age with any method of lorazepam administration. Seizures can be an adverse effect of the drug with any type of administration. However, lorazepam is usually administered for seizures.

The intensive care nurse should prioritize what assessments for a client prescribed both lorazepam and hydromorphone?

respiratory rate and oxygen saturation The combination of opioids and benzodiazepines creates a significant risk for central nervous system (CNS) depression; respiratory function is consequently an important focus of assessment. It would likely supersede other assessments, even though each may be warranted.

Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing lorazepam withdrawal?

severe insomnia for the past several nights Common signs and symptoms of benzodiazepine, like lorazepam, withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Memory lapses, unstable blood sugars, and depression are not typical.

In order to minimize the chances of withdrawal symptoms, the nurse knows that the client prescribed a benzodiazepine taken daily will likely be advised to take which precaution?

tapering the dose of drug over a prolonged period of time To avoid withdrawal symptoms, it is necessary to taper benzodiazepines gradually before discontinuing them completely. Long-acting benzodiazepines, anticonvulsants, and herbal remedies are not recommended in the effort to prevent withdrawal.

What information should the nurse provide to a client prescribed eszopiclone?

the importance of taking the drug immediately before going to bed People should take eszopiclone immediately prior to going to bed because of its rapid onset of action. It does not need to be taken with food and should not be combined with benzodiazepines. Regular blood work is not indicated.

An increased dosage of a prescribed benzodiazepine may be necessary if the client's current regimen includes what medication?

theophylline Theophylline, if taken with a benzodiazepine, leads to a decreased effect of the benzodiazepine, which might result in the need for an increased dosage of the benzodiazepine. Ranitidine, not cimetidine, if taken with a benzodiazepine, leads to a decreased effect of the benzodiazepine, which might result in the need for an increased dosage of the benzodiazepine. Oral contraceptives, when taken with benzodiazepines, increase the effects of benzodiazepines necessitating a change in dosage of the benzodiazepine. Alcohol should not be used with benzodiazepines because the combination increases the risk of CNS depression.

A 34-year-old executive for an insurance company has been taking lorazepam for the last 6 months for anxiety. The client abruptly stopped the medication. The client then calls the health care provider and reports feeling irritable, and increased heart rate, and restlessness. What would explain the client's current symptoms?

withdrawal from stopping the medication Prolonged administration of lorazepam or any other benzodiazepine produces physical dependence, and withdrawal symptoms occur if the drug is stopped suddenly. The symptoms of withdrawal include restlessness, irritability, tachycardia, insomnia, and sweating. Dependence is not synonymous with addiction.