Chapter 13 Drugs used for sleep

The nurse is teaching a patient about how to improve sleep quality. Which information does the nurse include in the teaching plan?

"Avoid heavy meals late in the evening." A heavy meal will tax the digestive system, making a person feel uncomfortable and unable to get soothing sleep.

The nurse is teaching a patient with a history of insomnia about sleep pattern disturbance. Which statement by the patient indicates the need for further instruction?

"Insomnia is an occasional normal occurrence of a healthy life." Insomnia is defined as the inability to sleep; it is not a disease but a symptom of physical or mental stress. Even though 95% of all adults experience insomnia sometime in their lives, it is not considered a "normal occurrence of a healthy life."

The nurse is instructing a patient about the use of medications to treat insomnia. Which statement by the patient indicates the need for further teaching?

"It is OK to take a sleeping pill every night if I need one."

Approximately which percentage of sleep time is spent in stage 1 sleep?

2% to 5% Rationale 2% to 5% of sleep is stage 1 sleep. Stage 2 sleep comprises about 50% of normal sleep time. p. 188

Which patient is most at risk for a paradoxical response to a barbiturate characterized by excitement, restlessness, and confusion?

A 76 yr old with severe pain

What type of food is prohibited with zolpidem (Ambien) therapy?

High fat meal

Which phrase is a primary therapeutic outcome sought from benzodiazepine therapy? Select all that apply.

Mild sedation Preoperative sedation with amnesia Short-term use to produce sleep Rationale The primary therapeutic outcomes sought from benzodiazepine therapy are to produce mild sedation, to induce preoperative sedation with amnesia, and for short-term use to produce sleep. Benzodiazepines are not used for permanent treatment of insomnia. The long-term use of these drugs is not recommended. p. 192

Which antipsychotic agent would the nurse expect to be prescribed for patients with psychoses and insomnia?

Quetiapine Rationale Quetiapine is ideally prescribed for patients with psychoses and insomnia. Anticonvulsants like topiramate and gabapentin are used to assist patients with sleep. Amitriptyline is antidepressant that is prescribed to assist patients with sleep. p. 189

Which assessment finding in a patient taking a sedative for insomnia concerns the nurse?

The patient has a decreased ability to perform activities of daily living.

A patient is being treated for insomnia with a benzodiazepine. Which drug would the nurse expect to be prescribed to avoid the occurrence of morning hangover?

Triazolam Rationale Patients using triazolam do not experience morning hangover. Taking quazepam may cause significant morning hangover. Estazolam causes minimal morning hangover. Significant morning hangover may occur if the patient takes flurazepam. p. 193

Which phrase accurately describes zolpidem sublingual tablets?

Used to prolong sleep duration without causing morning hangover Rationale Zolpidem is administered' to patients to prolong sleep duration without causing morning hangover. Melatonin is known to be helpful for patients travelling through time zones and experiencing jet lag. Short- acting benzodiazepines are often used intravenously for conscious sedation before short diagnostic procedures. Eszopiclone is effective for patients who wake up in the middle of the night or early morning. p. 196

When a nursing student is preparing to teach a patient about measures to promote good sleep, which component of the plan indicates a need for additional teaching?

Watch soothing programs on television and lower the temperature of the bedroom. Rationale The nurse would instruct the patient to refrain from watching television before sleep. In addition, the room temperature should be comfortable to promote good sleep. The nurse would encourage the patient to express any stress and sleep disorders. The patient should include adequate exercise in the day-to-day activities to promote good sleep. The nurse would advise the patient to refrain from consuming caffeinated products and drink warm milk before going to bed to promote sleep. p. 191

Which herbal product has been used for the treatment of jet lag?

melatonin

In order to obtain an adequate amount of sleep and maintain good health, what fraction of a person's adult life would typically be spent sleeping?

one third

Which phrases describe the various characteristics of chronic insomnia? Select all that apply.

A) At least 1 month of sleep disturbance D) Psychiatric disorders present in 40% of patients É) Fatigue or drowsiness that interferes with daytime functioning and professional activities Rationale Chronic insomnia is characterized by at least 1 month of sleep disturbance. Forty percent of patients with chronic insomnia may suffer psychiatric disorders. Chronic insomnia can cause fatigue or drowsiness that interferes with daytime functioning and employment responsibilities. Transient insomnia requires sleep disturbance that lasts for a few nights. Short-term insomnia requires sleep disturbance that lasts less than 3 weeks. p.189

Which evening strategies would the nurse encourage when teaching a patient about factor that promote sleep? Select all that apply.

A) Avoid chocolate and soft drinks B) Avoid vigorous exercise C) Consume warm milk D) Consume small amounts of protein Rationale Encourage the patient to avoid products that contain caffeine, such as coffee, tea, energy drinks, soft drinks, and chocolate. The patient should limit the total daily intake of these items. Warm milk and crackers are a bedtime snack that can help promote sleep. Protein foods and dairy products contain an amino acid that synthesizes serotonin, which is a neurotransmitter that has been found to increase sleep time and decrease the time required to fall asleep. For insomnia, suggest that the patient drink warm milk about 30 minutes before going to bed. Alcohol and caffeine consumption would be reduced or discontinued, especially within several hours of bedtime. p. 190

When educating a patient about the outcome of stage 4 of non-rapid eye movement (NREM) sleep, which information would the nurse provide? Select all that apply.

A) Stage 4 is dreamless and very restful. B) Stage 4 sleep may also be referred to as delta sleep. E) Stage 4 shows a 10% to 30% decrease in blood pressure, respiratory rate, and basal metabolic rate Rationale Stage 4 NREM sleep is dreafnless and very restful. It is also referred to as delta sleep based on the brain wave patterns observed during this stage. This stage is characterized by a 10% to 30% decrease in blood pressure, respiratory rate, and basal metabolic rate. Stage 2 of NREM sleep composes about 50% of the normal sleep time; stage 4 composes 10% to 15% of sleep time of young, healthy adults. Rapid eye movement (REM) sleep is characterized by increased heart rate, irregular breathing, and some muscular activity. p. 188

When providing teaching about the occurrence and incidences of insomnia, which facts would be included? Select all that apply.

A) Women experience insomnia twice as frequently as men. B) Ten percent to 15% of older adults report chronic insomnia. Rationale Women report experiencing insomnia twice as frequently as men. About 10% of adults and up to 20% of older people report having chronic insomnia. A higher incidence of insomnia is reported not by adolescents but by older adults, the unemployed, those of lower socioeconomic status, and the recently separated or widowed. As many as 40% of patients with chronic insomnia also have psychiatric disorders. Children do experience insomnia P.189

Playback Taking fluvoxamine together with ramelteon will lead to which effect?

Excessive sedation in the patient Rationale Fluvoxamine is responsible for inhibiting the metabolism of ramelteon. This can cause excessive sedation in the patient. Fluvoxamine when taken along with ramelteon does not increase the toxic effects of sedative hypnotic agents. Taking ramelteon with food is likely to lower the absorption rate of the drug. Taking ramelteon along with rifampin will reduce the therapeutic effect of the sedative-hypnotic agent as rifampin enhances its metabolism significantly. p. 197

When the patient taking temazepam develops blood dyscrasias, which symptoms would the nurse expect to find in the patient? Select all that apply.

Fever Jaundice Sore throat Rationale dyscrasias caused by a benzodiazepine such as temazepam. Anorexia and vomiting are signs of hepatotoxicity, The nurse expects to find symptoms such as fever, jaundice, and sore throat if a patient has developed blood not blood dyscrasias. p. 194

A patient taking temazepam for managing insomnia misreads the prescription and accidentally consumes higher doses of the medication. Which medication will the nurse expect to be prescribed to manage the accidental overdose of the drug?

Flumazenil Rationale The nurse expects the primary healthcare provider to prescribe flumazenil, which is an antidote used to manage accidental overdose of benzodiazepines. Quazepam and triazolam are benzodiazepines and would not be prescribed to manage the accidental overdose of temazepam. Eszopiclone is used in the treatment of insomnia. This is not the proper medication to manage benzodiazepine overdose. P. 192

Which drug is a long-acting benzodiazepine?

Flurazepam Rationale * Flurazepam is a long-acting benzodiazepine. Estazolam is an intermediate-acting benzodiazepine. Lorazepam and midazolam are short-acting benzodiazepines. p. 193

Which benzodiazepine is long acting and thus places a patient at greater risk for a morning hangover?

Flurazepam Rationale Flurazepam is a lokg-acting medication. Triazolam and midazolam are short-acting medications. Temazepam is an intermediate-acting medication. p. 197

Which benzodiazepine is long acting and places a patient at greater risk for a morning hangover?

Flurazepam (Dalmane) Flurazepam is a long acting medication. Triazolam and midazolam are short acting medications. Temazepam is an intermediate acting medication.

What information is included in the teaching plan for a patient for whom a hypnotic medication is ordered for insomnia?

Keep a nightlight on for safety in case you need to get out of bed.

A patient asks the nurse why her doctor said she could take her "sleeping pill," which is a benzodiazepine, for no more than 4 weeks. Which information serves as the basis of the nurse's response?

Long term use results in bizarre dreams and rebound insomnia when the drug is discontinued.

When evaluating an older patient for serious adverse effects related to nonbenzodiazepine therapy, the nurse notes excitement, euphoria, and restlessness. The nurse would conclude that the patient has developed which reaction to the drug?

Paradoxical response Rationale Older adults on nonbenzodiazepine therapy often have a paradoxical response to the drug. Excitement, euphoria, and restlessness are symptoms of paradoxical response. If the patient has hypersensitivity to the medication, symptoms such as hives, pruritus, rash, high fever, or the inflammation of the mucous membranes are likely to occur. Excitement, euphoria, and restlessness are not symptoms of physical dependence on the drug. If the patient develops blood dyscrasias because of the usage of the benzodiazepine, symptoms such as sore throat, fever, purpura, jaundice, or excessive and progressive weakness are likely to occur p. 197

The nurse is reviewing the medication history of a patient taking butabarbital (Butisol) for treatment of insomnia. The nurse contacts the prescriber after discovering the patient is also taking which medication?

Propranolol (Inderal) The barbiturate butabarbital may reduce the effects of beta-adrenergic blockers such as propranolol. Digoxin, nitroglycerin, and penicillin do not interact with butabarbital.

Which action is priority when treating an older patient who is taking a miscellaneous sedative-hypnotic agent and is responding paradoxically?

Provide safety measures like maintenance of bed rest, side rails, etc. Rationale When caring for an older patient who is taking a miscellaneous sedative-hypnotic agent and responding paradoxically, the nurse would provide safety measures like maintenance of bed rest, side rails, etc., to ensure the overall safety of the patient. When treating patients with insomnia, the nurse would advise limiting the consumption of caffeinated products to promote a good night's sleep; however, this is not the priority action for an older patient who is responding paradoxically. The nurse would suggest that the patient drink warm milk about 30 minutes before going to bed to promote sleep. This is not an important step that needs to be followed when dealing with an older patient who is responding paradoxically. If a patient is complaining of dizziness or light-headedness, the nurse would help the patient stay in the sitting position for several moments and then stand slowly. P. 197

Which assessment finding would the nurse anticipate in a patient with a long-term history of benzodiazepine use ?

Rebound insomnia and hallucination Rationale The nurse would check for rebound insomnia and hallucinations if the patient has a history of long-term benzodiazepine use. Older patients who are in severe pain may respond paradoxically to benzodiazepines and to miscellaneous sedative-hypnotic agents. Blurred vision and morning hangover are the common adverse In such cases, the dosage of the medication is reduced by the primary healthcare effects of benzodiazepine. provider. Benzodiazepine-induced sleep may cause reduced REM sleep in the patient. p 189

How does the effect of a benzodiazepine used for sedation differ in patients who smoke cigarettes from those who do not smoke?

Smokers may require larger doses to maintain the desired effect.

Monitoring for changes in hepatic function and blood dyscrasias is an essential part of the care plan for a patient on which medication?

diazepam Diazepam is a benzodiazepine. Hepatotoxicity and blood dyscrasias are adverse effects associated with this class of drugs.