Pharm 2 Test 2 (CH. 13)

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

A 76 year old with severe pain

A patient was discussing a recent development of nightmares and restlessness since the discontinuation of triazolam (Halcion) with the nurse, who recognized the symptoms of 1. rebound insomnia. 2. terminal insomnia. 3. paradoxical excitement. 4. initial insomnia.

ANS: 1

The nurse taking care of a patient who was admitted for an overdose of lorazepam (Ativan) knows this antidote will be used: 1. diphenhydramine (Benadryl). 2. temazepam (Restoril). 3. flumazenil (Romazicon). 4. selegiline (Eldepryl).

ANS: 3

In addition to facilitating sleep, what is another benefit of sedatives? a. Increased pain control postoperatively b. Reduced bronchial secretions c. Decreased patient anxiety d. Increased patient alertness

ANS: C

Which disease is associated with insufficient sleep? a. Cancer b. Glaucoma c. Myocardial infarction d. Renal failure

ANS: C

Which two phases make up normal sleep? a. Hypnagogic and hypnopompic b. Rapid eye movement (REM) and non REM c. Alpha and beta d. Delta and theta

ANS: B

The nurse is explaining the use of medications to a patient with insomnia. Which statement about sedatives is true? a. A sedative will produce sleep. b. Sedatives increase the total time in REM sleep. c. Increased relaxation occurs with sedatives. d. Sedatives are more potent than hypnotics.

ANS: C

When reviewing a patients history and physical information, the nurse notes that the patient has physicians orders for chloral hydrate and warfarin. During assessment of this patient, the nurse observes areas of petechiae and ecchymosis on the upper and lower extremities. The most appropriate lab work for the nurse to assess next is: a. liver function studies. b. C-reactive protein. c. sedimentation rate. d. prothrombin time.

ANS: D

Which sleep pattern stage diminishes as an effect of aging? a. Stage I b. Stage II c. Stage III d. Stage IV

ANS: D

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

Diazepam

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.

The nurse is making rounds at 0200 on the unit during the night shift and notes that one of the older patients is awake. The nurse reviews the patient's bedtime medication and sees that 5 mg of zolpidem (Ambien) was administered at 2100. What interventions are appropriate for the nurse to do next? (Select all that apply.) 1. Repeat the dose as ordered. 2. Provide patient comfort measures (i.e., back rub, quiet room, etc.). 3. Call the healthcare provider to obtain another sleep aid order. 4. Keep the patient awake to prevent rebound sleep. 5. Assess for paradoxical symptoms and provide safety measures.

ANS: 1, 2, 3, 5

The nurse was discussing the difference between temazepam (Restoril) and zolpidem (Ambien) with a patient requesting drug therapy for sleep disturbance. Which of the following statements are appropriate? (Select all that apply.) 1. "When you take Restoril, it can cause rebound insomnia if you abruptly stop taking it without tapering the drug." 2. "There is no difference between these drugs; you can take them without any worries." 3. "Ambien is also available in a sublingual tablet form, which disintegrates in seconds." 4. "The side effect of morning drowsiness is only caused by Restoril, not Ambien." 5. "Ambien is used for short-term treatment of insomnia."

ANS: 1, 3, 4, 5

The nurse is monitoring laboratory results for a patient who has been taking quazepam (Doral) for several years. The following tests need to be followed to monitored for hepatotoxicity: (Select all that apply.) 1. AST. 2. platelet count. 3. alkaline phosphatase. 4. WBC. 5. ALT.

ANS: 1, 3, 5

The nurse is reviewing an order for a sleep aid for a patient who was complaining of insomnia. The nurse understands that a sedative is different from a hypnotic in this manner 1. the sedative causes feelings of relaxation and rest, and the hypnotic agent causes feelings of restlessness and anxiety. 2. the sedative causes feelings of relaxation and rest, and the hypnotic agent produces sleep. 3. the hypnotic agent produces sleep, and the sedative causes no hangover effect. 4. the hypnotic agent causes feelings of relaxation and rest, and the sedative produces sleep.

ANS: 2

A patient who has been receiving benzodiazepines for several years was told by the nurse that this may cause 1. nephrotoxicity. 2. a rush of morning energy with repeated usage. 3. withdrawal symptoms if the drug is discontinued rapidly. 4. seizures during the time that the drug is being administered.

ANS: 3

The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints of back pain. The patient reports taking diphenhydramine for insomnia related to job stress. Which statement by the nurse is accurate regarding this medication? a. This medication should only be taken for 1 week. b. This medication can cause nausea. c. The medication should not be taken after eating a high fat meal. d. This is an herbal medication that has been used for hundreds of years.

ANS: A

The nurse is assessing a patient prior to discharge from same day surgery following an incisional breast biopsy. When assessing the patients central nervous system (CNS) function following sedative hypnotic therapy, what will the nurse include? (Select all that apply.) a. Level of alertness b. Orientation c. Ability to perform motor functions d. Blood pressure e. Usual pattern of sleep

ANS: A, B, C

What can occur as a result of rapid withdrawal from long term use of barbiturate therapy? (Select all that apply.) a. Anxiety b. Delirium c. Weakness d. Grand mal seizures e. Severe pain

ANS: A, B, C, D

Why are benzodiazepines often preferred over barbiturates? (Select all that apply.) a. They have selective action at specific receptor sites. b. There is a wide range of safety between therapeutic and lethal levels. c. REM sleep is decreased to a lesser extent. d. Accidental overdoses are well tolerated. e. There are no hypotensive episodes when rising to a sitting position.

ANS: A, B, C, D

Barbiturates have which common adverse effect(s)? (Select all that apply.) a. Residual daytime sedation b. Headache c. Hyperactivity d. Blurred vision e. Impaired coordination

ANS: A, B, D, E

A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia. Which action will the nurse take? a. Advise the patient to take the medication with food. b. Assess the patients blood pressure in sitting and lying positions. c. Inform the patient to discontinue the medication once sleep improves. d. Instruct the patient to lie down before taking the medication.

ANS: B

A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced. Which type of blood work will be performed? a. Renal function tests b. Liver function tests c. Clotting times d.Electrolyte panels

ANS: B

The nurse is administering Somnote to a patient. When providing medication education to the patient, the nurse will include that Somnote should be: a. thoroughly chewed. b. taken with a full glass of water. c. taken on an empty stomach. d. taken only before bedtime.

ANS: B

An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance. What type of medication effect is the patient exhibiting? a. Allergic b. Hypersensitivity c. Paradoxical d. Therapeutic

ANS: C

For what conditions are benzodiazepines prescribed? a. Chronic amnesia b. Chronic insomnia c. Preoperative sedation d. Psychotic episodes

ANS: C

The nurse is caring for an older patient recently admitted to an assisted living center who is experiencing insomnia associated with the recent relocation. At bedtime, which nursing action will assist the patient to sleep? a. Offering the patient hot tea b. Encouraging the patient to ambulate in the hallway c. Performing back massage d. Administering an analgesic

ANS: C

The nurse finds that a patient is extremely agitated, yells frequently, and is attempting to get out of bed without assistance. What is the nurses initial action? a.Administer zolpidem after taking the patients vital signs. b. Close the patients door for privacy after administering Tylenol. c. Administer benzodiazepine before calling the health care provider. d. Spend uninterrupted time listening to the patient.

ANS: D

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.