Nursing pharm chapter 13

The nurse teaching a patient about the use of hypnotics and what to expect when they are discontinued recognized the need for further instruction when the patient made which statement? a) "As I understand it, sedatives have the same effect as hypnotic medications" b) "Habitual use of benzodiazepines may result in physical dependence" c) "Since some of these drugs have unpleasant consequences such as rebound sleep, I will need to change my habits instead of relying on medications to sleep" d) "Insomnia is not a disease, but a symptom of the stress I am having since I became unemployed"

a) "As I understand it, sedatives have the same effect as hypnotic medications"

The nurse knows that the patient who has complained of insomnia can benefit from which alternative methods of inducing sleep? Select all that apply a) A limitation of stimulants close to bedtime b) Avoiding heavy meals late in the evening c) Drinking warm milk and eating crackers as a bedtime snack d) Limiting exercise during the day and only within 30 minutes of bedtime e) Consuming only decaffeinated beverages close to bedtime

a) A limitation of stimulants close to bedtime b) Avoiding heavy meals late in the evening c) Drinking warm milk and eating crackers as a bedtime snack e) Consuming only decaffeinated beverages close to bedtime

Which medications and/or substances does the nurse identify as potentially inducing or aggravating insomnia? Select all that apply a) Alcohol b) Caffeine c) Nicotine d) Benzodiazepines e) Anticonvulsants

a) Alcohol b) Caffeine c) Nicotine

The symptoms of hepatotoxicity are anorexia, nausea, vomiting, jaundice, hepatomegaly, splenomegaly, and abnormal liver function tests, which include what results? Select all that apply a) Bilirubin b) Platelets c) Alkaline phosphatase d) Aspartate aminotransferase (AST) e) Alanine aminotransferase (ALT)

a) Bilirubin c) Alkaline phosphatase d) Aspartate aminotransferase (AST) e) Alanine aminotransferase (ALT)

While teaching patients about nonpharmacologic methods to enhance sleep, which statement does the nurse include? a) Exercise during the day, not near bedtime b) Avoid drinking milk before going to bed c) Do not go to bed at the same time each night, go to bed when you feel the most tired d). Eat. your heaviest meal of the day about 45 minutes before you plan to go to bed

a) Exercise during the day, not near bedtime

The nurse knows which classification of drugs can be used for patients complaining of insomnia? Select all that apply a) Hypnotics b) Sedatives c) Antidepressants d) Anticonvulsants e) Anticholinergics

a) Hypnotics c) Antidepressants d) Anticonvulsants

Since once of the common adverse effects of benzodiazepines is blood dyscrasias, the nurse will monitor which lab values? Select all that apply a) Platelets b) Red Blood Cells c) Electrolytes d) Prothrombin time e) White blood cells with differential.

a) Platelets b) Red Blood Cells e) White blood cells with differential.

What do the therapeutic outcomes of benzodiazepines therapy include? Select all that apply a) To produce mild sedation b) To use short-term to produce sleep c) To manage migrane headaches d) To induce preoperative sedation with amnesia e) To increase the amount of REM sleep

a) To produce mild sedation b) To use short-term to produce sleep d) To induce preoperative sedation with amnesia

Chronic Insomnia a) at least 1 month of sleep disturbance b) the inability to fall asleep when desired c) early awakening with the inability to fall asleep again d) Compensatory REM sleep e) the inability to sleep f) a sleep disturbance that lasts less than 3 weeks g) the inability to stay asleep

a) at least 1 month of sleep disturbance

Rapid discontinuance of benzodiazepines after long-term use may result in symptoms similar to those of alcohol withdrawal, which include: Select all that apply a) delirium b) headaches c) weakness d) anxiety e) grand mal seizures

a) delirium c) weakness d) anxiety e) grand mal seizures

How is insomnia best defined? a) the inability to sleep b) Getting fewer than 5 hours of sleep at night c) Episodes of REM sleep that last only a few minutes d) Experiencing a drifting or floating sensation

a) the inability to sleep

The drug class nonbenzodiazepines, which include the benzodiazepine receptor agonists (e.g., zaleplon, zolpidem, eszopiclone), have which adverse effect that requires careful monitoring? a) Food slows the absorption of the drug b) Lightheadedness lasts for several moments and passes c) Habitual use may result in physical dependence d) An ultra-short-acting time that affects the tolerance to the drug

c) Habitual use may result in physical dependence

Scenario: Asked if having trouble getting to sleep or woke up and can't go back to sleep. The nurse's questions to the patient in the scenario are intended to determine if there is which type of insomnia? a) Initial insomnia or rebound insomnia b) Initial insomnia or intermittent insomnia c) Initial insomnia or terminal insomnia d) Initial insomnia or transient insomnia

c) Initial insomnia or terminal insomnia

Terminal insomnia a) at least 1 month of sleep disturbance b) the inability to fall asleep when desired c) early awakening with the inability to fall asleep again d) Compensatory REM sleep e) the inability to sleep f) a sleep disturbance that lasts less than 3 weeks g) the inability to stay asleep

c) early awakening with the inability to fall asleep again

Short-term insomnia a) at least 1 month of sleep disturbance b) the inability to fall asleep when desired c) early awakening with the inability to fall asleep again d) Compensatory REM sleep e) the inability to sleep f) a sleep disturbance that lasts less than 3 weeks g) the inability to stay asleep

f) a sleep disturbance that lasts less than 3 weeks

The nurse was reviewing a diet choice made by a patient who was suffering from insomnia. Which choice would be a good alternative to a sedative? a) Chocolate bar and hot milk b) Herbal tea and crackers c) Hot black tea and a cookie before bed d) Glass of wine and dark chocolate

b) Herbal tea and crackers

After long-term administration of sedative-hypnotic agents, the patient may experience what if the medications are discontinued? Select all that apply a) Drowsiness b) Restlessness c) Vivid nightmares d) Severe REM rebound sleep e) Quick return of normal sleep patterns

b) Restlessness c) Vivid nightmares d) Severe REM rebound sleep

A nurse was caring for a 54-year old patient who was admitted for benzodiazepine overdose after taking over 20 lorazepam (Ativan) tablets. The nurse expects which medication to be prescribed for the treatment of the overdose? a) quazepam (Doral) b) flumazenil (Romazicon) c) triazolam (Halcion) d) eszopiclone (Lunesta)

b) flumazenil (Romazicon)

Initial insomnia a) at least 1 month of sleep disturbance b) the inability to fall asleep when desired c) early awakening with the inability to fall asleep again d) Compensatory REM sleep e) the inability to sleep f) a sleep disturbance that lasts less than 3 weeks g) the inability to stay asleep

b) the inability to fall asleep when desired

After discussing with the patient in the scenario the best drugs to use for insomnia, the nurse recognizes the need for further education when the patient makes which statement? a) "So you are saying that I should take drugs for my insomnia for short periods of time to prevent side effects." b) "If I use a hypnotic prior to going to bed this will help with my insomnia." c) "If i don't start getting better sleep it will start to interfere with my work." d) "So you are saying the best type of drug to use for insomnia is a sedative."

d) "So you are saying the best type of drug to use for insomnia is a sedative."

Which statement does the nurse include when teaching a patient about zolpidem (Ambien) therapy? a) "No physical dependency will develop with use of this drug" b) "If you have difficulty sleeping, increase the dose by one-half" c) "Take the medication about 3 hours before you plan on going to sleep" d) "The 'morning hangover' side effect is generally not a problem with this medication."

d) "The 'morning hangover' side effect is generally not a problem with this medication."

How does the drug class benzodiazepines work? a) By activating the sleep function of the cerebral cortex b) By suppressing REM and stages III and IV sleep patterns c) By stimulating the neurotransmitter dopamine that initiates sleep d) By binding to receptors that stimulate the release of gamma-aminobutyric acid (GABA)

d) By binding to receptors that stimulate the release of gamma-aminobutyric acid (GABA)

rebound sleep a) at least 1 month of sleep disturbance b) the inability to fall asleep when desired c) early awakening with the inability to fall asleep again d) Compensatory REM sleep e) the inability to sleep f) a sleep disturbance that lasts less than 3 weeks g) the inability to stay asleep

d) Compensatory REM sleep

The phrase rebound sleep refers to what phenomenon? a) The return to previous insomnia symptoms b) The increase in amount of REM sleep that causes restlessness and vivid nightmares c) The return of normal sleep patterns after a hypnotic is discontinued d) The decrease in the amount of REM sleep that causes increased drowsiness

d) The decrease in the amount of REM sleep that causes increased drowsiness

Why may a pregnancy test be ordered when a patient is started on a benzodiazepine? a) These agents cross into breast milk b) The withdrawal symptoms are worse for pregnant mothers c) There is an increase incidence of maternal deaths after use of these drugs. d) There is an increased incidence of birth defects because these agents cross the placenta.

d) There is an increased incidence of birth defects because these agents cross the placenta.

Insomnia a) at least 1 month of sleep disturbance b) the inability to fall asleep when desired c) early awakening with the inability to fall asleep again d) Compensatory REM sleep e) the inability to sleep f) a sleep disturbance that lasts less than 3 weeks g) the inability to stay asleep

e) the inability to sleep

Intermittent insomnia a) at least 1 month of sleep disturbance b) the inability to fall asleep when desired c) early awakening with the inability to fall asleep again d) Compensatory REM sleep e) the inability to sleep f) a sleep disturbance that lasts less than 3 weeks g) the inability to stay asleep

g) the inability to stay asleep