Pharmacology Prep U Chapter 20 Anxiolytic and Hypnotic Agents

The infant may experience withdrawal symptoms during the postnatal period.

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. The mother will have withdrawal symptoms during labor. There is no cause for concern. The baby will have birth defects.

Administer the medication as prescribed

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 Contact the prescriber to confirm the dose Contact the prescriber to confirm the route Ensure flurazepam is available

respiratory disturbances and partial airway obstruction.

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: ataxia and confusion. respiratory disturbances and partial airway obstruction. seizures. leukopenia and diplopia.

eszopiclone

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? phenytoin loratadine eszopiclone norepinephrine

"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults."

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 quickly, but due to renal dysfunction, the medication must be reduced." "Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults." "Older adults metabolize the drug at the same speed as younger adults; I will check the dosage with your health care provider." "Older adults do not need as much of the medication for the desired effect as a younger adult does."

a dose adjustment should be made if these symptoms persist.

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. the drug should be stopped immediately if these effects persist. the drug should be administered intravenously if these effects persist. no changes should be made at this time; the adverse effects will resolve with continued use.

Benzodiazepine toxicity

A 75-year-old client is brought to the emergency department by the family. The family relates that the client has confusion, seizures, and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED, the nurse discovers that twice the number of tablets are missing from the vial as there should be if the prescription orders were being followed. What should the nurse suspect is wrong with this client? Benzodiazepine toxicity Antihypertensive toxicity Sedative toxicity Analgesic toxicity

Risk for injury

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 altered elimination Ineffective individual coping Risk for injury Risk for skin breakdown

Melatonin

A client has been admitted to the surgical floor and is scheduled for an elective minor procedure. During the health history, the client informs the nurse of difficulty sleeping until a few weeks ago when a hormone was recommended by a neighbor and started. To what hormone is this client referring? Soy Melatonin Progesterone Flaxseed

Tapering the dose of drug over a prolonged period of time

A client has been prescribed a benzodiazepine daily for treatment of an anxiety disorder. In order to minimize the chances of withdrawal symptoms, the nurse knows to include what precaution in client teaching? Tapering the dose of drug over a prolonged period of time Replacing the drug with a herbal supplement in anticipation of stopping the medication Substituting the immediate-acting form of the drug with a long-acting form Exchanging the drug for an anticonvulsant

Liver disease

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? Neurological diseases Liver disease Endocrine disorders Heart disease

Start another IV line in the client's right arm.

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. Notify the prescriber that the diazepam cannot be given. Add the diazepam to the current IV infusion. Wait until the other drug is completed to give the diazepam.

"Be sure not to stop the drug abruptly."

A client is prescribed an anxiolytic agent. What would be most important for the nurse to include in the teaching? "Be sure not to stop the drug abruptly." "Take the drug with meals if necessary." "Increase the amount of fiber in your diet." "Try other measures to help you relax, too."

bradycardia. When given intravenously, barbiturates can result in bradycardia, hypotension, hypoventilation, respiratory depression, and laryngospasm

A client is receiving a barbiturate intravenously. The nurse would monitor the client for: hypertension. bradycardia. tachypnea. bleeding.

½ hour before going to bed

A client is receiving ramelteon for insomnia. The nurse would instruct the client to take the drug at which time? 2 hours before going to bed 1 hour before going to bed ½ hour before going to bed Immediately before going to bed

Benzodiazepine overdose Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Anexate) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity.

A client presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the client has been taking medication throughout the evening. What would the nurse suspect? Hypnotic overdose Sedative overdose Anti-anxiety overdose Benzodiazepine overdose

1200

A client received lorazepam intravenously at 0900. The nurse should maintain the client on bedrest until approximately what time? 1200 1030 1330 1500

increasing the effects of the neurotransmitter GABA. Like all benzodiazepines, lorazepam increases the effects of GABA, which has an inhibitory effect on the CNS.

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. inhibiting the action of monoamine oxidase. affecting the regulation of serotonin and norepinephrine in the brain. increasing the amount of serotonin available in the synapses.

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 Zaleplon Meprobamate Diphenhydramine

oral contraceptive.

A decrease in dosage of a prescribed benzodiazepine most likely would be necessary if a client was also taking: theophylline. ranitidine. oral contraceptive. alcohol.

"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly."

A female client is prescribed a benzodiazepine for anxiety. She asks the nurse if she can stop the drug when she feels better. What is the nurse's best response? "Benzodiazepines do not cause physiologic dependence, and withdrawal symptoms will not occur if the drug is stopped abruptly." "Benzodiazepines may cause physiologic dependence, but withdrawal symptoms will not occur if the drug is stopped abruptly." "Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug's dosages are tapered." "Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly."

"This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities."

A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response? "An anxiolytic, such as alprazolam, is usually prescribed for long-term anxiety disorders." "This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities." "Anxiolytics are prescribed to treat anxiety and can be purchased without a prescription after discharge." "Anxiolytic drugs are different from antianxiety drugs, because they work without a tranquilizing effect."

Whether the client is experiencing drug intoxication or withdrawal

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 has a history of agitation Whether the client is currently taking antibiotics Whether the client is experiencing drug intoxication or withdrawal Whether the client is currently taking a diuretic

nausea.

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

respiratory depression

A nurse is administering a prescribed dose of chlordiazepoxide to a client. The nurse should closely assess the client for what adverse reaction? idiopathic thrombocytopenic purpura (ITP) respiratory depression esophageal bleeding urinary retention

Hypotension

A nurse is caring for a patient who has been administered a barbiturate. Which is a symptom of barbiturate toxicity that the nurse must monitor the patient for? Restlessness Euphoria Hypotension Confusion

Induces sleep

A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam? Decreases stress Eases pain Induces sleep Improves circulation

Have resuscitative equipment ready.

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? Arrange for a blood transfusion. Provide fiber-rich food. Provide plenty of fluids. Have resuscitative equipment ready.

Headache Sedation Light-headedness Dizziness

A nurse should recognize which as common early reactions caused by anxiolytics? (Select all that apply.) Headache Sedation Light-headedness Dizziness Hypertension

Increased risk for central nervous system depression

A patient admitted to the health care facility for alcohol withdrawal has been prescribed an antianxiety medication. Why should the nurse suggest the patient stop consuming alcohol while therapy is ongoing? Increased risk for digitalis toxicity Increased risk for respiratory depression Increased risk for sedation Increased risk for central nervous system depression

Phenobarbital

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

Falls risk assessment

An older adult client diagnosed with generalized anxiety disorder is prescribed a benzodiazepine. The nurse caring for the client knows to include what intervention in the client's care plan? Seizure precautions Falls risk assessment Frequent dysrhythmias monitoring Education regarding sexual dysfunction

Confusion

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? Headache Stress Confusion Anxiety

False

Barbiturates are considered the sedative and hypnotic drugs of choice. True False

Less central nervous system depression

Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics? Decreased risk of hepatic injury Less central nervous system depression Rapid onset and short duration Sublingual administration

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

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

Abnormal anxiety is prolonged and impairs normal function.

How should the nurse explain the major difference between normal and abnormal anxiety? Abnormal anxiety is generally unresponsive to treatment. Abnormal anxiety is prolonged and impairs normal function. Abnormal anxiety is a brief response to situational stress. Normal anxiety often triggers reports of insomnia.

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.

Respiratory distress is a contraindication for the use of barbiturates. True False

"Make sure that you go to bed immediately or very shortly after taking the pill." Eszopiclone is a treatment for insomnia, so drowsiness is assured and the client should go to bed after taking it.

The health care provider has ordered for a client eszopiclone 1 mg PO daily as needed. What education should the nurse provide to the client beginning this medication? "Make sure that you go to bed immediately or very shortly after taking the pill." "If you're still feeling anxious after taking the drug for the first week, tell your provider." "Some clients experience drowsiness after taking this medication, so avoid driving." "Ensure that you don't take this medication more than three nights consecutively."

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.

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 can exacerbate neuropathic pain Barbiturates can cause tachypnea in a client who is in pain Barbiturates cannot be given in combination with nonsteroidal anti-inflammatories.

antihistamines

The client reports using an over-the-counter (OTC) drug to treat insomnia. What classification of OTC medications is often used for this purpose? nonsteroidal anti-inflammatory drugs antihistamines salicylates antitussives

Increased sedative effect

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetidine and a sedative to calm the client. What should the nurse be concerned about? Decreased sedative effect Increased sedative effect If the client's insurance will cover the two drugs Cost of the drugs

Increased sedative effect

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetidine and a sedative to calm the client. What should the nurse be concerned about? Decreased sedative effect Increased sedative effect If the client's insurance will cover the two drugs Cost of the drugs

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

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 his urine output closely, due to the risk of kidney damage. Monitor for a yellowish color in the eyes and easy bruising, due to liver damage. Monitor for increased signs of confusion or forgetfulness. Monitor for muscle stiffness and rigid body posture.

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.

The etiology of anxiety involves which physiologic process? Stimulation of the parasympathetic nervous system Stimulating effects of somatotropin Increased activation of the autonomic nervous system Adrenocortical suppression

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

The medication nurse knows that when benzodiazepines are used with opioid analgesics, the analgesic dose should be adjusted in which way? It should be increased initially and reduced gradually. It should be reduced initially and increased gradually. It should be reduced initially and incrementally thereafter. It should be increased initially and incrementally thereafter.

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.

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 Bowel sounds Respiratory rate Skin temperature and color Hair texture

1 to 5 minutes

The nurse is preparing to administer prescribed diazepam intravenously to a client. How soon after administration does the nurse expect to observe onset of action? 1 to 5 minutes Under 1 minute 7 to 10 minutes More than 10 minutes

dependence

The nurse is providing health education for a client who has been prescribed a benzodiazepine. What adverse effect should the nurse discuss in the teaching? dependence suicide personality changes persistent insomnia

Depression of the cerebral cortex

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 Enhancement of action of GABA Effect on action potentials Enhancement of motor output

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.

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. Advise the client that increased blood pressure is an expected finding after discontinuing Xanax. Notify the health care provider of the abnormal vital signs. Document the client's vital signs in the electronic medical record and advise the charge nurse.

Buspirone

Which drug used to treat anxiety would be appropriate for a client who is a school teacher and is concerned about feeling sedated at work? Alprazolam Buspirone Diazepam Lorazepam

The adverse effects of benzodiazepines can persist for several days after stopping the drug.

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? Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. The client may have decreased liver function. The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. The adverse effects of benzodiazepines can persist for several days after stopping the drug.

Temazepam (Restoril) Triazolam (Halcion)

What are examples of benzodiazepine-type hypnotic and sedative drugs? (Select all that apply.) Temazepam (Restoril) Eszopiclone (Lunesta) Secobarbital (Seconal) Triazolam (Halcion) Zaleplon (Sonata)

Eszopiclone (Lunesta) Zaleplon (Sonata) Zolpidem (Ambien)

What are examples of nonbenzodiazepine-type hypnotic and sedative drugs? (Select all that apply.) Temazepam (Restoril) Eszopiclone (Lunesta) Zolpidem (Ambien) Triazolam (Halcion) Zaleplon (Sonata)

Chronic pain

What aspect of a client's health is most likely to cause insomnia? Hypothyroidism Morbid obesity Chronic pain Type 2 diabetes

"When did you have your last drink of alcohol?"

What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide? "When did you have your last drink of alcohol?" "What is motivating you to stop drinking alcohol?" "How has your alcohol use affected your quality of life?" "How much alcohol have you ingested in the last 8 hours?"

The client will not appear restless or confused.

What goal should the nurse identify for a client prescribed chlordiazepoxide? The client will not appear restless or confused. The client will remain in an unresponsive state for at least 6 hours. The client will not experience unpleasant effects when consuming alcohol. The client will be able to verbally express an understanding of alcoholism.

Arteriospasm

What might occur if a client inadvertently receives a benzodiazepine intra-arterially? CNS depression Blurred vision Urinary retention Arteriospasm

Lorazepam

When administering benzodiazepines, which medication should be considered the drug of first choice? Lorazepam Estazolam Temazepam Triazolam

Enhanced action of gamma-aminobutyric acid

When describing the action of benzodiazepines as anxiolytics, what would the nurse need to keep in mind? Enhanced action of gamma-aminobutyric acid Effect on action potentials Depression of the cerebral cortex Depressed motor output

Having the client walk to the bathroom

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 Raise the side rails Place the call light within reach Dim the lights

Buspirone

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

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

Which are examples of benzodiazepine antianxiety drugs? (Select all that apply.) Alprazolam (Xanax) Buspirone (BuSpar) Hydroxyzine (Atarax) Chlordiazepoxide (Librium) Lorazepam (Ativan)

flurazepam

Which drug is specifically marketed for the treatment of insomnia? flurazepam midazolam diazepam alprazolam