Prep U's - Chapter 54 - Drug Therapy for Anxiety and Insomnia

A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)? A. A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep. B. A 46-year-old man who receives an antidepressant and needs a sleep aid. C. A 52-year-old woman who needs to fall asleep quickly and stay asleep all night. D. A 20-year-old woman who will take the drug about once a week.

Answer: A Rationale: The nurse will most likely administer the zaleplon to the 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep. Zolpidem would most likely be administered to the 20-year-old who will take a sleep aid only once a week. Eszopiclone (Lunesta) will be given to the 52-year-old woman who needs to fall asleep quickly and has trouble staying asleep. The 46-year-old man will likely receive trazodone (Desyrel). This drug is given as a sleep aid for a patient who is taking an antidepressant.

A nurse is preparing to administer buspirone to a client with anxiety. The nurse should question this order if which disorder is noted in the client's past history? A. Psychoses B. Acute gout C. Cataract D. Diabetic retinopathy

Answer: A Rationale: The use of buspirone is contraindicated in clients with hypersensitivity, psychoses, and acute narrow-angle glaucoma. Ethambutol is contraindicated in clients with cataracts and diabetic retinopathy. Pyrazinamide is contraindicated in clients with acute gout.

The nurse is caring for an older adult client who is prescribed a benzodiazepine. When planning the client's assessment, the nurse should be aware of what possible adverse effect? A. unpredictable reactions. B. epistaxis. C. dysuria. D. acute renal failure.

Answer: A Rationale: Use benzodiazepines with caution in older adults or debilitated clients because of the possibility of unpredictable reactions and in clients with renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are needed for such clients. Acute renal failure, dysuria, and epistaxis (nosebleed) are not commonly related to therapy with these medications in older adults.

After teaching a group of nursing students about sedatives and hypnotics, the instructor determines that additional teaching is needed when the students conclude the absorption of which drug is affected by a high-fat meal? A. Zolpidem B. Ramelteon C. Zaleplon D. Eszopiclone

Answer: A Rationale: Zolpidem and tasimelteon should not be taken with food. A high-fat meal or snack can interfere with the absorption of the following drugs: eszopiclone, ramelteon, and zaleplon, however, they may be taken with food.

A nurse is preparing to administer temazepam to a client. The nurse will exercise caution if which medical issue is noted in the client's record? Select all that apply. A. Mental health problems. B. Habitual alcohol use. C. Hypertension. D. Hepatic impairment. E. Renal impairment.

Answer: A, B, D, E Rationale: A nurse should use caution when administering sedatives and hypnotics to clients with hepatic or renal impairment, habitual alcohol use, and mental health problems and in clients who are lactating. Hypertension is a symptom of benzodiazepine withdrawal. Individuals with hypertension should be cautiously administered the following: linezolid, cholinergic drugs, cholinergic blocking drugs, COMT inhibitors, antihistamines, decongestants, adrenergic, xanthine derivatives, and adrenergic bronchodilators.

A client admitted for insomnia related to stress is prescribed a sedative. Which actions would the nurse include in the plan of care to promote the effectiveness of the drug? A. Offer fiber-rich food. B. Provide back rubs. C. Encourage plenty of fluids. D. Give the client coffee or tea.

Answer: B Rationale: Back rubs are relaxing and help promote the effectiveness of the sedative. Fluids and fiber prevent constipation. Coffee and tea contain caffeine, which could interfere with the drug's effectiveness.

A nurse determines the possibility of benzodiazepine toxicity based on assessment of which adverse effect? A. Severe headache. B. Respiratory depression. C. Abdominal pain. D. Muscle pain.

Answer: B Rationale: Benzodiazepine toxicity causes sedation, respiratory depression, and coma. Abdominal pain, severe headache, and muscle pain are not symptoms of benzodiazepine toxicity.

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

Answer: B Rationale: Chlordiazepoxide is used primarily when clients are in acute alcohol withdrawal. Assessment should be focused on when the client last consumed alcohol to help in the planning of care. While the other questions are not inappropriate, they are not directly related to caring for a client experiencing alcohol withdrawal.

Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect? A. Hepatic failure B. Falls C. Constipation D. Heart failure

Answer: B Rationale: 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 an older adult due to the lack of fluid or fiber intake. Benzodiazepine use does not indicate high risk for heart failure or hepatic failure.

While reviewing a client record, the nurse sees that the client has a history of chronic insomnia. What assumption can the nurse have regarding the client? A. The client is experiencing an underlying serious illness. B. The client has periods of alternating deep and light sleep. C. The client has been experiencing dysfunctional sleep for more than 1 month. D. The client needs pharmacological assistance to go to sleep.

Answer: C Rationale: Occasional sleeplessness is a normal response to many stimuli and is not usually harmful. Insomnia is said to be chronic when it lasts longer than 1 month. Insomnia has many causes, including stressors as pain, anxiety, illness, changes in lifestyle or environment, and various drugs. However, one cannot assume a specific cause based on the information provided, so the nurse has no way to know if the client is experiencing a serious illness. Normal sleep includes alternating periods of deep and light sleep cycles. The definition of chronic insomnia does not include reference to the need for pharmacologic sleep therapy.

While reviewing a client record, the nurse sees that the client has a history of chronic insomnia. What assumption can the nurse have regarding the client? A. The client needs pharmacological assistance to go to sleep. B. The client is experiencing an underlying serious illness. C. The client has been experiencing dysfunctional sleep for more than 1 month. D. The client has periods of alternating deep and light sleep.

Answer: C Rationale: Occasional sleeplessness is a normal response to many stimuli and is not usually harmful. Insomnia is said to be chronic when it lasts longer than 1 month. Insomnia has many causes, including stressors as pain, anxiety, illness, changes in lifestyle or environment, and various drugs. However, one cannot assume a specific cause based on the information provided, so the nurse has no way to know if the client is experiencing a serious illness. Normal sleep includes alternating periods of deep and light sleep cycles. The definition of chronic insomnia does not include reference to the need for pharmacologic sleep therapy.

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? A. drive only 2 hours after consuming the drug and stop when it's time for the subsequent dose. B. avoid driving until he is aware of the adverse effects. C. avoid driving at night, because lorazepam affects the wake-sleep cycle and can lead to drowsiness. D. change his profession, because the drug has long-term effects after cessation of therapy.

Answer: B Rationale: 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 with anxiety is prescribed anxiolytic therapy. Before administering the drug, which symptoms of anxiety would the nurse expect to find on the pre administration assessment? A. Increased glucose level. B. Increased blood pressure. C. Decreased pulse rate. D. Decreased muscle tension.

Answer: B Rationale: Increased blood pressure is a manifestation of anxiety. Additional manifestations include increased pulse rate and increased muscle tension. Increased glucose levels are not associated with anxiety.

The nurse is aware that there is some research that reveals that anxiety may be treated with nutritional and herbal supplements. Which nutritional and/or herbal supplement is used in this treatment? A. Caffeine B. Kava C. Melatonin D. Whey

Answer: B Rationale: Kava is the nutritional/herbal supplement that is recommended for the treatment of anxiety. Caffeine may possibly increase symptoms of anxiety. Melatonin is used to reestablish sleep- wake cycles, and whey is used to build muscle mass.

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

Answer: B Rationale: People use over-the-counter medications as sleep aids; these medications include antihistamines alone or in combination with pain relievers. The other drugs lack the sedative properties.

A client reports taking kava for stress relief. What should the nurse teach the client about the supplement? A. Research supports that herbal supplements are generally safer to use than drugs. B. The Food and Drug Administration (FDA) warns that kava may cause severe liver toxicity. C. Kava use can cause increasing hyperactivity, excessive talking, and nervousness. D. Its effectiveness hasn't been confirmed, but it has few adverse effects.

Answer: B Rationale: The FDA issued a warning that products containing kava have been implicated in several cases of severe liver toxicity (e.g., hepatitis, cirrhosis, liver failure). It causes sedation, not stimulation. Herbs are not necessarily safer than drugs. Adverse effects of kava include impaired thinking, judgment, motor reflexes, and vision. Serious adverse effects may occur with long-term heavy use, including decreased plasma proteins, decreased platelet and lymphocyte counts, dyspnea, and pulmonary hypertension.

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? A. "Occasional seizures may occur when starting this new medication." B. "I may be a little drowsy at first when I start taking this medication." C. "I will likely experience hyperactivity when taking this medication." D. "I may suffer from a mild rash when taking this medication."

Answer: B Rationale: 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.

The nurse works on a busy floor giving multiple sedatives and hypnotics. What priority concern should the nurse carefully assess for when administering a sedative or hypnotic? A. Decreased peristalsis. B. Depressed respiratory function. C. Confusion. D. Ataxia.

Answer: B Rationale: The top priority concern is decreased respiratory function. Without adequate respiratory function, the body will be deprived of oxygen. Confusion and ataxia are safety concerns, especially for older adults, but are not the top priority and most life-threatening concerns. Sedatives and hypnotics depress the central nervous system and are not commonly known to decrease peristalsis.

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

Answer: C Rationale: Benzodiazepines make GABA more effective, which leads to the anxiolytic effect. The drug does not affect action potentials. Depression of the cerebral cortex and motor output are associated with the use of barbiturates.

A client receiving antianxiety drug therapy reports constipation. The nurse explains this is the result of which factor? A. Overdose of an antianxiety drug. B. Excess fibrous food in the diet. C. Slowed intestinal transit time. D. Oral administration of the drug.

Answer: C Rationale: Constipation results from the action of the antianxiety agents, which slow intestinal transit time. An increased fiber intake would help combat the constipation. Constipation does not result from an overdose of the drug or from oral administration. An overdose may result in "benzotoxicity" which causes sedation, respiratory distress, and coma. Oral administration may result in dry mucous membranes which will affect the mouth and swallowing.

A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine? A. Clonazepam B. Alprazolam C. Diazepam D. Lorazepam

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

Answer: C Rationale: 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 controlled substances. Therefore, anxiolytics require a prescription. Anxiolytic drugs exert their tranquilizing effect by blocking certain neurotransmitter sites.

A client is brought to the emergency department with suspected overdose of a benzodiazepine. Which drug should the nurse anticipate administering to counteract the effects of the overdose? A. Naltrexone B. Diazepam C. Flumazenil D. Naloxone

Answer: C Rationale: Flumazenil is the antidote for benzodiazepine toxicity. Naloxone is used to reverse the effects of opioids. Naltrexone is used primarily to treat alcohol dependence and to block the effects of suspected opioids if they are being used by a person undergoing treatment for alcohol dependence. Diazepam is a benzodiazepine and would only increase the client's toxicity.

The nurse administers promethazine to the client before sending the client to the preoperative holding area. What outcome demonstrates therapeutic effects? A. The client is conscious but drowsy. B. The client is unresponsive to verbal and physical stimuli. C. The client's blood pressure is below 130/80 mm Hg. D. The client is asleep.

Answer: A Rationale: Antihistamines (promethazine, diphenhydramine) can be very sedating in some people. They are used as preoperative medications and postoperatively to decrease the need for narcotics. The goal, however, is not to make the client unresponsive or asleep. No effect on blood pressure is intended.

The nurse is caring for a client who has a sedative hypnotic ordered. The nurse should consider this drug contraindicated if the client has what disorder? A. liver failure. B. neurological diseases. C. heart diseases. D. endocrine disorders.

Answer: A Rationale: Benzodiazepines undergo extensive hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects. Neurological disorders, endocrine disorders, and heart disease are not contraindications for the use of benzodiazepines.

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

Answer: A Rationale: Chlordiazepoxide may have profound central nervous system (CNS) effects, including respiratory depression, and the nurse must assess accordingly. Urinary retention, ITP, and esophageal bleeding have not been noted.

A nurse emphasizes the need to avoid caffeine and caffeinated beverages with a client undergoing treatment for insomnia based on which known caffeine effect? A. Wakefulness B. Depression C. Restlessness D. Delirium

Answer: A Rationale: Clients with insomnia should not have any caffeine intake of any kind including drinking beverages containing caffeine because it can cause wakefulness. Caffeine does not cause depression, delirium, or restlessness.

A client is prescribed flurazepam. When explaining the drug to the client, the nurse would include which actions as its effect? A. Induction of sleep. B. Easing of pain. C. Decreased stress. D. Improvement in circulation.

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

A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam? A. induces sleep. B. improves circulation. C. decreases stress. D. eases pain.

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

Miss Martin, a 55-year-old woman admitted with chronic obstructive pulmonary disease, is being discharged from the hospital. She is prescribed lorazepam at home for anxiety. The nurse is reviewing information with the client about this medication. Which statement by the client would indicate the need for additional teaching? A. "I should take the medication first thing in the morning, every day." B. "I should report to my provider if I have difficulty walking or any confusion." C. "I should not drive until I know how the medication will affect me." D. "I should not take the medication before I go to work, because it could make me sleepy."

Answer: A Rationale: Lorazepam, like other benzodiazepines, is generally well tolerated, with few adverse effects. Mild drowsiness is common but transient, occurring in the first few days of therapy and then dissipating. Ataxia and confusion may also occur, especially in older adults and in debilitated clients. Dose adjustments should be made if these effects persist.

A client who is prescribed a hypnotic asks the nurse, "About how long will I be taking this medication?" Which time frame would the nurse most likely include in the response? A. 2 weeks. B. 6 weeks. C. 4 weeks. D. 8 weeks.

Answer: A Rationale: Sedatives and hypnotics are best given for no more than 2 weeks and preferably for a shorter time. Sedatives and hypnotics can become less effective after they are taken for a prolonged period.

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

Answer: A Rationale: The client being treated with chlordiazepoxide should not appear restless or confused and should not report thought disturbances. Unresponsiveness is an emergency, and the drug does not cause unpleasant effects if alcohol is consumed.

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? A. Confusion B. Anxiety C. Headache D. Stress

Answer: A Rationale: The nurse should look for signs of confusion in an older adult client when monitoring the effects of the administered drug. Headache, stress, and anxiety are causes of insomnia.

Ms. Buller is a 28-year-old patient who has been admitted to the hospital for abdominal pain. She puts on her call light because she is having difficulty breathing, palpitations, and increasing sweating. As the nurse caring for Ms. Buller, you complete a physical assessment, and you note her blood pressure, pulse, and respirations are elevated. You inquire about her symptoms; she states that she is afraid to be in the hospital because something bad will happen to her. What is Ms. Buller most likely suffering from? A. Insomnia B. General anxiety disorder. C. Panic attack. D. Impaired coping.

Answer: C Rationale: Panic disorders are described as sudden feelings of terror that come on suddenly and repeatedly without warning. Panic attacks are usually accompanied by physical changes such as heart pounding, sweating, weakness, faintness, or dizziness. A feeling of impending doom, fear of losing control, and loss of touch with reality are common in panic attacks. Because patients cannot understand or explain the physical changes that are occurring, they may be concerned about these symptoms, believing they are dying or losing their minds. Occurring at any time, even during sleep, the symptoms of a panic attack usually peak in 10 minutes but may continue for a while longer.

Which client should the nurse expect to receive a lower-than-usual dose of benzodiazepines? A. a client whose anxiety is due to pain caused by gallstones. B. a client who is 6 months post gastrectomy. C. a client with alcoholic liver disease. D. a client who has irritable bowel syndrome.

Answer: C Rationale: The benzodiazepines are metabolized extensively in the liver. Clients with liver disease must receive a smaller dose and be monitored closely. Gastrointestinal and biliary health problems would not necessitate a lower dose.

A client with a history of epilepsy is taking a benzodiazepine. The nurse evaluates teaching as effective when the client makes which statement? A. "I should always take the medication with meals." B. "I should not take aspirin with this medication." C. "I should not stop this drug without talking to my health care provider first." D. "I should avoid grapefruit juice for the duration of treatment."

Answer: C Rationale: The client makes a correct statement when saying the drug should not be stopped without talking to the health care provider first because withdrawal of benzodiazepines requires careful monitoring and should be gradually withdrawn. Medications do not have to be taken with food, aspirin is not contraindicated, and the medication need only be taken while the condition being treated continues. Grapefruit juice is not contraindicated.

A client with anxiety has asked the nurse about discontinuing the use of a benzodiazepine. What is the best response from the nurse? A. "important that you continue the medication even if you want to stop." B. "You need to first increase the dose and then stop." C. "Be sure to gradually decrease the dosage over time." D. "This medication can be stopped at any time."

Answer: C Rationale: The nurse should suggest the client gradually decrease the dosage schedule to avoid withdrawal symptoms. It is not advisable for the nurse to suggest just stopping the medication, increasing the dosage, or continuing with the medication as prescribed.

A client has been prescribed alprazolam 0.5 mg PO t.i.d. for the treatment of anxiety. What statement by the client demonstrates an accurate understanding of the drug regimen? A. "I must take the drug on an empty stomach." B. "I should temporarily decrease the amount of fiber in my diet." C. "I will make sure not to stop the drug abruptly." D. "I can take an OTC antihistamine if I'm still feeling anxious."

Answer: C Rationale: There is a risk of withdrawal if anxiolytics are stopped abruptly. Anxiolytics can be taken with foods or meals. The client would need to increase his intake of fiber to prevent constipation. Additional sedatives, anxiolytics or hypnotics should be avoided.

The nurse is caring for an older adult client who is prescribed a benzodiazepine. When planning the client's assessment, the nurse should be aware of what possible adverse effect? A. acute renal failure B. dysuria C. unpredictable reactions D. epistaxis (nosebleed)

Answer: C Rationale: Use benzodiazepines with caution in older adults or debilitated clients because of the possibility of unpredictable reactions and in clients with renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are needed for such clients. Acute renal failure, dysuria, and epistaxis (nosebleed) are not commonly related to therapy with these medications in older adults.

A nurse is reviewing the medical record of a client with anxiety who is to receive an antianxiety agent as part of the treatment. The nurse recognizes that benzodiazepines would not be used based on which of the following conditions? Select all that apply. A. Hypotension B. Cataracts C. Psychoses D. Acute narrow-angle glaucoma E. Pregnancy

Answer: C, D, E Rationale: The use of benzodiazepines is contraindicated in clients with known hypersensitivity, psychoses, acute narrow-angle glaucoma, and pregnancy.

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.) A. Doses of antidepressants need to be increased. B. Phenothiazine use usually results in hyperactivity. C. Opioid analgesics should be used cautiously. D. Prescribed versus over-the-counter antihistamines have no effect. E. Alcohol use can increase sedative effects.

Answer: C, E Rationale: 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.

Long-term use of which anxiolytics can result in physical or psychological dependence? (Select all that apply.) A. Buspirone (BuSpar) B. Doxepin (Sinequan) C. Alprazolam (Xanax) D. Hydroxyzine (Atarax) E. Chlordiazepoxide (Librium)

Answer: C, E Rationale: Long-term use of benzodiazepines such as alprazolam and chlordiazepoxide can result in physical or psychological dependence.

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? A. avoid driving at night, because lorazepam affects the wake-sleep cycle and can lead to drowsiness. B. drive only 2 hours after consuming the drug and stop when it's time for the subsequent dose. C. change his profession, because the drug has long-term effects after cessation of therapy. D. avoid driving until he is aware of the adverse effects.

Answer: D Rationale: 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 brought to the emergency department with suspected overdose of a benzodiazepine. Which drug should the nurse anticipate administering to counteract the effects of the overdose? A. Naltrexone B. Naloxone C. Diazepam D. Flumazenil

Answer: D Rationale: Flumazenil is the antidote for benzodiazepine toxicity. Naloxone is used to reverse the effects of opioids. Naltrexone is used primarily to treat alcohol dependence and to block the effects of suspected opioids if they are being used by a person undergoing treatment for alcohol dependence. Diazepam is a benzodiazepine and would only increase the client's toxicity.

A client has received a benzodiazepine for sedation before a diagnostic procedure. Which agent would the nurse expect the client to receive to reverse the sedative effects? A. Triazolam B. Promethazine C. Temazepam D. Flumazenil

Answer: D Rationale: Flumazenil is the antidote for benzodiazepines and is used to reverse the sedation of benzodiazepines used for diagnostic procedures. Temazepam and triazolam are benzodiazepines used as hypnotics. Promethazine is an antihistamine with sedative effects.

A client who is receiving a benzodiazepine asks the nurse about having a dry mouth. Which suggestion would the nurse include in the teaching plan for this client? A. "Make sure you eat a lot of green leafy vegetables." B. "Try drinking about 8 ounces of water at least every 2 hours." C. "Change your position slowly as you get out of bed." D. "Sucking on hard sugarless candy might help you."

Answer: D Rationale: For dry mouth, the nurse should suggest sucking on hard, sugarless candies or chewing sugarless gum. Frequent sips of water would also help, but drinking 8 ounces of water every 2 hours could lead to fluid overload. Eating green leafy vegetables would help with constipation. Changing positions slowly would be appropriate if the client reported dizziness or lightheadedness.

Ms. Mole, a 65-year-old woman with a history of chronic insomnia, is being seen for follow-up care. The nurse needs to develop a plan of care with Ms. Mole to improve her sleep. In addition to drug therapy, what would the nurse recommend as part of the client's plan of care? A. Advise the client to smoke cigarettes just before bedtime if she is a smoker. B. Advise the client to take long naps in the afternoon. C. Advise the client to avoid food after 6:00 p.m. D. Advise the client to practice relaxation techniques.

Answer: D Rationale: In addition to the drug therapy, clients suffering from chronic insomnia may also need to apply behavioral techniques, such as relaxation therapy. Relaxation techniques such as progressive relaxation and rhythmic breathing allow the muscles to relax and the mind to stop "racing," thereby allowing natural sleep to occur. Smoking cigarettes before bedtime and taking long naps in the afternoon are some of the behaviors associated with chronic insomnia. It is not necessary to avoid all food in the evening.

A review of a client's history reveals that the client uses kava for stress relief. When teaching the client about this herb, the nurse would include a discussion about which as a serious consequence associated with its use? A. Heart failure. B. Kidney failure. C. Stroke. D. Liver failure.

Answer: D Rationale: Kava-containing products have been associated with liver-related injuries including hepatitis, cirrhosis, and liver failure. The FDA has issued alerts regarding kava and its effects on the liver; however, none has been issued for kidney failure, heart failure, or stroke.

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

Answer: D Rationale: Phenobarbital is considered the prototype barbiturate.

The nurse is providing education to a client regarding healthy sleeping habits. What statement most accurately describes an aspect of rapid eye movement (REM) sleep? A. Clients with decreased REM sleep cycles are clinically depressed. B. Older clients have increased periods of REM sleep cycles. C. There is little benefit provided by REM sleep cycles. D. REM deprivation can lead to serious psychological problems.

Answer: D Rationale: REM sleep is thought to be mentally and emotionally restorative; REM deprivation can lead to serious psychological problems, including psychosis. It is estimated that a person spends about 75% of sleeping hours in non-REM sleep and about 25% in REM sleep. However, older adults often have a different pattern, with less deep sleep, more light sleep, more frequent awakenings, and generally more disruptions. While possible, ineffective REM sleep does not always result in depression.

A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse? A. Client has a history of bladder infection in the last year. B. Client recently quit drinking one alcoholic beverage per day. C. Client has history of one spontaneous miscarriage. D. Client is diagnosed with hepatitis C.

Answer: D Rationale: 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.

After teaching a group of nursing students about sedatives and hypnotics, the instructor determines that additional teaching is needed when the students conclude the absorption of which drug is affected by a high-fat meal? A. Anorexia B. Heartburn C. Anxiety D. Headache

Answer: D Rationale: The nurse should assess for headache as the initial adverse reaction in the client after administering alprazolam. Heartburn and anorexia are not adverse reactions commonly observed. This medication relieves anxiety.