adaptive quizzing chapter 12 central nervous system

Which parameter determines whether a drug is classified as a sedative or hypnotic?

The degree of inhibition of nerve impulse transmission to the CNS.

Verapamil, when administered with benzodiazepines, increases the drug concentrations of benzodiazepines, thereby causing toxicity. Therefore, a patient taking verapamil should be prescribed with a nonbenzodiazepine drug to treat the sleep disorder. Eszopiclone is a nonbenzodiazepine drug that should be prescribed for the patient in this case. Alprazolam, temazepam, and clonazepam are benzodiazepine drugs, which might cause toxicity in the patient when taken along with verapamil.

The heat in malignant hyperthermia results from the contraction of muscles, the product of a massive release of calcium from the sarcoplasmic reticulum. By acting at the sarcoplasmic reticulum to block the release of calcium, dantrolene relaxes skeletal muscle and helps reduce the patient's temperature. Dantrolene is not responsible for the release of sodium, glucose, or potassium.

flumazenil

a bezodiazepine antidote, antagonizes the action of benzodiazepine by blocking the central nervous system for benzodiazepines and increase their serum concentrations if these drugs were administered the toxic effects of benzodiazepine would aggravate they should be avoided

diazepam

blocs the receptors responsible for alcohol addiction and helps treat and prevent alcohol withdrawal symptoms does not inhibit nerve impulse transmission is a benzodiazepine drug used for the treatment of sleep disorders contraindicated in patients with drug allergy glaucoma or prenacny

The nurse should monitor older adults who are prescribed a benzodiazepine for insomnia for which potential side effect?

Ataxia

Which medication is beneficial for reducing pre-surgery anxiety and decreasing the patient's ability to remember an uncomfortable medical procedure? 1 Ramelteon 2 Midazolam 3 Alprazolam 4 Eszopiclone

Midazolam

A patient has been prescribed eszopiclone. The nurse educates the patient to safely take the medication. Which instruction will the nurse include in patient teaching?

"Allow at least 8 hours for sleep."

Midazolam

Midazolam is known to cause amnesia and anxiolysis as well as sedation and is therefore commonly used before certain procedures. The other answers are not common side effects of midazolam.

Dantrolene acts on the sarcoplasmic reticulum in the treatment of malignant hyperthermia. What does it help to block?

Calcium

The nurse is assessing a patient who reports having insomnia. On further assessment, the nurse finds that the patient has been taking verapamil for hypertension. What type of medication does the nurse expect the primary health care provider to prescribe for the insomnia?

Eszopiclone

Which drug is used as an antidote for overdose of oral benzodiazepine or excessive intravenous sedation? 1 Flumazenil 2 Olanzapine 3 Furosemide 4 Activated charcoal

Flumazenil

What are contraindications to the administration of barbiturates? Select all that apply.

Pregnancy Drug allergy Significant respiratory difficulties

REM sleep

REMs occur; vivid dreams breathing may be irregular

Which nursing intervention may be particularly beneficial to an African-American patient with insomnia?

Recommending that the patient consume a glass of warm lactose-free milk at bedtime

An Asian patient reports unusual sleep patterns and lack of sleep. The nurse asks the patient to drink warm milk before going to sleep. However, the patient develops diarrhea. What is the best nonpharmacologic nursing intervention to promote patient comfort?

Suggest drinking lactose-free milk at bedtime.

Benzodiazepine doses for children and the elderly should start small with gradual increases to prevent ataxia and excessive sedation. Thus, these patients should be closely monitored for these adverse effects. Dyspnea, alertness and hallucinations are not potential side effects of benzodiazepines.

Use of barbiturates during pregnancy may lead to miscarriage. Barbiturates can cause hypersensitivity reactions such as urticaria, rash, and fever. Barbiturates may also cause respiratory depression. Hypotension is one of the adverse effects of barbiturates. They are used to treat status epilepticus, because they are prescribed to decrease central nervous system activity.

REM interference

daytime fatigue occurs in cases with this and is a reduction in the cumulative amount of REM sleep as a result of prolonged sedative hypnotic use

Which is the most important nursing intervention while caring for a teenage patient who is on benzodiazepine therapy? 1 Monitoring for suicidal tendencies 2 Encouraging the patient to drink more fluids 3 Assessing the patient's risk for injury or falls 4 Monitoring the patient's renal and hepatic function

monitoring for suicidal tendencies because of the prolonged effects on the central nervous system the patient may develop suicidal tendencies, therefore the nurse should closely monitor the teenage patient for this older adults may have an increased risk of falling because of excessive drowsiness

sedation

no required for a patient who has symptoms of alcohol withdrawal

verapamil

prolongs benzodiazepine action by decreasing the metabolism of benzodiasepine not used to treat benzodiazepine toxicity

Which drug is contraindicated in patients with chronic obstructive pulmonary disease (COPD)? 1 Zaleplon 2 Diazepam 3 Ramelteon 4 Pentobarbital

ramelteon

when a benzodiazepine and rifampin are administered simultaneously

rifampin decreases the benzodiazepines effect by increasing its metabolism

During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement?

"Sedative drugs reduce nervousness, whereas hypnotics cause sleep when given in high dosages."

Which drug is derived from gamma-aminobutyric acid (GABA) and reduces muscle spasticity? 1 Baclofen 2 Dantrolene 3 Methocarbamol 4 Cyclobenzaprine

1 baclofen

non-REM sleep

1. dozing or feelings of drifting off to sleep, person can be easily awakened, slow, side-toside eye movements; insomniacs have longer stage 1 periods than nomal 2. sleep deepening and higher arousal threshold being required to awaken the patient 3 deep sleep; difficult to wake person respiratory rates, pulse,and blood pressure may decrease; stages 3 and 4 often combined and referred to as "delta sleep" or "slow-wave sleep " delta sleep associated with the highest arousal threshold 4. very difficult to wake person, person may be very groggy if awakened, dreaming occurs especially about daily events, sleepwalking or bedwetting may occur

1, 2, 4 Tricyclic antidepressants, MAOIs, and RMAOIs interact with barbiturates. These drugs increase the activity of barbiturates and may lead to severe central nervous system depression. SSRIs and SNRI are not contraindicated with barbiturates, because they do not prolong the effects of barbiturates. A patient with epilepsy is prescribed barbiturates. On further assessment, the nurse finds that the patient has depression. What classes of antidepressants does the nurse expect the primary health care provider to avoid when prescribing to this patient? Select all that apply. 1 Tricyclic antidepressant 2 Monoamine oxidase inhibitor (MAOI) 3 Selective serotonin reuptake inhibitor (SSRI) 4 Reversible monoamine oxidase inhibitor (RMAOI) 5 Serotonin and noradrenaline reuptake inhibitor (SNRI)

124

What is the result of a potential drug interaction between benzodiazepines and rifampin? 1 Increased daytime sleepiness 2 Prolonged benzodiazepine action 3 Decreased benzodiazepine effects 4 Increased central nervous system (CNS) depression

3 decreased benzodiazepine effects

The nurse is teaching a group of nursing students about the stages of non-rapid eye movement (non-REM) sleep. Which is the third stage of sleep? 1 Dozing 2 Relaxation 3 Deep sleep 4 Sleepwalking

3 deep sleep

Why is diazepam used for the treatment and prevention of alcohol withdrawal symptoms? 1 Because of its amnesic properties 2 Because of its inhibition of nerve impulse transmission 3 Because of its suppression of gamma-aminobutyric acid (GABA) receptors 4 Because of the presence of benzodiazepine receptors adjacent to the receptors responsible for alcohol addiction

4 because of the presence of benzodiazepine receptors adjacent to the receptors responsible for alcohol addiction

A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes before arrival. The nurse can anticipate that which drug will be prescribed?

Activated charcoal

Midazolam has been prescribed for a patient to be administered by intravenous injection 2 minutes before a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is what?

Amnesia

Patients experiencing a barbiturate overdose are given activated charcoal through a nasogastric tube. Activated charcoal binds the drug molecules in the stomach. It also has the effect of drawing the drug from the circulation into the gastrointestinal tract for elimination.

Charcoal is not administered to treat benzodiazepine toxicity; flumazenil is generally used to treat benzodiazepine toxicity. There is no specific antidote for muscle relaxant overdoses. They are best treated with conservative supportive measures. If the patient is administered azole along with benzodiazepine, the effect of benzodiazepine will be prolonged.

Sedatives are drugs that have an inhibitory effect on the CNS to the degree that they reduce nervousness, excitability, and irritability without causing sleep.

Hypnotics are drugs that, when given at low to moderate dosages, calm or soothe the central nervous system (CNS) without inducing sleep but when given at high dosages cause sleep. These terms are not interchangeable.

Which benzodiazepine has rapid onset, is short acting, relieves anxiety, and provides sedation before and during procedures?

Midazolam

A drug is classified either as a sedative or a hypnotic based on the degree of inhibition of nerve impulse transmission to the CNS. The degree of patient responsiveness depends on the patient's health history and the dosage of the drug administered. Increased duration of action of the drug on the CNS inhibits the transmission of the nerve impulse to the same extent but for a prolonged period of time. As the dosage of a sedative drug increases, it can have the same effect as hypnotic drugs. This clearly limits the use of the dosage to classify the drugs as sedatives or hypnotics.

The nurse instructs the patient taking eszopiclone to allow 8 hours for sleep because the drug induces sleep lasting 8 hours. A patient who takes eszopiclone and wakes up before 8 hours can be at risk for lethargy and injury while performing activities such as driving a car or navigating stairs. The nurse may recommend that the patient take eszopiclone with food, which may mask the unpleasant taste associated with the drug. Hangover and palpitation are uncommon adverse effects of eszopiclone.

A patient is brought to the trauma care unit for administration of activated charcoal via a nasogastric tube every 4 hours. What may be the reason for this?

The patient is experiencing a barbiturate overdose.

A patient who has difficulty sleeping has been prescribed diazepam. On the follow-up assessment, the nurse finds that the patient has prolonged sleep. What assessment finding is the reason for the prolonged sleep?

The patient takes grapefruit juice along with diazepam.

A patient is scheduled for a brief surgical procedure. Which drug does the nurse expect to be used during surgery?

Thiopental

There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the gastrointestinal tract, preventing absorption into the bloodstream. The nurse would not anticipate that naloxone, flumazenil, or ipecac syrup would be prescribed.

Thiopental is an ultrashort-acting drug that is used as anesthesia for short surgical procedures. So, the nurse expects thiopental (Pentothal) to be administered to the patient. Butabarbital (Butisol) is used as a sedative. Phenobarbital (Luminal) is used for the prophylaxis of epileptic seizures. Pentobarbital (Nembutal) is used to control convulsive conditions.

pentobarbital

amphotericin B, hydrocortisone, and hydromorphone are incompatible with this drug they may not cause swelling at ht eIV site is a barbiturate class of drug used as hypnotic sedative and anticonvulsant it is contraindicated in patients with drug allergy pregnancy or severe kidney or liver disease

methocarbomol and cyclobenzaprine

are centrally acting muscle relaxants but are not derivative of GABA

benzodiazepines

are combined with anesthetics, analgesics and neuromuscular blocking agents for their amnesic properties, but this does not help in treating alcohol withdrawal. these produce sedation by acting on GABA receptors but this doesn't reduce the symptoms of alcohol withdrawal these receptors in the CNS are present in the same area as the receptors responsible for alcohol addiction and helps treat and prevent alcohol withdrawal symptoms these have amnesic properties that are used for moderate sedation suppress the activity of GABA receptors to facilitate sleep during the treatment of insomnia narrow angle glaucoma contraindicates these

methohexital and thiopental

are examples of ultra short acting barbiturates

muscle relaxants

are prescribed for patients with huntington's disease to reduce choreiform movement more effective when used in combination with physical therapy muscle relaxants are primarily used for relief from painful musculoskeletal conditions but are also used to relieve the pain associated with trigemin

stage 4 of non-REM sleep

bedwetting and sleepwalking very hard to wake up a person

A patient with multiple sclerosis participates in a rehabilitation program. The patient takes baclofen to help manage muscle spasticity. How will the baclofen interfere with the patient's rehabilitation activities? 1 By causing gastrointestinal distress 2 By impairing coordinated movements 3 By increasing pain associated with activities 4 By producing drowsiness, lethargy, and blurred vision

by producing drowsiness lethargy and blurred vision

Which drug is the only muscle relaxant that acts directly on the skeletal muscle? Incorrect1 Baclofen 2 Diazepam Correct3 Dantrolene 4 Cyclobenzaprine

dantrolene works directly on skeletal muscle by suppressin gthe release of calcium form teh sarcoplasmic reticulum to ease contractions

Which condition contraindicates barbiturates? 1 Drug allergy 2 Cardiac disease 3 Epileptic disease 4 Narrow-angle glaucoma

drug allergy

A patient reports unusual sleep patterns and lack of sleep. What is the best nonpharmacologic patient teaching the nurse can provide to reset the patient's internal clock? 1 Avoiding alcohol at bedtime 2 Avoiding tobacco at bedtime 3 Sleeping more during the day 4 Establishing a set sleep pattern

establishing a set sleep pattern

The nurse erroneously administers a high dose of a benzodiazepine to a patient who has insomnia. What drug will the nurse expect the primary health care provider to prescribe to treat this potential overdose? 1 Rifampin 2 Verapamil 3 Flumazenil 4 Olanzapine

flumazenil

midazolam

has the ability to induce amnesia which temporarily reduces the patients memory

A patient reports swelling at the site of infusion of intravenous (IV) pentobarbital. Which event does the nurse suspect as the cause of swelling? 1 Intravenous infiltration 2 Infusion of other drugs 3 Infusion without dilution 4 Infusion that is too rapid

intravenous infiltration

baclofen

is a derivative of gamma-aminobutyric acid (GABA) it is one of the most effective muscle relaxants reduces muscle spasticity in patient with multiple sclerosis and parkinsons disease.

phenobarbital

is a generic barbiturate is categorized as long acting based on potency time to onset of action and duration of action used as an epileptic seizure prophylaxis and secobarbital are examples of short acting barbbiturates

antidote

is a medication given to reduce the symptoms of drug overdose or toxicity

dantrolene

is a muscle relaxant that directly acts on the skeletal muscles to reduce their rigidity; however it is not a derivative of GABA

zaleplon

is a nonbenzodiazepine drug used for the treatment of insomnia contraindicated in patients with drug allergy glaucoma or pregnancy

activated charcoal

is administered for an overdoes of barbiturates it prevents liver damage by quickly eliminating the barbiturates from the body

REM rebound

is an abnormally large amount of rem sleep that often leads to frequent and vivid dreams

butabarbital

is an example of an intermediate-acting barbiturate

valerian

is an herbal product that is contriandicated in patients with cardiac disease

furosemide

is commonly used to eliminate barbiturates by promoting diuresis

infusing pentobarbital without dilution

is not safe, however it may not necessarily cause swelling

ramelteon

is recommended for the treatment of insomnia is contraindicated for patients with COPD or sleep apnea

Midazolam

is used during the preoperative period to relieve anxiety, provide sedation, and help induce general anesthesia. Its rapid onset and brief duration of action provide the nurse with a higher degree of control over the effects of the drug. Diazepam is an old benzodiazepine used to relieve anxiety, induce muscle relaxation, and control seizure activity. Flurazepam, temazepam, and other older benzodiazepines are indicated for insomnia; these have been supplanted by newer drugs.

sedative hypnotic benzodiazepines and miscellaneous drugs

long acting = clonazepam(klonopin) diazepam(valium) and flurazepam(dalmane) intermediate acting = alprazolam (xanax), lorazepam(ativan) and temazepam (restoril) short acting = eszopiclone (lunesta), midazolam (versed), ramelteon (rozerem), triazolam (halcion), zaleplon (sonata), zolpidem (ambien)

Which category of phenobarbital is most commonly used in the treatment of epilepsy? Correct1 Long-acting barbiturates 2 Short-acting barbiturates 3 Ultrashort-acting barbiturates 4 Intermediate-acting barbiturates

long acting barbiturates

olanzapine

may interact with benzodiapsepines when administered simultaneously is not an antidote for benzodiapzepines

too rapid an infusion

may produce profound hypotension and marked respiratory depression

Which is a side effect of the nonbenzodiazepine drug zolpidem? 1 Bedwetting Correct2 Sleepwalking 3 Increased perspiration 4 Increased body weight

sleepwalking

Asians have a high incidence of lactose intolerance,

so the use of milk at bedtime to promote sleep may lead to gastrointestinal (GI) distress, abdominal cramping, and bloating. Hence, lactose-free milk may be used. Some Asian Americans may practice acupuncture for sleep. However, it may not be effective for GI upset that has been caused by lactose intolerance. Chinese patients require lower doses of benzodiazepines to promote sleep. However, these drugs may not help to treat lactose intolerance. Some Hispanics may use home remedies of vegetables and herbs for sleep. However, these may not be effective for lactose intolerance.

because the receptors for benzodiazepines and alcohol addiction are present in the same area in the CNS

some benzodiazepines such as diazepam and chlordiazepoxide are used for alcohol withdrawal

barbiturates

such as pentobarbital, inhibit the transmission of nerve impulses can be used as hypnotics, sedatives, and anticonvulsants and for anesthesia is contraindicated in patients with known drug allergy pregnancy or severe kidney or liver disease are indicated for hte treatment of epileptic disease becuase of their anticonvulsant properites

The primary health care provider has asked the nurse to administer diazepam to a patient who has symptoms of alcohol withdrawal. Why does the primary health care provider select this drug for the patient? 1 The patient may need to be sedated to relieve symptoms of alcohol withdrawal. 2 The drug acts on benzodiazepine receptors that play a role in alcohol addiction. 3 The drug may reduce the memory of painful symptoms related to alcohol withdrawal. 4 The drug acts on gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS).

the drug acts on benzodiazepine receptors

in the instance of an intravenous (IV) infiltration,

the site may become swollen, erythematous and tender.

Why are muscle relaxants prescribed for patients with Huntington disease? 1 To relieve nerve pain 2 To reduce muscle rigidity 3 To prevent lightheadedness 4 To reduce choreiform movement

to reduce choreiform movement

Which is the characteristic feature of rapid eye movement (REM) rebound sleep? 1 Bedwetting 2 Sleepwalking 3 Vivid dreams 4 Daytime fatigue

vivid dreams

What are examples of nonbenzodiazepine drugs? Select all that apply. 1 Zaleplon 2 Zolpidem 3 Diazepam 4 Midazolam 5 Eszopiclone

zaleplon zolpidem and eszopiclone