Anxiety, Sleep, ADHD meds zzzz

The nurse is caring for a patient who was just prescribed Guanfacine for ADHD. Which of the following adverse reactions should the nurse teach the patient to be aware of? a.Hypotension b.Severe liver injury c.Misuse potential d.Suppressed appetite

A

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? "When it is time to discontinue this drug, you will need to taper it off slowly." "Protect your skin from the sun to prevent rash and exaggerated sunburn." "Increase your intake of fluid and high-fiber food to prevent constipation." "Take this medication on an empty stomach at least 2 hours after meals."

A Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

Which statement will the nurse include when teaching a patient about atomoxetine [Strattera]? A. Atomoxetine has no potential for abuse. B. Atomoxetine is a central nervous system stimulant. C. Atomoxetine exerts its therapeutic effect by increasing the release of dopamine. D. Atomoxetine is not approved for the treatment of adults with attention-deficit/hyperactivity disorder.

A Atomoxetine [Strattera] is a nonstimulant drug. It inhibits the uptake of norepinephrine, and it is approved for the treatment of adults with attention-deficit/hyperactivity disorder. It has no potential for abuse.

Which of the following medications used in the management of anxiety has a delayed onset of action? A. buspirone (BuSpar) B. diphenhydramine (Benadryl) C. lorazepam (Ativan) D. butalbital (Fiorinal)

A Buspirone takes several days to weeks for it to have clinical activity.

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis therefore is most likely? A. Panic disorder B. Bipolar disorder C. Generalized anxiety disorder D. Clinical depression

A Panic disorder is characterized by symptoms similar to those of a myocardial infarction (MI). Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.

A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement by the nurse is the most helpful? A. "The primary treatment is therapy, but there are some medications that have been somewhat effective." B. "The primary treatment is monotherapy with an SSRI." C. "The primary treatment is a combination of multiple medications." D. "The primary treatment is benzodiazepine for anxiety."

A Post-traumatic stress disorder can be treated with psychotherapy and with drugs. There are multiple therapy types and strategies. Regarding drugs, evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one SNRI (venlafaxine). Of these four drugs, only two—paroxetine [Paxil] and sertraline [Zoloft]—are FDA-approved for PTSD

The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." "No, all of the sleep medications are controlled substances." "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider." "Yes, but it is not for chronic insomnia."

A Ramelteon [Rozerem] is a relatively new hypnotic with a unique mechanism of action: activation of receptors for melatonin. The drug is approved for treating chronic insomnia characterized by difficulty with sleep onset, but not with sleep maintenance. Long-term use is permitted. Of the major drugs for insomnia, ramelteon is the only one not regulated as a controlled substance.

A nurse is caring for a client who has been taking amphetamine/dextroamphetamine sulfate for the traetment of ADHD for 2 weeks. The nurse should report which of the following findings to the provider? A. Weight loss of 2.3 kg (5lbs) B. BP 110/70 mm Hg C. Apical pulse 80/min D. Respiratory rate 16/min

A The medication can cause a decreased appetite and thus weight loss. The nurse should instruct the client to weigh themselves and report unintended weight loss.

A nurse is administering diazepam to a client who is having a colonoscopy. Which of the following actions should the nurse take? A. Ensure flumazenil is available to administer for toxicity management. B. Monitor for client for an increase in blood pressure. C. Expect the client to become unconscious within 30 seconds. D. Measure the capnography level every hour until the client is awake and oriented.

A The nurse should monitor the client for diazepam toxicity, such as respiratory depression and hypotension. The nurse should be prepared to administer Flumazenil (GABA antagonist) to reveres the effects of diazepam.

You're providing education to a patient who is prescribed to take a Benzodiazepine for panic attacks. Which statements below require you to re-educate the patient about this medication? SELECT TWO THAT APPLY: A. "I will monitor my consumption of alcohol and limit myself to 5 beers a day." B. "Driving is not recommended while taking this medication." C. "It is safe to get pregnant while taking this medication." D. "Signs of toxicity include slow heart rate, decreased respiration, extreme drowsiness, and slurred speech."

A, C Patients taking benzodiazepine should avoid alcohol (and other CNS depressants such as barbituates and opioids). Also benzodiazepine is pregnancy category D and should be avoided during pregnancy and nursing.

A patient was prescribed buspirone with a benzodiazepine for immediate treatment of Generalized Anxiety Disorder. After how many weeks should they be tapered off of the benzodiazepine? a.1 week b.2-4 weeks c.5 weeks d.6-8 weeks

B Abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks (2-4)

A nurse is teaching about Zolpidem to a client who has insomnia. The nurse should identify that which of the following client statements indicates an understanding of the teaching? A. "I will need to get lab test prior to refilling this medication." B. "I will use this medication for a short period of time. C. "I will need to take this medication for 1 week before results are seen." D. "I will need to change the medications to prevent building up a tolerance."

B Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the Rx. *During lecture, Dr. Cohen mentioned that benzodiazepine like drugs are one of the most over-prescribed medications.

A nurse is caring for a client who has a new Rx for amphetamine sulfate. The nurse should monitor the client for which of the following adverse effects? A. Hypotension B. Tinnitus C. Palpitations D. Bronchospasm

C Amphetamine can cause dysrhythmias and the client should watch for signs/Sx of dysrhythmia, such as palpitations.

Which patient would the nurse anticipate being prescribed atomoxetine [Strattera] for ADHD? A. An 18-year-old effectively being treated with Adderall B. A 10-year-old with no previous treatment for ADHD C. A 24-year-old with a history of stimulant abuse D. A 30-year-old with a history of depression and ADHD

C Atomoxetine is recommended for treatment of ADHD in cases where there may be concern for stimulant abuse or there exists a strong aversion to treatment with stimulant medications. Accordingly, because CNS stimulants are more effective and have a long record of safety and efficacy, it would seem prudent to reserve atomoxetine for patients who are unresponsive to or intolerant of the stimulants. In the absence of a compelling reason, patients doing well on the stimulants shouldn't switch.

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? A. Diarrhea B. Risk for abuse C. Dizziness D. Weight gain

C Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? A. "This medication should not make me feel drowsy." B. "This medication should help me feel less anxious." C. "I will drink grapefruit juice instead of coffee with breakfast." D. "I will take my medication three times per day."

C Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder? A. Clonazepam [Klonopin] B. Alprazolam [Xanax] C. Propranolol [Inderal] D. Sertraline [Zoloft]

C Propranolol [Inderal] and other beta blockers can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity (eg, tremors, sweating, tachycardia, palpitations). Doses are relatively small (eg, only 10 to 80 mg for propranolol).

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? Norepinephrine Acetylcholine Serotonin (5-HT) Gamma-aminobutyric acid (GABA)

D Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

Benzodiazepines can be used to treat all the following conditions except? A. Seizures B. Prior to an invasive procedure C. Anxiety D. Alzheimer's disease E. Insomnia

D Benzodiazepines are not prescribed to treat Alzheimer's disease.

A 25-year-old patient comes to the outpatient department for regular follow-up. Patient's medical condition include GERD and ADHD, and patient takes famotidine and clonidine. Patient complains about a recent worsening of the symptoms that has been causing him emotional distress. The practitioner decides to stop the current medication and try a new drug to treat the patient's ADHD. Which of the following should concern the practitioner when discontinuing his current medication? A. Paroxysmal atrial fibrillation B. Anaphylactic reaction C. Renal shutdown D. Rebound hypertensive crisis

D Patients taking clonidine regularly should not discontinue it abruptly as it can lead to rebound hypertension, anxiety, and tremor.

The nurse is caring for a patient taking dextroamphetamine [Dexedrine]. Which symptom, if present, is most likely an adverse effect of this drug? A. Heart rate of 60 beats/min B. Respiratory rate of 10 breaths per minute C. Weight gain D. Restlessness

D The adverse effects of amphetamines include central nervous system (CNS) stimulation (insomnia, restlessness, talkativeness), weight loss, cardiac stimulation (dysrhythmias, angina, hypertension), and psychosis (paranoia).