CH 54 Drugs for Anxiety and Insomnia (E1)
A nurse is providing instructions to a client who has a new prescription for zolpidem. Which of the following instructions should the nurse include? A) Notify the provider if you plan to become pregnant. B) Take the medication 1 hour before you plan to go to sleep. C) Allow at least 6 hours for sleep when taking zolpidem. D) To increase effectiveness, take it with a bedtime snack.
A
If diazepam (Valium) is administered intravenously, when will its onset of action be observed? A) 1 to 5 minutes B) 7 to 10 minutes C) more than 10 minutes D) less than 1 minute
A
In order to minimize the chances of withdrawal symptoms, the nurse knows that the client prescribed a benzodiazepine taken daily will likely be advised to take which precaution? A) tapering the dose of drug over a prolonged period of time B) replacing the drug with a herbal supplement in anticipation of stopping the medication C) substituting the immediate-acting form of the drug with a long-acting form D) exchanging the drug for an anticonvulsant
A
When administering benzodiazepines, which medications should be considered the drug of first choice? A) lorazepam (Ativan) B) estazolam (Prosom) C) temazepam (Restoril) D) triazolam (Halcion)
A
Which condition will place the client prescribed a benzodiazepine at risk for toxicity? A) decreased albumin B) increased calcium C) decreased potassium D) normal bicarbonate
A
A client diagnosed with insomnia is prescribed flurazepam (Dalmane). This medication has a longer half-life than 24 hours. Which contributes to the long half-life of this medication and other benzodiazepines? A) metabolism by cytochrome P450 B) presence of active metabolites C) excretion by the renal system D) movement of calcium in the cell
B
A client is prescribed midazolam (Versed) in combination with an opioid in the preoperative phase of a laparoscopic cholecystectomy. What does the administration of midazolam assist in minimizing? A) oral secretions B) anxiety C) hypotension D) muscle tone
B
A client is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation? A) triazolam (Halcion) B) midazolam (Versed) C) oxazepam (Serax) D) chlordiazepoxide (Librium)
B
A nurse has noted that a newly admitted client has been taking ramelteon (Rozerem) for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug? A) somnambulism (sleepwalking) B) difficulty falling asleep at night C) early morning waking D) frequent nighttime awakenings
B
A nurse is teaching a client who has a new prescription for ramelteon. The nurse should instruct the client to avoid which of the following foods at the time of medication administration? A) Baked potato B) Fried chicken C) Whole-grain bread D) Citrus fruits
B
A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority? A) Administer flumazenil. B) Identify the client's level of orientation. C) Infuse IV fluids. D) Prepare the client for gastric lavage
B
An older adult client is diagnosed with generalized anxiety disorder. The use of benzodiazepines in this client population creates a specific need for which intervention? A) seizure precautions B) falls risk assessment C) frequent dysrhythmias monitoring D) education regarding sexual dysfunction
B
In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client? A) increased diffusion and perfusion B) decreased cardiac workload C) increased level of consciousness D) decreased blood pH
B
The intensive care nurse should prioritize what assessments for a client prescribed both lorazepam (Ativan) and hydromorphone (Dilaudid)? A) arterial blood gases B) respiratory rate and oxygen saturation C) deep tendon reflexes and pupillary response D) cardiac rate and rhythm
B
Which hypnotic may be safely taken for long-term treatment of insomnia? A) lorazepam (Ativan) B) eszopiclone (Lunesta) C) chloral hydrate (Noctec) D) oxazepam (Serax)
B
Which symptom is characteristic of acute benzodiazepine withdrawal? SELECT ALL THAT APPLY. A) bradycardia B) agitation C) lethargy D) diaphoresis E) palpitations
B, E
A child diagnosed with night terrors is prescribed a benzodiazepine agent. What increased risk should the child be monitored for? A) development of insomnia B) development of drug dependence C) development of mood disorders D) development of hepatotoxicity
C
A client's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The client asks the nurse what likely prompted the health care provider to change the medication. What is the nurse's best response? A) "Your doctor may have been concerned about causing depression." B) "Your doctor may have been worried about the possibility of convulsions." C) "Long-term use of benzodiazepines can result in dependency." D) "Long-term use of benzodiazepines can cause insomnia."
C
A nurse is caring for a client who is receiving moderate sedation with diazepam IV. The client is over sedated. Which of the following medications should the nurse should expect to administer to this client? A) Ketamine B) Nalrexone C) Flumazenil D) Fluvoxamine
C
A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the teaching? A) I should take this medication on an empty stomach. B) I will follow a low-sodium diet while taking this medication. C) I need to discontinue this medication slowly. D) I should not crush this medication before swallowing.
C
The etiology of anxiety involves which physiological process? A) stimulation of the parasympathetic nervous system B) stimulating effects of somatotropin C) increased activation of the autonomic nervous system D) adrenocortical suppression
C
What aspect of a client's health is most likely to cause insomnia? A) hypothyroidism B) morbid obesity C) chronic pain D) type 2 diabetes
C
A nurse is caring for a client who is to undergo a surgical procedure. Which of the following preexisting conditions can be a contraindication for the use of ketamine as an IV anesthetic? A) PUD B) Breast cancer C) Diabetes mellitus D) Schizophrenia
D
A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following information should the nurse include? A) Take this medication on an empty stomach. B) Expect optimal therapeutic effects within 24 hours. C) Take this medication when needed for anxiety. D) This medication has a low risk for dependency.
D
Benzodiazepines fall under what schedule of drugs? A) Schedule I B) Schedule II C) Schedule III D) Schedule IV
D
Three days after discontinuing diazepam (Valium) 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? A) Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. B) The client may have decreased liver function. C) The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. D) The adverse effects of benzodiazepines can persist for several days after stopping the drug.
D
Which medication can be most safely administered to an older adult experiencing insomnia? A) alprazolam (Xanax) B) clonazepam (Klonopin) C) diazepam (Valium) D) temazepam (Restoril)
D
Which medication will reduce the effects of sedation and respiratory depression in a client suspected of experiencing benzodiazepine toxicity? A) olmesartan medoxomil B) pancrelipase C) pamidronate disodium D) flumazenil
D
alprazolam (Xanax), lorazepam (Ativan), tempazepam (Restoril)
Intermediate acting benzo
clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane)
Long acting benzo
midazolam (Versed), triazolam (Halcion), eszopiclone (Lunesta), zolpidem (Ambien)
Short acting benzo
