Pharm Ch20: Anxiolytic/Hypnotics
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 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 do not cause physiologic dependence, and withdrawal symptoms will not occur if the drug is stopped abruptly." "Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly."
"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly." Benzodiazepines are widely used for anxiety and insomnia and are also used for several other indications. They have a wide margin of safety between therapeutic and toxic doses and are rarely fatal, even in overdose, unless combined with other CNS depressant drugs, such as alcohol. They are schedule IV drugs under the Controlled Substances Act. They are drugs of abuse and may cause physiologic dependence; therefore, withdrawal symptoms occur if the drugs are stopped abruptly.
The nurse is caring for a client who has been prescribed oxazepam. What statement by the client would suggest an increased risk of CNS depression to the nurse? "If I get constipated, I sometimes take a stool softener for a couple of days." "I'm also taking baby Aspirin each day for my heart." "I'm almost finished my course of antibiotics for this sinus infection." "I take an over-the-counter antihistamine each day for my allergies."
"I take an over-the-counter antihistamine each day for my allergies."
A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam? Decreases stress Induces sleep Improves circulation Eases pain
Induces sleep Flurazepam induces sleep. - one of the first benzo hypnotics
A client's medication regimen for treatment of anxiety has been changed from a benzodiazepine to buspirone (BuSpar). The client asks the nurse what makes this medication safer than the benzodiazepine the client has taken. What is the nurse's best response? "It produces muscle relaxant effects to decrease back pain." "It will not produce sedation like benzodiazepines." "It produces anticonvulsant action to prevent convulsions." "It provides you with a sleep additive to decrease insomnia."
"It will not produce sedation like benzodiazepines."
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? "Long-term use of benzodiazepines can result in dependency." "Your provider may have been worried about the possibility of convulsions." "Your provider may have been concerned about causing depression." "Long-term use of benzodiazepines can cause insomnia."
"Long-term use of benzodiazepines can result in dependency."
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 at the same speed as younger adults; I will check the dosage with your health care provider." "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 do not need as much of the medication for the desired effect as a younger adult does."
"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults." In older adults, most non-benzodiazepines are metabolized more slowly, and half-lives are longer than in younger adults. Exceptions are lorazepam and oxazepam, whose half-lives and dosages are the same for older adults as for younger ones. The recommended initial dose of zaleplon or zolpidem is 5 mg, one half of the initial dose recommended for younger adults. Dosages of eszopiclone should also be reduced for older adults, beginning with 1 mg initially, not to exceed 2 mg at bedtime.
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." "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." "This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities."
"This type of medication is typically prescribed to treat excess anxiety that interferes with daily activities."
What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide? "What is motivating you to stop drinking alcohol?" "How much alcohol have you ingested in the last 8 hours?" "When did you have your last drink of alcohol?" "How has your alcohol use affected your quality of life?"
"When did you have your last drink of alcohol?" 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.
The nurse is caring for a client treated with flumazenil for benzodiazepine toxicity. After administering flumazenil what should the nurse carefully assess for? Hypotension, arrhythmias, and cardiac arrest Agitation, confusion, and seizures Hypertension and renal insufficiency Cerebral hemorrhage and dystonia
Agitation, confusion, and seizures
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? More than 10 minutes 7 to 10 minutes Under 1 minute 1 to 5 minutes
1 to 5 minutes Intravenous diazepam is administered intravenously to decrease seizure activity and has a 1- to 5-minute onset of action.
antacid-benzodiazepine interaction
Antacids slow metabolism of benzodiazepines, prolonging effects
What might occur if a client inadvertently receives a benzodiazepine intra-arterially? CNS depression Arteriospasm Urinary retention Blurred vision
Arteriospasm
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 Anti-anxiety overdose Benzodiazepine overdose Sedative overdose
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 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? Antihypertensive toxicity Analgesic toxicity Benzodiazepine toxicity Sedative toxicity
Benzodiazepine toxicity Common manifestations include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures. -withdrawal symptoms
The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize? Assessment for bleeding Anaphylaxis Oxygen saturation Blood pressure
Blood pressure
A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse? Client has a history of bladder infection in the last year. Client is diagnosed with hepatitis C. Client recently quit drinking one alcoholic beverage per day. Client has history of one spontaneous miscarriage.
Client is diagnosed with hepatitis C. 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.
The nurse should not administer sedatives or hypnotic drugs to which client? Comatose client Client with a history of asthma Client with an egg allergy Woman of childbearing age
Comatose client
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? Stress Headache Anxiety Confusion
Confusion 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.
In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client? Decreased blood pH Decreased cardiac workload Increased level of consciousness Increased diffusion and perfusion
Decreased cardiac workload Antianxiety and sedative-hypnotic drugs are often useful in critically ill clients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase level of consciousness.
The nurse is providing health education to a client who has been prescribed a barbiturate. The nurse should describe what mechanism of action? Effect on action potentials Enhancement of motor output Enhancement of action of GABA Depression of the cerebral cortex
Depression of the cerebral cortex
A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine? Clonazepam Alprazolam Lorazepam Diazepam
Diazepam
As a result of a drug error, a client has inadvertently been given an intra-arterial injection of a benzodiazepine. The care team should monitor closely for what complication? Disseminated intravascular coagulation Cerebrovascular accident Auditory nerve damage Gangrene
Gangrene
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? Provide plenty of fluids. Provide fiber-rich food. Have resuscitative equipment ready. Arrange for a blood transfusion.
Have resuscitative equipment ready.
A nurse is caring for a patient who is being administered alprazolam. What initial adverse reaction of alprazolam should the nurse assess for? Headache Heartburn Allergy Anorexia
Headache The nurse should assess for headache as the initial adverse reaction in the patient after administering alprazolam. Heartburn, anorexia, and allergy are adverse reactions observed in the patient after administering salicylates.
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 Confusion Hypotension
Hypotension The nurse must monitor the patient for hypotension, which is one of the symptoms of barbiturate toxicity. Restlessness, euphoria, and confusion are withdrawal symptoms seen in the use of sedatives and hypnotics.
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 central nervous system depression Increased risk for sedation Increased risk for respiratory depression
Increased risk for central nervous system depression The nurse should suggest that the patient stop consuming alcohol while therapy is going on because such consumption increases the risk for CNS depression. Increased risk for digitalis toxicity is identified when the patient is taking digoxin for management of cardiac problems. Increased risk for sedation and respiratory depression is identified when tricyclic antidepressants or antipsychotics are being used simultaneously.
When describing the uses for sedatives and hypnotics, which would the nursing instructor identify as the primary use? Depression Insomnia Hypertension Anxiety
Insomnia Sedatives and hypnotics are used primarily to treat insomnia. Anxiolytics are used to treat anxiety. Antihypertensive drugs are used to treat high blood pressure (hypertension) and antidepressants such as SSRIs are used to treat 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? Rapid onset and short duration Decreased risk of hepatic injury Sublingual administration Less central nervous system depression
Less central nervous system depression
What would lead the nurse to suspect that a client is experiencing withdrawal symptoms associated with benzodiazepine use? Nightmares Dry mouth Urinary retention Hypotension
Nightmares Signs and symptoms of benzodiazepine withdrawal include nightmares, nausea, headache, and malaise. Dry mouth, hypotension, and urinary retention are adverse effects associated with benzodiazepine use.
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.) Opioid analgesics should be used cautiously. Phenothiazine use usually results in hyperactivity. Prescribed versus over-the-counter antihistamines have no effect. Doses of antidepressants need to be increased. Alcohol use can increase sedative effects.
Opioid analgesics should be used cautiously. Alcohol use can increase sedative effects. 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.
A patient admitted to the health care facility for insomnia related to stress is prescribed a sedative. What intervention should the nurse perform to promote the effects of the sedative? Provide plenty of fluids Provide fiber-rich food Provide beverages Provide back rubs
Provide back rubs The nurse must provide back rubs to the patient to promote the effects of the sedative. Providing plenty of fluids and fiber-rich foods are measures taken to prevent constipation. Providing beverages does not help to promote the effect of the sedatives.
A client is to receive diazepam as part of the treatment for status epilepticus. The client has ana peripheral intravenous infusion in the left arm that is being used to administer phenytoin. Which action would be most appropriate for the nurse to do? Contact the prescriber to question the order. Wait until the infusion is completed to give the diazepam. Start another IV line in the client's right arm. Add the diazepam to the current IV infusion.
Start another IV line in the client's right arm. When giving diazepam IV, it should not be mixed in solution with any other drugs. It would be best to start an IV in another site such as the opposite arm so that the patient can receive the full benefits of both drugs. Notifying the prescriber that the diazepam cannot be given or waiting until the other drug is completed before giving the diazepam is inappropriate. Adding it to the current infusion is inappropriate because potentially serious drug-drug interactions can occur.
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 Substituting the immediate-acting form of the drug with a long-acting form Replacing the drug with a herbal supplement in anticipation of stopping the medication Exchanging the drug for an anticonvulsant
Tapering the dose of drug over a prolonged period of time
If a pregnant client has taken a benzodiazepine during pregnancy, what would be the biggest concern? The baby will have birth defects. There is no cause for concern. The infant may experience withdrawal symptoms during the postnatal period. The mother will have withdrawal symptoms during labor.
The infant may experience withdrawal symptoms during the postnatal period. Women taking barbiturates and benzodiazepines should be warned of the potential risk to the fetus so that contraception methods may be instituted. A child born to a mother taking a benzodiazepine may experience withdrawal during the postnatal period.
A benzodiazepine is prescribed for a pregnant woman with insomnia. When describing the effects on the newborn, which would the nurse include? The newborn can develop drug toxicity. The newborn can develop withdrawal symptoms. The newborn can develop mental disabilities. The newborn can develop physical deformation.
The newborn can develop withdrawal symptoms. Administration of a benzodiazepine to a pregnant client can cause the client's newborn child to develop withdrawal symptoms. Administration of a benzodiazepine to a pregnant client does not cause physical deformation, drug toxicity, or mental disabilities in the newborn child.
A male patient is being discharged home from the hospital after having pneumonia. At home, the patient will be taking the same drugs he was taking before he was hospitalized. These drugs include an anti-anxiety medication and a medication for insomnia. During the home care nurse's initial visit, what should the nurse review with the patient? The risks of injuries if mental and physical responses are slowed by drugs The risk of injuries if reaction times are slowed by drugs The risk of injuries if the mental processes are slowed by drugs The risk of injuries if let insomnia go untreated by drugs
The risks of injuries if mental and physical responses are slowed by drugs
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 is currently taking a diuretic Whether the client is experiencing drug intoxication or withdrawal Whether the client is currently taking antibiotics Whether the client has a history of agitation
Whether the client is experiencing drug intoxication or withdrawal
Which condition will place the client prescribed a benzodiazepine at risk for toxicity? increased calcium decreased albumin decreased potassium normal bicarbonate
decreased albumin Clients with liver disease are at risk for adverse effects with drugs that are highly bound to plasma proteins. Neither increased calcium nor decreased potassium will have a direct impact on benzodiazepine toxicity. The normal bicarbonate will not contribute to benzodiazepine toxicity.
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
dependence
What is the prototype for the classification of drugs referred to as benzodiazepines? diazepam lorazepam alprazolam clonazepam
diazepam
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? norepinephrine loratadine eszopiclone phenytoin
eszopiclone
Which drug is specifically marketed for the treatment of insomnia? diazepam midazolam alprazolam flurazepam
flurazepam
A client who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by: affecting the regulation of serotonin and norepinephrine in the brain. increasing the effects of the neurotransmitter GABA. inhibiting the action of monoamine oxidase. increasing the amount of serotonin available in the synapses.
increasing the effects of the neurotransmitter GABA.
Ramelteon (Rozerem)
melatonin receptor agonist (non-benzo); approval for long-term insomnia tx
The nurse is assessing a client who has been prescribed lorazepam. Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing withdrawal? unstable blood sugars in recent days current mood is described as "depressed" severe insomnia for the past several nights uncharacteristic memory lapses
severe insomnia for the past several nights Common signs and symptoms of benzodiazepine, like lorazepam, withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Memory lapses, unstable blood sugars, and depression are not typical.
The nurse is providing education to a client who has been prescribed eszopiclone. What information should the nurse include? the importance of taking the drug immediately before going to bed the need to have monthly blood work drawn during treatment the importance of taking the drug with food the need to supplement the medication with a benzodiazepine
the importance of taking the drug immediately before going to bed
A client asks, "How long before sleep should I take ramelteon?" Which time frame will the nurse give this client as part of client teaching? 15 minutes 45 minutes 10 minutes 20 minutes
45 minutes Ramelteon is rapidly absorbed orally, reaching peak plasma levels in about 45 minutes.
Zolpidem is prescribed for a hospitalized 58-year-old client having difficulty falling asleep at night. What is the best time for the nurse to administer this medication? 3 PM 9 PM 6 PM 12 PM
9 PM
What accurately defines hypnosis? A loss of awareness and reaction to environmental stimuli A extreme state of sedation in which the person no longer senses or reacts to incoming stimuli A feeling of tension, nervousness, apprehension, or fear A state of tranquility
A extreme state of sedation in which the person no longer senses or reacts to incoming stimuli Hypnosis is an extreme state of sedation in which the person no longer senses or reacts to incoming stimuli. A state of tranquility is produced through minor tranquilizers by decreasing anxiety. Anxiety is a feeling of tension, nervousness, apprehension, or fear. Sedation is the loss of awareness and reaction to environmental stimuli, which may lead to drowsiness.
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? Chlordiazepoxide Oxazepam Midazolam Triazolam
Midazolam Midazolam is frequently used for conscious sedation during invasive procedures. None of the remaining options are used for conscious sedation.
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? Contact the prescriber to confirm the dose Ensure flurazepam is available Contact the prescriber to confirm the route Administer the medication as prescribed
Administer the medication as prescribed
What should the nurse's pre-administration physical assessment for the administration of an anxiolytic include? (Select all that apply.) Blood pressure Blood glucose Pulse Respiratory rate Weight
Blood pressure Pulse Respiratory rate Weight The nurse's pre-administration physical assessment for the administration of an anxiolytic should include blood pressure, pulse, respiratory rate, and weight.
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? Zaleplon Buspirone Diphenhydramine Meprobamate
Buspirone
Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety? Zaleplon Meprobamate Buspirone Diphenhydramine
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 Diazepam Buspirone Lorazepam
Buspirone
What exerts its anxiolytic effects by potentiating the effects of gamma-aminobutyric acid (GABA)? (Select all that apply.) Chlordiazepoxide (Librium) Lorazepam (Ativan) Alprazolam (Xanax) Buspirone (BuSpar) Hydroxyzine (Atarax)
Chlordiazepoxide (Librium) Lorazepam (Ativan) Alprazolam (Xanax)
A nurse has noted that a newly admitted client has been taking ramelteon for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug? Somnambulism Early morning waking Frequent nighttime awakenings Difficulty falling asleep at night
Difficulty falling asleep at night Ramelteon (Rozerem) is use for the long-term treatment of insomnia characterized by difficulty with sleep onset. Ramelteon is not effective in managing any of the other suggested sleep-related issues. - melatonin agonist, approved for long-term use
A client reports being prescribed a hypnotic for treatment of chronic insomnia. What drug does the nurse suspect the client is taking? Zaleplon Oxazepam Lorazepam Eszopiclone
Eszopiclone Eszopiclone is the first oral nonbenzodiazepine hypnotic to receive FDA approval for long-term use (up to 12 months). Zaleplon is a nonbenzodiazepine hypnotic used for short-term treatment (7-10 days) of insomnia. Oral lorazepam and oxazepam are benzodiazepines prescribed for anxiety; the latter is also used in the management of alcohol withdrawal.
Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect? Heart failure Falls Constipation Hepatic failure
Falls
Eszopiclone is thought to react with norepinephrine to achieve its action. False True
False Eszopiclone is thought to react with GABA sites near benzodiazepine receptors.
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? Cost of the drugs If the client's insurance will cover the two drugs Increased sedative effect Decreased sedative effect
Increased sedative effect An increased sedative effect may occur when a sedative is given with cimetidine for gastric upset.
The medication nurse knows that when benzodiazepines are used with opioid analgesics, the analgesic dose should be adjusted in which way? It should be reduced initially and incrementally thereafter. It should be increased initially and reduced gradually. It should be increased initially and incrementally thereafter. It should be reduced initially and increased gradually.
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.
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? Heart disease Neurological diseases Liver disease Endocrine disorders
Liver disease Benzodiazepines undergo hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects.
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.
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. Antianxiety drugs are not known to cause kidney or liver damage but should be used cautiously in elderly clients, and in clients with impaired liver function or impaired kidney function. Antianxiety drugs more likely can cause muscle relaxation than rigidity. A symptom of withdrawal from antianxiety drugs is muscle tension.
An adult client with a diagnosis of alcoholism is to be treated with chlordiazepoxide on an in-client basis. When administering chlordiazepoxide, the nurse should implement which client-focused intervention? Promptly stopping the medication once status improvements are noted Administering the oral form of the medication if the client is combative Monitoring vital signs closely during intravenous (IV) administration Assessing the client's cardiac status prior to administering each dose
Monitoring vital signs closely during intravenous (IV) administration The nurse should take the client's vital signs regularly when giving the IV form of this drug, as well as observe and document subjective and objective reports by the client. Combative clients usually require a parenteral route of administration, and it is unnecessary to perform a full cardiac assessment before each dose. Usage should be tapered, and not stopped abruptly, to prevent rebound central nervous system stimulation.
Lorazepam can be administered to a client via which routes? (Select all that apply.) Transdermal Rectal Oral Intramuscular Intravenous
Oral Intramuscular Intravenous Lorazepam can be administered to a client via the oral, IM, and IV routes.
Anxiolytic drugs can be used in the management of which conditions? (Select all that apply.) Panic attacks Diabetic neuropathy Seizures Hypertension Alcohol withdrawal
Panic attacks Seizures Alcohol withdrawal
A nurse is caring for a patient with insomnia. For which type of patient should the nurse exercise caution when administering sedatives and hypnotics? Patients with heart trouble Patients with gastrointestinal upset Patients with hypertension Patients who are lactating
Patients who are lactating The nurse should exercise caution while administering sedatives and hypnotics to lactating patients. Patients with heart trouble, hypertension, and gastrointestinal problems are not contraindicated in the use of sedatives and hypnotics.
After reviewing the various drugs that are classified as barbiturates, a student demonstrates understanding when identifying which as the prototype? Phenobarbital Amobarbital Pentobarbital Secobarbital
Phenobarbital
Barbiturate prototype
Phenobarbital
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. Hair texture Bowel sounds Respiratory rate Skin temperature and color Blood pressure
Respiratory rate Skin temperature and color Blood pressure 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. Bowel sounds and hair texture would not be as important as assessing blood pressure, respiratory rate, and skin temperature for the client who is anxious.
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? The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. The adverse effects of benzodiazepines can persist for several days after stopping the drug. The client may have decreased liver function.
The adverse effects of benzodiazepines can persist for several days after stopping the drug.
What goal should the nurse identify for a client prescribed chlordiazepoxide? The client will not appear restless or confused. The client will be able to verbally express an understanding of alcoholism. The client will not experience unpleasant effects when consuming alcohol. The client will remain in an unresponsive state for at least 6 hours.
The client will not appear restless or confused. 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.
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.
a dose adjustment should be made if these symptoms persist. If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist.
A client is prescribed midazolam in combination with an opioid in the preoperative phase of a laparoscopic cholecystectomy. What does the administration of midazolam assist in minimizing? muscle tone anxiety oral secretions hypotension
anxiety
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? drive only 2 hours after consuming the drug and stop when it's time for the subsequent dose. change his profession, because the drug has long-term effects after cessation of therapy. avoid driving until he is aware of the adverse effects. avoid driving at night, because lorazepam affects the wake-sleep cycle and can lead to drowsiness.
avoid driving until he is aware of the adverse effects.
A client is receiving a barbiturate intravenously. The nurse would monitor the client for: bleeding. tachypnea. bradycardia. hypertension.
bradycardia. When given intravenously, barbiturates can result in bradycardia, hypotension, hypoventilation, respiratory depression, and laryngospasm.
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.
nausea.
Eszopiclone (Lunesta)
non-benzo, for chronic insomnia, approved for use up to 12 mo
One week ago, a 74-year-old was started on a benzodiazepine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication? not taking the medication as ordered (noncompliance) taking too much of the medication (nonadherence) paradoxical excitement allergic reaction to the benzodiazepine
paradoxical excitement When beginning drug therapy with a sedative or benzodiazepine to treat anxiety, the older client may experience an effect that is the opposite of intended. This effect is known as paradoxical excitement, whereby the client is wide awake and hyperactive rather than calm and relaxed.
A nurse knows that when elderly clients take a sedative or hypnotic, they are at increased risk for oversedation. When they become very confused and demonstrate marked excitement, this is known as which type of reaction? allergic reaction idiosyncratic reaction paradoxical reaction adverse reaction
paradoxical reaction
A nurse is administering a prescribed dose of chlordiazepoxide to a client. The nurse should closely assess the client for what adverse reaction? urinary retention idiopathic thrombocytopenic purpura (ITP) respiratory depression esophageal bleeding
respiratory depression 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 client is receiving ramelteon for insomnia. The nurse would instruct the client to take the drug at which time? Immediately before going to bed ½ hour before going to bed 2 hours before going to bed 1 hour before going to bed
½ hour before going to bed
