Pharmacology Chapter 20 to add

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. Alcohol use can increase sedative effects.

A client is prescribed an anxiolytic agent. What would be most important for the nurse to include in the teaching?

"Be sure not to stop the drug abruptly."

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?

9 PM

How should the nurse explain the major difference between normal and abnormal anxiety?

Abnormal anxiety is prolonged and impairs normal function.

A client has been admitted to the emergency department in convulsions and been prescribed 200 mg amobarbital (Amytal sodium) IV STAT. What is the nurse's best action?

Administer the medication and monitor the client's status closely

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?

Administer the medication as prescribed

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, and withdrawal symptoms will occur if the drug is 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?

"I take an over-the-counter antihistamine each day for my allergies."

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 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."

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 more slowly, and half-lives are longer than in younger adults."

A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response?

"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?

"When did you have your last drink of alcohol?"

The nurse is caring for a client treated with flumazenil for benzodiazepine toxicity. After administering flumazenil what should the nurse carefully assess for?

Agitation, confusion, and seizures

Anxiolytic drugs can be used in the management of which conditions? (Select all that apply.)

Alcohol withdrawal Seizures Panic attacks

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?

1 to 5 minutes

What exerts its anxiolytic effects by potentiating the effects of gamma-aminobutyric acid (GABA)? (Select all that apply.)

Alprazolam (Xanax) Chlordiazepoxide (Librium) Lorazepam (Ativan)

A nurse is caring for a patient who has just been transported to the operating room. Twenty minutes prior to leaving for the operating room, this patient was medicated with topical promethazine. What is the rationale for giving promethazine prior to surgery?

Anxiety, nausea, and vomiting

The nurse obtains the following vital signs on a client: BP 160/85, P 90, RR 24. The client is recently divorced and reports taking alprazolam for the past seven weeks but stopped the medication yesterday. What is the nurse's first action?

Ask the client about experiencing increased anxiety, difficulty concentrating, or tremors.

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?

Benzodiazepine overdose

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?

Less central nervous system depression

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?

Benzodiazepine toxicity

The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize?

Blood pressure

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.

Blood pressure Respiratory rate Skin temperature and color

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?

Buspirone

Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety?

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?

Buspirone

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 is diagnosed with hepatitis C.

The nurse should not administer sedatives or hypnotic drugs to which client?

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?

Confusion

The client is scheduled for surgery. The nurse administers diazepam (Valium) preoperatively for what purpose?

Decreased anxiety

In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?

Decreased cardiac workload

The nurse is providing health education to a client who has been prescribed a barbiturate. The nurse should describe what mechanism of action?

Depression of the cerebral cortex

A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine?

Diazepam

What are examples of nonbenzodiazepine-type hypnotic and sedative drugs? (Select all that apply.)

Eszopiclone (Lunesta) Zolpidem (Ambien) Zaleplon (Sonata)

Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?

Falls

An older adult client diagnosed with generalized anxiety disorder is prescribed a benzodiazepine. The nurse caring for the client knows to include what intervention in the client's care plan?

Falls risk assessment

Barbiturates are considered the sedative and hypnotic drugs of choice.

False

Eszopiclone is thought to react with norepinephrine to achieve its action.

False

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?

Have resuscitative equipment ready.

A nurse is preparing to administer an anxiolytic to a client. What would be most appropriate for the nurse to do before administering the drug?

Have the client void.

A nurse is caring for a patient who is being administered alprazolam. What initial adverse reaction of alprazolam should the nurse assess for?

Headache

A nurse should recognize which as common early reactions caused by anxiolytics? (Select all that apply.)

Headache Sedation Light-headedness Dizziness

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 central nervous system depression

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?

Increased sedative effect

A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam?

Induces sleep

The nurse is reviewing a client's current drug regimen and notes that the client takes 30 mg flurazepam daily. The nurse should suspect what health problem?

Insomnia

Lorazepam can be administered to a client via which routes? (Select all that apply.)

Intramuscular Oral Intravenous

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 for increased signs of confusion or forgetfulness.

After reviewing the various drugs that are classified as barbiturates, a student demonstrates understanding when identifying which as the prototype?

Phenobarbital

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 back rubs

Which interventions should be included in a nursing diagnosis of risk for injury for client who has received a hypnotic? Select all that apply.

Raise the siderails of the bed. Advise client to call for assistance. Observe the client for 1 to 2 hours after the medication administration to evaluate the effect

A client appears very drowsy at bedtime and is difficult to arouse. The client is receiving Halcion 0.25 mg PO at bedtime. Based on these findings, what would be the best nursing diagnosis for this client?

Risk for injury

What are examples of benzodiazepine-type hypnotic and sedative drugs? (Select all that apply.)

Temazepam (Restoril) Triazolam (Halcion)

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 withdrawal symptoms.

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

Respiratory distress is a contraindication for the use of barbiturates.

True

The nurse is reviewing signs and symptoms of benzodiazepine withdrawal with a client who has taken diazepam daily for several years. The nurse should describe which possible effects of benzodiazepine withdrawal? Select all that apply.

Urinary retention Nausea Nightmares Headache

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 experiencing drug intoxication or withdrawal

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?

eszopiclone

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 client reports using an over-the-counter (OTC) drug to treat insomnia. What classification of OTC medications is often used for this purpose?

antihistamines

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?

avoid driving until he is aware of the adverse effects.

Which medications are capable of central nervous system depression, hypnosis, deep coma, respiratory depression, and prescribed infrequently?

barbiturates

A client is receiving a barbiturate intravenously. The nurse would monitor the client for:

bradycardia.

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

A nurse has been taught to observe for adverse reactions whenever administering a medication. One non-nervous system reaction after giving a sedative is:

nausea

A decrease in dosage of a prescribed benzodiazepine most likely would be necessary if a client was also taking:

oral contraceptive.

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?

paradoxical excitement

The nurse gives a 68-year-old client diphenhydramine to help the client sleep the night before surgery. At midnight, the nurse notes the client is awake and agitated. What pharmacologic principle would be the cause of this reaction?

paradoxical excitement, which is the opposite reaction than what was expected

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?

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?

respiratory depression

A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for:

respiratory disturbances and partial airway obstruction.

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?

severe insomnia for the past several nights

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