Pharmacology Prep U Chapter 20 Anxiolytic and Hypnotic Agents

A client who has claustrophobia is scheduled for an magnetic resonance imaging for the investigation of an abdominal mass. The nurse should anticipate what pre-medication order?

Lorazepam 2 mg PO

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

• Pentobarbital (Nembutal) • Secobarbital (Seconal)

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

• Temazepam (Restoril) • Triazolam (Halcion)

Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing lorazepam withdrawal?

severe insomnia for the past several nights

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

Blood pressure

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 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.

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?

difficulty falling asleep at night

What is thought to play a role in maintenance of the circadian rhythm?

Rozerem

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?

anxiety

The nurse is assessing a breastfed infant at a well-child visit and determines the child is lethargic and losing weight. Which assessment question should the nurse prioritize? Select all that apply.

"Are you currently taking any medications?"

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."

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 nursing student is confused about the difference between a sedative and a hypnotic drug. The student demonstrates a need for further instruction when making which statement?

A hypnotic produces a relaxing effect, while a sedative induces drowsiness.

What is the prototype for the classification of drugs referred to as benzodiazepines?

Diazepam

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

Diazepam (Valium)

A patient who was on benzodiazepine antianxiety drug therapy intends to discontinue the treatment. What should the nurse suggest regarding continuation of the medication?

Gradually decrease dosage schedule.

Which action by the new nurse would alert the charge nurse that more education is needed for the new nurse, after administering an anxiolytic to a client?

Having the client walk to the bathroom

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetadine and a sedative to calm the client. What should the nurse be concerned about?

Increased sedative effect

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.

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

bradycardia

What aspect of a client's health is most likely to cause insomnia?

chronic pain

A male client tells the nurse that he has been taking an herbal supplement to aid with insomnia. What herbal supplement is the client taking?

melatonin

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

oral contraceptive

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?

tapering the dose of drug over a prolonged period of time

A 34-year-old executive for an insurance company has been taking lorazepam for the last 6 months for anxiety. The client abruptly stopped the medication. The client then calls the health care provider and reports feeling irritable, and increased heart rate, and restlessness. What would explain the client's current symptoms?

withdrawal from stopping the medication

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

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

What should the nurse's pre-administration assessment for a client receiving a sedative or hypnotic include? (Select all that apply.)

• Blood pressure • Pulse • Respiratory rate

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

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

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

Abnormal anxiety is prolonged and impairs normal function.

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

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

Induces sleep

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 increased gradually.

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.

A nurse is caring for a client with insomnia. The client is prescribed a sedative. Which adverse reaction to sedatives is a gastrointestinal reaction?

Nausea

What would lead the nurse to suspect that a client is experiencing withdrawal symptoms associated with benzodiazepine use?

Nightmares

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 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

What might occur if a client inadvertently receives a benzodiazepine intra-arterially?

Arteriospasm

The client is experiencing pain. The nurse questions the health care provider's order to administer barbiturates to this client for what reason?

Barbiturates can cause paradoxical excitement

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 (BuSpar)

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

Comatose client

The nurse administers an anxiolytic to the client. The nurse recognizes the family needs further teaching on the effects of the medication when the family initiates what action?

Encourages the client to walk to the bathroom independently

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

Falls

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?

Perform back rubs

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

Phenobarbital

A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform?

Provide respiratory assistance

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

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

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?

falls risk assessment

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 intensive care nurse should prioritize what assessments for a client prescribed both lorazepam and hydromorphone?

respiratory rate and oxygen saturation

Which information should be included in the teaching plan of a client who is taking a sedative for a diagnosis of insomnia? Select all that apply.

• Do not drive or operate heavy machinery while taking the medication. • Do not drink alcoholic beverages 2 hours before or within 8 hours after taking the drug.

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

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

An older adult client is prescribed a hypnotic. The nurse would assess the client closely for which of the following? Select all that apply.

• Excitement • Ataxia • Confusion