Pharmacology Prepu Ch. 20 Anxiolytic and Hypnotic Agents

How should the nurse explain the major difference between normal and abnormal anxiety? Abnormal anxiety is a brief response to situational stress. Normal anxiety often triggers reports of insomnia. Abnormal anxiety is prolonged and impairs normal function. Abnormal anxiety is generally unresponsive to treatment.

Abnormal anxiety is prolonged and impairs normal function.

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

Long-term use of which anxiolytics can result in physical or psychological dependence? (Select all that apply.) Alprazolam (Xanax) Buspirone (BuSpar) Hydroxyzine (Atarax) Chlordiazepoxide (Librium) Doxepin (Sinequan)

Alprazolam (Xanax) Chlordiazepoxide (Librium)

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? Confusion Oral secretions Hypotension and bradycardia Anxiety, nausea, and vomiting

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? Document the client's vital signs in the electronic medical record and advise the charge nurse. Ask the client about experiencing increased anxiety, difficulty concentrating, or tremors. Notify the health care provider of the abnormal vital signs. Advise the client that increased blood pressure is an expected finding after discontinuing Xanax.

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? Sedative overdose Hypnotic overdose Anti-anxiety overdose Benzodiazepine overdose

Benzodiazepine overdose

The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize? Anaphylaxis Assessment for bleeding Blood pressure Oxygen saturation

Blood pressure

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

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 recently quit drinking one alcoholic beverage per day. Client has a history of bladder infection in the last year. Client is diagnosed with hepatitis C. Client has history of one spontaneous miscarriage.

Client is diagnosed with hepatitis C.

The nurse should not administer sedatives or hypnotic drugs to which client? Woman of childbearing age Client with an egg allergy Comatose client Client with a history of asthma

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? Anxiety Headache Confusion Stress

Confusion

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

Diazepam

When describing the action of benzodiazepines as anxiolytics, what would the nurse need to keep in mind? Enhanced action of gamma-aminobutyric acid Effect on action potentials Depression of the cerebral cortex Depressed motor output

Enhanced action of gamma-aminobutyric acid

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 Auditory nerve damage Cerebrovascular accident Gangrene

Gangrene

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? Dim the lights Raise the side rails Place the call light within reach Having the client walk to the bathroom

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 cimetidine and a sedative to calm the client. What should the nurse be concerned about? Increased sedative effect Decreased sedative effect If the client's insurance will cover the two drugs Cost of the drugs

Increased sedative effect

What would lead the nurse to suspect that a client is experiencing withdrawal symptoms associated with benzodiazepine use? Dry mouth Nightmares Hypotension Urinary retention

Nightmares

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? Ineffective individual coping Risk for injury Risk for altered elimination Risk for skin breakdown

Risk for injury

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 adverse effects of benzodiazepines can persist for several days after stopping the drug. 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 client may have decreased liver function.

The adverse effects of benzodiazepines can persist for several days after stopping the drug.

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. The newborn can develop drug toxicity. The newborn can develop physical deformation. The newborn can develop mental disabilities.

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 risk of injuries if reaction times 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 The risk of injuries if the mental processes are slowed 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 has a history of agitation Whether the client is currently taking antibiotics Whether the client is currently taking a diuretic Whether the client is experiencing drug intoxication or withdrawal

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: the drug should be administered intravenously if these effects persist. the drug should be stopped immediately if these effects persist. a dose adjustment should be made if these symptoms 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.

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 nonsteroidal anti-inflammatory drugs antitussives salicylates

antihistamines

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? oral secretions hypotension anxiety muscle tone

anxiety

A male client's anxiety is interfering with his ability to perform basic activities of daily living and return to work. The nurse expects that which diagnosis will probably be made by his health care provider? Chronic anxiety disorder Intermittent anxiety disorder Abnormal anxiety disorder Anxiety disorder

anxiety disorder

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

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

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. drowsiness. dizziness. headache.

nausea.

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 taking too much of the medication (nonadherence) allergic reaction to the benzodiazepine not taking the medication as ordered (noncompliance)

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? pronounced effect from the medication due to the inability of the blood-brain barrier to work effectively paradoxical excitement, which is the opposite reaction than what was expected medication error; the nurse actually gave the wrong medication delayed onset of action due to decreased distribution of the medication

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

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: seizures. leukopenia and diplopia. ataxia and confusion. respiratory disturbances and partial airway obstruction.

respiratory disturbances and partial airway obstruction.

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 with food the need to have monthly blood work drawn during treatment the importance of taking the drug immediately before going to bed the need to supplement the medication with a benzodiazepine

the importance of taking the drug immediately before going to bed

What aspect of a client's health is most likely to cause insomnia? Hypothyroidism Morbid obesity Chronic pain Type 2 diabetes

Chronic pain

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? Endocrine disorders Liver disease Neurological diseases Heart disease

Liver disease

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." "Take the drug with meals if necessary." "Increase the amount of fiber in your diet." "Try other measures to help you relax, too."

"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? "If I get constipated, I sometimes take a stool softener for a couple of days." "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'm also taking baby Aspirin each day for my heart."

"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." "It produces anticonvulsant action to prevent convulsions." "It produces muscle relaxant effects to decrease back pain." "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."

What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide? "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?" "What is motivating you to stop drinking alcohol?"

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