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21. A client with anxiety is prescribed anxiolytic therapy. Before administering the drug, the nurse assesses the client for symptoms of anxiety. Which of the following would the nurse expect to find? A) Increased blood pressure B) Decreased muscle tension C) Increased glucose level D) Decreased pulse rate

Ans: A Feedback: Increased blood pressure is a manifestation of anxiety. Additional manifestations include increased pulse rate and increased muscle tension. Increased glucose levels are not associated with anxiety.

23. A client who was receiving a benzodiazepine for treatment of anxiety tells the nurse that he has decided to discontinue the treatment. Which of the following would the nurse include in the teaching plan for this client? A) "Be sure to gradually decrease the dosage over time." B) "It's fine to just stop taking the medication." C) "You need to first increase the dose and then stop." D) "It's important that you continue the medication even if you want to stop."

Ans: A Feedback: The nurse should suggest the client gradually decrease the dosage schedule to avoid withdrawal symptoms. It is not advisable for the nurse to suggest just stopping the medication, increasing the dosage, or continuing with the medication as prescribed.

10. A client is hospitalized and is prescribed diazepam. Before administering the drug, which of the following information should the nurse obtain? Select all that apply. A) Complete medical history B) Mental status exam C) Anxiety level D) Pain assessment E) Medication history

Ans: A, B, C Feedback: Before starting anxiolytic therapy in a hospitalized client, the nurse obtains a complete medical history, including mental status and anxiety level.

15. An older adult client is experiencing anxiety. Which anxiolytic drug would the nurse identify as being relatively safe to administer to this client at a normal dose? Select all that apply. A) Buspirone B) Lorazepam C) Oxazepam D) Alprazolam E) Diazepam

Ans: A, B, C Feedback: Lorazepam, oxazepam, and buspirone are relatively safer for older adult clients when given at normal doses.

6. After administering an anxiolytic, the nurse assesses the client for adverse reactions. Which of the following would the nurse identify as a common early reaction to this group of drugs? Select all that apply. A) Headache B) Sedation C) Lightheadedness D) Dizziness E) Hypertension

Ans: A, B, C, D Feedback: Common early reactions caused by anxiolytics include mild drowsiness, sedation, lightheadedness, dizziness, and headache.

7. A nurse suspects that a client who is receiving lorazepam may be experiencing benzodiazepine withdrawal based on assessment of which of the following? Select all that apply. A) Anxiety B) Tremor C) Photophobia D) Insomnia E) Metallic taste

Ans: A, B, C, E Feedback: Symptoms of benzodiazepine withdrawal include increased anxiety, concentration difficulties, tremor, and sensory disturbances, such as paresthesias, photophobia, hypersomnia, and metallic taste.

11. A client is prescribed lorazepam. The nurse understands that this drug can be given by which route? Select all that apply. A) Intramuscular B) Oral C) Transdermal D) Intravenous E) Rectal

Ans: A, B, D Feedback: Lorazepam can be administered to a client via the oral, IM, and IV routes.

18. A nurse is preparing a teaching plan for a client who is prescribed an anxiolytic. As part of the plan, the nurse addresses medications that should be avoided to reduce the risk of increased CNS depression and sedation. Which of the following would the nurse include? Select all that apply. A) Alcohol B) Analgesics C) Digoxin D) Tricyclic antidepressants E) Antipsychotics

Ans: A, B, D, E Feedback: Alcohol, analgesics, tricyclic antidepressants, and antipsychotics should be used with caution with anxiolytics due to increased CNS depression and increased risk of sedation.

5. A nurse is preparing to administer an anxiolytic drug. The nurse integrates knowledge of this group of drugs, understanding that the drugs can be used in the management of which of the following conditions? Select all that apply. A) Alcohol withdrawal B) Diabetic neuropathy C) Seizures D) Panic attacks E) Hypertension

Ans: A, C, D Feedback: Anxiolytic drugs can be used in the management of anxiety disorder, panic attacks, convulsions, seizures, and alcohol withdrawal and for preanesthetic sedation and muscle relaxation.

13. Before administering a prescribed anxiolytic to a client, which of the following would the nurse include in the physical assessment of the client? Select all that apply. A) Blood pressure B) Blood glucose C) Pulse D) Respiratory rate E) Weight

Ans: A, C, D, E Feedback: The nurse's preadministration physical assessment for the administration of an anxiolytic should include blood pressure, pulse, respiratory rate, and weight.

3. A nurse is administering an antianxiety agent to a client. The nurse understands that long-term use of which of the following anxiolytics would be most likely to lead to physical or psychological tolerance? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Doxepin

Ans: A, D Feedback: Although long-term use of benzodiazepines such as alprazolam and chlordiazepoxide and nonbenzodiazepines such as buspirone, hydroxyzine, and doxepin can result in physical or psychological dependence, benzodiazepines are more likely to result in physical dependence and tolerance.

16. A nurse is preparing to administer an anxiolytic agent via intramuscular injection. Which of the following would be most important for the nurse to keep in mind? Select all that apply. A) The client should be monitored closely for 3 hours postinjection. B) Intramuscular injection should be given in chronic states. C) The client should remain in a lying position for about 30 minutes. D) The drug should be administered into a large muscle mass. E) The client should be kept conscious for at least 1 hour after administration.

Ans: A, D Feedback: Intramuscular administration of an anxiolytic should be done primarily in an acute state. The drug should be administered in a large muscle mass, the client should be observed closely for at least 3 hours, and the client should be kept lying down for 30 minutes to 3 hours after drug administration.

1. After teaching a group of nursing students about antianxiety drugs, the instructor determines that the teaching was successful when the students identify which as an example? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Lorazepam

Ans: A, D, E Feedback: Alprazolam, chlordiazepoxide, and lorazepam are examples of benzodiazepine antianxiety drugs. Buspirone and hydroxyzine are considered nonbenzodiazepines.

4. A nurse is administering an antianxiety agent that exerts its anxiolytic effects by potentiating the effects of gamma-aminobutyric acid (GABA). Which of the following might the nurse be administering? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Lorazepam

Ans: A, D, E Feedback: Benzodiazepines like alprazolam, chlordiazepoxide, and lorazepam exert their anxiolytic effects by potentiating the effects of gamma-aminobutyric acid (GABA). Nonbenzodiazepines exert their effects in different ways.

9. The nurse is assessing an infant at a well-child visit and notices that the infant has been losing weight and is lethargic. The mother is breastfeeding the child. The nurse questions the mother about any medications that she might be taking. Which of the following, if being taken by the mother, would alert the nurse to a problem? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Lorazepam

Ans: A, D, E Feedback: Benzodiazepines like alprazolam, chlordiazepoxide, and lorazepam taken by a breastfeeding mother can result in lethargy and weight loss in the infant. Buspirone and hydroxyzine do not appear to have the same effect.

28. A client is prescribed a benzodiazepine as treatment for anxiety. After administration of the drug, the client reports dizziness and lightheadedness. Which nursing diagnosis would the nurse identify as a priority? A) Impaired Comfort B) Risk for Injury C) Ineffective Coping D) Deficient Knowledge

Ans: B Feedback: Dizziness and lightheadedness place the client at risk for falls; therefore, Risk for Injury would be the priority. Impaired Comfort would be appropriate if the client reported problems such as dry mouth or constipation. Ineffective Coping would be appropriate if the client reported continued feelings of anxiety. There is no evidence to suggest that the client lacks knowledge of the drug therapy.

30. A client who is receiving a benzodiazepine tells the nurse that his mouth feels really dry. Which of the following would the nurse include in the teaching plan for this client? A) "Try drinking about 8 ounces of water at least every 2 hours." B) "Sucking on hard sugarless candy might help you." C) "Make sure you eat a lot of green leafy vegetables." D) "Change your position slowly as you get out of bed."

Ans: B Feedback: For dry mouth, the nurse should suggest sucking on hard, sugarless candies or chewing sugarless gum. Frequent sips of water would also help, but drinking 8 ounces of water every 2 hours could lead to fluid overload. Eating green leafy vegetables would help with constipation. Changing positions slowly would be appropriate if the client reported dizziness or lightheadedness.

26. A client who experiences panic attacks in social situations has been prescribed an antianxiety medication. The nurse would assess which of the following before administering the drug? A) Temperature B) Blood pressure C) Blood sugar D) Red blood cell count

Ans: B Feedback: The nurse should check the client's blood pressure before administering the antianxiety drug because physiologic manifestations of panic attacks can include increased blood pressure. Temperature, blood sugar, and RBC count are not adversely affected by antianxiety drugs.

17. A client who is prescribed an anxiolytic tells the nurse that she is constipated. Which of the following would be most appropriate for the nurse to suggest? Select all that apply. A) Stop taking the drug. B) Increase fluid intake. C) Increase fiber intake. D) Ask to have the drug given by injection. E) Take the drug on an empty stomach.

Ans: B, C Feedback: Clients receiving an anxiolytic should be advised to increase fluid and fiber intake to address constipation. The drug should not be stopped or changed to an injectable form. Taking the drug on an empty stomach may lead to GI upset.

2. The nurse is reviewing the medication record of a client who is prescribed a nonbenzodiazepine. Which of the following would the nurse expect to find? Select all that apply. A) Alprazolam B) Buspirone C) Hydroxyzine D) Chlordiazepoxide E) Doxepin

Ans: B, C, E Feedback: Buspirone, doxepin, and hydroxyzine are examples of nonbenzodiazepine antianxiety drugs. Alprazolam and chlordiazepoxide are benzodiazepines.

12. During assessment of a client, a nurse suspects that the client is experiencing anxiety. Which of the following would support the nurse's suspicion? Select all that apply. A) Facial flushing B) Tense posture C) Extreme restlessness D) Somnolence E) Facial grimaces

Ans: B, C, E Feedback: During the intake history, the nurse observes the client for behavioral signs indicating anxiety (e.g., inability to focus, extreme restlessness, facial grimaces, tense posture).

8. A nurse is reviewing the medical record of a client with anxiety who is to receive an antianxiety agent as part of the treatment. The nurse recognizes that benzodiazepines would not be used based on which of the following conditions? Select all that apply. A) Cataracts B) Acute narrow-angle glaucoma C) Hypotension D) Psychoses E) Pregnancy

Ans: B, D, E Feedback: The use of benzodiazepines is contraindicated in clients with known hypersensitivity, psychoses, acute narrow-angle glaucoma, and pregnancy.

25. A client receiving antianxiety drug therapy complains of constipation. The nurse understands that this is the result of which of the following? A) Excess fibrous food in the diet B) Overdose of an antianxiety drug C) Slowed intestinal transit time D) Oral administration of the drug

Ans: C Feedback: Constipation results from the action of the antianxiety agents, which slow intestinal transit time. An increased fiber intake would help combat the constipation. Constipation does not result from an overdose of the drug or from oral administration.

29. A client is brought to the emergency department with suspected overdose of a benzodiazepine. Which of the following should the nurse anticipate administering to counteract the effects of the overdose? A) Naloxone B) Naltrexone C) Flumazenil D) Diazepam

Ans: C Feedback: Flumazenil is the antidote for benzodiazepine toxicity. Naloxone is used to reverse the effects of opioids. Naltrexone is used primarily to treat alcohol dependence and to block the effects of suspected opioids if they are being used by a person undergoing treatment for alcohol dependence. Diazepam is a benzodiazepine and would only increase the client's toxicity.

20. A client who is prescribed buspirone therapy also is receiving digoxin for heart failure. The nurse understands that this client would be at increased risk for which of the following? A) Sedation B) Respiratory depression C) Digitalis toxicity D) Central nervous system depression

Ans: C Feedback: The client faces an increased risk for digitalis toxicity due to the effect of interaction of buspirone with digoxin. Increased risk for sedation and respiratory depression are caused by the interaction of buspirone with tricyclic antidepressants and antipsychotics. Increased risk for central nervous system depression is caused by the interaction of buspirone with alcohol.

19. A nurse is caring for a client who is receiving alprazolam. The nurse would be alert for which of the following as an initial adverse reaction with this drug? A) Heartburn B) Anorexia C) Headache D) Allergy

Ans: C Feedback: The nurse should assess for headache as the initial adverse reaction in the client after administering alprazolam. Heartburn, anorexia, and allergy are adverse reactions observed in the client after administering salicylates.

14. A nurse suspects that a client is experiencing anxiety. Which physical assessment findings would support the nurse's suspicion? Select all that apply. A) Hypotension B) Decreased respiratory rate C) Increased muscle tension D) Pale skin E) Bradycardia

Ans: C, D Feedback: Physiological manifestations of anxiety can include hypertension, tachycardia, increased rate and depth of respirations, increased muscle tension, and cool, pale skin.

27. A nurse is caring for an older adult client who is prescribed an antianxiety agent parenterally. Which of the following would be most important for the nurse to do? A) Arrange for a blood transfusion. B) Provide fiber-rich food. C) Provide plenty of fluids. D) Have resuscitative equipment ready.

Ans: D Feedback: The nurse should have resuscitative equipment ready because older adult clients may experience apnea and cardiac arrest during the treatment. Providing fiber-rich food and plenty of fluids is appropriate to prevent constipation and is unrelated to the use of the parenteral route. The need for a blood transfusion would not arise during the treatment.

24. A client admitted to the health care facility for alcohol withdrawal has been prescribed an antianxiety medication. The nurse instructs the client about the need for cessation of alcohol consumption based on the understanding that the client would be at increased risk for which of the following? A) Antianxiety drug toxicity B) Respiratory depression C) Sedation D) CNS depression

Ans: D Feedback: The nurse should suggest that the client 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 client 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 with an antianxiety agent.

22. A nurse is assigned to care for a hospitalized client with anxiety. Buspirone is prescribed. When reviewing the client's history, which of the following, if found, would the nurse identify as a contraindication for this drug? A) Cataract B) Diabetic retinopathy C) Acute gout D) Psychoses

Ans: D Feedback: The use of buspirone is contraindicated in clients with hypersensitivity, psychoses, and acute narrow-angle glaucoma. Ethambutol is contraindicated in clients with cataracts and diabetic retinopathy. Pyrazinamide is contraindicated in clients with acute gout.