chapter 20 - pharm exam 2
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." explanation: Although taking the drug with meals, increasing fiber intake (to prevent constipation), and using additional measures to promote relaxation would be helpful instructions, it would be most important for the nurse to warn the client not to stop the drug abruptly. There is a risk for withdrawal if anxiolytics, both benzodiazepines and barbiturates, are stopped abruptly.
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." explanation: Buspirone will not produce sedation. Compared with the benzodiazepines, buspirone (BuSpar) lacks muscle relaxant and anticonvulsant effects; does not cause sedation or physical or psychological dependence; does not increase the CNS depression of alcohol and other drugs; and is not a controlled substance.
The health care provider has ordered for a client eszopiclone 1 mg PO daily as needed. What education should the nurse provide to the client beginning this medication?
"Make sure that you go to bed immediately or very shortly after taking the pill." Explanation: Eszopiclone is a treatment for insomnia, so drowsiness is assured and the client should go to bed after taking it. It is not prescribed for anxiety. Short term use is recommended, but there is no need to limit use to three nights consecutively.
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." Explanation: Drugs used to treat anxiety are called antianxiety, or anxiolytic, drugs. Long-term use of benzodiazepines, such as Xanax, can result in physical or psychological dependence. Due to the risk of dependence, benzodiazepines are used for short-term anxiety relief. Due to the risk of dependence, anxiolytics are classified as schedule IV contolled substances. Therefore, anxiolytics require a prescription. Anxiolytic drugs exert their tranquilizing effect by blocking certain neurotransmitter sites.
A client informs the nurse that he plans on discontinuing the prescribed lorazepam (Ativan) he has been taking for the past four months. What is the nurse's best action in response to this client's statement?
Advise the client to contact his healthcare provider about tapering off the medication. Explanation: Long-term use of benzodiazepines, such as Ativan, may result in physical dependence. When discontinuing benzodiazepine, a gradually decreasing dosage schedule (tapering) should be used. Merely documenting the client's plan does not address the need for the client to taper off the medication. Rather than continuing the current dose and then abruptly stopping, the client should taper off the medication slowly. The onset of withdrawal symptoms usually occurs within one to 10 days after discontinuing the drug.
A group of nursing students are reviewing information about antianxiety drugs. The students demonstrate understanding of the information when they identify which as another name for this group of drugs?
Anxiolytics Explanation: Antianxiety drugs are also referred to as anxiolytics. Opioids are narcotic drugs used in the treatment of acute pain; NSAIDs are nonsteroidal anti-inflammatory medications used in treatment of chronic pain such as arthritis; and anesthetics are medications used to induce unconsciousness for surgery or administered locally to block pain during a procedure such as suturing.
What should the nurse's pre-administration assessment for a client receiving a sedative or hypnotic include? (Select all that apply.)
BP, pulse, RR
The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize?
Blood pressure Explanation: Hypotension is a possible effect when barbiturates are given IV and is more common than hypoxia. Bleeding is not associated with intravenous barbiturate use. Anaphylaxis would be a serious but rare occurrence.
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 Explanation: Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and central nervous system relaxing effects. Diphenhydramine is an antihistamine that can be sedating.
A nurse is caring for a client who is prescribed barbiturates. The nurse would assess the client for which of the following?
CNS depression Mood alteration Hypnosis Explanation: The nurse should monitor the client for CNS depression, mood alteration, and hypnosis, which are effects of barbiturates.
A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine?
Diazepam explanation: Diazepam is the prototype benzodiazepine. High-potency benzodiazepines such as alprazolam, lorazepam, and clonazepam may be more commonly prescribed due to their greater therapeutic effects and rapid onset of action.
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 Explanation: Having the client walk to the bathroom would be appropriate before administering the drug to reduce the client's risk for injury. Raising the side rails would be appropriate after administering an anxiolytic. Placing the call light within reach would be appropriate after administering an anxiolytic. Dimming the lights would be appropriate after administering an anxiolytic.
The nurse is reviewing the medication chart of an 82-year-old man who has recently moved to a long-term care facility. The record reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this resident's drug regimen?
Increased risk for falls Explanation: In a systematic review of medications as risk factors for falls, it was found that one of the main group of drugs associated with this risk were benzodiazepines. Benzodiazepines are not associated with cold intolerance, anorexia, or aggression.
A client who has claustrophobia is scheduled for an magnetic resonance imaging (MRI) for the investigation of an abdominal mass. The nurse should anticipate what pre-medication order?
Lorazepam 2 mg PO explanation: Benzodiazepines are often prescribed to relieve pre-procedure anxiety. Eszopiclone, ramelteon and suvorexant are hypnotics which would induce several hours of sleep, which would be problematic.
A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform?
Provide respiratory assistance explanation: The nurse must provide respiratory assistance to the patient showing symptoms of barbiturate toxicity. Providing assistance with movement, supportive care, and a safe environment are suggested for patients at risk for injury due to drowsiness or impaired memory.
How should the nurse explain the major difference between normal and abnormal anxiety?
abnormal anxiety is prolonged and impairs normal function
A client is receiving a barbiturate intravenously. The nurse would monitor the client for:
bradycardia explanation: When given intravenously, barbiturates can result in bradycardia, hypotension, hypoventilation, respiratory depression, and laryngospasm. Bleeding is not associated with barbiturate therapy.
What aspect of a client's health is most likely to cause insomnia?
chronic pain
The nurse should not administer sedatives or hypnotic drugs to which client?
comatose patient explanation: The nurse should not administer these drugs to comatose clients, those with severe respiratory problems, those with a history of habitual drug and alcohol use, or pregnant or lactating women. The nurse could safely administer sedatives or hypnotics to a client with a history of asthma as long as the client is not having an acute attack. A woman of childbearing age can receive sedatives or hypnotics after it is confirmed she is not currently pregnant. An egg allergy is not a contraindication to sedative or hypnotic administration.
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 explanation: The nurse should look for signs of confusion in the elderly 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 cardiac workload Explanation: 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 (LOC)
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 Explanation: Ramelteon, the newest oral nonbenzodiazepine hypnotic, has received FDA approval 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.
Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?
falls
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 Explanation: Adverse effects of benzodiazepines may include contributing to falls and other injuries unless clients are carefully monitored and safeguarded. Seizures, dysrhythmias, and sexual dysfunction are not characteristic adverse effects.
A nurse should not administer secobarbital to a patient with insomnia caused by:
pain explanation: Barbiturates have no analgesic action and, when given in the presence of pain, may cause restlessness, excitement, and delirium; therefore, the use of barbiturates in patient with pain-related insomnia is not recommended
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. Explanation: A priority assessment would be for respiratory disturbances and partial airway obstruction. These adverse effects usually occur when a high dose of the drug is given prior to a procedure. Ataxia and confusion are also adverse effects of lorazepam, but are seen mostly in older adults. Leukopenia and diplopia are not adverse effects specific to intravenous administration but are general hematologic and ophthalmic adverse effects that can occur in anyone of any age with any method of lorazepam administration. Seizures can be an adverse effect of the drug with any type of administration. However, lorazepam is usually administered for seizures.
The intensive care nurse should prioritize what assessments for a client prescribed both lorazepam and hydromorphone?
respiratory rate and oxygen saturation explanation: The combination of opioids and benzodiazepines creates a significant risk for central nervous system (CNS) depression; respiratory function is consequently an important focus of assessment. It would likely supersede other assessments, even though each may be warranted.
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 Explanation: To avoid withdrawal symptoms, it is necessary to taper benzodiazepines gradually before discontinuing them completely. Long-acting benzodiazepines, anticonvulsants, and herbal remedies are not recommended in the effort to prevent withdrawal.
