Chapter 54- Drug Therapy for Anxiety and Insomnia
11. When administering benzodiazepines, which medications should be considered the drug of first choice? A) lorazepam B) estazolam C) temazepam D) triazolam
A
1. If diazepam is administered intravenously, when will its onset of action be observed? A) 1 to 5 minutes B) 7 to 10 minutes C) more than 10 minutes D) less than 1 minute
A
16. 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? A) tapering the dose of drug over a prolonged period of time B) replacing the drug with a herbal supplement in anticipation of stopping the medication C) substituting the immediate-acting form of the drug with a long-acting form D) exchanging the drug for an anticonvulsant
A
7. Which condition will place the client prescribed a benzodiazepine at risk for toxicity? A) decreased albumin B) increased calcium C) decreased potassium D) normal bicarbonate
A
The nurse is conducting patient teaching for a patient who will be taking alprazolam for treatment of anxiety. Which of the following medications increases the amount of alprazolam in the body? A. diltiazem (Cardizem) B. timolol (Istalol) C. albuterol inhaler D. bosentan (Tracleer)
A
Zolpidem (Ambien) is the most appropriate choice for patients with which condition? A) difficulty in initiating and maintaining sleep B) morning awakening C) agitation and violent outbursts D) obstructive sleep apnea and respiratory problems
A
8. 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? A) seizure precautions B) falls risk assessment C) frequent dysrhythmias monitoring D) education regarding sexual dysfunction
B
Which baseline laboratory tests should a patient receive prior to starting the benzodiazepine? A) blood glucose level B) liver enzymes C) lipid profile D) thyroid panel
B
Which of the following medications can be administered to the elderly, accumulates to a small extent in the brain, and is not affected by diminished hepatic function? A. diazepam B. lorazepam C. clonazepam D. chlordiazepoxide
B
Which teaching fact is the priority for the woman receiving treatment for acute short-term anxiety with a benzodiazepine? A) Monitor serum glucose levels. B) Avoid alcohol when taking these medications. C) Take medications with food. D) Expect a delay in therapeutic effects of several weeks.
B
12. In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client? A) increased diffusion and perfusion B) decreased cardiac workload C) increased level of consciousness D) decreased blood pH
B
13. A client is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation? A) triazolam B) midazolam C) oxazepam D) chlordiazepoxide
B
17. The intensive care nurse should prioritize what assessments for a client prescribed both lorazepam and hydromorphone? A) arterial blood gases B) respiratory rate and oxygen saturation C) deep tendon reflexes and pupillary response D) cardiac rate and rhythm
B
19. Which hypnotic may be safely taken for long-term treatment of insomnia? A) lorazepam B) eszopiclone C) chloral hydrate D) oxazepam
B
2. A client diagnosed with insomnia is prescribed flurazepam. This medication has a longer half-life than 24 hours. Which contributes to the long half-life of this medication and other benzodiazepines? A) metabolism by cytochrome P450 B) presence of active metabolites C) excretion by the renal system D) movement of calcium in the cell
B
20. 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? A) somnambulism (sleepwalking) B) difficulty falling asleep at night C) early morning waking D) frequent nighttime awakenings
B
3. 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? A) oral secretions B) anxiety C) hypotension D) muscle tone
B
6. Which symptom is characteristic of acute benzodiazepine withdrawal? Select all that apply. A) bradycardia B) agitation C) lethargy D) diaphoresis E) palpitations
B, E
10. A child diagnosed with night terrors is prescribed a benzodiazepine agent. What increased risk should the child be monitored for? A) development of insomnia B) development of drug dependence C) development of mood disorders D) development of hepatotoxicity
C
14. The etiology of anxiety involves which physiological process? A) stimulation of the parasympathetic nervous system B) stimulating effects of somatotropin C) increased activation of the autonomic nervous system D) adrenocortical suppression
C
15. What aspect of a client's health is most likely to cause insomnia? A) hypothyroidism B) morbid obesity C) chronic pain D) type 2 diabetes
C
4. 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? A) "Your doctor may have been concerned about causing depression." B) "Your doctor may have been worried about the possibility of convulsions." C) "Long-term use of benzodiazepines can result in dependency." D) "Long-term use of benzodiazepines can cause insomnia."
C
When a patient is prescribed chlordiazepoxide (Librium) for acute alcohol withdrawal, which herbal supplement may increase the risk of increased central nervous system depression? A) garlic B) ginger C) St. John's wort D) Ginkgo biloba
C
Oxazepam (Serax) can be used in the treatment for patients who have which conditions? SELECT ALL THAT APPLY. A) severe agitation B) schizophrenia with hallucinations C) anxiety with depression D) opioid dependence E) alcoholism
C, E
18. 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? A) Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. B) The client may have decreased liver function. C) The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. D) The adverse effects of benzodiazepines can persist for several days after stopping the drug.
D
5. Which medication will reduce the effects of sedation and respiratory depression in a client suspected of experiencing benzodiazepine toxicity? A) olmesartan medoxomil B) pancrelipase C) pamidronate disodium D) flumazenil
D
9. Which medication can be most safely administered to an older adult experiencing insomnia? A) alprazolam B) clonazepam C) diazepam D) temazepam
D
Benzodiazepines are thought to work by doing whichof the following? A. exciting the CNS B. stimulating the reticular activating system C. increasing inhibitory feelings D. enhancing the effects of GABA
D
When a 5-year-old child is scheduled for a sleep electroencephalogram (EEG), which medication is a drug of choice prior to the diagnostic test? A) diazepam (Valium) B) lorazepam (Ativan) C) zolpidem (Ambien) D) diphenhydramine (Benadryl) OR Choral hydrate
D
When a patient receives a prescription for zolpidem (Ambien), which teaching point is most important?' A) Take the medication with a high-fat meal. B) Only take the medication if acetaminophen PM does not produce sleep. C) Go to bed immediately after taking the medication. D) Take the medication if nondrug relaxation has not produced sleep.
c
