PNE 104. Ch. 21 Sedatives and hypnotics. Clinical Pharm. Susan Ford 11th Ed.
The patient has Dalmane 15 mg PO at bedtime ordered. The drug comes in 30-mg tablets. How much should the nurse give this patient?
1/2 tablet
After administration of a hypnotic, a client complains of being unable to sleep. What is the nurse's best action?
Notify the health care provider.
The nurse assesses a respiratory rate of 10 breaths/minute in an adult client. Before administering a sedative, what is the nurse's best action?
Notify the health care provider.
Due to specific enzyme reaction:
grapefruit or its juice should not be taken if the patient is on triazolam or zaleplon.
Zolpidem (Ambien) is prescribed for a hospitalized client having difficulty falling asleep at night. What is the best time for the nurse to administer this medication?
11 PM
A nurse would inform a client receiving a nonbenzodiazepine that the drug usually begins to have a diminished hypnotic effect after how long?
14 days
The nonbenzodiazepines have diminished hypnotic effects after how long? (Choose one)
14 days
The nonbenzodiazepine effects diminish after approximately __________.
2 weeks ****NOTE: A person taking these for longer than 2 weeks may have a tendency to increase the dose to produce the desired effects (such as sleep sedation).
Insomnia affects nearly
70 million people in the US. Although it is often treated in the outpatient setting, many hospitalized patients suffer from insomnia, too.
Melatonin
A hormone manufactured by the pineal gland that produces sleepiness
What is the nurse's best action when administering zaleplon to a client?
Administer on an empty stomach.
What instructions should the nurse provide to the client to ensure compliance with taking sedatives or hypnotics for insomnia? Select all that apply.
"Consult your primary care provider if unable to sleep." "A time-released form of the medication may be an option for you."
A client asks the nurse about continuing to drink one glass of red wine per day while also taking zolpidem (Ambien) for insomnia. What is the nurse's best response?
"Do not drink any alcoholic beverage two hours before taking the drug."
A woman who travels extensively for her job has been prescribed triazolam (Halcion) as a sleep aide. During patient teaching, what information should the nurse prioritize?
"If you stop taking this drug suddenly, you might find that your insomnia is worse than ever."
A nurse enters the client's room to administer bedtime medications. The client informs the nurse that he is not ready to go to sleep and to leave the sleeping pill with him and he will take it when he is ready. What would be the nurse's best response?
"Just push the call light when you are ready and I will bring it to you then."
A nurse enters the patient's room to administer bedtime medications. The patient informs the nurse that he is not ready to go to sleep, but to leave the Lunesta with him and he will take it when he is ready to settle down. What would be the nurse's best response?
"Just ring the call bell when you are ready and I will bring it to you then."
A nursing assistant is seen carrying a bedtime snack of crackers and coffee into a client's room. The nurse is preparing to administer an oral dose of zaleplon (Sonata) to the client. What is the nurse's best action?
Advise the client that a snack may interfere with absorption of this medication.
An older adult client complains of insomnia while hospitalized. What are the best ways the nurse can help promote sleep? Select all that apply.
Dim hallway lights. Request a prescription for a sedative. Administer eszopiclone (Lunesta) per the prescribed dose.
A physician prescribes a total of 1.5 mg of estazolam to a patient. The available tablet of estazolam contains 1 mg of the drug. How many tablets of estazolam will the nurse have to administer to the patient at a time?
1.5 tablets
The client has Dalmane 15 mg PO at bedtime ordered. The drug comes in 30-mg tablets. How much should the nurse administer to this client?
1/2 tablet
Criteria for insomnia diagnosis:
1. Difficulty falling asleep 2. waking often and trouble going back to sleep 3. waking too early in the morning 4. feeling tired upon waking
Adverse reactions to sedatives/hypnotics:
1. Dizziness 2. drowsiness 3. headache 4. nausea
Uses for sedatives/hypnotics:
1. Insomnia 2. convulsions or seizures 3. adjuncts for anesthesia 4. preoperative sedation 5. conscious sedation
Do not administer these drugs to:
1. comatose patients 2. those with severe respiratory problems 3. those with a history of drug 4. alcohol habitual use 5. pregnant or lactating women.
These drugs work by depressing the CNS. Barbiturate use is
1. lessening because of both dependency and harsh adverse reactions. 2. The nonbarbiturates include both benzodiazepines and nonbenzodiazepines.
Insomnia may be caused by
1. lifestyle changes, such as a new job, moving to a new town, or returning to school; 2. jet lag 3. chronic pain 4. headaches 5. stress 6. anxiety.
Actions of barbiturates
1. producing CNS depression 2. mood alterations ranging from mild excitation to mild sedation 3. hypnosis (sleep) 4. deep coma 5. respiratory depression
Sedatives and hypnotics can also cause
1. respiratory depression. 2. Other CNS depressants, such as alcohol, should not be used with these drugs.
A physician prescribes a total of 1.5 mg of estazolam to a client. The available tablet of estazolam contains 1 mg of the drug. How many tablets of estazolam will the nurse have to administer to the client at a time?
1.5 tablets
A 45-year-old male client tells the nurse that he has not slept through the night for the past 2 weeks. Which drug might the physician prescribe for this client?
eszopiclone (Lunesta)
Chapter 21 Review: Prepare for NCLEX: Apply your knowledge #8 The clinic nurse prepares teaching materials to give a client about use of a hypnotic. Which statement would cause the nurse to contact the primary health care provider?
Answer: "Stopping off at the tavern should help calm me before bedtime." No alcoholic beverages!!
Chapter 21 Review: Prepare for NCLEX: Alternate-Format-Questions #10 When teaching about nonbenzodiazepine hypnotics, certain foods should not be taken CB they interfere w/absorption. Select all that apply. 1. peanut butter & crackers 2. ice cream 3. apple pie w/ice cream 4. chocolate pudding
Answer: 1, 2, 3 1. peanut butter and crackers 2. ice cream 3. apple pie with ice cream
The nurse enters a client's room at the beginning of a day shift and finds a medicine cup at the bedside containing one oral dose of zolpidem (Ambien). What should be the nurse's first action?
Ask the client why the medication was left at the bedside.
Chapter 21 Review: Prepare for NCLEX: Alternate-Format-Questions #9 Criteria for diagnosing insomnia include which of the items below? Select all that apply. 1. waking to early 2. sleeping in the middle of the day 3. difficulty falling asleep 4. trouble returning to sleep at night
Answer: 1, 3, 4 1. waking too early 3. difficulty falling asleep 4. trouble returning to sleep at night
An adolescent has been prescribed a benzodiazepine for sleep disturbances after her parents divorced. What is the most important teaching point for the nurse to tell the client about this medication?
Discuss contraceptive methods if the client is sexually active.
Chapter 21 Review: Prepare for NCLEX: Build your knowledge #5 Which of the following points should be included in a teaching plan for a client taking a sedative or hypnotic?
Answer: Do not use any OTC cold, cough, or allergy medications while taking a sedative or hypnotic.
Chapter 21 Review: Prepare for NCLEX: Build your knowledge #1
Answer: TEST
Chapter 21 Review: Prepare for NCLEX: Build your knowledge #1 Sedative and hypnotic drugs exert action to depress the ______.
Answer: central nervous system.
Chapter 21 Review: Prepare for NCLEX: Build your knowledge #2 Nonbarbiturates are used instead of barbiturates because they_______.
Answer: have fewer adverse reactions
Chapter 21 Review: Prepare for NCLEX: Apply your knowledge #7 An elderly woman has arthritis in her lower back, and the pain keeps her awake at night. She asks if she can have a "sleeping pill." In considering her request, the nurse must take into account that hypnotic medications might ______.
Answer: not be the drug of choice when pain causes insomnia.
Chapter 21 Review: Prepare for NCLEX: Build your knowledge #3 Which of these assessments should the nurse report immediately to the primary health provider?
Answer: respiration rate of 8 breaths/min (low breath rate)
Chapter 21 Review: Prepare for NCLEX: Build your knowledge #4 When giving a hypnotic to an older client, the nurse is aware that ________.
Answer: smaller doses of the drug are usually given to older clients.
Chapter 21 Review: Prepare for NCLEX: Build your knowledge #6 Which of the following sedatives/hypnotics is a pregnancy category X drug?
Answer: temazepam (Restoril)
The nurse counts a respiratory rate of 8 breaths/minute for a client who received a sedative one hour ago. What is the nurse's priority action?
Assess level of consciousness.
The nurse is assessing the respiratory status of a post surgical client. The nurse counts a respiratory rate of 8 breaths/minute for the client who received a sedative one hour ago. What is the nurse's priority action?
Assess level of consciousness.
The nursing instructor is teaching about sedatives and hypnotics. The student correctly identifies the two classes of sedatives as being which? Select all that apply.
Barbiturates Nonbarbiturates
The nursing student is learning in pharmacology class about sedatives and hypnotics. The student correctly identifies the two classes of sedatives as being which of the following? (Select both that apply.)
Barbiturates Nonbarbiturates
Classes of sedatives and hypnotics
Barbiturates, nonbarbiturates
A nurse is caring for a client who is prescribed barbiturates. The nurse would assess the client for which of the following? Select all that apply.
CNS depression Mood alteration Hypnosis
A nurse is caring for a patient who is prescribed barbiturates. Which effects of barbiturates should the nurse monitor the patient for? (Select all that apply.)
CNS depression Mood alteration Hypnosis
A nursing student is researching information about secobarbital (Seconal). The student would most likely find that this drug is classified in which pregnancy category?
Category D
Secobarbital (Seconal) is classified in which pregnancy category? (Choose one)
Category D
Benzodiazepines are classified in which pregnancy category? (Choose one)
Category X
Before administering a barbiturate to a client, what is the nurse's priority action?
Check level of consciousness.
A nurse obtains a health history from a client who has been prescribed temazepam (Restoril). Which finding would require immediate follow-up by the nurse?
Client is diagnosed with hepatitis C.
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 is diagnosed with hepatitis C.
The nurse should not administer sedatives or hypnotic drugs to which client?
Comatose client
An elderly patient is administered a sedative for the treatment of insomnia. Which sign should the nurse look for in the patient when monitoring the effects of the administered drug?
Confusion
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
The nurse is about to administer temazepam (Restoril) when the client informs the nurse that this medication has not been effective when taken in the past. What is nurse's best action?
Consult the health care provider.
A client in long term care regularly takes opioid analgesics for back pain relief. Recently, the client has been prescribed a low-dose hypnotic for insomnia. What is the nurse's first action before administering these medications?
Consult the primary health care provider.
A 79-year-old client in a long term care facility regularly takes opioid analgesics for back pain relief. Recently, the client has been prescribed a low-dose hypnotic for insomnia. What is the nurse's first action before administering these medications?
Consult the primary healthcare provider.
The nurse should carefully assess for which top priority concern when administering a sedative or hypnotic?
Depressed respiratory function
The nurse is caring for a client who has a sedative hypnotic ordered. The nurse should consider this drug contraindicated if the client had what disorder?
Liver failure
An agent classified as a hypnotic is used primarily for preventing the feelings of tension or fear.
False
Valerian
Herb used for its sedative effects
Which of the following is defined as a drug that induces drowsiness? (Choose one)
Hypnotic
Why would the nurse anticipate the healthare provider ordering a hypnotic instead of another classification of antianxiety drug?
Hypnotics work best on a client who is experiencing insomnia due to psychosocial stress
A patient who suffers from GERD and diverticulosis has just been admitted to a medical floor. The admitting physician orders cimetadine and a sedative to calm the patient. About what should the nurse be concerned?
Increased sedative effect
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
When describing the uses for sedatives and hypnotics, which would the nursing instructor identify as the primary use?
Insomnia
The nurse should consider which assessment questions before administering a sedative or hypnotic? Select all that apply.
Is the client uncomfortable? Is it too early to give the drug? Are there any environmental disturbances? Has a consent form been signed? What are the client's baseline vital signs?
Supplementation of which hormones has been used in the treatment of insomnia due to jet lag?
Melatonin
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
A nurse is caring for a patient with insomnia. The patient is prescribed a sedative. Which adverse reaction to sedatives is a gastrointestinal reaction?
Nausea
A nursing student studying sedatives and hypnotics in pharmacology class correctly states that they are best given for which of the following periods?
No more than 2 weeks
The nursing student has learned about a group of unrelated drugs that includes Lunesta and Ambien. This group is known as which of the following?
Nonbenzodiazepines
The nursing student has learned about several groups of drugs and some are unrelated drugs that includes Lunesta and Ambien. These two medications belong in which group?
Nonbenzodiazepines
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 patient receiving halcion 0.25 mg PO at bedtime appears very drowsy and is difficult to rouse when the nurse enters the room. Based on these findings, what would be the best nursing diagnosis for this patient?
Risk for injury
A client asks the nurse about the risks of taking melatonin for insomnia. What is the nurse's best response?
Synthetic forms from a reliable source carry decreased risk of contamination.
A 77-year-old patient is suffering from insomnia. Which of the following medications can be safely administered to this patient to induce sleep?
Temazepam (Restoril)
The client is being premedicated for surgery. The nurse administers promethazine to the client before sending the client to the preoperative holding area. What outcome demonstrates therapeutic effects?
The client is conscious but drowsy
Which of these outcomes is most appropriate to establish for a client receiving a hypnotic medication before a minor procedure?
The client will remain relaxed and calm during the procedure.
An older adult client has been taking zolpidem as a sleep aid for the past 2 months. On admission to the assisted-living facility, it is determined that the drug is no longer needed. What guideline should be included in the nurse's care?
The drug needs to be withdrawn gradually.
Examples of drugs that are specifically marketed for the treatment of insomnia include:
flurazepam, temazepam, and triazolam.
If a pregnant client has taken a benzodiazepine during pregnancy, what would be the biggest concern?
The infant may experience withdrawal symptoms during the postnatal period.
If a pregnant patient has taken a benzodiazepine during pregnancy, what should be the biggest concern?
The infant may experience withdrawal symptoms during the postnatal period.
A pregnant patient with insomnia is administered a benzodiazepine. What is the possible effect of benzodiazepine on the health of the newborn child?
The newborn can develop withdrawal symptoms
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 physician prescribing a drug for sleep will usually select a nonbarbiturate instead of a barbiturate. This is mainly due to which of the following reasons?
They have a lesser effect than barbiturates do on the respiratory rate.
After teaching a group of nursing students about herbal products used for sleep and relaxation, the instructor determines that the teaching was successful when the students identify which as being used to improve overall sleep quality, shortening the length of time it takes to fall asleep and decreasing the number of nighttime awakenings?
Valerian
The nurse is conducting an educational presentation on the use of drugs and herbal supplements. Which herbal supplements is used mainly for its sedative-hypnotic properties?
Valerian
The nurse is conducting an educational presentation on the use of drugs and herbal supplements. Which of the following herbal supplements is used mainly for its sedative-hypnotic properties?
Valerian
Which of the following herbal products has been used to improve overall sleep quality, shortening the length of time it takes to fall asleep, and decreasing the number of nighttime awakenings? (Choose one)
Valerian
An 86-year-old client was administered a sedative at bedtime, which resulted in hyper-alertness and confusion. The client's son present at the bedside, states he does not understand the term "paradoxical reaction." What is the nurse's best explanation for this term?
When a drug has the opposite effect of the usual intent
An older adult client was administered a sedative at bedtime, which resulted in hyper-alertness and confusion. The client's son states he does not understand the term "paradoxical reaction." What is the nurse's best explanation for this term?
When a drug has the opposite effect of the usual intent
A nurse practitioner is ordering a new sedative for a 72-year-old client. What is an important consideration for this client before the practitioner orders this type of drug?
age of the client Explanation: Elderly clients may require a smaller hypnotic dose; in some instances a sedative dose produces sleep.
A nurse practitioner is ordering a new sedative for an elderly patient. What is an important consideration for this patient before the practitioner orders this type of drug?
age of the patient
A patient who has just had abdominal surgery 2 days ago reports not sleeping since the surgery. She states that her pain is constant and rates it between a 5 and 6 on a scale of 0 to 10. This patient should be given which type of drug in order to promote sleep?
analgesic
What classification of over-the-counter (OTC) medications is often used by clients as treatment for insomnia?
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?
anxiety
nurses use complementary techniques to promote the effects of a sedative or hypnotic. What are some things nurses can do to promote an optimal response to therapy? (Select all that apply.)
back rubs quiet atmosphere night lights or darkened room
Nurses use complementary techniques to promote the effects of a sedative or hypnotic. Some things nurses can do to promote an optimal response to therapy are which of the following? (Select all that apply.)
back rubs quiet atmosphere night lights or darkened room
Which medications are capable of central nervous system depression, hypnosis, deep coma, respiratory depression, and prescribed infrequently?
barbiturates
Sedatives and hypnotics are divided into two classes:
barbiturates and nonbarbiturates.
The nonbarbiturates are classified into two groups:
benzodiazepines and nonbenzodiazepines.
Classes of nonbarbiturates
benzodiazepines, nonbenzodiazepines
What aspect of a client's health is most likely to cause insomnia?
chronic pain
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
The client who reports a headache the morning after taking a hypnotic is experiencing which complications?
drug hangover
The patient who reports a headache and excessive drowsiness the morning after taking a hypnotic is experiencing which of the following complications?
drug hangover
Sedative
drug producing a relaxing, calming effect
Hypnotic
drug that induces sleep
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
A nursing student demonstrates understanding of the uses of sedatives and hypnotics when identifying acceptable uses as which of the following? (Select all that apply.)
insomnia convulsions seizures adjuncts for anesthesia
Sedatives and hypnotics are used to primarily to treat:
insomnia.
Contraindications to sedative and hypnotic drugs are:
known hypersensitivity to sedatives and hypnotics.
A nale 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 nurse has been taught to observe for adverse reactions whenever administering a medication. One non-nervous system reaction after giving a sedative is:
nausea.
Adverse reactions to sedative and hypnotic drugs are:
nervous system reactions include: 1. dizziness 2. drowsiness 3. headache gastrointestinal reaction: 1. nausea (most common)
A nurse should not administer secobarbital to a patient with insomnia caused by:
pain.
A nurse knows that when elderly clients take a sedative or hypnotic, they are at increased risk for oversedation. When they become very confused and demonstrate marked excitement, this is known as which type of reaction?
paradoxical reaction
A nurse knows that when elderly patients take a sedative or hypnotic, they are at increased risk for oversedation. When they become very confused and demonstrate marked excitement, this is known as which type of reaction?
paradoxical reaction
A nursing student correctly identifies the benzodiazepines as being which of the following class of drugs?
pregnancy category X
Sedatives produce a
relaxing and calming effect
These drugs are meant to treat insomnia for only a
short period of time, such as 2 weeks.
Hypnotic drugs produce
sleep.
What information should the nurse provide to a client prescribed eszopiclone?
the importance of taking the drug immediately before going to bed
Nonbarbiturates sedatives/hypnotics have essentially the same mode of action as the barbiturates-that is, __________.
they depress the CNS.
Sedatives and hypnotics are primarily used to
treat insomnia.
Ataxia
unsteady gait; muscular incoordination
A patient informs the nurse that he has been taking an herb to help with mild anxiety. The patient says he has it in his tea every morning and it seems to help. He further states that it is GRAS (generally recognized as safe) for use in the United States. What is the name of this herb?
valerian
Paradoxical reaction
when a drug or treatment has the opposite effect of the usual intent