A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?
A.
A patient who travels frequently for business reports occasional instances of being unable to
fall asleep. The patient tells the nurse that job demands require staying up late and then getting
up early for meetings. The nurse expects that the provider will prescribe which medication for
this patient?
C.
Zaleplon [Sonata] works well for people who have trouble falling asleep and, because of its short duration of action, can be taken late at night without causing a hangover or next-day sedation early in the morning.
Zolpidem [Ambien] has a longer duration and is a good choice for patients who have difficulty maintaining sleep.
Flurazepam has a long duration of action.
Trazodone causes daytime grogginess.
A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:
B.
A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a
respiratory rate of 10 breaths/minute. The nurse will expect to administer which of the following?
B.
A patient who has been using secobarbital for several months to treat insomnia tells the nurse
that the prescriber has said the prescription will be changed to temazepam [Restoril] because
it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam:
D.
Benzodiazepines potentiate the actions of GABA, and because the amount of GABA in the CNS
is finite, these drugs’ depressive effect on the CNS is limited. Benzodiazepines depress the CNS
but not to the extent that barbiturates do
A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug’s half-life is only 2 to 3 hours. Which response by the nurse is correct?
C.
Flurazepam has a half-life of 2 to 3 hours; however, its metabolite has a long half-life, so giving
the drug results in long-lasting effects.
A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do?
C.
This patient is describing complex sleep-related behavior, which occurs when patients carry out
complex behaviors while taking benzodiazepines but have no memory of their actions.
These actions can occur with normal doses but are more likely with excessive doses or when
benzodiazepines are combined with alcohol or other CNS depressants, so the nurse is correct in
evaluating this possibility
A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement?
B.
A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD)
reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct?
C.
A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient?
C.
A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching?
C.
Ativan should not be withdrawn quickly; it must be tapered to prevent withdrawal symptoms.
Moreover, Buspar does not have immediate effects. Because no cross-dependence occurs with
these two medications, they may be taken together while the benzodiazepine is tapered.
A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear,
which usually dissipate within 30 minutes. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class?
B.
This patient is showing characteristics of panic disorder. All three major classes of antidepressants
are effective, but selective serotonin reuptake inhibitors are first-line drugs. Benzodiazepines are
second-line drugs and are rarely used because of their abuse potential.
Selective serotonin reuptake inhibitors are known to be effective for which disorders?
Select all that apply.
a. Generalized anxiety disorder (GAD)
b. Obsessive-compulsive disorder
c. Panic disorder
d. Posttraumatic stress disorder
e. Social anxiety disorder
ANS: A , B , C , E
SSRIs have been shown to be effective in treating GAD, OCD, panic disorder, and social anxiety disorder.
They are used to treat PTSD but have not demonstrated effectiveness in clinical research
During an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient’s behavior?
D.
A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long-term medications. The nurse will
expect the provider to order which treatment?
A.
This patient is describing social anxiety disorder; the symptoms are related to performance only and are not generalized to all social situations. Because this patient must speak in front of an audience only three or four times per year, a PRN medication can be used
A patient who has obsessive-compulsive disorder (OCD) has been undergoing behavioral therapy but continues to exhibit symptoms that interfere with daily life. Which intervention will the nurse expect the provider to order for this patient?
a. Alprazolam [Xanax]
b. Buspirone [Buspar]
c. Deep brain stimulation
d. Fluoxetine [Paxil]
ANS: D
Patients with OCD usually respond optimally to a combination of an SSRI, such as fluoxetine, and behavioral therapy
A nurse is performing an admission assessment on a patient. The patient reports taking alprazolam [Xanax] for “nerves.” The nurse knows that this patient is most likely being treated for which condition?
D.
Benzodiazepines are the first-choice drugs for anxiety, and alprazolam and lorazepam are
prescribed most often. Selective serotonin reuptake inhibitors (SSRIs) are the first-line drugs for
the treatment of OCD. Panic disorder is treated with any of the three classes of antidepressants:
SSRIs, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs)
An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle?
D.
The patient is clearly in a state of extreme, uncontrolled anxiety. Benzodiazepines are the drugs of
choice for acute episodes of anxiety because of their rapid onset of action
A child will begin taking methylphenidate [Ritalin] for attention-deficit/hyperactivity disorder.
Important baseline information about this patient will include:
D.
Side effects of methylphenidate include a reduced appetite, and children taking these drugs should
be monitored for growth suppression.
A child has been taking SD methylphenidate [Ritalin], 10 mg at 0800 and 1200 and 5 mg at
1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child’s appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do?
B.
This child is showing slight improvement with the medication but has trouble taking the noon dose;
therefore, a once-daily formulation would increase compliance and improve effects.
An adult patient will begin taking atomoxetine [Strattera] for attention- deficit/hyperactivity disorder. What will the nurse teach this patient?
A.
Atomoxetine is a selective inhibitor of norepinephrine (NE) reuptake, and its effects probably are
the result of adaptive changes that occur after uptake blockade, which can take 1 to 3 weeks.
Appetite suppression is an adverse effect of this drug. Atomoxetine does not have abusepotential,
and abstinence syndrome does not occur when it is withdrawn. Suicidal thoughts may occur in
children and adolescents, but not in adults.
A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child’s parent indicates a need for further teaching?
B.
Stimulants do not suppress negative behaviors directly and do not directly cause a decrease in
hyperactivity. They act by improving attention and focus so that positive behaviors can be learned
to replace negative behaviors.
A university student who is agitated and restless and has tremors is brought to the emergency
department. The patient’s heart rate is 110 beats/minute, the respiratory rate is 18 breaths/minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient?
D.
A patient who is morbidly obese is admitted for treatment. The prescriber orders lisdexamfetamine [Vyvanse]. The nurse will be concerned if this patient shows signs of
B.
Stimulants can produce cardiovascular effects. Any patient reporting shortness of breath needs to be evaluated for cardiovascular problems.
A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group’s understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which answers?
Select all that apply.
a. “Amphetamines increase fatigue.”
b. “Amphetamines suppress the perception of pain.”
c. “Amphetamines increase appetite.”
d. “Amphetamines increase the heart rate.”
e. “Amphetamines elevate mood.”
ANS: B , D , E
At customary doses, amphetamines increase wakefulness and alertness, reduce fatigue, elevate
mood, and augment self-confidence and initiative. Amphetamines also suppress appetite and the
perception of pain and increase the heart rate.
A nurse working the night shift begins taking modafinil [Alertec]. The nurse is telling a coworker about the medication. Which statement is correct?
C.
Modafinil is used to increase wakefulness in patients with excessive sleepiness, including those
with shift-work sleep disorder (SWSD).
A nurse is teaching the parents of a child who has attention-deficit/hyperactivity disorder about
methylphenidate [Concerta]. Which statement by the child’s parents indicates understanding of the teaching?
C.
A young adult begins taking clonidine [Kapvay] to treat ADHD symptoms after suffering anorexia with methylphenidate [Ritalin]. What will the nurse include when teaching this patient about taking clonidine?
B.
A parent thinks a school-aged child has ADHD. The nurse asks the parent to describe the child’s behaviors. Which behaviors are characteristic of ADHD?
Select all that apply.
a. Anxiety
b. Compulsivity
c. Hyperactivity
d. Inattention
e. Impulsivity
ANS: C, D , E
zolpidem brand name
ambien
Zaleplon brand name
sonata
Eszopiclone brand name
lunesta
Patient is taking Fluvoxamine reports insomnia. Prescriber should avoid which hypnotic?
C.
Patient with heart failure is taking digoxin, and reports insomnia. Which hypnotic warrants using caution due to risk of digoxin toxicity?
C.
Buspirone should be used with caution in patient using the following drugs: Select all that apply.
a. erythromycin
b. ketoconazole
c. grapefruit juice
d. digoxin
e. warfarin
a, b, c
Modafinil induces metabolism of which drugs?
a. contraceptives
b. cyclosporine
c. carbamazepine
d. azithromycin
e. lithium
a, b
Atomoxetine will need dosage reduction due to the following CYP inhibitors: Select all the apply.
a. paroxetine (Paxil)
b. fluoxetine (Prozac)
c. ciprofloxacin
d. carbamazepine
e. quinidine.
a, b, e
Author
BodeS
ID
363871
Card Set
CH 29-31
Description
Chapter 29, “Sedative-Hypnotic Drugs”
Chapter 30, “Management of Anxiety Disorders”
Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder”