pharm 27+28

Hypnotics also are referred to as antianxiety agents.
True False

Hypnotics have a more intense depressant effect on the central nervous system than do sedatives
True False

Phenobarbital also has anticonvulsant activity.
True False

Combinations of chloral hydrate and alcohol cause rapid loss of consciousness.
True False

Short-term use of barbiturates does not result in the development of tolerance.
True False

A client asks the nurse why she develops vertigo, dizziness, nausea, and vomiting after taking phenobarbital. The nurse’s best response would be:

a.
“Barbiturates can cause a “hangover” effect resulting in these manifestations.”
b.
“These are adverse effects specific to phenobarbital.”
c.
“These are symptoms of toxicity that we need to report to your doctor.”
d.
“Barbiturates can produce anterograde reactions leading to these symptoms.”

The nurse is caring for a client receiving IV midazolam for conscious sedation for a procedure. The nurse should:

a.
administer it IV 60 minutes prior to the procedure.
b.
monitor closely for respiratory depression.
c.
maintain a continuous administration during the procedure.
d.
provide warm blankets to prevent hypothermia.

When teaching clients, the nurse explains that the most common ingredient in nonprescription sleep aids is:

a.
aspirin.
c.
diphenhydramine.
b.
acetaminophen.
d.
estazolam.

The nurse is aware that particular attention is warranted for the client who is prescribed phenobarbital, particularly when the client also takes:




a.
acetaminophen.
b.
warfarin.
c.
ranitidine.
d.
acetylsalicylic acid.

When planning nursing assignments, the charge nurse understands that which of the following clients receiving benzodiazepines as hypnotics are at greatest risk for complications?

a.
clients receiving a benzodiazepam as a premedication for surgery
b.
women
c.
clients above the age of 20 years
d.
clients who are depressed or suicidal

How does chloral hydrate compare with other prescription agents in terms of its effect on REM sleep?

a.
Like barbiturates, it suppresses REM sleep.
b.
Unlike barbiturates, it suppresses REM sleep.
c.
Like benzodiazepines, it does not suppress REM sleep.
d.
It affects REM sleep more than phenobarbital.

A client is prescribed 15 mg of flurazepam for sleep that could be repeated if the client were unable to sleep. At 0100, the client complains of inability to sleep. Should the night nurse give the client a second dose of flurazepam?

a.
It is prescribed, so the nurse should administer it.
b.
Yes, after trying to determine why the client is unable to sleep.
c.
Probably no; she should wait until 4 a.m. to see if the client can sleep on his or her own.
d.
No, it is too late for a second dose.

After administering triazolam to a hospitalized client the nurse should:

a.
turn off the client’s room lights.
b.
raise the client’s siderails.
c.
take no special precautions, unless the nurse believes the client has difficulty ambulating.
d.
place the client on a monitor.

An elderly client receiving eszopiclone asked the nurse why he only takes 2 mg of the drug, while his son takes 4 mg. The nurse’s best response is:

a.
“You are prescribed the lower dose, because at your age you do not process and eliminate drugs the same as your son.”
b
“You should ask your doctor for an increased dose, explaining that your son takes a higher dose.”
c.
“Because this drug affects what we call REM sleep, older clients should not receive more than 2 mg of this drug.”
d.
“I don’t know why your son would be prescribed such a high dose of this drug, but I will check with your doctor about it.”

Which of the following would be the most supportive nursing measures to assist clients with sleep needs?

a.
make clients feel secure by performing frequent assessments
b.
schedule all medications to be administered during the daytime
c.
be sure all visitors have left the nursing unit by 2100
d.
maintain adequate pain management

When teaching a client who is prescribed zolpidem tartrate the most appropriate statement by the nurse is:

a.
“Take the medication with dinner, as it works better when taken with food.”
b.
“Avoid driving your car after you have taken this medication.”
c.
“Monitor of your activities, especially ambulation.”
d.
“Don’t take this medication if you take omega-3 supplements.”

The nurse understands which of the following about chloral hydrate?

a.
short duration of action, rarely produces a hangover feeling
b.
long duration of action, often produces a hangover feeling
c.
short duration of action, usually produces a hangover feeling
d.
long duration of action, rarely produces a hangover feeling

When discussing the use of nonprescription sleep aids, the nurse should instruct clients that:

a.
these medications are only effective if taken nightly for at least two weeks.
b.
you should not take these medications if you have a heart condition.
c.
talk with your doctor if insomnia lasts longer than two weeks.
d.
be sure to ask your doctor which sleep aid is preferred.

When used as hypnotics, some barbiturates lose their effectiveness after ____ of regular use.

a.
two weeks
b.
three months
c.
three days
d.
six months

Parenteral pentobarbital should be administered with care because:

a.
intramuscular abscesses are common.
b.
infiltration can cause tissue necrosis
c.
it can cause sedation.
d.
it has a high incidence of phlebitis.

16. The nurse understands that a client benefit of using benzodiazepams as preprocedural or conscious sedation is:

a.
they don’t cause respiratory depression.
b.
using them is less expensive than anesthesia.
c.
they produce very few adverse effects.
d.
they produce amnesia for the event.

The nurse understands that which is true of alcohol?

a.
It should never be used in the elderly.
b.
It will not produce sedation, regardless of the client’s age.
c.
It is a potent central nervous system depressant.
d.
It is a potent facilitator for other CNS stimulants.

A nurse suspects barbiturate toxicity in assessing which of the following client manifestations?

a.
warm dry skin
b.
hypertension
c.
redness to the skin
d.
sustained pupillary constriction

After instructing the client prescribed zolpidem tartrate, which of the following comments by the client indicates his understanding of the teaching?

a.
“I need to have a follow-up visit with my doctor in a week.”
b.
“If I take a nap during the day, the medication will work better at bedtime.”
c.
“If I can’t sleep after taking one pill, I can take another one.”
d.
“I can buy this medication without a prescription.”

When evaluating a client receiving 75 mg of trazodone each night for sleep, the client tells the nurse that she is experiencing insomnia again in spite of taking the trazodone. The nurse anticipates that the health care provider will:

a.
change the client’s medication to phenobarbital.
b.
increase the dose of trazodone to 100 mg each night.
c.
decrease the dose of trazodone, because it is causing excitation.
d.
prescribe a placebo for this client.

When instructing a client using nonprescription sleep aids, the nurse should instruct the client to:

a.
avoid alcohol.
b.
drink plenty of fluids with these
c.
eat a high-fiber diet.
d.
limit salt intake while taking these.

The nurse should question a prescription for triazolam for which client?

a.
a client following bladder surgery
b.
a medical client with heart failure
c.
a psychiatric client
d.
a postpartum mother

The client who abruptly discontinues using trazolam should be monitored for:

a.
rebound insomnia.
b.
“hangover” effect
c.
anterograde amnesia.
d.
substance abuse.

The nurse understands that the nonbenzodiazepam medications are limited to use in clients:

a.
on short-term therapy.

b.
who can no longer be treated with benzodiazepams.
c.
who are 18 years old or older.
d.
with chronic insomnia.

Situational anxiety exists when a stressful or threatening occurrence provokes an anxious response
True False

Pathologic anxiety can usually be related to a specific cause or event.
True False

Even a moderate amount of anxiety is detrimental to a person’s normal functioning.
True False

Antianxiety agents (anxiolytics) are sometimes referred to as “minor tranquilizers.”
True False

Most benzodiazepines are metabolized primarily by microsomal enzymes in the liver.
True False

Buspirone has been prescribed for the client. The nurse knows the optimum therapeutic response should be achieved in:

a.
one to two days.
b.
two to four days
c.
one to two weeks
d.
three to four weeks.

The nurse understands which of the following is true regarding antidepressant drugs:

a.
higher initial doses are often required in elderly clients.
b.
the client should be started on a single, daily dose.
c.
antidepressants can cause constipation and urinary retention.
d.
antidepressant drugs do not exert both peripheral and central anticholinergic actions.

Antidepressant therapy should not be used on a p.r.n. basis because:

a.
undesirable side effects are more likely to occur.
b.
it is difficult to achieve client cooperation when dosing is irregular.
c.
therapeutic effects of therapy may not be evident for two to three weeks.
d.
clients may not know when they are needed.

In addressing deficient knowledge about treatment of mental illness, the nurse should:

a.
suggest potential benefits of antipsychotic medications.
b.
inform the client that many people recover from mental illness.
c.
inform the client that most people achieve control of illness through use of medication.
d.
teach the client about the process of self-adjustment of medications.

In evaluating a client on anxiolytics for the presence of therapeutic effects, which of the following would indicate a positive response?

a.
decreased frequency of seizures
b.
increased blood pressure
c.
improved muscular rigidity
d.
decreased pulse rate

Successful resolution of the goal related to deficient knowledge of the client receiving alprazolam would be:

a.
Client asks appropriate questions of the nurse regarding self-administration of alprazolam as prescribed.
b.
Client does not sustain injury resulting from alprazolam therapy.
c.
Client remains compliant with alprazolam therapy.
d.
Client verbalizes understanding of anxiolytic medication, adverse effects, and the need for compliance.

The client prescribed fluoxetine refuses to take the medication after three days, stating the medication is causing him to be drowsy “even during the day.” The best response by the nurse is:

a.
“These initial side effects can be difficult, but they generally decrease with continued use of the medication.”
b.
“These side effects are serious. You should stop taking the medication.”
c.
“I’ll inform your health care provider that you no longer want to take this medication.”
d.
“Prozac is prescribed for a serious psychiatric disorder; therefore, you cannot refuse to take this medication.”

In caring for a client on lithium therapy, the nurse should:

a.
encourage the client to avoid sodium-based beverages.
b.
instruct the client to consume foods low in sodium.
c.
assess the client for use of diuretics.
d.
instruct significant others to monitor client’s vital signs daily at home.

A client receiving amitriptylin has achieved the desired dosage level. The nurse should instruct the client to:

a.
always take at bedtime.
b.
do not take with food or drugs containing tyramine.
c.
do not take in the evening.
d.
never use in combination with diuretics.

When teaching a client taking lithium about dietary intake of fluids, the nurse should instruct the client to limit intake of:

a.
fruit juices.
b.
caffeinated beverages
c.
sugar-containing beverages.
d.
artificially sweetened beverages.

If a once-daily dose of an antipsychotic medication has inadvertently been skipped, the client should be instructed to:

a.
call the health care provider immediately.
b.
double the dose of the medication for the next day.
c.
do nothing except take the next daily dose as prescribed.
d.
take one-half the normal dose the next day and the full dose thereafter.

The nurse would provide education to the client about decreasing the occurrence of orthostatic hypotension by stating:

a.
“Rise slowly in the morning.”
b.
“Do not abruptly stop taking your medication.”
c.
“Wear elastic stockings at all times.”
d.
“Eat a high-carbohydrate snack at night.”

The nurse has taught the client about the importance of not abruptly discontinuing anxiolytic medications. The nurse believes that the client understands the concepts when the client is able to verbalize which of the following symptoms of withdrawal?

a.
abrupt onset of seizures, hypertension
b.
insomnia, weakness, and irritability
c.
increased hunger, headache
d.
nausea, vomiting, drowsiness

When teaching a client taking clozapine, the nurse should include:

a.
restrict your fluid intake.
b.
increase your exercise level.
c.
avoid sunscreen products.
d.
avoid direct sunlight.

A client taking an anxiolytic drug should avoid the simultaneous use of:

a.
antihypertensives.
b.
central nervous system depressants.
c.
B-complex vitamins.
d.
ascorbic acid supplements.

A client who has been taking an anxiolytic comes to the clinic with the following signs and symptoms: nausea and vomiting, headache, anxiety, irritability, muscle tremors, and insomnia. The nurse should consider that the client may be experiencing:

a.
drug overdose.
b.
sudden drug withdrawal
c.
an idiosyncratic reaction to the drug.
d.
a hypersensitivity reaction to the drug.

The health care provider prescribes flumazenil for a client receiving a benzodiazepine. The nurse assesses the client for manifestations of:

a.
psychotic response to the benzodiazepine.
b.
toxic manic reaction to the benzodiazepine.
c.
abrupt withdrawal of benzodiazepine.
d.
benzodiazepine-induced CNS depression.

The client taking an antipsychotic agent complains of dry mouth and nasal congestion. The nurse understands that these manifestations indicate:

a.
a toxic response to the medication.
b.
anticholinergic effects
c.
a hypertensive crisis.
d.
extrapyramidal symptoms (EPS).

Tardive dyskinesia is most likely to develop in clients on antipsychotic drugs:

a.
when drug doses are increased.
b.
within the first three weeks of therapy. c.
when long-term therapy is discontinued.
d.
when the client exhibits episodes of depression.

A client is receiving pheneizine sulfate for his affective disorder. The nurse should instruct the client to avoid which of the following foods?

a.
pork chops
b.
chicken livers
c.
saltine crackers
d.
canned peaches

A client receiving antipsychotic therapy experiences a paradoxical reaction. The nurse should:

a.
change administration to every other day.
b.
change administration to twice per day.
c.
assist the client to a supine position.
d.
hold the next dose and notify the health care provider.

A client receiving lithium has a serum lithium level of 0.8 mEq/L. The nurse should:

a.
plan to administer the next dose.
b.
notify the health care provider immediately.
c.
monitor the client for hypotension.
d.
Monitor the client for hyperreflexia.

The client receiving clozapine asks the nurse why she needs weekly blood tests. The nurse’s best response is:

a.
“Clozapine can cause a blood disorder, so we monitor you weekly to detect it early.”
b.
“We routinely do weekly blood tests on clients receiving antipsychotic medications.”
c.
“It is nothing to be concerned about, but be sure to keep your weekly appointments.”
d.
“I really don’t know, but we can ask your doctor at your next visit.”

Which of the following benzodiazepines would be most appropriate to administer to an elderly client?

a.
doxepin
b.
oxazepam
c.
alprazolam
d.
phenelzine

A client is experiencing an extrapyramidal symptom. Which of the following is an EPS?

a.
clonic seizure
b.
peptic ulceration
c.
akathisia
d.
hypertension

The health care provider prescribes sertraline to a client for depression. The nurse understands that this agent acts as a/an:

a.
monoamine oxidase inhibitor.
b.
selective serotonin reuptake inhibitor (SSRI).
c.
benzodiazepine.
d.
tricyclic antidepressant.

Clients using a monoamine oxidase (MAO) inhibitor should avoid the use of:

a.
oral decongestants.
b.
multivitamin products
c.
aspirin.
d.
laxatives.

The client who is prescribed tranylcypromine sulfate must be cautioned against incorporation of which of the following foods into the diet?

a.
milk
b.
potatoes
c.
cheddar cheese
d.
oranges

When administering and monitoring medications given to clients for psychiatric disorders, the nurse should anticipate:

a.
Most of these clients are too ill to take their medication without assistance.
b.
Compliance issues are common in these clients.
c.
The need to teach the client that all side effects resolve with time.
d.
Most of these clients do not have support systems.

When caring for a client receiving risperidone, the nurse should:

a.
monitor the client for anemia.
b.
monitor the client’s vital signs
c.
monitor the client’s triglyceride level.
d.
monitor the client’s blood glucose.

When caring for a client receiving olanzapine, the nurse should:

a.
instruct the client to restrict sodium intake.
b.
encourage the client to exercise at least four times a week.
c.
monitor the client’s cholesterol levels.
d.
monitor the client’s dietary intake.

When caring for a hospitalized client prescribed paroxetine, the nurse should:

a.
provide assistance with ambulation.
b.
assign a nursing assistant to feed the client.
c.
closely monitor the client’s urinary output.
d.
restrict use of opioids for pain management.

During a follow-up office visit of a male client taking an antidepressant, the client tells the nurse that, “since I started taking this medication I haven’t been able to get an erection.” The nurse’s best response is:

a.
“You really need to be compliant with your medications.”
b.
“We’ll talk to your doctor about changing your medication.”
c.
“Weren’t you told that this could be a side effect of your medication?”
d.
“I’ll talk to your doctor before your next appointment, to see if anything can be done.”