Chapter 34-Sadative,Hypnotic Drugs

Question 1

1. 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?
   a.
   “Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia.”
   b.
   “Benzodiazepines depress neuronal functions by acting at a single site in the brain.”
   c.
   “Benzodiazepines induce muscle relaxation by acting on sites outside the central nervous system.”
   d.
   “Benzodiazepines promote sleep through effects on the limbic system.”

Answer 1

A

Question 2

2. 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:
   a.
   does not depress the central nervous system.
   b.
   shows no respiratory depression, even in toxic doses.
   c.
   mimics the actions of a central nervous system inhibitory neurotransmitter.
   d.
   potentiates endogenous gamma-aminobutyric acid (GABA) producing a finite CNS depression.

Answer 2

D

Question 3

3. 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?
   a.
   “Benzodiazepines commonly cause residual effects lasting into the day after the dose is given.”
   b.
   “The patient is having a paradoxical reaction to this medication.”
   c.
   “This patient must have developed a previous tolerance to benzodiazepines.”
   d.
   “When this drug is metabolized, the resulting compound has longer-lasting effects.”

Answer 3

D

Question 4

4. A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:
   a.
   the alcohol does not interact with the benzodiazepine.
   b.
   the benzodiazepine potentiates alcohol withdrawal symptoms.
   c.
   the benzodiazepine relieves muscle spasms and spasticity.
   d.
   the patient has a cross-dependence to the benzodiazepine.

Answer 4

D

Question 5

5. 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?
   a.
   Ask the patient about any alcohol consumption in conjunction with the benzodiazepine.
   b.
   Contact the prescriber to request an order for a benzodiazepine with a shorter duration.
   c.
   Reassure the patient that this is most likely caused by a paradoxical reaction to the benzodiazepine.
   d.
   Tell the patient that this is an example of anterograde amnesia, which is an expected effect of the benzodiazepine.

Answer 5

A

Question 6

6. A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?
   a.
   Double-check the chart to make sure the last dose was given.
   b.
   Request an order for a longer-acting benzodiazepine.
   c.
   Suspect a possible paradoxical reaction to the clorazepate.
   d.
   Withhold the next dose until a drug level can be drawn.

Answer 6

C

Question 7

7.	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 per minute. The nurse will expect to administer which of the following?
a.
Flumazenil [Romazicon]
b.
Gastric lavage
c.
Respiratory support
d.
Toxicology testing

Answer 7

C

Question 8

8. A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?
   a.
   A central nervous system stimulant and IV fluids
   b.
   Activated charcoal and flumazenil [Romazicon]
   c.
   Maintaining adequate oxygenation to the brain
   d.
   Naloxone [Narcan] and a cathartic

Answer 8

C

Question 9

9.	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?
a.
Flurazepam
b.
Trazodone [Desyrel]
c.
Zaleplon [Sonata]
d.
Zolpidem [Ambien]

Answer 9

C

Question 10

10. 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.
    “Phenobarbital doses for seizures are nonsedating.”
    b.
    “This is a short-acting barbiturate, so sedation wears off quickly.”
    c.
    “Tolerance to the sedative effects will develop in a few weeks.”
    d.
    “You may actually experience paradoxical effects of euphoria.”

Answer 10

A

Question 11

11. A patient with a history of depression and suicidal ideation is taking fluoxetine [Prozac]. The patient reports difficulty maintaining sleep and is prescribed secobarbital [Seconal] as a sedative-hypnotic. The nurse preparing this patient for discharge from the hospital will:
    a.
    contact the provider to suggest an order for ramelteon [Rozerem].
    b.
    instruct the patient to use alcohol in moderation.
    c.
    request an order to change to trazodone [Desyrel] for sleep.
    d.
    suggest that the patient try alternative remedies for sleep.

Answer 11

C

Question 12

12.	A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be:
a.
alternative medications.
b.
improved sleep hygiene.
c.
short-term barbiturates.
d.
triazolam [Halcion].

Answer 12

B

Question 13

13. A patient complains of chronic insomnia and reports being tired of being tired all the time. The patient is reluctant to try pharmacologic remedies and asks the nurse what to do. What will the nurse suggest?
    a.
    “Eat a large meal in the evening to induce drowsiness.”
    b.
    “Get out of bed for a while if you can’t fall asleep.”
    c.
    “Have a glass of wine at bedtime to relax.”
    d.
    “Take a short nap early in the afternoon every day.”

Answer 13

B

Question 14

1.	A nurse recognizes that the actions of benzodiazepines include which findings? (Select all that apply.)
a.
Sleep deprivation
b.
Relief of general anxiety
c.
Suppression of seizures and/or seizure activity
d.
Development of tardive dyskinesia
e.
Increase in muscle spasms

Answer 14

B. C.

Question 15

2.	Which sedative-hypnotics are useful for both difficulty falling asleep and difficulty maintaining sleep? (Select all that apply.)
a.
Eszopiclone [Lunesta]
b.
Flurazepam [Dalmane]
c.
Temazepam [Restoril]
d.
Triazolam [Halcion]
e.
Extended-release zolpidem [Ambien CR]

Answer 15

A. B. E.