Cns Depressants + Stim

Question 1

What are the 5 stages of sleep?

Answer 1

-Non- REM sleep-

Stage 1: Dozing 2-5% of normal sleep (those with insomnia have longer stage 1)

Stage 2: Relaxed but person can be easily awakened – 50% of sleep

Stage 3: Deep Sleep – BP, HR may decrease (5% of sleep)

Stage 4: Difficult to wake – dreaming occurs (10-15% of sleep)

-REM Sleep-
Vivid dreams; irregular breathing (25-33%)

Question 2

What drug class is Used for severe anxiety, insomnia, substance use withdrawal, seizure disorders, skeletal muscle
relaxation, as adjuncts during surgery, among others

Answer 2

Benzodiazepines

Zolpiedem tartate (ambien)
Zopiclone (iMovane)

Question 3

What is the site of action for serotonin agonists?

A) cerebrovascular system (5-ht receptors)

B) cerebral cortex

C) hypothalamic and limbic regions

D) medulla and brain stem

Answer 3

A) cerebrovascular system (5-ht receptors)

Question 4

What is the site of action for anorexiants?

A) cerebrovascular system (5-ht receptors)

B) cerebral cortex

C) hypothalamic and limbic regions

D) medulla and brain stem

Answer 4

C) hypothalamic and limbic regions

Question 5

What is the site of action for amphetamines, modafinil, and phenidates?

A) cerebrovascular system (5-ht receptors)

B) cerebral cortex

C) hypothalamic and limbic regions

D) medulla and brain stem

Answer 5

B) cerebral cortex

Question 6

What is the site of action for analeptics (caffeine, -phylline’s)

A) cerebrovascular system (5-ht receptors)

B) cerebral cortex

C) hypothalamic and limbic regions

D) medulla and brain stem

Answer 6

D) medulla and brain stem

Question 7

Match the trade name to the generic

-atomoxetine hydrochloride
-amphetamine aspartame monohydrate
-methylphenidate hydrochloride

-adderall
-strattera
-concerta/Ritalin

Answer 7

-atomoxetine hydrochloride (strattera)

-amphetamine aspartame monohydrate (adderall)

-methylphenidate hydrochloride (concerta/ritalin)

Question 8

-FILL IN THE BLANK

-Triptans, also known as serotonin receptor agonists, work by stimulating serotonin receptors in the brain
and are a common mainstay for the treatment of _________ _________.

-Known as triptans because all the triptans end in “-triptan”

Answer 8

migraine headaches.

Question 9

What are the 3 anti-epileptic drugs known as the first line defense

Answer 9

Barbiturates (phenobarbital)

Hydantoins (phenytoin)

Iminostillbenes (carbamazepine)

Question 10

True or false:

Iminostilbenes are indicated for the management of tonic -clonic and focal seizures

Answer 10

False

Hydatoins are indicated for this use

Question 11

What are the indications for GABA analogs

Answer 11

Medication examples: gabapentin (Neurontin); pregabalin (Lyrica)

-Multiple indications, including adjunctive treatment for seizures; chronic pain; pruritis; restless
leg syndrome, among others

-Common adverse effects include: weight gain, peripheral edema, dry mouth, dizziness,
drowsiness, vision changes, constipation, appetite increase; potential for misuse; potential for
withdrawal effects

Question 12

A client has a seizure disorder and is taking phenytoin sodium (Dilantin) regularly. Answer the following questions:
1. The client is complaining his “gums are overgrown” and is uncomfortable when he eats food. What is the Nurse’s main concern?

2. The client asks the Nurse if he can drink Alcohol when taking this medication. How should the
   Nurse respond?
3. The client has primary hypertension and is taking Amlodipine to help control his blood pressure.
   Why would the Nurse be concerned with this combination?
4. The client reports Right upper quadrant pain. The Nurse notices his ALT, and ALP are both elevated
   >3x the upper limit. What would the Nurse be concerned about?

Answer 12

1. Main concern is gingival hyperplasia (gum overgrowth caused by the drug)
2. The drug and alcohol interact potentially increasing the risk of side effects and decreasing the effectiveness of the medication
3. Dilantin may increase the metabolism of amlodipine therefore decreasing its effectiveness.
4. Don’t stop pills abruptly as it could really increase the risk of a seizure recurrence
5. We would be concerned with possible liver toxicity of damage as a result from the drug

Question 13

A patient has been admitted to the emergency department, because of an overdose of an oral benzodiazepine. He is extremely drowsing, but still responsive. The nurse will prepare for which immediate intervention?

A) administration of flumazenil

B) administration of naloxone

C) intubation and mechanical ventilation

D) hemodialysis to remove the drug from bloodstream

Answer 13

A) administration of flumazenil

Naloxone doesn’t work on benzos

Question 14

An older adult has been given a barbiturate for sleep induction, but the night nurse noted the patient was awake most of the night, watching tv, reading in bed. The nurse documents the patient had what type of reaction to the medication?

A) allergic

B) teratogenic

C) paradoxical

D) idiopathic

Answer 14

C) paradoxical

Question 15

The nurse is preparing to administer a medication for sleep. Which intervention applies to the administration of a non-benzodiazepines, such as tartrate (sublinox)

A) these drugs need to be taken about 1 hour before bed time

B) because of their rapid onset, these drugs need to be taken just before bedtime

C) the patient needs to be cautioned about the high incidence of morning drowsiness that may occur after taking these drugs

D) these drugs are less likely to interact with alcohol

Answer 15

The correct answer is:

B) Because of their rapid onset, these drugs need to be taken just before bedtime.

Non-benzodiazepine sleep medications, such as tartrate (Sublinox), are known for their fast-acting properties. They are designed to be taken just before bedtime, as they work quickly to induce sleep. It is important for the nurse to follow the recommended dosing instructions and administer the medication at the appropriate time to ensure its maximum effectiveness in helping the patient fall asleep. This intervention ensures that the medication is timed appropriately to align with the patient’s desired sleep schedule

Question 16

For a patient taking a muscle relaxant the nurse will monitor for which adverse effect?

A) CNS depression

B) hypertension

C) peripheral Edema

D) blurred vision

Answer 16

The correct answer is A) CNS depression.

Muscle relaxants are medications that are commonly used to treat conditions such as muscle spasms, muscle strains, and musculoskeletal injuries. They work by reducing muscle tone and relaxing muscles, which can result in various effects on the central nervous system (CNS).

One of the main adverse effects of muscle relaxants is CNS depression, which refers to a decrease in the functioning of the central nervous system. This can cause symptoms such as drowsiness, sedation, impaired coordination, and slowed reflexes. It is important for nurses to monitor patients taking muscle relaxants for signs of CNS depression, as it can impair their ability to perform activities that require alertness, such as driving or operating machinery, and may increase the risk of falls or accidents.

Question 17

A hospitalized patient is reporting having difficulty sleeping. Which action will the nurse take first to address this problem?

A) administer a sedative- hypnotic drug, if ordered

B) offer tea made with herbal preparation valerian

C) encourage patient to exercise by walking up and down the halls a few times, if tolerated.

D) provide a restful environment and reduce loud noises.

Answer 17

D) provide a restful environment and reduce loud noises

Question 18

Which considerations are important for the nurse to remember when administering a benzodiazepine as a sedative- hypnotic drug (sata)

A) these drugs are intended for long-term management of insomnia.
B) The drugs can be administered safely with other CNS depressants for insomnia.
C) The dose needs to be given one hour before the patient’s bedtime.
D) The drug is used as a first choice treatment for sleeplessness.
E) The patient needs to be evaluated for the drowsiness that may occur in the morning after a benzodiazepine is taken.

Answer 18

The correct options are:

C) The dose needs to be given one hour before the patient’s bedtime.
E) The patient needs to be evaluated for the drowsiness that may occur in the morning after a benzodiazepine is taken.

Question 19

The patient wanted a sleeping pill and the surgeon wrote a prescription for Ambien, 10 mg at bedtime as needed for sleep. What is the nurses priority action at the time?

A) Review the potential adverse effects with the patient.

B) Suggest that the patient tried drinking a glass of wine at bedtime.

C) Contact the prescriber to question the dose of Ambien.

D) Assist the patient to find a pharmacy to fill the prescription on her way home.

Answer 19

A) Review the potential adverse effects with the patient

Question 20

A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see what adverse effect?

A) Bradycardia

B) nervousness

C) mental clouding

D) drowsiness at night

Answer 20

B) nervousness

Question 21

A patient at a weight management clinic who was given a prescription for orlistat (Xenical) calls the clinic hotline because of a “Terrible adverse effect” the nurse suspects the patient is referring to which problem?

A)nausea
B) sexual dysfunction
C) urinary dysfunction
D) imbalanced nutrition, more than bodily requirements

Answer 21

A)nausea

Question 22

The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is the most appropriate?
a. Inadequate fluid volume
b. Sleep deprivation
c. Reduced memory
d. Imbalanced nutrition, more than body requirements

Answer 22

The most appropriate nursing diagnosis for a patient receiving an anorexiant would be:

d. Imbalanced nutrition, more than body requirements

An anorexiant is a medication that helps suppress appetite, which can lead to reduced intake of food and subsequent weight loss

Question 23

A patient has a new prescription for sumatriptan succinate (Imitrex). The nurse providing patient teaching on self-ad- ministration will include which information?
a. Correct technique for intramuscular injections
b. Take the medication before the headache worsens
c. Allow at least 30 minutes between injections
d. Take no more than 4 doses in a 24-hour period

Answer 23

b. Take the medication before the headache worsens

Question 24

The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan succinate (Imitrex) as part of
treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy?
a. Cardiovascular disease
b. Chronic bronchitis
c. History of renal calculi
d. Diabetes mellitus type 2

Answer 24

a. Cardiovascular disease

Cardiovascular disease may be a contraindication to triptan therapy, including sumatriptan succinate (Imitrex), as it can increase the risk of adverse cardiovascular events. Triptans work by constricting blood vessels in the brain, and they can also cause constriction of blood vessels in other parts of the body, including the heart and blood vessels

Question 25

The nurse is reviewing medication therapy with the parents
of an adolescent with ADHD. Which statement(s) is/are correct? (Select all that apply.)
a. “Be sure to have your child blow his nose before adminis-
tering the nasal spray.”
b. “This medication is used only when symptoms of ADHD
are severe.”
c. “The last dose should be taken 4 to 6 hours before bed-
time to avoid interference with sleep.”
d. “Be sure to contact the physician right away if you notice
expression of suicidal thoughts.”
e. “We will need to check your child’s height and weight
periodically to monitor physical growth.”
f. “If adverse effects become severe, stop the medication for
3 to 4 days.”

Answer 25

The correct statements are:

a. “Be sure to have your child blow his nose before administering the nasal spray.”

c. “The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep.”

d. “Be sure to contact the physician right away if you notice expression of suicidal thoughts.”

e. “We will need to check your child’s height and weight periodically to monitor physical growth.”

Statement b is incorrect, as medication therapy for ADHD is typically used as part of a comprehensive treatment plan and not only for severe symptoms. Medication for ADHD is usually prescribed based on the severity of the symptoms, overall health status of the patient, and other individual factors, as determined by the healthcare provider.

Statement f is also incorrect, as stopping medication abruptly without consulting the healthcare provider can result in withdrawal effects or recurrence of symptoms. Any changes to the medication regimen should be discussed with the healthcare provider.

Question 26

A patient with narcolepsy is having problems with excessive
daytime sleepiness. The nurse expects which drug to be pre- scribed to improve the patient’s wakefulness?
a. phentermine (Ionamin)
b. almotriptan (Axert)
c. modafinil (Provigil)
d. methylphenidate (Ritalin)

Answer 26

c. modafinil (Provigil)

Question 27

The nurse is reviewing the drugs currently taken by a patient who will be starting drug therapy with carbamazepine (Tegretol). Which drug may raise a concern for interactions? a. digoxin (Lanoxin®)
b. acetaminophen (Tylenol®)
c. diazepam (Valium)
d. warfarin sodium (Coumadin®)

Answer 27

a. digoxin (Lanoxin®)

Digoxin is a medication used to treat heart failure and certain heart rhythm abnormalities. Carbamazepine (Tegretol) is known to interact with several medications, including digoxin, potentially leading to decreased effectiveness or increased side effects of either medication

Question 28

1. The nurse is preparing to give medications. Which of the following is the most appropriate nursing action for intrave- nous (IV) phenytoin (Dilantin)?
   a. Give IV doses via rapid IV push.
   b. Administer in normal saline solutions.
   c. Administer in dextrose solutions.
   d. Ensure continuous infusion of drug

Answer 28

b. Administer in normal saline solutions.

The most appropriate nursing action for IV phenytoin (Dilantin) is to administer it in normal saline solutions. Phenytoin is not compatible with dextrose solutions, as it can precipitate and become ineffective. Additionally, IV phenytoin should not be given as a rapid IV push, as it can cause cardiovascular adverse effects

Question 29

Which response would the nurse expect to find in a patient with a phenytoin (Dilantin) level of 35 mcg/L?
a. Ataxia
b. Hypertension
c. Seizures
d. No unusual response; this level is therapeuti

Answer 29

a. Ataxia

Phenytoin (Dilantin) is an antiepileptic medication used to treat and prevent seizures. Therapeutic drug monitoring, including measuring blood levels of phenytoin, is commonly performed to ensure that the medication is within the therapeutic range and to minimize the risk of adverse effects. The therapeutic range for phenytoin levels is typically between 10 to 20 mcg/L for most patients

Question 30

4. A patient is taking pregabalin (Lyrica) but does not have a history of seizures. The nurse recognizes that this drug is also
   indicated for which of the following?
   a. Postherpetic neuralgia
   b. Viral infections
   c. Parkinson’s disease
   d. Depression

Answer 30

a. Postherpetic neuralgia

Question 31

The nurse is assessing a newly admitted patient who has a
history of seizures. During the assessment, the patient has
a generalized seizure that does not stop for several minutes. The nurse expects that which drug will be ordered for this condition?
a. valproic acid (Depakote®)
b. gabapentin (Neurontin)
c. carbamazepine (Tegretol)
d. lorazepam (Ativan)

Answer 31

d. lorazepam (Ativan)

Question 32

8. The nurse is providing education for a patient who will be taking an AED for the first time. Which statement by the patient indicates that further teaching is indicated?
   a. “I will take the medicine at the same time every day.”
   b. “I will check with my doctor before taking any over-the- counter drugs.”
   c. “I will keep the appointments to check my bloodwork.”
   d. “I can drive to work again once my drug levels are normal.

Answer 32

d. “I can drive to work again once my drug levels are normal.”

This statement indicates a misunderstanding about the effects of anti-epileptic drugs (AEDs). AEDs are prescribed to control seizures and prevent their recurrence, but they do not necessarily normalize drug levels in the blood. Driving restrictions for patients taking AEDs are usually based on factors such as the type and frequency of seizures, response to treatment, and relevant laws and regulations in the patient’s jurisdiction.

Question 33

6. The nurse is administering an AED and will follow which guidelines? (Select all that apply.)
   a. Monitor the patient for drowsiness.
   b. Stop medications if seizure activity disappears.
   c. Give the medication at the same time every day.
   d. Give the medication on an empty stomach.
   e. Notify the prescriber if the patient is unable to take the
   medication

Answer 33

Right
a. Monitor the patient for drowsiness.
c. Give the medication at the same time every day.
e. Notify the prescriber if the patient is unable to take the medication.

Wrong
b. Stop medications if seizure activity disappears - This statement is not accurate. AEDs should not be stopped abruptly without consulting the healthcare provider, even if seizure activity disappears. Abrupt discontinuation of AEDs can lead to rebound seizures or withdrawal symptoms.

d. Give the medication on an empty stomach - This statement is not accurate. Whether AEDs should be given on an empty stomach or with food depends on the specific medication and its instructions. Some AEDs are recommended to be taken with food to minimize potential gastrointestinal side effects, while others may be taken on an empty stomach. The nurse should follow the specific instructions provided by the prescriber or the medication’s package insert for proper administration.