Mod 14- Anxiolytic and Hypnotic Agents

Question 1

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?

Answer 1

Correct response:
eszopiclone
Explanation:
Eszopiclone (Lunesta) is a newer medication commonly prescribed to treat insomnia.

Question 2

How should the nurse explain the major difference between normal and abnormal anxiety?

Answer 2

Abnormal anxiety is prolonged and impairs normal function.

Question 3

After reviewing the various drugs that are classified as barbiturates, a student demonstrates understanding when identifying which as the prototype?

Answer 3

Phenobarbital

Question 4

In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?

Answer 4

Decreased cardiac workload
Explanation:
Antianxiety and sedative–hypnotic drugs are often useful in critically ill clients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort.

Question 5

A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The client asked the nurse how this medication will affect his job. The nurse would advise him how?

Answer 5

avoid driving until he is aware of the adverse effects

Question 6

Which action by the new nurse would alert the charge nurse that more education is needed for the new nurse, after administering an anxiolytic to a client?

Answer 6

Having the client walk to the bathroom

Question 7

The nurse is caring for a client who has been prescribed oxazepam. What statement by the client would suggest an increased risk of CNS depression to the nurse?

Answer 7

“I take an over-the-counter antihistamine each day for my allergies.”

Question 8

A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for:

Answer 8

respiratory disturbances and partial airway obstruction.

Question 9

A nurse is caring for a patient who has just been transported to the operating room. Twenty minutes prior to leaving for the operating room, this patient was medicated with topical promethazine. What is the rationale for giving promethazine prior to surgery?

Answer 9

Anxiety, nausea, and vomiting

Question 10

A client is prescribed an anxiolytic agent. What would be most important for the nurse to include in the teaching?

Answer 10

Correct response:
“Be sure not to stop the drug abruptly.”
There is a risk for withdrawal if anxiolytics, both benzodiazepines and barbiturates, are stopped abruptly.

Question 11

A client is receiving a barbiturate intravenously. The nurse would monitor the client for:

Answer 11

bradycardia.
Explanation:
When given intravenously, barbiturates can result in bradycardia, hypotension, hypoventilation, respiratory depression, and laryngospasm.

Question 12

A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform?

Answer 12

Provide respiratory assistance
Explanation:
The nurse must provide respiratory assistance to the patient showing symptoms of barbiturate toxicity. Providing assistance with movement, supportive care, and a safe environment are suggested for patients at risk for injury due to drowsiness or impaired memory.

Question 13

The medication nurse knows that when benzodiazepines are used with opioid analgesics, the analgesic dose should be adjusted in which way?

Answer 13

It should be reduced initially and increased gradually.
Explanation:
When benzodiazepines are used with opioid analgesics, the analgesic dose should be reduced initially and increased gradually to avoid excessive CNS depression.

Question 14

A client with a high-pressure job temporarily requires an anxiolytic that has no sedative properties. What medication is most likely to meet this client’s needs?

Answer 14

Buspirone
Explanation:
Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety.

Question 15

A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam?

Answer 15

Induces sleep

Question 16

A client has been prescribed a benzodiazepine daily for treatment of an anxiety disorder. In order to minimize the chances of withdrawal symptoms, the nurse knows to include what precaution in client teaching?

Answer 16

Tapering the dose of drug over a prolonged period of time

Question 17

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?

Answer 17

anxiety

Question 18

A client’s medication regimen for treatment of anxiety has been changed from a benzodiazepine. The client asks the nurse what likely prompted the health care provider to change the medication. What is the nurse’s best response?

Answer 18

“Long-term use of benzodiazepines can result in dependency.”

Question 19

The nurse gives a 68-year-old client diphenhydramine to help the client sleep the night before surgery. At midnight, the nurse notes the client is awake and agitated. What pharmacologic principle would be the cause of this reaction?

Answer 19

paradoxical excitement, which is the opposite reaction than what was expected

Question 20

A 70-year-old male client asks why he is receiving a lower dose of zaleplon than his son. As part of the nurse’s teaching plan, which explanation will the nurse give this client?

Answer 20

“Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults.”

Question 21

A nurse should recognize which as common early reactions caused by anxiolytics? (Select all that apply.)

Answer 21

Headache
Sedation
Light-headedness
Dizziness

Question 22

One week ago, a 74-year-old was started on a benzodiazepine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication?

Answer 22

paradoxical excitement

Question 23

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?

Answer 23

Difficulty falling asleep at night

Question 24

An adult client with a diagnosis of alcoholism is to be treated with chlordiazepoxide on an in-client basis. When administering chlordiazepoxide, the nurse should implement which client-focused intervention?

Answer 24

Monitoring vital signs closely during intravenous (IV) administration

Question 25

The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse’s best response?

Answer 25

Correct response:
Monitor for increased signs of confusion or forgetfulness.
Explanation:
Recent studies link the chronic use of benzodiazepines by those over 65 years of age to a greater chance of developing dementia.

Question 26

A 75-year-old client is brought to the emergency department by the family. The family relates that the client has confusion, seizures, and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED, the nurse discovers that twice the number of tablets are missing from the vial as there should be if the prescription orders were being followed. What should the nurse suspect is wrong with this client?

Answer 26

Benzodiazepine toxicity

Question 27

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetidine and a sedative to calm the client. What should the nurse be concerned about?

Answer 27

Increased sedative effect
Explanation:
An increased sedative effect may occur when a sedative is given with cimetidine for gastric upset

Question 28

Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics?

Answer 28

Less central nervous system depression
Explanation:
Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the client needs to be alert such as when driving or working.

Question 29

A group of nursing students answers correctly if they identify which medication as the prototype benzodiazepine?

Answer 29

Diazepam

Question 30

Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?

Answer 30

Falls