Unit 5 Pharm Chapter 20 Flashcards
A client is to receive diazepam as part of the treatment for status epilepticus. The client has a peripheral intravenous infusion in the left arm that is being used to administer phenytoin. Which action would be most appropriate for the nurse to do?
A) Add the diazepam to the current IV infusion.
B) Contact the prescriber to question the order.
C) Wait until the infusion is completed to give the diazepam.
D) Start another IV line in the client’s right arm.
D) Start another IV line in the client’s right arm.
Rationale:When giving diazepam IV, it should not be mixed in solution with any other drugs. It would be best to start an IV in another site such as the opposite arm so that the client can receive the full benefits of both drugs. Notifying the prescriber that the diazepam cannot be given or waiting until the other drug is completed before giving the diazepam is inappropriate and could result in further seizure activity. Adding it to the current infusion is inappropriate because potentially serious drug–drug interactions can occur.
The nurse is reviewing the signs and symptoms of benzodiazepine withdrawal with a client who has taken diazepam daily for several years. The nurse should describe what possible effects of benzodiazepine withdrawal? Select all that apply.
A) Urinary retention
B) Depression
C) Nightmares
D) Headache
E) Nausea
C) Nightmares
D) Headache
E) Nausea
Rationale:Urinary retention is an adverse effect of benzodiazepines but not a sign of withdrawal. Nausea, nightmares, and headache are manifestations of benzodiazepine withdrawal. Depression is not likely to occur
The nurse is providing health education to a client who has been prescribed a barbiturate. The nurse should describe what mechanism of action?
A) Effect on action potentials
B) Enhancement of action of GABA
C) Depression of the cerebral cortex
D) Enhancement of motor output
C) Depression of the cerebral cortex
Rationale:Barbiturates depress the cerebral cortex. Benzodiazepines make GABA more effective, leading to the anxiolytic effect. Barbiturates do not affect action potentials. Barbiturates depress motor output
Respiratory distress is a contraindication for the use of barbiturates.
A) FALSE
B) TRUE
B) TRUE
Rationale:Barbiturates commonly produce respiratory distress, so the individual in distress should not receive this drug because respiration can be further depressed or distressed.
A client has been prescribed alprazolam 0.5 mg PO t.i.d. for the treatment of anxiety. What statement by the client demonstrates an accurate understanding of the drug regimen?
A) “I must take the drug on an empty stomach.”
B) “I should temporarily decrease the amount of fiber in my diet.”
C) “I will make sure not to stop the drug abruptly.”
D) “I can take an OTC antihistamine if I’m still feeling anxious.”
C) “I will make sure not to stop the drug abruptly.”
Rationale:There is a risk of withdrawal if anxiolytics are stopped abruptly. Anxiolytics can be taken with foods or meals. The client would need to increase his or her intake of fiber to prevent constipation. Additional sedatives, anxiolytics, or hypnotics should be avoided.
Eszopiclone is thought to react with norepinephrine to achieve its action.
A) FALSE
B) TRUE
A) FALSE
Rationale:Eszopiclone is thought to react with GABA sites near benzodiazepine receptors.
A client received lorazepam intravenously at 09:00. The nurse should maintain the client on bed rest until approximately what time?
A) 0930
B) 1100
C) 1200
D) 1030
C) 1200
Rationale:Clients who receive parenteral benzodiazepines should be monitored in bed for a period of at least 3 hours. Thus, the client would be allowed out of bed at approximately 12:00 hours.
The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize?
A) Blood pressure
B) Assessment for bleeding
C) Anaphylaxis
D) Oxygen saturation
A) Blood pressure
Rationale:Hypotension is a possible effect when barbiturates are given IV and is more common than hypoxia. Bleeding is not associated with intravenous barbiturate use. Anaphylaxis would be a serious but rare occurrence
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?
A) Zaleplon
B) Diphenhydramine
C) Buspirone
D) Meprobamate
C) Buspirone
Rationale:Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and central nervous system relaxing effects. Diphenhydramine is an antihistamine that can be sedating
A client receives an intravenous dose of diazepam at 18:00. The nurse would expect this drug to exert its peak effects as which time?
A) 1900
B) 1930
C) 2000
D) 1830
D) 1830
Rationale:Intravenous diazepam peaks in approximately 30 minutes, so the maximum effect of the drug would be seen around 18:30.
An increased dosage of a prescribed benzodiazepine may be necessary if the client’s current regimen includes what medication?
A) Cimetidine
B) Oral contraceptives
C) Theophylline
D) Calcium channel blockers
C) Theophylline
Rationale:Theophylline, if taken with a benzodiazepine, leads to a decreased effect of the benzodiazepine, which might result in the need for an increased dosage of the benzodiazepine. Ranitidine, not cimetidine, if taken with a benzodiazepine, leads to a decreased effect of the benzodiazepine, which might result in the need for an increased dosage of the benzodiazepine. Oral contraceptives, when taken with benzodiazepines, increase the effects of benzodiazepines necessitating a reduced dosage of the benzodiazepine. A calcium channel blocker would not affect benzodiazepine therapy.
The nurse is caring for a child on the pediatric unit who is having difficulty sleeping. What drug would be safest to administer as a first-line drug to induce sleep?
A) Chloral hydrate
B) Diazepam
C) Chlordiazepoxide
D) Diphenhydramine
D) Diphenhydramine
Rationale:The antihistamines diphenhydramine and promethazine are more popular and safer for use in helping to calm children and to induce rest and sleep. Use of anxiolytic and hypnotic drugs with children is challenging. The response of the child to the drug may be unpredictable; inappropriate aggressiveness, crying, irritability, and tearfulness are common. As a result, chloral hydrate, chlordiazepoxide, and diazepam would be administered only if diphenhydramine was not effective.
The nurse questions an order to administer barbiturates to a client with pain for what reason?
A) Barbiturates can cause tachypnea in a client who is in pain.
B) Barbiturates can cause paradoxical excitement.
C) Barbiturates cannot be given in combination with nonsteroidal antiinflammatories.
D) Barbiturates can exacerbate neuropathic pain.
B) Barbiturates can cause paradoxical excitement.
Rationale:Barbiturates should not be administered to clients with acute or chronic pain because it can cause paradoxical excitement and mask other symptoms. There is no indication that barbiturates make pain more severe. There is no known risk of tachypnea, and they are not contraindicated with NSAIDs
The nurse’s colleague administers an anxiolytic to the client. The nurse recognizes the colleague needs further teaching on the effects of the medication when the colleague performs what action?
A) Dims the lights, pulls the curtains closed, and turns the volume down on the TV
B) Places the call light within reach and instructs the client to call if they need anything
C) Raises the side rails and puts the bed in the low position
D) Encourages the client to walk to the bathroom independently
D) Encourages the client to walk to the bathroom independently
Rationale:Having the client walk to the bathroom would be appropriate before administering the drug, but after administration of the medication, the client could become dizzy or light-headed and fall, so the colleague increases the client’s risk for injury. Raising the side rails, placing the call light within reach, and creating an appropriate environmental setting would be appropriate after administering an anxiolytic.
Barbiturates are considered the sedative and hypnotic drugs of choice.
A) FALSE
B) TRUE
A) FALSE
Rationale:Barbiturates are associated with numerous adverse effects that can be severe in addition to the risk for addiction and dependence. Newer anxiolytic agents have replaced barbiturates in most instances
