Drug Therapy in Nursing 4th Edition Aschenbrenner Venable Test Bank
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Chapter 15- Drugs Relieving Anxiety and Promoting Sleep
|1.||A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia. Which of the following will the nurse include in a teaching plan for this patient? (Select all that apply.)|
|A)||The drug should not be used for longer than 1 month.|
|B)||It should be taken 1 hour to 90 minutes before going to bed.|
|C)||The drug does not cause sleepiness in the morning.|
|D)||One of the most common adverse effects of the drug is headache.|
|E)||It is available in both quick-onset and continuous-release oral forms.|
|Ans:||C, D, E|
|Zolpidem generally is not used for more than 7 to 10 days at a time. It induces sleep rapidly and should be taken immediately before going to bed. It is true that the drug does not seem to produce residual effects the next morning or cause prolonged rebound effects when it is discontinued. It is available in both quick-onset and continuous-release oral forms, and common adverse effects of the drug are headache, prolonged drowsiness, and dizziness.|
|2.||A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)?|
|A)||A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep|
|B)||A 20-year-old woman who will take the drug about once a week|
|C)||A 52-year-old woman who needs to fall asleep quickly and stay asleep all night|
|D)||A 46-year-old man who receives an antidepressant and needs a sleep aid|
|The nurse will most likely administer the zaleplon to the 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep. Zolpidem would most likely be administered to the 20-year-old who will take a sleep aid only once a week. Eszopiclone (Lunesta) will be given to the 52-year-old woman who needs to fall asleep quickly and has trouble staying asleep. The 46-year-old man will likely receive trazodone (Desyrel). This drug is given as a sleep aid for a patient who is taking an antidepressant.|
|3.||A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that|
|A)||she will report this to the physician immediately.|
|B)||the drug is not going to work for her and the medication needs to be changed.|
|C)||optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment.|
|D)||it may take up to 6 months for the drug to relieve her anxiety.|
|The nurse will inform the patient that it will likely take 3 to 4 weeks of treatment before she notices consistent relief of her anxiety. However, some improvement is often seen within 7 to 10 days of starting therapy. Since the patient had only been taking the drug 1 week, there is no need to inform the physician. The nurse would not make the assumption that the medication is not going to work for the patient nor would she tell her that it would take up to 6 months to see therapeutic results.|
|4.||A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for|
|A)||a diet high in fat.|
|B)||a history of current or past alcohol use.|
|C)||current nicotine use.|
|D)||a diet high in carbohydrates.|
|The patient who has history of alcohol or substance abuse may be a poor candidate for lorazepam because the patient is more likely to develop dependence on the drug. Alcohol will also have an additive effect with lorazepam. A diet high in fat and carbohydrates or nicotine use should not affect the use of lorazepam.|
|5.||A truck driver has been diagnosed with a generalized anxiety disorder (GAD) and lorazepam has been prescribed. The patient asked the nurse how this medication will affect his job. The nurse advised him to|
|A)||avoid driving until he is aware of the adverse effects.|
|B)||change his profession, because the drug has long-term effects after cessation of therapy.|
|C)||avoid driving at night, because lorazepam affects the wake–sleep cycle and can lead to drowsiness.|
|D)||drive only 2 hours after consuming the drug and stop when it’s time for the subsequent dose.|
|Drowsiness, sedation, and ataxia may occur when the drug is started, but these effects should disappear once the patient becomes accustomed to the drug. The nurse must advise the patient to avoid driving or performing any other tasks that require mental alertness and concentration until the effects of the drug are known. Lorazepam does not have prolonged effects after cessation of therapy, so the nurse would not advise the patient to change his profession. The patient should avoid driving until the drug effects are known, instead of avoiding driving only at night or for 2 hours after drug consumption.|
|6.||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 which of the following?|
|A)||Ataxia and confusion|
|B)||Respiratory disturbances and partial airway obstruction|
|D)||Leukopenia and diplopia|
|A priority assessment would be for respiratory disturbances and partial airway obstruction. These adverse effects usually occur when a high dose of the drug is given prior to a procedure. Ataxia and confusion are also adverse effects of lorazepam, but are seen mostly in older adults. Leukopenia and diplopia are not adverse effects specific to intravenous administration but are general hematologic and ophthalmic adverse effects that can occur in anyone of any age with any method of lorazepam administration. Seizures can be an adverse effect of the drug with any type of administration. However, lorazepam is usually administered for seizures.|
|7.||A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient’s daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that|
|A)||a dose adjustment should be made if these symptoms persist.|
|B)||the drug should be stopped immediately if these effects persist.|
|C)||the drug should be administered intravenously if these effects persist.|
|D)||no changes should be made at this time; the adverse effects will resolve with continued use.|
|If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist. If the drug is stopped immediately, withdrawal symptoms may occur. Intravenous administration or continuing the same dosage and medication would not help relieve ataxia or confusion in the patient.|
|8.||A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon (Sonata). The nurse will be sure to ask the patient if she is taking|
|The nurse will assess for cimetidine use. Cimetidine greatly increases the level of circulating zaleplon and could cause toxic effects in the patient. Secobarbital is a barbiturate, and oxycodone and meperidine are narcotics that would not be used with lorazepam because the combinations may depress respiratory drive, create severe hypotension or bradycardia, and substantially alter level of consciousness.|
|9.||An 80-year-old patient has been taking lorazepam since his wife died a year ago. He has been staying with his son, but will now move to an assisted living facility. Before admission to the assisted living facility, the patient’s physician has determined that the drug is no longer needed. The nurse at the facility will plan to|
|A)||stop the drug immediately.|
|B)||suggest that another anti-anxiety drug be prescribed to stop the craving for a benzodiazepine.|
|C)||withdraw the drug gradually over a 2 to 3 week period.|
|D)||observe for urticaria and rash.|
|It is important for the nurse to understand that lorazepam should be gradually withdrawn, because the patient has been using the drug for a year. If stopped abruptly the patient could experience withdrawal symptoms. The craving for benzodiazepines will decrease over time without the use of another drug. Urticaria and rash are adverse effects of the drug, not withdrawal effects.|
|10.||Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work?|
|Buspirone does not cause as much sedation and functional impairment as lorazepam, alprazolam, and diazepam. However, it can cause dizziness, nausea, headache, nervousness, lightheadedness, or excitement.|
|11.||At the prompting of her husband, a woman made an appointment with her primary care provider to discuss her debilitating worry and stress that seem to transcend her circumstances. She was subsequently diagnosed with an anxiety disorder based primarily on her|
|A)||combination of psychological and physiological signs and symptoms.|
|B)||failure to identify the specific cause of her stress.|
|C)||excessive and irrational fear and dread.|
|D)||lack of insight into her worrying .|
|Anxiety disorders are differentiated their own distinctive features, but they all share characteristics of excessive and irrational fear and dread. Some, but not all, patients have physiological symptoms or lack of insight. Not all patients with anxiety disorders are unable to identify the sources and triggers of their anxiety.|
|12.||A 59-year-old woman has presented to a clinic requesting a prescription for lorazepam (Ativan) in order to treat her recurrent anxiety. Her care provider, however, believes that a selective serotonin reuptake inhibitor (SSRI) would be more appropriate. What advantage do SSRIs have over benzodiazepines in the treatment of anxiety?|
|A)||SSRIs generally have fewer adverse effects.|
|B)||SSRIs have a more rapid therapeutic effect.|
|C)||SSRIs do not require serial blood tests during therapy.|
|D)||SSRIs require administration once per week, versus daily or twice daily with benzodiazepines.|
|SSRIs are generally well tolerated with few adverse effects. Unlike the benzodiazepines, they do not cause diminished alertness or ataxia. However, they take longer to have a therapeutic effect. Neither class of drug necessitates serial blood testing. SSRIs are normally taken daily.|
|13.||A patient who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by|
|A)||increasing the effects of the neurotransmitter GABA.|
|B)||inhibiting the action of monoamine oxidase.|
|C)||affecting the regulation of serotonin and norepinephrine in the brain.|
|D)||increasing the amount of serotonin available in the synapses.|
|Like all benzodiazepines, lorazepam increases the effects of GABA, which has an inhibitory effect on the CNS. However, none of the benzodiazepines act like GABA or increase the amount of GABA present. MAOIs inhibit monoamine oxidase and tricyclic antidepressants primarily affect serotonin and norepinephrine levels. SSRIs increase the availability of serotonin in the synapses.|
|14.||Medication reconciliation of an 82-year-old man who has recently moved to a long-term care facility reveals that the man takes 1 to 2 mg of lorazepam bid prn. The nurse should recognize what consequence of this aspect of the resident’s drug regimen?|
|B)||Increased risk for falls|
|C)||Risk for paradoxical aggression|
|In a systematic review of medications as risk factors for fall, it was found that one of the main group of drugs associated with this risk were benzodiazepines. Benzodiazepines are not associated with cold intolerance, anorexia, or aggression.|
|15.||A woman who travels extensively for her job has been prescribed triazolam (Halcion) as a sleep aide. During patient teaching, what information should the nurse prioritize?|
|A)||“To avoid becoming dependent on this drug, you should only take it every other night.”|
|B)||“Having one to two alcoholic drinks each evening can make Halcion more effective.”|
|C)||“You need to plan your bedtime carefully, because you should take this drug 1 to 2 hours before you want to sleep.”|
|D)||“If you stop taking this drug suddenly, you might find that your insomnia is worse than ever.”|
|Abruptly discontinuing triazolam may produce rebound sleep disorder, in which the insomnia is worse than it was before treatment. Dependence is a possibility with all benzodiazepines, but the response to this risk is short-term use, not alternating days of use. Alcohol should be avoided during treatment and the drug should be taken shortly before retiring for the night.|