Anti-anxiety / Benzos
The nurse is teaching the client taking alprazolam. Which substances should the client be instructed to avoid? Select all that apply.
a. Alcohol
b. caffeine
c. Narcotics
d. Antioxidants
e. Antihistamines
f. Antidepressants
ANS: A, C, E, F
Rationale: Alprazolam is a CNS depressant, and alcohol, narcotics, antihistamines, and antidepressants can further decrease CNS.
The nurse is assessing the client who has begun therapy with duloxetine (Cymbalta). Which assessment parameter should be the nurse’s priority?
a. Relief of neuropathic pain
b. Increase in anxiety or irritability
c. Liver function test (LFT) results
d. Suicidal ideations
ANS: D
Rationale:Duloxetine (Cymbalta) is a selective serotonin norepinephrine reuptake inhibitor (SNRI) used in the treatment of major depression. Suicidal ideation is the most acute threat to life and should be assessed, especially when initiating duloxetine
A client is diagnosed with renal insufficiency. The nurse develops a teaching plan based on the diagnosis and antipsychotic drug usage. The client asks the nurse why it is so important to have renal function tests routinely. The nurse replies that if renal function test results become abnormal, what may be a consequence?
a. The drug may need to be lowered in dosage or discontinued
b. The drug will be discontinued immediately
c. The drug will be continued with caution
d. The drug dosages will be increased to increase absorption
ANS: A
Because most antipsychotic drugs are extensively metabolized in the liver and the metabolites are excreted through the kidneys, the drugs should be used cautiously in clients with impaired renal function. Renal function should be monitored periodically during long-term therapy. If renal function test results (e.g., blood urea nitrogen) become abnormal, the drug may need to be lowered in dosage or discontinued.
The client is taking gabapentin. The nurse evaluates that gabapentin is effective when obtaining which assessment findings?
a. Less muscle weakness and decreased spasticity
b. Decrease in chronic pain intensity and seizures
c. Increased WBC count and increased hemoglobin
d. Improvement in mobility and cognitive function
ANS: B
Rationale: Gabapentin is an antiepileptic medication that can be used for chronic pain control.
A patient has been diagnosed with Parkinson¶s disease (PD) and begins treatment with levodopa/carbidopa (Sinemet). After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:
a. add a dopamine agonist.
b. discuss the "on-off" phenomenon.
c. increase the dose of Sinemet.
d. re-evaluate the diagnosis.
ANS: D
Rationale:
Patients beginning therapy with levodopa/carbidopa should expect therapeutic effects to occur
after several months of treatment. Levodopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The "on-off" phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated.
Including off-label conditions, lorazepam is appropriately prescribed for? (Select all)
a. Hypertension
b. Generalized anxiety disorder
c. Chronic depression
d. Preoperative amnesia
e. Status epilepticus
f. Nausea and vomiting caused by chemotherapy
g. Alcohol withdrawal
ANS: B, D, E, F, G
Rationale: Lorazepam (Ativan) is used in treating anxiety disorders, most frequently GAD, and for short-term relief of anxiety that occurs with depression. Lorazepam, when given IM or IV preoperatively and before anesthesia, produces sedation, relieves anxiety, and decreases the client's ability to recall events surrounding surgery. Off-label uses of lorazepam include treating status epilepticus, chemotherapy-induced nausea and vomiting, the symptoms of acute alcohol withdrawal, and psychogenic catatonia. It is not used for a primary diagnosis of depression.
The nurse is caring for a client taking fluoxetine for depression. Which assessment findings indicate that the medication is effective? Select all that apply.
a. Improved sleep
b. Decreased anxiety
c. Reduced appetite
d. Weight loss
e. Interest in physical activity
ANS: A, B, E
Rationale: Selective serotonin reuptake inhibitors such as fluoxetine are the drugs of first choice in the treatment of depression. Assessment findings that indicate therapeutic effects include improved sleep, decreased anxiety, improved appetite, and interest in physical activity. Weight loss is an adverse effect from this medication.
A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures? (Select all that apply.)
a. Electroconvulsive therapy
b. Moderate use of alcohol to reduce stress
c. Psychotherapy
d. Regular sleep and exercise
e. Using a chart to monitor mood changes
ANS: C, D, E
Rationale: BPD should be treated with a combination of drugs and adjunctive psychotherapy, because drug therapy alone is not optimal. Other measures, such as regular sleep and exercise and recognizing early symptoms of mood change, help minimize extreme mood swings. Electroconvulsive therapy is effective, but it is not the first-choice treatment; it is reserved for patients who have not responded to other therapies. Avoidance of alcohol is recommended.
A client who is receiving an antiseizure agent reports feeling sleepy and tired and reports dizziness when standing up. Which intervention would the nurse most likely implement as the priority?
a. Hydration
b. Safety precautions
c. Skin care measures
d. Emotional support
ANS: B
Rationale: The client is experiencing CNS effects that could lead to injury. Therefore, the nurse would need to implement safety precautions as the priority. Hydration may be needed if the client were experiencing vomiting or diarrhea. Skin-care measures would be appropriate for the development of a rash. Emotional support would be appropriate if the client had verbalized difficulty coping with the condition or drug therapy.
A nursing student wants to know why a patient who has been taking levodopa (Dopar) for years will now receive levodopa/carbidopa (Sinemet). The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?
a. "Carbidopa increases the availability of levodopa in the central nervous system. "
b. "Carbidopa reduces the incidence of nausea and vomiting. "
c. "Combination products reduce peripheral cardiovascular side effects. "
d. "Combination products cause fewer dyskinesias and decreased psychosis. "
ANS: D
Rationale: Adding carbidopa to levodopa does not reduce the incidence of dyskinesias or psychosis. In fact, carbidopa can increase the intensity and the speed of onset of these effects. Carbidopa inhibits decarboxylation of levodopa in the intestine and peripheral tissues, leading to more levodopa in the CNS. Carbidopa cannot cross the blood-brain barrier, so it does not have this action in the CNS. Peripheral side effects are reduced, including nausea, vomiting, and cardiovascular effects.
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
ANS: C
Rationale: When benzodiazepines are administered IV, severe effects, including profound hypotension, respiratory arrest, and cardiac arrest, can occur. Respiration should be monitored, and the airway must be managed if necessary. Flumazenil (Romazicon) is a competitive benzodiazepine receptor antagonist and is used to reverse the sedative effects but may not reverse respiratory depression. Gastric lavage would not be effective, because the benzodiazepine has been given IV. Without further indication of the ingestion of other drugs, toxicology testing is not a priority.
A client has been diagnosed with depression. The provider has ordered sertraline. The client asks, "How soon will it be until I feel better?" What would be the best response by the nurse?
a. "The med will start to work immediately."
b. "The med will improve your energy in 1 to 2 days, but the symptoms of sadness will not improve for a week.
c. "The med will decrease only your visible symptoms of depression.“
d. "The med will start to work in about 10 days, but it may take up to 4 weeks to be fully effective."
ANS: D
Rationale: Achieving antidepressant effects from sertraline, can take anywhere from 10 days to 4 weeks. Some symptoms of depression, like loss of energy, may be corrected before the mood is fully elevated.
Which of the following best describes the goal of antipsychotic therapy in schizophrenia?
a. Cure the disorder and eliminate all symptoms
b. Suppress positive symptoms and improve quality of life
c. Reverse structural brain damage caused by the disorder
d. Eliminate the need for psychosocial support
ANS: B
Rationale: Antipsychotic drugs help manage symptoms—especially positive symptoms like hallucinations and delusions—but do not cure schizophrenia. Medication is most effective when combined with psychosocial interventions like therapy and community support.
What explanation should the nurse provide for why pregnancy is discouraged in females who are being treated for seizure disorders?
a. Seizure disorders are genetic
b. Seizure disorders are familial
c. Antiepilepsy drugs decrease fertility
d. Antiepilepsy drugs are teratogenic
ANS: D
Rationale: Antiepileptic drugs such as valproic acid must be used cautiously during pregnancy because they are teratogenic. Seizure disorders are not normally genetic or familial. Anti Epilepsy medications do not decrease fertility.
A nurse is preparing to administer carbidopa-levodopa to a client with Parkinson’s disease. The client asks why they can’t just take dopamine directly. What is the nurse’s best response?
a. “Dopamine is rapidly absorbed and eliminated by the kidneys.”
b. “Dopamine can cause severe cardiac effects if given orally.”
c. “Dopamine does not cross the blood-brain barrier, so carbidopa-levodopa is needed.”
d. “Carbidopa-levodopa works faster than dopamine and lasts longer in the body.”
ANS: C
Rationale: Dopamine cannot cross the blood-brain barrier, so levodopa is used as a precursor that can cross. Carbidopa helps prevent levodopa’s breakdown in the periphery, increasing its availability in the brain.
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
ANS: B, C
Rationale: Benzodiazepines are indicated to relieve the symptoms of general anxiety and to suppress the central nervous system, thereby suppressing seizures and/or seizure activity. Benzodiazepines cause sleepiness, not sleep deprivation. Benzodiazepines do not cause tardive dyskinesia. Benzodiazepines relax muscles; they do not increase muscle spasms.
A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss:
a. changing the medication to another drug class.
b. discontinuing the medication immediately.
c. hospitalizing the patient for closer monitoring.
d. requiring more frequent clinic visits for this patient.
ANS: C
Rationale:
Patients with depression often think of suicide, and during treatment with antidepressants, these thoughts often increase for a time. Patients whose risk of suicide is especially high should be hospitalized. All antidepressants carry this risk, so changing medication is not recommended. Discontinuing the medication is not recommended. More frequent clinic visits are recommended for patients with a low to moderate risk of suicide.
A nurse is assessing a client admitted with suspected bipolar disorder. Which of the following client statements is most consistent with the manic phase of the disorder?
a. “I can’t concentrate, and my thoughts keep racing.”
b. “I don’t care about anything anymore. I just stay in bed.”
c. “I’ve been sleeping more than usual and feel tired all the time.”
d. “I feel like I deserve to be punished for everything.”
ANS: A
Rationale: The manic phase of bipolar disorder is often marked by racing thoughts, distractibility, increased energy, decreased need for sleep, impulsivity, and sometimes grandiosity.
What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity?
a. Diazepam
b. Duloxetine
c. Insulin
d. Meperidine
ANS: A
Rationale:
IV diazepam is an adjunctive skeletal muscle relaxant administered for the treatment of severe recurrent convulsive seizures and status epilepticus. Duloxetine is an antidepressant medication. Neither meperidine nor insulin is administered for status epilepticus.
Which statement best describes how pramipexole (Mirapex) works in treating Parkinson’s disease?
a. It inhibits acetylcholine receptors to reduce muscle tremors.
b. It increases dopamine release from remaining neurons.
c. It stimulates dopamine receptors to improve motor control.
d. It prevents the metabolism of dopamine in the brain.
ANS: C
Rationale: Pramipexole is a dopamine agonist, meaning it binds to dopamine receptors and stimulates them, mimicking the effects of dopamine to reduce motor symptoms.
An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle?
a. Benzodiazepines have a very short half-life.
b. Physical dependence is not a risk when taking benzodiazepines.
c. Benzodiazepines are known to cure generalized anxiety.
d. Benzodiazepines have a rapid onset of action.
ANS: D
Rationale: The patient is clearly in a state of extreme, uncontrolled anxiety. Benzodiazepines are the drug of choice for acute episodes of anxiety because of their rapid onset of action. Benzodiazepines do not have a very short half-life. Benzodiazepines are associated with physical dependence. Benzodiazepines do not cure generalized anxiety, nor do any other drugs.
A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to:
a. avoid foods containing tyrosine.
b. consume alcohol in moderation.
c. sit or lie down when feeling lightheaded.
d. take the medication in the morning.
ANS: C
Rationale: Orthostatic hypotension can occur with TCAs. Patients should be advised to sit or lie down if they feel lightheaded to prevent falls. Foods containing tyrosine cause adverse effects in patients taking MAOIs. Patients taking TCAs should be counseled to avoid all alcohol. Because TCAs cause sedation, the medication should be taken at bedtime.
The nurse is explaining to a client how aripiprazole (Abilify) works. Which statement by the client indicates understanding?
a. “It helps balance dopamine and serotonin in my brain.”
b. “It works by increasing the production of dopamine.”
c. “It completely blocks dopamine receptors to stop hallucinations.”
d. “It reduces anxiety by depressing the central nervous system.”
ANS: A
Rationale: Aripiprazole is an atypical antipsychotic that works by modulating dopamine and serotonin activity—it acts as a dopamine system stabilizer. It doesn’t fully block dopamine (like haloperidol), and it doesn’t work like anxiolytics.
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. "
ANS: A
Rationale: Phenobarbital and mephobarbital are used for seizure disorders and suppress seizures at doses that are nonsedative. Phenobarbital is a long-acting barbiturate. At therapeutic doses, sedative effects do not occur. Paradoxical drug effects are associated with benzodiazepines and in older adults and debilitated patients with barbiturates.
A client with early-stage Parkinson’s disease is prescribed amantadine. The nurse knows this drug is beneficial because it:
a. Blocks the reuptake of dopamine and increases its release.
b. Inhibits acetylcholine production to reduce rigidity.
c. Acts as a dopamine precursor like levodopa.
d. Directly activates dopamine receptors in the basal ganglia.
ANS: A
Rationale: Amantadine promotes dopamine release and prevents reuptake, making more dopamine available at synapses. It is typically used for early or mild symptoms.