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A client tells the nurse that he or she worries about everything all day, feels confused, restless. Which should the nurse suspect the client is experiencing? 1. Generalized anxiety 2. Social anxiety 3. Post-traumatic stress disorder (PTSD) 4. Panic disorder
Answer: 1 Explanation: 1. Generalized anxiety disorder is characterized by excessive anxiety but not to panic levels. Other symptoms include restlessness, muscle tension, and loss of focus and ability to concentrate. Relaxation techniques are effective in reducing anxiety. 2. Social anxiety disorder is characterized by "performance anxiety," (i.e., extreme fear when a patient is in a social situation); there is no information to support that this is what the patient is experiencing. Also, telling the patient to "calm down" is nontherapeutic. 3. Post-traumatic stress disorder is situational anxiety that develops in response to re?experiencing a previous traumatic life event; there is no information that the patient has experienced a trauma. 4. Panic disorder is characterized by intense feelings of apprehension, terror, and impending doom and increased autonomic nervous system anxiety; the patient does not have these symptoms.
Which client should the nurse be most concerned with taking benzodiazepines? 1. An 87-year-old client who uses a cane for ambulation 2. A 9-year-old child with panic attacks 3. A 42-year-old businessman who travels internationally 4. A 32-year-old mother of two preschool children
Answer: 1 Explanation: 1. Benzodiazepines should be used with caution in older adults due to their adverse effects of drowsiness and sedation. This puts older adults at risk of falls. 2. Benzodiazepines must be used with caution in children, but these patients are not at as high risk as older adults. 3. There is minimal concern with benzodiazepine use in a 42-year-old patient. 4. There is minimal concern with benzodiazepine use in a 32-year-old patient.
The nurse is preparing the education for a client prescribed a selective serotonin reuptake inhibitors (SSRI). Which adverse effects should the nurse include in the teaching? 1. Drowsiness and coma 2. Weight gain and sexual dysfunction 3. Headache and nausea 4. Dry mouth and urine retention
Answer: 2 Explanation: 1. Drowsiness or coma is not a common adverse effect. 2. Weight gain or sexual dysfunction are common adverse effects and may result in poor medication adherence. 3. Headache is not a common adverse effect. 4. Although anticholinergic effects such as dry mouth and urine retention could occur, they are not as common as another set of adverse effects.
Which information should the nurse include in the teaching for a client prescribed ramelteon? 1. Daytime drowsiness is common. 2. There is an increased risk of physical dependence. 3. Relatively short onset of action. 4. The primary action is to induce a deep sleep state.
Answer: 3 Explanation: 1. Ramelteon has less of a residual of daytime drowsiness. 2. Ramelteon does not result in physical dependence. 3. Ramelteon has a relatively short onset of action. 4. Ramelteon is a melatonin receptor agonist that has been shown to mainly improve sleep induction.
Which should the nurse recognize is a benefit of obtaining a thorough history from a client who is experiencing anxiety? 1. Pharmacotherapy can be prescribed. 2. The type of counseling can be prescribed based on the history. 3. The category of anxiety disorder can be identified. 4. The treatment plan can be created
Answer: 1 Explanation: 1. Pharmacotherapy can be prescribed by the healthcare provider based on the history of the client. 2. The type of counseling a patient may require is not prescribed based on a health history. 3. A health history is not used to determine the category of anxiety disorder. 4. A treatment plan is not created based on a health history.
A client has taken different prescriptions over the past two years that have been unsuccessful in treating his or her insomnia. Which condition should the nurse suspect the client may be experiencing? 1. Sleep apnea 2. Anxiety disorder 3. Addiction 4. Personality disorde
Answer: 1 Explanation: 1. Sleep apnea is a medical condition that must be treated to relieve the insomnia associated with the disorder. Medications such as benzodiazepines depress respiratory drive and exacerbate sleep apnea. 2. It is unlikely that a client with an anxiety disorder would sell their medication. 3. There is no information that suggests the client may have an addiction. 4. There is no information that suggest the client might have a personality disorder.
The nurse has completed group education for clients with anxiety disorders. Which statement made be a client indicates an understanding of the education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Relaxation techniques will often decrease anxiety." 2. "Antianxiety medicine should be used until anxiety is gone." 3. "Antianxiety medicine should not be used indefinitely." 4. "Therapy may help identify where this anxiety comes from." 5. "Different medications are required for treating anxiety than for treating difficulty sleeping."
Answer: 1, 3, 4 Explanation: 1. Nonpharmacological techniques such as relaxation techniques are effective in reducing some levels of anxiety. 2. Absence of anxiety is an unrealistic goal because all individuals will have some level of anxiety during their lifetime. 3. For most patients, antianxiety medication is intended for short-term use. 4. Clients with anxiety disorders should be encouraged to uncover the cause of the anxiety through cognitive behavioral therapy or other counseling techniques. 5. Often, the same medication can be used for anxiety as well as insomnia.
The nurse has completed the education for a client prescribed buspirone (BuSpar). Which statement made by the client indicates further teaching is required? 1. "The side effects I might experience include dizziness, headache, and drowsiness." 2. "I can take this prescription when I feel anxious and it will relax me." 3. "This prescription should be taken on a regular basis for it to help me." 4. "I don't need to worry about becoming dependent on this prescription."
Answer: 2 Explanation: 1. Side effects of buspirone (BuSpar) include dizziness, headache, and drowsiness. 2. Buspirone (BuSpar) works by altering levels of neurotransmitters and takes a few weeks to achieve optimal anxiety reduction. It cannot be used as an "as needed" (prn) medication. 3. Buspirone (BuSpar) works by altering levels of neurotransmitters and takes a few weeks to achieve optimal anxiety reduction. The drug must be taken consistently for this to occur. 4. Dependence and withdrawal are less of a concern with buspirone (BuSpar) than with some other antianxiety drugs
Which statement regarding the use of zolpidem (Ambien) for insomnia is accurate? 1. Clients using Ambien should avoid foods that contain tyramine. 2. Ambien will take longer to produce an effect when taken with food. 3. Ambien is contraindicated during pregnancy but can be taken by breastfeeding mothers. 4. Ambien is classified as a benzodiazepine.
Answer: 2 Explanation: 1. Clients using MAOIs (not Ambien) should avoid foods high in tyramine. 2. The absorption of Ambien is slowed when taken with food. 3. It is classified as pregnancy category B and should be avoided by breastfeeding mothers. Patients using MAOIs (not Ambien) should avoid foods high in tyramine. 4. It is classified as a nonbenzodiazepine CNS depressant.
) Which explanation best explains why barbiturates are rarely used to treat anxiety and insomnia? 1. They have a greater associated cost. 2. They have a high risk of producing an allergic response. 3. They are seldom effective. 4. They produce many serious adverse effects.
Answer: 4 Explanation: 1. Barbiturates are not necessarily more expensive. 2. Allergic reactions can occur, but are rare, and are not a primary reason they are no longer used for anxiety and/or insomnia. 3. Barbiturates can be effective. 4. Barbiturates were the drug of choice for anxiety and insomnia prior to the discovery of safer drug alternatives.
A client presents to the clinic with symptoms of hyperthermia and diaphoresis. The client's prescription history includes escitalopram (Lexapro), St. John's wort, levothyroxine, and acetaminophen. Which should the nurse suspect has occurred? 1. The patient may be experiencing serotonin syndrome. 2. The patient may have contracted a virus. 3. The patient may be experiencing withdrawal. 4. The patient may be experiencing thyroid toxicosis.
Answer: 1 Explanation: 1. The use of St. John's wort combined with escitalopram places the patient at risk for serotonin syndrome. Symptoms of serotonin syndrome include hyperthermia and diaphoresis. 2. There is no indication the patient has a virus. 3. Escitalopram, St. John's wort, levothyroxine, or acetaminophen are not associated with withdrawal symptoms. 4. The primary cause of thyroid toxicosis is an overactive thyroid gland. The client is prescribed levothyroxine to replace thyroid hormone due to an underactive thyroid gland.
A client asks the nurse to describe NREM stage 3 sleep. Which response should the nurse provide the client? 1. "This is the lightest stage of sleep and is profoundly affected by anxiety." 2. "Dreaming occurs here; without dreams you will be irritable and paranoid." 3. "This is the deepest stage of sleep; without it you will be tired and depressed." 4. "This is also called paradoxical sleep."
Answer: 3 Explanation: 1. NREM stage 3 is not the lightest stage of sleep. 2. Dreaming occurs in REM sleep, not NREM sleep. 3. NREM stage 3 sleep is the deepest stage of sleep. Clients who are deprived of it experience depression and a feeling of apathy and fatigue. 4. REM sleep is often called paradoxical sleep.
A client ask the nurse which part of the brain controls anxiety and insomnia. Which response should the nurse provide? 1. "The limbic system and reticular activating system control anxiety and insomnia." 2. "The frontal lobes and limbic system control anxiety and insomnia." 3. "The thalamus and reticular activating system control anxiety and insomnia." 4. "The limbic system and hypothalamus control anxiety and insomnia."
Answer: 1 Explanation: 1. Neural systems associated with anxiety and restlessness include the limbic system and the reticular activating system. The reticular activating system is responsible for sleeping and wakefulness and performs an alerting function for the entire cerebral cortex. 2. The frontal lobes are not responsible for anxiety and sleep. 3. The thalamus is not responsible for anxiety and sleep. 4. The hypothalamus is not responsible for anxiety and sleep.
A client is prescribed zolpidem (Ambien) for treatment of short-term insomnia. Which is the primary safety concern of the nurse? 1. Dizziness and daytime sedation 2. Nausea 3. Diarrhea 4. Sleepwalking
Answer: 4 Explanation: 1. Dizziness and daytime sedation are common side effects of zolpidem (Ambien) and usually subside after a few days on the medication. 2. Nausea is a common side effect of zolpidem (Ambien) and usually subsides after a few days on the medication. 3. Diarrhea is a common side effect of zolpidem (Ambien) and usually subsides after a few days on the medication. 4. During sleepwalking, a patient may leave the home and cause injury to self.
The nurse has provided teaching for a client prescribed clonazepam (Klonopin). Which is an important outcome when evaluating the client's understanding of the teaching? 1. The client will verbalize the signs of developing Stevens-Johnson rash. 2. The client will verbalize the importance of dietary restrictions related to this drug. 3. The client will verbalize the importance of having routine laboratory work. 4. The client will verbalize the consequences of abruptly stopping the drug.
Answer: 4 Explanation: 1. Stevens-Johnson rash is not a side effect of benzodiazepines. 2. There aren't any diet restrictions with the use of benzodiazepines. 3. Routine blood work is not required with the use of benzodiazepines. 4. Abrupt discontinuation of benzodiazepines like clonazepam (Klonopin) can result in serious withdrawal symptoms.
Which condition is a client most likely experiencing who tells the nurse he or she is having difficulty sleeping because he or she has two final exams approaching? 1. Situational anxiety 2. Social anxiety 3. Obsessive-compulsive disorder 4. Performance anxiety
Answer: 1 Explanation: 1. The final examination is a temporary event that is the cause of the anxiety. Once the examination is over, it is likely that the situational anxiety will end. 2. Social anxiety is a fear of crowds. 3. Obsessive-compulsive disorder (OCD) involves recurrent, intrusive thoughts or repetitive behaviors that interfere with normal activities or relationships. 4. Although the situation presented required the student to perform on the exam, it is best defined as situational anxiety.
Which should the nurse recommend to a client as a primary approach to managing stress? 1. A combined approach using a prescription and nonpharmacological strategies 2. The use of an anxiolytic 3. The practice of meditation 4. To determine the cause of the anxiety
Answer: 4 Explanation: 1. A combined approach using a prescription and nonpharmacological strategies is not a primary approach to managing stress. 2. The use of medications alone is not a primary approach. 3. Meditation may or may not be useful for specific individuals. 4. Stress is generally a symptom of an underlying disorder. It is more productive to uncover and address the cause than to treat the symptoms
A client who has been taking lorazepam (Ativan) for 2 years presents to the clinic and tells the nurse that he or she stopped taking his or her medication 3 days prior. Which assessment findings should the nurse anticipate? 1. Increased heart rate, fever, and muscle cramps 2. Nothing different; it is safe to abruptly stop lorazepam (Ativan) 3. Pinpoint pupils, constipation, and urinary retention 4. A sense of calmness and lack of anxiety
Answer: 1 Explanation: 1. Many central nervous system (CNS) depressants can cause physical and psychological dependence. The withdrawal syndrome for some central nervous system (CNS) depressants can include fever, seizures, increased pulse, anorexia, muscle cramps, disorientation, etc. 2. It is not safe to abruptly stop lorazepam (Ativan); withdrawal symptoms will occur. 3. Pinpoint pupils, constipation, and urinary retention are signs of opioid use. 4. The patient would be anxious, not calm, during benzodiazepine withdrawal.
) A client asks the nurse why he or she is prescribed different types of medications for his or her anxiety and insomnia. Which response should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You will be taking medications known as sedative-hypnotics." 2. "You will be taking medications known as antidepressants." 3. "You will be taking a medication known as paraldehyde." 4. "You will be taking medications known as barbiturates." 5. "You will be taking medications known as benzodiazepines."
Answer: 1, 2, 5 Explanation: 1. The three categories of medications used to treat anxiety and sleep disorders include the sedative-hypnotics. 2. The three categories of medications used to treat anxiety and sleep disorders include the antidepressants. 3. Paraldehyde is no longer used for anxiety or insomnia because of significant side effects and the availability of more effective medications. 4. Barbiturates are no longer used for anxiety or insomnia because of significant side effects and the availability of more effective medications. 5. The three categories of medications used to treat anxiety and sleep disorders include the benzodiazepines.
A client experiencing nervousness asks the nurse why escitalopram was prescribed. Which response should the nurse provide the client? 1. "The same brain chemicals are involved with anxiety and depression." 2. "You are really depressed; it is just manifested as anxiety. These medications are safer than benzodiazepines." 3. "Your doctor thinks that this is the best treatment for your anxiety, and these medications are safer than benzodiazepines." 4. "The two disorders are similar, and if you treat depression, the anxiety goes away.
Answer: 1 Explanation: 1. Antidepressants are frequently used to treat symptoms of anxiety. They reduce anxiety by altering levels of norepinephrine and serotonin. These neurotransmitters are also associated with depression. 2. The client is being treated for generalized anxiety; this is different from depression. 3. Telling the client that the doctor knows best is a condescending reply and does not answer the patient's question. 4. Depression and anxiety are two separate disorders.
Which area of the brain is primarily responsible for maintaining sleep and wakefulness? 1. Reticular activating system 2. Cerebral cortex 3. Limbic system 4. Cerebellum
Answer: 1 Explanation: 1. The reticular activating system is responsible for sleeping and wakefulness. 2. The primary functions of the cerebral cortex do not include sleep and wakefulness. 3. The limbic system is responsible for emotional expression, learning, and memory. 4. The primary functions of the cerebellum do not include sleep and wakefulness.
Which drug category can be used for treating anxiety? 1. Antitussives 2. Anticoagulants 3. Seizure drugs 4. Antibiotics
Answer: 3 Explanation: 1. Antitussives are used as cough suppressants. 2. Anticoagulants are used to prevent blood clots from forming. 3. In addition to antidepressants, several other drug classes are used to treat anxiety, including seizure drugs. 4. Antibiotics are used primarily for bacterial infections.
) A client with anxiety and insomnia asks the nurse about the benefits of treatment with a benzodiazepine. Which response should the nurse provide the client? 1. "Benzodiazepines are the most effective." 2. "Benzodiazepines have the lowest risk of dependency and tolerance." 3. "Benzodiazepines are most likely to be covered under insurance premiums." 4. "Benzodiazepines are most affordable."
Answer: 2 Explanation: 1. Benzodiazepines are not necessarily more effective than other drugs. 2. Benzodiazepines have a lower risk of dependency and tolerance than do other drugs used for anxiety and insomnia (such as the barbiturates). 3. Benzodiazepines are not necessarily more likely to be covered under insurance premiums. Although economics is an important factor in pharmacology, drug safety should be considered. 4. Benzodiazepines are not necessarily more affordable. Although economics is an important factor in pharmacology, drug safety should be considered.
A client presents to the emergency department suspected of overdosing on lorazepam (Ativan). Which prescription should the nurse prepare to administer? 1. Pralidoxime (Protopam) 2. Naloxone (Narcan) 3. Flumazenil (Romazicon) 4. Nalmefene (Revex)
Answer: 3 Explanation: 1. Pralidoxime (Protopam) is indicated for treatment of organophosphate poisoning. 2. Naloxone (Narcan) is indicated for treatment of opiate overdose. 3. Should an overdose of benzodiazepines occur, flumazenil (Romazicon) is a specific benzodiazepine receptor antagonist that can be administered to reverse central nervous system (CNS) depression. 4. Nalmefene (Revex) is indicated for treatment of opiate overdose.
A client with a generalized anxiety disorder asks the nurse if he or she will need medication for treatment. Which response should the nurse provide the client? 1. "A prescription is a common treatment for clients with anxiety disorders." 2. "A prescription is necessary initially; followed by therapy." 3. "You most likely will not require a prescription." 4. "A prescription is necessary when anxiety interferes with your quality of life."
Answer: 4 Explanation: 1. A prescription is not necessarily a common treatment for anxiety disorders. Many anxiety disorders can be managed without a prescription. 2. A prescription combined with therapy is considered the best approach for treatment of anxiety disorders. 3. The nurse does not have enough information to tell the patient that a prescription will probably not be necessary. 4. It is more beneficial to the client to identify and treat the cause of anxiety than to use a prescription. When anxiety becomes severe enough to significantly interfere with the patient's quality of life, pharmacotherapy is indicated.