Anxiolytics/hypnotics
1. Which medication below is NOT considered a Benzodiazepine?
A. Alprazolam
B. Lorazepam
C. Clorazepate
D. Phenobarbital
D. Phenobarbital is a barbiturate. How you can recognize a Benzodiazepine is that the middle of the generic drug name will have either “ze” or “zo” and most end with “pam” or “lam” expect Clorazepate and Chlordiazepoxide.
Which of the following antidepressant drug classes causes anticholinergic effects?
A. MAOIs
B. SSRIs
C. SNRIs
D. TCAs
D. TCAs can cause anticholinergic effects such as blurred vision, constipation, dry mouth, and urinary retention.
The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery
a. Take as little pain medication as possible to prevent addiction.
b. Ask for pain medication before the pain gets severe.
c. Request your pain medication whenever it is available to you.
d. Wait as long as possible for pain medication; it will work more effectively.
b. The nurse should emphasize the importance of pain control, stressing to the client that pain relief is greater if the medication is taken when pain is not very severe. If the client waits too long for pain medication, it will be much harder to control the pain. Also, the client should not take pain medication whenever it is available, but only when it is needed. It is rare for a client to become addicted to pain medication when it is taken for the relief of pain. The need for the pain medication goes away when the pain subsides.
The nursing student identifies which people as qualified to administer anesthesia? (Check all that apply.)
A. anesthesiologist
B. physicians assistant
C. nurse anesthetist
D. surgeon
E. OR nurse
A, C
Both specially trained nurses and health care providers can administer anesthesia. An anesthesiologist is a physician with special training in administering anesthesia. A nurse anesthetist is a nurse with a master's degree and special training who is qualified to administer anesthetics.
Which of the following medical condition(s) can be considered as contraindication(s) to use of anxiolytics and hypnotics? SATA
A. Psychosis
B. Alcoholic intoxication
C. Acute gastroenteritis
D. Liver dysfunction
A, B, D
A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient?
A) Monitor food intake for levels of tyramine.
B) Assess for weight loss and difficulty sleeping.
C) Monitor the patient for severe headaches.
D) Implement suicide precautions.
D. Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the patient. Severe headache and reactions to tyramine-containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patients safety.
The nurse receives a phone call from a male client who has become constipated while taking the opioid analgesic prescribed for his pain. The nurse instructs the client to do what to help relieve this problem? (Select all that apply.)
a. Eat a diet low in fiber
b. Drink 2 to 3 quarts of water per day
c. Take a daily stool softener
d. Take a laxative twice a day
e. Try to establish a regular bowel routine
B, C, E
Constipation is a common problem that occurs with the use of opioids. The client should be encouraged to eat a high-fiber diet, drink 2 to 3 quarts of water, take daily stool softener and laxative (if OK'd by a health care provider), and establish a bowel routine
A) Capillary refill
B) I & O
C) Respirations and Airway
D) Pain management
C
Which of the following medications has the greatest risk for severe adverse effects?
A. Zolpidem
B. Phenobarbital
C. Buspirone
D. Diazepam
B. Phenobarbital is a barbiturate medication which has a greater risk for sedation and dependence than other anxiolytic/hypnotic drugs. Benzodiazepines are the most commonly used anxiolytic medications, and have less adverse effects than barbiturates. Buspirone is a newer anti anxiety medication without many of the CNS effects and severe adverse effects associated with other anxiolytic drugs. Zolpidem causes sedation and is only indicated to treat insomnia.
All of the following antidepressant medications increase levels of norepinephrine EXCEPT:
A. TCAs
B. SSRIs
C. MAOIs
D. SNRIs
B. SSRIs specifically block reuptake of serotonin and allow this neurotransmitter to accumulate in the synaptic cleft. TCAs, MAOIs, and SNRIs all act to increase both serotonin and norepinephrine levels. MAOIs also increase levels of dopamine as well as the other biogenic amines.
The nurse suspects opioid overdose in a client after surgery. What interventions must the nurse initiate for this client? (Select all that apply.)
a. Administer naloxone
b. Decrease the client's IV fluids
c. Notify the health care provider
d. Prepare for endotracheal intubation
e. Insert a Foley catheter
A, C, D
The nurse will notify the provider, administer naloxone, and prepare for endotracheal intubation. If the client has an IV, the nurse would increase the rate. It is possible the nurse would insert a Foley catheter, but it is not a priority nursing intervention at this time. The priority interventions revolve around the client's respiratory status.
What is one of the registered nurse’s primary roles in the administration of general anesthetic?
A) Assessing the client’s status during recovery from anesthetic
B) Determining the client’s most appropriate medication
C) Administering intravenous anesthetics as prescribed
D) Administering inhaled anesthetics as prescribed
A. Nursing roles in the care of clients under general anesthetic consist primarily of support and assessment. These medications are generally administered by anesthesiologists, not registered nurses. As with other medications, the care provider primarily determines the best medication.
Which of the following statements are CORRECT about benzodiazepines?
A. "Benzodiazepines are CNS stimulants."
B. "Benzodiazepines provide the most therapeutic and safest effects when prescribed with opioids."
C. "Benzodiazepines can be used to treat seizures."
D. "Narcan is the antidote used to reverse toxicity caused by Benzodiazepines."
C is correct.
Benzodiazepines are CNS depressants, they should NOT be used with opioids (the FDA has issued a black box warning on this due to the increased risk of overdose), and Flumazenil is the antidote for Benzodiazepines.
A patient on MAOI antidepressants presents to the ER with occipital headache, neck stiffness, sweating, nausea, and vomiting. The nurse assessing this patient is right to assume this patient is experiencing:
A. Serotonin syndrome
B. Cholinergic crisis
C. Hypertensive crisis
D. Withdrawal syndrome
C. Hypertensive crisis is a severe and life threatening adverse effect associated with the use of MAOI antidepressants.
Follow up Q: The risk for this adverse effect increases with the consumption of what foods?
The nurse is caring for a client who is receiving a prescribed opioid analgesic. What reactions that could be related to the drug therapy should prompt the nurse to contact the health care provider immediately? Select all that apply:
a. Respiratory rate of less than 10 breaths/min
b. Decrease in pulse
c. Diarrhea
d. Increase in blood pressure
e. Blood pressure of 95/65 mmHg
a, b, e
The nurse should contact the provider immediately if any of the following occurs while a client is receiving an opioid analgesic: significant decrease in respiratory rate or a respiratory rate less than 10 breaths/min; significant increase or decrease in the pulse rate or a change in the pulse quality; or significant decrease in blood pressure or a systolic pressure below 100 mmHg. Constipation is more likely than diarrhea with opioid use, and an increase in blood pressure is not a noted adverse reaction.
A surgical client's balanced anesthesia includes the use of vecuronium. What nursing action should the operating room nurses prioritize?
A. Monitoring the client for signs of increased level of consciousness
B. Assessing and protecting the client's airway
C. Protecting the client's skin integrity
D. Monitoring the client's deep tendon reflexes
B. The maintenance of the client's airway and respiratory function following the administration of neuromuscular blocking agents such as vecuronium is the most important nursing implication. The importance of airway protection supersedes that of DTR assessment, assessing LOC, and maintaining skin integrity, though each of these is a valid consideration.
Which intervention is the nurses PRIORITY for a patient taking lorazepam?
A. Ensure this patient has an EKG monitor
B. Assist with ambulating the client
C. Lower lights and ensure quiet environment
D. Initiate seizure precautions
B. Lorazepam is a benzodiazepine. This drug class has depressant effects and can cause sedation, drowsiness, and lethargy. The nurse should initiate safety/fall precautions and assist with ambulating the client. If this medication is given parenterally, the nurse should ensure the client stays in bed for at least 3 hours after administration.
The nurse is assessing a patient in the ED that recently began SSRI therapy for treatment of depression. Which of the following findings would the nurse find alarming? SATA
A. weight loss
B. seizures
C. sexual dysfunction
D. high blood pressure
E. fever
F. nausea
B, D, E
These are all s/sx of serotonin syndrome. The other options are normal adverse effects associated with SSRI therapy.
To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)
a. Keep the lights in the client's room turned down.
b. Assist client from their bed to the toilet.
c. Assist client with rising from a lying position.
d. Assist client with hall-walking activities.
e. Advise the client to stay in bed all night.
B, C, D
To decrease the risk of injury to a client taking an opioid, the nurse should assist the client with ambulatory activities and with rising from a sitting or lying position. The nurse should also keep the client's room well-lit during daytime hours, keep the client's room free of clutter, and advise the client to seek assistance when getting out of bed at night.