Deck 17: Antianxiety Drugs

Question 1

A patient diagnosed with agoraphobia took alprazolam 0.5 mg three times daily for 3 months and then discontinued it. The next day the patient called the nurse reporting insomnia, shakiness, and sweating. What should be the focus of the nurse's assessment questions?

A) Whether the patient may have also been drinking alcohol or taking antihistamines.
B) The possibility that the patient has built up tolerance to alprazolam and needs an increased dose.
C) The likelihood that the patient is having withdrawal symptoms from abrupt discontinuation of the drug.
D) Whether the patient has progressed to panic attacks and needs a nonbenzodiazepine medication.

Answer 1

The likelihood that the patient is having withdrawal symptoms from abrupt discontinuation of the drug.

Question 2

An emergency room patient was very anxious after a serious car accident. Lorazepam 2 mg intramuscularly was administered. One hour later, which finding indicates to the nurse that the medication was effective?

A) Improved problem-solving skills
B) Increased alertness
C) Increased verbalization
D) Reduced environmental scanning

Answer 2

Reduced environmental scanning

Question 3

A patient in the emergency room has status epilepticus. The nurse should anticipate administration of what medication?

A) Diazepam (Valium)
B) Buspirone (BuSpar)
C) Clorazepate (Tranxene)
D) Chlordiazepoxide (Librium)

Answer 3

Diazepam (Valium)

Question 4

Which patient behavior should the nurse identify as the greatest risk for overdose with a benzodiazepine?

A) Taking the drug with antacids
B) Taking the drug before meals
C) Combining the drug with alcohol
D) Experiencing depression as well as anxiety

Question 5

What medication information should the nurse provide the patient newly prescribed buspirone?

A) Produces profound sedation.
B) Will be effective in 7 to 10 days.
C) Has a high risk for development of dependence.
D) Is often associated with cross-tolerance with other CNS depressants.

Question 6

A patient states, "I have the same thoughts over and over. I feel compelled to count all my footsteps." The nurse can expect the health care provider to prescribe what medication?

A) Alprazolam
B) Propranolol
C) Clonazepam
D) Clomipramine

Question 7

What is the half-life of diazepam for an older adult likely to be?

A) 10 hours
B) 30 hours
C) 40 hours
D) 80 hours

Question 8

The nurse would expect a patient with which comorbid diagnosis to have a magnified response to the usual dose of a benzodiazepine drug?

A) Rheumatoid arthritis
B) Migraine headache
C) Hepatic cirrhosis
D) Osteoporosis

Question 9

A patient had five emergency room visits in the past month and reports, "I feel so nervous. I think I'm having heart attacks." The patient is diagnosed with panic attacks. Which comment by the nurse shows understanding of treatment for panic attacks?

A) "Selective serotonin reuptake inhibitors (SSRIs) are often helpful for long-term treatment and prevention of panic attacks."
B) "Benzodiazepine tranquilizers are therapeutic for long-term treatment and prevention of panic attacks."
C) "No medications are particularly helpful for panic attacks. Let's work on some strategies to help you manage your fears."
D) "Panic attacks result from an instability of the neurotransmitter acetylcholine. Meditation will be more helpful than drugs."

Question 10

A patient started diazepam 5 mg twice daily 6 months ago. Now, the patient requires 10 mg to achieve the same effect. What phenomenon is responsible for this situation?

A) Addiction
B) Tolerance
C) Dependence
D) Disinhibition

Question 11

A health care provider prescribes lorazepam for an anxious older adult at a longer than usual dose. To assure patient safety, what is the nurse's best action?

A) Assess for a history of drug abuse.
B) Administer the drug as prescribed.
C) Confer with the health care provider.
D) Assess the patient's pupillary reaction to light.

Question 12

A patient seeking treatment for anxiety says, "I can't think. My job depends on my ability to think. I need medicine, but the drugs I took a few years ago made me too sleepy. I could lose my job." What information is most important for the nurse to consider when formulating a response?

A) All antianxiety medication has sedating properties.
B) Buspirone alleviates anxiety without sedation or cognitive clouding.
C) The patient's description of anxiety does not warrant treatment with medication.
D) The patient may be trying to manipulate the nurse to assist with getting the desired prescription.

Question 13

A patient diagnosed with social phobia begins propranolol. The nurse should teach the patient to expect what reaction to this therapy?

A) Sympathetic nervous system symptoms of anxiety will be reduced.
B) A sense of euphoria for 30 minutes after taking the drug.
C) Experience amnesia for the social situations that are most intimidating.
D) Feeling a little drowsy but having no orthostatic hypotension.

Question 14

The teaching plan for a patient beginning buspirone should include information identifying this drug as having what property?

A) Norepinephrine inhibitor
B) Serotonergic antagonist
C) Serotonin agonist
D) GABA inhibitor

Question 15

A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's priority action?

A) Begin seizure precautions.
B) Refer the patient for addiction counseling.
C) Institute a behavior modification program.
D) Prepare to administer flumazenil.

Question 16

A patient received one dose of flumazenil. What is the nurse's next action?

A) Carefully observe for benzodiazepine overdose symptoms.
B) Teach the patient about dietary restrictions.
C) Prevent injury during seizure activity.
D) Force 500 mL oral fluids over 2 hours.

Question 17

The nurse would expect to administer flumazenil for a patient with which diagnosis?

A) Acute alcohol withdrawal
B) Benzodiazepine overdose
C) Benzodiazepine-resistant anxiety
D) Psychotic disorder

Question 18

A patient who has been taking a benzodiazepine for panic attacks is to be started on buspirone. Which instruction should the nurse provide?

A) "Take decreasing doses of the benzodiazepine for several days until the buspirone becomes effective."
B) "Stop taking the benzodiazepines immediately. Wait 2 days, and then start the buspirone."
C) "You should take buspirone only once a day. More frequent dosing can cause dependency."
D) "Tolerance to buspirone may develop in about a month, requiring larger doses to be prescribed."

Question 19

By what mechanism does lorazepam reduce anxiety?

A) Increasing serotonin levels
B) Blocking dopamine receptors
C) Depressing norepinephrine levels
D) Potentiating gamma-aminobutyric acid (GABA)

Question 20

A patient has taken diazepam for 1 week for back spasms. The patient reports "feeling sleepy all the time." Which response will best address the patient's concern?

A) "The dosage probably needs to be decreased."
B) "Drowsiness indicates a paradoxical reaction to the drug."
C) "Tolerance to the sedative effect of the drug will develop quickly."
D) "Sleepiness is an unavoidable side effect of nonbenzodiazepine drugs."

Question 21

When a patient reports using both alprazolam and propofol, which inference applies?

A) The combination of these medications will not result in a drug-drug interaction.
B) Potentially lethal sedation and CNS depression would be expected with this drug combination.
C) Tolerance to propofol probably developed very quickly in the presence of alprazolam.
D) This drug combination was safe, but the patient needs close medical supervision.

Question 22

The teaching plan for a patient beginning oxazepam should include what instructions? (Select all that apply.)

A) Take the drug on an empty stomach.
B) Avoid discontinuing the drug abruptly.
C) Stop taking the drug if side effects occur.
D) Drink only moderate amounts of alcohol.
E) Avoid herbal preparations.

Question 23

A patient in the emergency room is suspected to have an overdose of benzodiazepines. Which assessment findings validate this diagnosis? (Select all that apply.)

A) Blood pressure 180/94 mm Hg
B) Diminished reflexes
C) Hypervigilance
D) Somnolence
E) Confusion

Question 24

A patient takes antacids, cimetidine, and phenytoin. The health care provider prescribes a benzodiazepine for anxiety. Which drug interactions is the patient at risk for experiencing? (Select all that apply.)

A) Increased plasma level of benzodiazepine related to cimetidine therapy
B) Increased absorption of the benzodiazepine if taken with the antacid
C) Euphoria and disinhibition associated with phenytoin therapy
D) Serotonin syndrome associated with cimetidine use
E) Potential phenytoin toxicity

Question 25

Which individual would be most likely to experience a paradoxical reaction to a benzodiazepine drug?

A) A child with attention-deficit hyperactivity disorder (ADHD)
B) An adult with obsessive-compulsive disorder
C) A teenager with an eating disorder
D) An adult with major depression