Question 1

Which area of the brain is primarily responsible for maintaining sleep and wakefulness?

Accepted Answer

The reticular activating system (also known as reticular formation) is a network of neurons located in the brainstem, which is responsible for maintaining the appropriate levels of arousal and wakefulness required for various cognitive and behavioral functions. It receives input from various sensory systems and brain areas and then sends output to multiple brain regions, including the cerebral cortex and thalamus, to regulate the state of consciousness. Dysfunction in the reticular activating system can lead to hypersomnia, insomnia, and other sleep disorders.

Question 2

The patient tells the nurse, "I am really confused after talking to my doctor. He said I would be taking different kinds of medications for my anxiety and insomnia. Will you please explain it?" What is the best response by the nurse?

Accepted Answer

A,B,E

Question 3

Benzodiazepines are often the drug of choice for managing anxiety and insomnia. Which statement best explains why?

Accepted Answer

B

Question 4

The nurse has completed medication education for the anxious patient who is receiving buspirone (BuSpar). The nurse determines that the patient needs additional instruction when the patient makes which statement?

Accepted Answer

Buspirone (BuSpar) is not a medication that works immediately to relieve anxiety. It needs to be taken on a regular basis to be effective, and it does not provide immediate relief of anxiety symptoms.

Question 5

The patient is receiving zolpidem (Ambien) for treatment of short-term insomnia. What is the primary safety concern of the nurse when the patient takes this medication?

Accepted Answer

Zolpidem (Ambien) can cause complex sleep-related behaviors such as sleepwalking, which is a significant safety concern as it can lead to injury.

Question 6

The patient has been treated by the same physician for 2 years and has had insomnia the entire time. Many different medications have been tried with limited success. What should be the nurse's primary assessment at this time?

Accepted Answer

The nurse should assess for a primary sleep disorder such as sleep apnea, as the patient has had persistent insomnia despite treatment, indicating a possible underlying sleep disorder.

Question 7

The patient has been receiving escitalopram (Lexapro) for treatment of obsessive-compulsive disorder. Unknown to the nurse, the patient has also been self-medicating with St. John's wort. The patient comes to the office with symptoms of hyperthermia and diaphoresis. Which statement best describes the result of the nurse's assessment?

Accepted Answer

The combination of escitalopram, a selective serotonin reuptake inhibitor (SSRI), and St. John's wort, an herbal supplement with serotonergic properties, can lead to an excessive accumulation of serotonin, resulting in serotonin syndrome. Symptoms include hyperthermia and diaphoresis.

Question 8

Which drug category can be used for treating anxiety?

Accepted Answer

Seizure drugs, such as benzodiazepines and antidepressants, can be prescribed for the treatment of anxiety disorders. Antitussives are used to treat coughs, anticoagulants are used to thin blood, and antibiotics are used to treat infections, none of which are effective for anxiety.

Question 9

The patient is receiving escitalopram (Lexapro) for treatment of generalized anxiety disorder. The patient asks the nurse, "I am just nervous, not depressed. Why am I taking an antidepressant medicine?" What is the best response by the nurse?

Accepted Answer

Selective serotonin reuptake inhibitors (SSRIs) like escitalopram are used to treat both depression and anxiety because they affect the same neurotransmitters involved in both conditions.

Question 10

The patient tells the nurse he worries about everything all day, feels confused, restless, and just can't stop worrying. What is the best response by the nurse?

Accepted Answer

The patient's symptoms are indicative of generalized anxiety disorder (GAD), characterized by excessive worry and restlessness. Teaching relaxation techniques is an appropriate response.

Question 11

The patient comes to the emergency department after an overdose of lorazepam (Ativan). The nurse will plan to administer which medication?

Accepted Answer

Flumazenil (Romazicon) is a benzodiazepine antagonist used to reverse the effects of benzodiazepines like lorazepam.

Question 12

The patient has been taking lorazepam (Ativan) for 2 years. The patient stopped this medication after a neighbor said the drug manufacturer's plant was contaminated with rat droppings. What best describes the nurse's assessment of the patient when seen 3 days after stopping his medication?

Accepted Answer

Abruptly stopping lorazepam, a benzodiazepine, after long-term use can lead to withdrawal symptoms such as increased heart rate, fever, and muscle cramps.

Question 13

The patient is receiving the benzodiazepine clonazepam (Klonopin) for the treatment of panic attacks. What is an important medication outcome for this patient as it relates to safety?

Accepted Answer

Abruptly stopping clonazepam, a benzodiazepine, can lead to withdrawal symptoms and potentially dangerous consequences, so it is important for the patient to understand the risks of discontinuing the medication without medical guidance.

Question 14

The patient tells the nurse that she is interested in the human brain and questions which parts of the brain control anxiety and insomnia. What is the best reply by the nurse?

Accepted Answer

The limbic system is involved in emotional regulation, including anxiety, and the reticular activating system is involved in sleep-wake cycles, affecting insomnia.

Question 15

The patient is scheduled to have an EEG to confirm the presence of a sleep disorder. The patient asks the nurse to describe NREM stage 3 sleep. What is the best response by the nurse?

Accepted Answer

NREM stage 3 sleep is the deepest stage of non-rapid eye movement sleep, and it is essential for feeling rested and rejuvenated. Lack of this stage can lead to fatigue and depression.

Question 16

The most productive way of managing stress would be to

Accepted Answer

Determining the cause of stress and addressing it accordingly is the most productive way to manage stress, as it targets the root of the problem rather than just alleviating symptoms.

Question 17

The nurse has completed group education for patients with anxiety disorders. The education is evaluated as successful when the patients make which statements?

Accepted Answer

Relaxation techniques can help manage anxiety (A). Antianxiety medications are not typically used indefinitely due to potential dependency and side effects (C). Therapy can help uncover the root causes of anxiety (D).

Question 18

The patient has generalized anxiety disorder. He asks the nurse, "Will I need medication for this? My neighbor is very nervous and he takes medication." What is the best response by the nurse?

Accepted Answer

Medication is often recommended when anxiety significantly impacts a person's daily functioning and quality of life.

Question 19

The nurse works with a physician who frequently prescribes benzodiazepines. The use of benzodiazepines in which patient would cause the nurse the most concern?

Accepted Answer

Benzodiazepines can cause sedation and increase the risk of falls, which is particularly concerning for an elderly patient who already has mobility issues.

Question 20

An individual who has difficulty sleeping due to two final examinations scheduled for the same day later in the week most likely would be suffering from

Accepted Answer

Situational anxiety is a temporary feeling of anxiety that occurs in response to a specific situation, such as having two final exams on the same day.

Quiz 14: Drugs for Anxiety and Insomnia