Question 1

A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced.Which type of blood work will be performed?

Accepted Answer

Liver function tests will be performed because nausea, vomiting, and jaundice can be indicative of hepatotoxicity.Abnormal liver function test results (i.e., elevated bilirubin, aspartate transaminase [AST], alanine transaminase [ALT], gamma glutamyl transferase [GGT], and alkaline phosphatase levels, as well as prothrombin time) are indicative of hepatotoxicity.Benzodiazepines do not affect the kidneys, clotting times, and electrolytes.

Question 2

The nurse is assessing a patient prior to discharge from same day surgery following an incisional breast biopsy.When assessing the patient's central nervous system (CNS) function following sedative hypnotic therapy, what will the nurse include? (Select all that apply.)

Accepted Answer

Because sedative hypnotics depress overall CNS function, the nurse should identify the patient's level of alertness and orientation and ability to perform motor functions.Blood pressure is a vital sign and falls under cardiovascular assessment.Usual sleep pattern should be obtained for information on sleep pattern disruption, but not for CNS function.

Question 3

A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia.Which action will the nurse take?

Accepted Answer

Measuring blood pressure in sitting and lying positions is important to assess for transient hypotension.Ativan does not have to be taken with food.Rapid discontinuance of the medication after long term use may result in symptoms similar to those of alcohol withdrawal.Gradual withdrawal of benzodiazepines is over 2 to 4 weeks.Medications should be taken sitting up.

Question 4

An older adult patient received a hypnotic agent at 9:00 PM.At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance.What type of medication effect is the patient exhibiting?

Accepted Answer

A paradoxical effect may occur in older adult patients.This includes periods of excitement, confusion, restlessness, and euphoria.Allergies to medications tend to manifest in skin or respiratory symptoms.A patient who is hypersensitive to a hypnotic would be difficult to rouse.A therapeutic effect for a hypnotic would be sedation.

Question 5

The nurse finds that a patient is extremely agitated, yells frequently, and is attempting to get out of bed without assistance.What is the nurse's initial action?

Accepted Answer

Assessing the patient's level of anxiety is important.The patient may only need someone to listen to what stressors he or she is facing.The nurse must assess the patient before medication can be administered.

Question 6

The nurse is caring for an older patient recently admitted to an assisted living center who is experiencing insomnia associated with the recent relocation.At bedtime, which nursing action will assist the patient to sleep?

Accepted Answer

Providing a back rub will promote relaxation and reduce anxiety associated with a new environment.This would also provide an opportunity for the nurse to encourage the patient to express feelings.The patient should avoid products containing caffeine, such as coffee, tea, soft drinks, and chocolate.A quiet unwinding activity before bedtime is helpful for sleep promotion.Administering an analgesic is not an appropriate action.

Question 7

The nurse is administering Somnote to a patient.When providing medication education to the patient, the nurse will include that Somnote should be:

Accepted Answer

Somnote is available in capsule form and should not be chewed, should be taken with a full glass of water, should be taken after meals, and is usually ordered to be taken three times a day after meals.

Question 8

The nurse is explaining the use of medications to a patient with insomnia.Which statement about sedatives is true?

Accepted Answer

A hypnotic is a drug that produces sleep; a sedative quiets the patient and gives a feeling of relaxation and rest, not necessarily accompanied by sleep.Sedatives do not increase the total time in REM sleep.A small dose of a drug may act as a sedative, whereas a larger dose of the same drug may act as a hypnotic and produce sleep.

Question 9

When reviewing a patient's history and physical information, the nurse notes that the patient has physician's orders for chloral hydrate and warfarin.During assessment of this patient, the nurse observes areas of petechiae and ecchymosis on the upper and lower extremities.The most appropriate lab work for the nurse to assess next is:

Accepted Answer

Chloral hydrate may enhance the anticoagulant effects of warfarin.The patient should be observed for petechiae, ecchymoses, nosebleeds, bleeding gums, dark tarry stools, and bright red or coffee ground emesis.Prothrombin time should be monitored, and the physician should reduce the dosage of warfarin, if necessary.

Question 10

The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints of back pain.The patient reports taking diphenhydramine for insomnia related to job stress.Which statement by the nurse is accurate regarding this medication?

Accepted Answer

Antihistamines (particularly diphenhydramine and doxylamine) have sedative properties that may be used for short term treatment of mild insomnia.They are common ingredients in over the counter (OTC) sleep aids.Tolerance develops after only a few nights of use; increasing the dose actually causes a more restless and irregular sleep pattern.Diphenhydramine does not cause nausea.There is no restriction on taking diphenhydramine after a high fat meal.Diphenhydramine is not an herbal medication.

Question 11

What can occur as a result of rapid withdrawal from long term use of barbiturate therapy? (Select all that apply.)

Accepted Answer

Anxiety, delirium, weakness, and grand mal seizures can be symptoms of rapid withdrawal from long term use of barbiturate therapy.Severe pain is not a symptom of rapid withdrawal from long term use of barbiturate therapy.

Question 12

Barbiturates have which common adverse effect(s)? (Select all that apply.)

Accepted Answer

The long half life of a barbiturate medication often causes residual daytime sedation.Headache is a general adverse effect of barbiturates.Blurred vision is an adverse effect associated with the hypnotic dosages of long acting barbiturates.Impaired coordination is an adverse effect of barbiturates.Hyperactivity is not generally an adverse effect of barbiturates unless the patient is experiencing a paradoxical response.

Question 13

Why are benzodiazepines often preferred over barbiturates? (Select all that apply.)

Accepted Answer

The selectivity of specific drugs at receptor sites accounts for the wide variety of uses.There is a wide safety margin between the therapeutic and lethal dosages for these drugs.Benzodiazepines decrease REM sleep to a lesser extent.Intentional and unintentional overdoses of benzodiazepines are often well tolerated and not fatal.There are transient hypotensive episodes with benzodiazepine therapy.

Question 14

For what conditions are benzodiazepines prescribed?

Accepted Answer

The sedative hypnotic effect of benzodiazepines facilitates surgical sedation.Short acting benzodiazepines are administered intramuscularly for preoperative sedation.They are also given intravenously for conscious sedation before short diagnostic procedures or for the induction of general anesthesia.Benzodiazepines are not recommended for long term use and do not affect amnesia.Benzodiazepines are a poor choice for the treatment of chronic insomnia because of their risk for habituation.Benzodiazepines do not have an antipsychotic effect.

Question 15

Which sleep pattern stage diminishes as an effect of aging?

Accepted Answer

As we age, stage IV sleep diminishes.Many people older than 75 years do not demonstrate any stage IV sleep patterns.Between 2% and 5% of sleep is stage I.Stage II comprises about 50% of normal sleep time.Stage III is a transition between lighter sleep and deeper sleep.

Question 16

In addition to facilitating sleep, what is another benefit of sedatives?

Accepted Answer

Preoperatively, sedatives will help decrease patient anxiety and facilitate sleep.Sedatives are not long acting enough to affect postoperative pain control.Sedatives do not affect bronchial secretions.Sedatives diminish patient alertness.

Question 17

Which disease is associated with insufficient sleep?

Accepted Answer

Individuals who sleep less than 5 hours a night have a threefold increased risk of heart attacks.Cancer, glaucoma, and renal failure are not associated with lack of sleep.

Question 18

Which two phases make up normal sleep?

Accepted Answer

Normal sleep can be divided into two phases, REM and non REM.Hypnagogic is the state between waking and sleeping; hypnopompic is the transition between sleeping and waking states.Beta waves are those associated with day to day wakefulness.During periods of relaxation while still awake, our brain waves become slower, increase in amplitude, and become more synchronous.These types of waves are called alpha waves.The first stage of sleep is characterized by theta waves.During a normal night's sleep, a sleeper passes from the theta waves of stages 1 and 2 to the delta waves of stages 3 and 4.Delta waves are the slowest and highest amplitude brain waves.

Quiz 14: Drugs Used for Sleep