Deck 18: Pharmacotherapy of Anxiety and Sleep Disorders

Question 1

A client complains of frequent awakenings during the night with an inability to return to sleep.The client does not have difficulty falling asleep initially.Which medication would the nurse anticipate preparing?

A)Eszopiclone (Lunesta)
B)Estazolam (ProSom)
C)Temazepam (Restoril)
D)Ramelteon (Rozerem)

Answer 1

Eszopiclone (Lunesta)

Question 2

A client,who experienced shortness of breath,tachycardia,profuse diaphoresis,and trembling learns that all cardiac diagnostic tests are negative for an acute myocardial infarction.During the assessment,the nurse is told about a major problem that has caused the client great concern over the last two months.The nurse interprets this information as being consistent with which anxiety disorder?

A)Social
B)Generalized
C)Panic
D)Obsessive-compulsive

Answer 2

Panic

Question 3

It is important for the nurse to obtain a thorough history from a client who is experiencing anxiety.What can the nurse distinguish through the history? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The best method of pharmacotherapy
B)Whether the client might benefit from individual or group therapy
C)The category of anxiety disorder
D)The region of the brain that is causing the anxiety disorder
E)Substances that might worsen anxiety

Answer 3

The best method of pharmacotherapy
Whether the client might benefit from individual or group therapy
Substances that might worsen anxiety

Question 4

Signals routed through the amygdala ultimately connect with the hypothalamus,an important center responsible for modulating the fight-or-flight response of the autonomic nervous system.Which are emotional states associated with this connection? Note: Credit will be given only if all choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Euphoria
B)Aggression
C)Anger
D)Sexual drive
E)Fatigue

Question 5

A client who is complaining of anxiety and difficulty sleeping has asked what prescription medications would assist in getting to sleep.What would be appropriate responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Diphenhydramine (Benadryl)
B)Valerian root
C)Ramelteon (Rozerem)
D)Flurazepam (Dalmane)
E)Zolpidem (Ambien)

Question 6

The client is diagnosed with post-traumatic stress disorder (PTSD).What will the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Tachycardia
B)Extreme nervousness or panic attacks
C)A fear of crowds
D)A fear of exposure to germs
E)Hallucinations,nightmares,or flashbacks

Question 7

A client comes to the emergency department with shortness of breath,difficulty breathing,pressure in the chest,and a feeling of impending doom.After diagnostic tests and an electrocardiogram,the findings are not consistent with an acute myocardial infarction.What should the nurse do next?

A)Assess the gastrointestinal system.
B)Obtain a history of recent events that might trigger anxiety or that might indicate drug abuse.
C)Ask the health care provider to prescribe pain medication.
D)Prepare discharge forms for the client.

Question 8

A client with anxiety and insomnia has been taking alprazolam (Xanax)for five days.What is the priority for the nurse to assess in this client?

A)Stopping the use of birth control pills
B)Thoughts of suicide
C)Taking the medication with grapefruit juice
D)Drowsiness after taking the medication

Question 9

A client is taking verapamil for hypertension,Glucotrol for management of type II diabetes,and melatonin for sleep.Which the nurse ask about these medications?

A)"How is the melatonin helping you with sleep?"
B)"How long have you been taking the verapamil for blood pressure control?"
C)"What was the result of your last hemoglobin A1C level?"
D)"What was your blood pressure before you began taking the verapamil?"

Question 10

The nurse distinguishes medications used in general surgery as either hypnotic or sedative,or sedative-hypnotic.The nurse can anticipate the anesthesiologist using which sedative-hypnotic for induction of anesthesia?

A)Clorazepate (Tranxene)
B)Alprazolam (Xanax)
C)Thiopental sodium (Pentobarbital)
D)Temazepam (Restoril)

Question 11

A client diagnosed with generalized anxiety disorder is prescribed a tricyclic antidepressant,Doxepin (Sinequan).Which statement indicates that the client understands the actions of this medication?

A)"I'm glad to have a medication that will take away my anxiety right away."
B)"I'm glad the health care provider has ordered a medication that won't produce side effects."
C)"I need to be careful not to take Sinequan for a long period,due to the possibility of drug dependency."
D)"I might need to suck on sugar-free hard candy for my dry mouth."

Question 12

A client whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications to induce sleep.Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Walking 2-3 miles or engaging in some other exercise every morning can enhance sleep."
B)"There are alternative methods to treat insomnia,such as yoga,meditation,and massage therapy."
C)"Eating a large meal at bedtime will help induce sleep."
D)"Avoid caffeinated beverages,nicotine,and alcohol immediately prior to bedtime."
E)"Count sheep after lying down in order to enhance sleep."

Question 13

A client diagnosed with insomnia,triggered by anxiety,is prescribed paroxetine (Paxil).When the client asks the nurse why an antidepressant has been prescribed,which response by the nurse is the most appropriate?

A)"Paxil is a sedative-hypnotic that will enhance sleep."
B)"There is a link between insomnia and anxiety.Many antidepressants that are effective for treating anxiety are also given to treat insomnia."
C)"Antidepressant medications are safer than other medications used to induce sleep."
D)"Antidepressants act immediately,allowing for faster relief from insomnia."

Question 14

A client who recently returned from duty in Iraq is diagnosed with post-traumatic stress disorder (PTSD).The client's family questions what this means.How should the nurse respond to the family?

A)"The client might experience sweating,increased heart rate,and blushing when asked to speak to an audience."
B)"Whenever in an enclosed,small space,the client might experience an attack of sweating,racing heart,shortness of breath,and trembling."
C)"The client might experience nightmares,hallucinations,or flashbacks,accompanied by a racing heart,sweating,shortness of breath,and trembling."
D)"It might be common for the client to repetitively wash his hands over and over without apparent reason."

Question 15

The spouse of a client tells the nurse about the client's twitching and jerking shortly after lying down and says it stops after the client goes into a deep sleep.Which response is the most appropriate from the nurse?

A)Suggest the client see a sleep specialist to obtain medication for restless leg syndrome.
B)Reassure the spouse that this might be a part of the normal sleep cycle.
C)Explain that the client should not drink caffeinated beverages immediately before bedtime.
D)Suggest the client take measures to assist sleepiness,such as sleep in a dark,quiet room.

Question 16

A client diagnosed with narcolepsy,sleepwalking,and cataplexy is prescribed a selective serotonin reuptake inhibitor (SSRI).Which explanation regarding this medication is the most accurate?

A)It lowers levels of serotonin,thereby increasing serotonin and elevating energy levels.
B)It helps with sleepwalking because the increase in serotonin allows the client a deeper sleep.
C)It decreased sleepiness,as SSRIs are stimulants,which will help the client maintain wakefulness.
D)It decreased episodes of slurred speech,sagging of the jaw,and head nodding.

Question 17

A client is complaining of irritability,difficulty with memory,constant fatigue,and an inability to fall asleep.The client averages 3 hours of sleep each night,has been following a restricted calorie evening meal as part of a weight loss plan,and exercises every evening.Instead of food,the client drinks no-calorie caffeinated sodas.What should the nurse suggest to this client?

A)Eating a larger meal later in the evening will facilitate better sleep and relieve the symptoms.
B)An MRI might be necessary to determine the factors causing the symptoms.
C)Dieting is a common cause for difficulty sleeping.
D)Changes in hormones due to exercising late in the evening and late intake of caffeine might be disrupting the NREM sleep phase,causing the stated symptoms.

Question 18

A client has been in the intensive care unit for a week receiving various procedures throughout the day and night.Currently the client,though physiologically stable,is irritable and paranoid and complains of vivid dreams when dozing off to sleep.What are the best actions for the nurse to take at this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Check the client's oxygen status.
B)Request an order for sleep medication.
C)Assess the client's vital signs.
D)Turn down the lights at night and reduce noise to a minimum.
E)Schedule all tests and procedures before 9 p.m.or after 7 a.m.

Question 19

A client who recently experienced the loss of a spouse asks the nurse if there are any over-the-counter herbs or nonprescription medications that can be used to improve insomnia.Which response by the nurse is the most appropriate? Standard Text: Select all that apply.

A)"Ginger root is commonly taken to improve sleep."
B)"Ginkgo is an herb commonly taken to improve sleep."
C)"Diphenhydramine (Benadryl)and doxylamine are over-the-counter meds sometimes taken to produce drowsiness."
D)"Valerian and melatonin are herbs commonly taken to improve sleep."
E)"Kava is an herb taken to improve sleep."

Question 20

A client is being assessed for complaints of difficulty getting to and staying asleep,chronic fatigue,and difficulty staying awake during daytime hours.A sleep study has been ordered.Which medication should the nurse teach the client to avoid prior to the sleep study?

A)Fosinopril (Monopril),10 mg p.o.q.d.,an ACE inhibitor
B)Calan SR,(verapamil)120 mg p.o.q.d.,a calcium channel blocker
C)Folic acid,1 mg p.o.
D)Buspirone (BuSpar),10 mg p.o.b.i.d.,a nonbenzodiazepine anxiolytic

Question 21

A client being treated for an anxiety disorder is prescribed medication for sleep to be provided every evening.Why is the client prescribed sleeping medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)There is a link between anxiety and sleep.
B)Improving sleep will help with the anxiety disorder.
C)Less antianxiety medication will be needed during the day.
D)It will prevent rebound insomnia.
E)It will stop the client from worrying about not getting enough sleep.

Question 22

The nurse is coaching a client on nonpharmacologic interventions to improve sleep.What would be included in these instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Meditation
B)Guided imagery
C)Deep breathing
D)Drinking chamomile tea
E)Keeping a light on

Question 23

Since long-term use of phenobarbital can lead to osteomalacia,a client is instructed to consume foods high in vitamin D,vitamin K,and folic acid.Which statement indicates the client understands these instructions?

A)"I need to eat more broiled poultry,turnip greens,and nuts."
B)"I need to eat more fish,green vegetables,and milk."
C)"I need to eat more fruits,beef,and milk."
D)"I need to eat more dried fruits,cantaloupe,and dairy products."

Question 24

A client is prescribed a medication that will inhibit the function of the reticular activating system.What will the nurse assess as effects of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Drowsiness
B)Sleeping
C)Alertness
D)Dilated pupils
E)Elevated blood pressure

Question 25

The nurse withholds a scheduled dose of secobarbital (Seconal)to a client and notifies the health care provider when what was assessed? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Respiratory rate of 8 breaths per minute
B)Heart rate of 58 beats per minute
C)Blood pressure 124/88 mmHg
D)Temperature 99.8^ºF
E)Pain level 5 on numeric pain scale

Question 26

A client experiencing hyperventilation,diaphoresis,and difficulty breathing with chest tightness was diagnosed with panic attacks after a negative cardiac workup.What action should the nurse implement first?

A)Perform a 12-lead EKG.
B)Administer oxygen via nasal cannula at 2-4 L/min.
C)Move the client from the waiting area to a private ED cubicle.
D)Prepare to administer lorazepam (Ativan).

Question 27

The nurse's client is prescribed medication for anxiety and sleep,and the nurse is providing instruction on lifestyle changes.What would be included in this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Avoid caffeine.
B)Avoid smoking.
C)Limit alcohol intake.
D)Exercise before bedtime.
E)Limit the intake of green leafy vegetables.

Question 28

A client recovering from surgery is prescribed zolpidem (Ambien)for sleep.The client is scheduled for physical therapy at 8 p.m.What should the nurse do when providing the client with this medication?

A)Crush the medication in a small amount of food.
B)Provide the medication with food.
C)Administer the medication prior to attending physical therapy because it takes 30-60 minutes to produce effects.
D)Administer the medication immediately prior to expected sleep.

Question 29

A client is prescribed a medication for anxiety that will affect the limbic system.When instructing the client,the nurse explains that this medication will affect which areas? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Emotions
B)Behavior
C)Long-term memory
D)Secretion of corticotropin-releasing factor
E)Production of melatonin

Question 30

The nurse is providing discharge instructions to a client who has been started on a monoamine oxidase inhibitor (MAOI).Which statement indicates that the client needs further teaching?

A)"I might need to monitor my blood sugars more closely."
B)"I'm not sure how I am going to wake up without my morning coffee."
C)"I sure would like to stop by Pizza Hut for a pizza on my way home from the hospital."
D)"I will try to get out of bed more slowly."

Question 31

A client receiving phenobarbital for seizure control has a temperature of 102°F,periorbital and oral edema,and an erythematous rash over the entire body.Which action by the nurse is the priority?

A)Give the phenobarbital as ordered.
B)Hold the phenobarbital and notify the health care provider of the client's condition.
C)Hold the phenobarbital and inquire of family members if these symptoms have been present previous to hospitalization.
D)Give the phenobarbital and notify the health care provider of the client's condition.

Question 32

A client is prescribed duloxetine (Cymbalta)for fibromyalgia.When teaching the client about this medication,the nurse will include which adverse or side effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Constipation is an adverse effect.
B)Weight loss can occur when taking this medication.
C)Headaches are an adverse effect.
D)An increase in sexual desire may occur.
E)Symptoms of social anxiety disorder may decrease while taking this medication.

Question 33

Lorazepam (Ativan)is ordered to be given through the intravenous route for a client with status epilepticus.The client currently has an intravenous infusion of dextrose 5% and 0.9% normal saline at the rate of 125 mL/hr.Which action demonstrates the correct administration of this medication by the nurse?

A)Administering Ativan by slow IV injection over a 2- to 4-minute period.
B)Injecting the Ativan quickly via IV push.
C)Discontinuing the intravenous infusion prior to administering the medication.
D)Mixing the Ativan in a 50cc bag of NS and administering piggyback over 30 minutes.

Question 34

The nurse is preparing to administer intravenous lorazepam (Ativan)to a client.Which nursing intervention is a priority following the parenteral administration of this medication?

A)Assess for drug interactions with other medications.
B)Instruct client to change positions slowly,especially from lying to standing.
C)Monitor for changes in respirations.
D)Assess for seizure activity.

Question 35

A client with anxiety reports difficulty sleeping and waking up several times throughout the night.The nurse is concerned that the client can develop imbalances in which neurotransmitters? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Acetylcholine
B)Serotonin
C)Norepinephrine
D)Dopamine
E)Gamma-aminobutyric acid

Question 36

During a medical history,a client tells the nurse about waiting several hours before falling asleep and waking up repeatedly during the night only to wait again to fall asleep.The nurse would document this client's symptoms as being which types of insomnia? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Sleep-onset
B)Sleep-maintenance
C)Sleep-offset
D)Nonrestorative sleep
E)Parasomnia

Question 37

The nurse notes that a client is prescribed zolpidem (Ambien)at a dose smaller than is recommended.What would the nurse review to determine the reason for the reduced dose? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Client's age
B)Blood-urea-nitrogen level
C)Creatinine level
D)Liver function studies
E)White blood cell count

Question 38

During a health history,a client expresses concern to the nurse about finances and the health of older parents.What will the nurse assess to determine whether this client is experiencing generalized anxiety disorder? Standard Text: Select all that apply.

A)Restlessness
B)Elevated blood pressure
C)Urinary urgency
D)Blushing
E)Repeating the numbers 1 through 13

Question 39

A hospitalized client who is not prescribed medication for sleep tells the nurse about using a sedative to sleep "for years." What will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Sleeplessness
B)Anxiety
C)Daytime drowsiness
D)Dizziness
E)Blurred vision