Deck 14: Drugs for Anxiety and Insomnia

Question 1

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

A) Reticular activating system
B) Cerebral cortex
C) Limbic system
D) Cerebellum

Answer 1

Reticular activating system

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?

A) "You will be taking medications known as sedative-hypnotics."
B) "You will be taking medications known as antidepressants."
C) "You will be taking a medication known as paraldehyde."
D) "You will be taking medications known as barbiturates."
E) "You will be taking medications known as benzodiazepines."

Answer 2

"You will be taking medications known as sedative-hypnotics."
"You will be taking medications known as antidepressants."
"You will be taking medications known as benzodiazepines."

Question 3

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

A) Benzodiazepines are the most effective.
B) Benzodiazepines have the lowest risk of dependency and tolerance.
C) Benzodiazepines are most likely to be covered under insurance premiums.
D) Benzodiazepines are the most affordable.

Answer 3

Benzodiazepines have the lowest risk of dependency and tolerance.

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?

A) "Side effects I might experience include dizziness, headache, and drowsiness."
B) "I can take this medication when I feel anxious and it will relax me."
C) "I have to take this medicine on a regular basis for it to help me."
D) "I don't need to worry about becoming dependent on this medication."

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?

A) Dizziness and daytime sedation
B) Nausea
C) Diarrhea
D) Sleepwalking

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?

A) Assess for a primary sleep disorder such as sleep apnea.
B) Assess if the patient has been selling his medications to addicts.
C) Assess if the patient has an addictive personality disorder.
D) Assess the patient for a primary personality 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?

A) The patient is experiencing symptoms of St. John's wort toxicity, as the medication was most likely outdated.
B) The patient has contracted a viral infection. Escitalopram (Lexapro) and St. John's wort are safe to take together.
C) The patient has not been taking escitalopram (Lexapro) and is experiencing withdrawal.
D) The patient has combined two antidepressant medications and is experiencing serotonin syndrome.

Question 8

Which drug category can be used for treating anxiety?

A) Antitussives
B) Anticoagulants
C) Seizure drugs
D) Antibiotics

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?

A) "The same brain chemicals are involved with anxiety as well as depression."
B) "You are really depressed; it is just manifested as anxiety. These medications are safer than benzodiazepines."
C) "Your doctor thinks that this is the best treatment for your anxiety, and these medications are safer than benzodiazepines."
D) "The two disorders go together, and if you treat depression, the anxiety goes away."

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?

A) "You have generalized anxiety; I will teach you some relaxation techniques."
B) "This sounds like social anxiety. You need to calm down and you'll be fine."
C) "You have posttraumatic stress disorder (PTSD), and it is time for your therapy session."
D) "This is called panic disorder; I'll get your medication for you."

Question 11

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

A) Pralidoxime (Protopam)
B) Naloxone (Narcan)
C) Flumazenil (Romazicon)
D) Nalmefene (Revex)

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?

A) Increased heart rate, fever, and muscle cramps
B) Nothing different; it is safe to abruptly stop lorazepam (Ativan)
C) Pinpoint pupils, constipation, and urinary retention
D) A sense of calmness and lack of anxiety

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?

A) The patient will verbalize the signs of developing Stevens-Johnson rash.
B) The patient will verbalize the importance of diet restrictions related to this drug.
C) The patient will verbalize the importance of having routine blood work done.
D) The patient will verbalize the consequences of stopping the drug abruptly.

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?

A) "The limbic system and reticular activating system control anxiety and insomnia."
B) "The frontal lobes and limbic system control anxiety and insomnia."
C) "The thalamus and reticular activating system control anxiety and insomnia."
D) "The limbic system and hypothalamus control anxiety and 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?

A) "This is the lightest stage of sleep and is profoundly affected by anxiety."
B) "Dreaming occurs here; without dreams you will be irritable and paranoid."
C) "This is the deepest stage of sleep; without it you will be tired and depressed."
D) "This is the also called paradoxical sleep."

Question 16

The most productive way of managing stress would be to

A) use a combined approach (drug use and nonpharmacological strategies).
B) use anxiolytics.
C) practice meditation.
D) determine the cause and address it accordingly.

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?

A) "Relaxation techniques will often decrease anxiety."
B) "Antianxiety medicine should be used until anxiety is gone."
C) "Antianxiety medicine should not be used indefinitely."
D) "Therapy may help identify where this anxiety comes from."
E) "Different medications are required for treating anxiety than for treating difficulty sleeping."

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?

A) "Medications are a way of life for patients with anxiety disorders."
B) "Medication is necessary initially; later we will try therapy."
C) "Probably not, but you shouldn't compare yourself to your neighbor."
D) "Medication is necessary when anxiety interferes with your 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?

A) An 87-year-old patient who uses a cane for ambulation
B) A 9-year-old child with panic attacks
C) A 42-year-old businessman who travels internationally
D) A 32-year-old mother of two preschool children

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

A) situational anxiety.
B) social anxiety.
C) obsessive-compulsive disorder.
D) performance anxiety.

Question 21

The patient is diagnosed with post-traumatic stress disorder. What will the nurse assess in this patient?

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

Question 22

Which explanation best indicates why barbiturates are rarely used to treat anxiety and insomnia?

A) They have a greater associated cost.
B) They have a high risk of producing an allergic response.
C) They are seldom effective.
D) They produce many serious adverse effects.

Question 23

It is important for the nurse to obtain a thorough history from a patient who is experiencing anxiety. This history will help to distinguish

A) the best method of pharmacotherapy.
B) whether the patient 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.

Question 24

A patient who has 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. How should the nurse respond to this patient?

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 25

Which common adverse effects of selective serotonin reuptake inhibitors (SSRIs) would be stressed by the nurse during patient discharge?

A) Drowsiness and coma
B) Weight gain and sexual dysfunction
C) Headache and nausea
D) Dry mouth and urine retention

Question 26

A patient whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications to induce sleep. How should the nurse respond?

A) "Make certain your bedroom is nice and warm."
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 27

A patient taking which of the following medications should avoid foods high in tyramine?

A) MAOIs
B) SSRIs
C) Beta blockers
D) Benzodiazepines

Question 28

A patient has been in the intensive care unit for a week receiving various procedures throughout the day and night. Currently the patient, 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?

A) Check the patient's oxygen status.
B) Request an order for sleep medication.
C) Assess the patient'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 29

Which statement regarding the use of zolpidem (Ambien) for insomnia is accurate?

A) Patients using Ambien should avoid foods that contain tyramine.
B) Ambien will take longer to produce an effect when taken with food.
C) Ambien is contraindicated during pregnancy but can be taken by breastfeeding mothers.
D) Ambien is classified as a benzodiazepine.

Question 30

A patient who is complaining of anxiety and difficulty sleeping has asked what prescription medications would assist in getting to sleep. What would be appropriate responses?

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