Deck 22: Pharmacotherapy of Anxiety and Insomnia

Question 1

A client diagnosed with generalized anxiety disorder was treated with a selective serotonin reuptake inhibitor (SSRI).The SSRI caused the client sexual dysfunction.The physician changed the prescription to a tricyclic antidepressant, Doxepin (Sinequan).The client indicates understanding of actions of the newly prescribed medication by which statement?
1)"I'm glad the physician has ordered a medication that won't produce side effects."
2)"I might need to suck on sugar-free hard candy for my dry mouth."
3)"I'm glad to take a medication that will take away my anxiety right away."
4)"I need to be careful not to take Sinequan for a long period, due to the possibility of drug dependency."

Answer 1

2

Question 2

It is important for the nurse to obtain a thorough history from a client who is experiencing anxiety.This history will help to distinguish: (Select all that apply.)
1)Substances that might worsen anxiety.
2)The correct dose for phenobarbital.
3)The best method of pharmacotherapy.
4)Whether the client might benefit from individual or group therapy.
5)Whether the client might require restraints.

Answer 2

1, 3, 4

Question 3

A client is being assessed for complaints of difficulty getting to sleep and staying asleep, chronic fatigue, and difficulty staying awake during daytime hours.A sleep study has been ordered.Which of the following medications should the nurse inform the client not to take prior to the sleep study?
1)Fosinopril (Monopril), 10 mg p.o.q.d., an ACE inhibitor
2)Folic acid, 1 mg p.o.
3)Buspirone (BuSpar), 10 mg p.o.b.i.d., a non-benzodiazepine anxiolytic
4)Calan SR, (verapamil)120 mg p.o.q.d., a calcium channel blocker

Answer 3

3

Question 4

A client is brought to the ED with shortness of breath, tachycardia, profuse diaphoresis, and trembling.A cardiac workup shows a normal 12-lead EKG, negative cardiac enzymes, and a normal cardiac echocardiogram.The client has had a major concern, about which the client has been worried for the past two months.The nurse interprets this data as being positive for which of the following diagnoses?
1)Social anxiety disorder
2)Obsessive-compulsive disorder (OCD)
3)Generalized anxiety disorder
4)Panic disorder

Question 5

The nurse distinguishes medications used in general surgery as either hypnotic or sedative, or sedative-hypnotic.The nurse can anticipate the anesthesiologist using which of the following as a sedative-hypnotic for induction of anesthesia?
1)Alprazolam (Xanax)
2)Clorazepate (Tranxene)
3)Thiopental sodium (Pentobarbital)
4)Temazepam (Restoril)

Question 6

A client has been in the ICU for six nights and seven days.There have been numerous activities performed on the client throughout the night shifts, alarms going off, and lights on in the client's room.VS are now stable, 0₂ saturation is 98%, the client is breathing on her own without difficulty, lab work is within normal limits, and arterial blood gas results are within normal limits.The client is irritable and paranoid, and complains of vivid dreams when dozing off to sleep.The best action for the nurse is to: (Select all that apply.)
1)Obtain an order for a repeat arterial blood gas level.
2)Check the oxygen tubing for kinks.
3)Schedule all tests and procedures before 9 p.m.or after 7 a.m.
4)Turn down the lights at night and reduce noise to a minimum.
5)Request an order for medication to help client sleep.

Question 7

Parents of a client who recently returned from duty in Iraq tell the nurse that the client has been released from duty with a diagnosis of post-traumatic stress disorder.The parents question what this means.Which of the following is the best response? (Select all that apply.)
1)It might be common for the client to repetitively wash his hands over and over without apparent reason
2)The client might experience sweating, increased heart rate, and blushing when asked to speak to an audience
3)Whenever in an enclosed, small space, the client might experience an attack of sweating, racing heart, shortness of breath, and trembling.
4)The client might experience nightmares, hallucinations, or flashbacks, accompanied by a racing heart, sweating, shortness of breath, and trembling.

Question 8

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.Emotional states associated with this connection include: (Select all that apply.)
1)Anxiety.
2)Anger.
3)Aggression.
4)Euphoria.
5)Sexual drive.

Question 9

A client who is complaining of anxiety and difficulty sleeping has asked what could be prescribed to assist in getting to sleep.Which of the following would be an appropriate response? (Select all the apply.)
1)Valerian root
2)Diphenhydramine (Benadryl)
3)Flurazepam (Dalmane)
4)Zolpidem (Ambien)
5)Ramelteon (Rozerem)

Question 10

The client is diagnosed with post-traumatic stress syndrome.The nurse would expect which of the following conditions? (Select all that apply.)
1)Hallucinations, nightmares, or flashbacks
2)Tachycardia, extreme nervousness, or panic attacks
3)A fear of crowds
4)A fear of exposure to germs
5)Comorbid difficulty finding energy to perform activities of daily living

Question 11

A client with anxiety and insomnia was prescribed alprazolam (Xanax).This is the fifth day the client has taken the medication.It is most important for the nurse to assess for:
1)Drowsiness after taking the medication.
2)Whether the client is eating grapefruit or drinking grapefruit juice.
3)Use of contraceptives to prevent pregnancy.
4)Thoughts of suicide.

Question 12

A client, who has been prescribed Paxil for treatment of insomnia triggered by anxiety that has been experienced ever since the client's son joined the Army six months ago, asks the nurse why an antidepressant has been prescribed.The best reply by the nurse would be:
1)Paxil is a sedative-hypnotic that will enhance sleep.
2)Antidepressant medications are safer than other medications used to induce sleep.
3)There is a link between insomnia and anxiety.Many antidepressants are given to treat anxiety that are also effective for treating insomnia.
4)Antidepressants act immediately, allowing for faster relief from insomnia.

Question 13

The spouse of a client complains that the client often has twitching and jerkiness shortly after lying down to sleep.The twitching and jerking discontinue after the client goes into a deep sleep.The best action of the nurse is to: (Select all that apply.)
1)Reassure the spouse that this might be a part of the normal sleep cycle.
2)Suggest the client take measures to assist sleepiness, such as sleep in a dark, quiet room.
3)Explain that the client should not drink caffeinated beverages immediately before bedtime.
4)Suggest the client see a sleep specialist to obtain medication for "restless leg syndrome."

Question 14

A client who has recently experienced the loss of a spouse asks the nurse if there are some over-the-counter herbs or nonprescription medications that the client can take to improve insomnia.The nurse replies: (Select all that apply.)
1)"Diphenhydramine (Benadryl)and doxylamine are over-the-counter meds sometimes taken to produce drowsiness."
2)"Valerian and melatonin are herbs commonly taken to improve sleep."
3)"Kava is an herb taken to improve sleep."
4)"Ginger root is commonly taken to improve sleep."
5)"Ginkgo is an herb commonly taken to improve sleep."

Question 15

A client is admitted to the ED with diaphoresis, HR of 120, B/P 146/86, R 24, shortness of breath, c/o difficulty breathing, pressure in the chest, and a feeling of impending doom.O₂ is applied at 2 L/min via nasal cannula, a twelve lead EKG is obtained, a peripheral IV is started with D5NS at 125 cc/hr, nitroglycerin sublingual is administered without improvement in symptoms, ASA 81mg p.o.is administered, and blood work is sent to the lab for a CBC, a chemistry panel, and cardiac enzymes.The client has a positive family history of heart disease.This is the first episode that the client has experienced.The client denies having CP, SOB, or fatigue with exertion.The EKG shows NSR with no pertinent abnormalities.The BNP (B-type natriuretic peptide), Tnl (troponin), and CPK (creatine phosphokinase)enzymes are all within normal limits.Which of the following should the nurse perform next?
1)Schedule a cardiac catheterization as ordered by physician.
2)Start a piggyback infusion of nitroglycerin as ordered.
3)Administer morphine 2 mg IV until chest pressure has resolved.
4)Obtain a history of recent events that might trigger anxiety or that might indicate drug abuse.

Question 16

A client comes to the medical clinic with complaints of irritability, difficulty with memory, constant fatigue, and an inability to fall asleep.The client states that she is unable to fall asleep until 2 or 3 a.m., and has to get up for work by 5 a.m.The client has been trying to lose weight, so she is limiting her caloric intake at suppertime to 500 calories eaten no later than 5 p.m., and the client runs three miles every evening around 8 p.m.The client drinks diet Cokes in the evening instead of snacking on food.Which of the following would be the best response by the nurse?
1)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.
2)Dieting is a common cause for difficulty sleeping.
3)An MRI might be necessary to determine the factors causing the symptoms.
4)Eating a larger meal later in the evening will facilitate better sleep and relieve the symptoms.

Question 17

A client complains of difficulty staying awake during the daytime.It is common for the client to briefly fall asleep at stoplights, while standing in line at the bank counter, and whenever the client sits in a chair for more than five minutes.Sometimes the client experiences sudden slurred speech, sagging of the jaw, and nodding of the head.The client's spouse complains that the client sleepwalks.The client is diagnosed with narcolepsy, and is started on a selective serotonin reuptake inhibitor (SSRI).The nurse explains to the client that the SSRI is given to treat:
1)The episodes of slurred speech, sagging of the jaw, and head nodding.
2)Low levels of serotonin, thereby increasing serotonin and elevating energy levels.
3)Sleepwalking, as an increase in serotonin allows the client a deeper sleep.
4)Sleepiness, as SSRIs are stimulants, which will help the client maintain wakefulness.

Question 18

The nurse is obtaining the medication history from a client newly admitted to the hospital.The client is taking verapamil for HTN, Glucotrol for management of type II diabetes, and melatonin for sleep.Which of the following should the nurse ask?
1)"What was your blood pressure before you began taking the verapamil?"
2)"Tell me the reason you are taking the melatonin."
3)"What was the result of your last hgb A1C?"
4)"How long have you been taking the verapamil for B/P control?"

Question 19

The client's chief complaint is frequent awakenings during the night with an inability to return to sleep.The client doesn't have difficulty falling asleep initially.Which medication would the nurse anticipate preparing?
1)Estazolam (ProSom)
2)Temazepam (Restoril)
3)Eszopiclone (Lunesta)
4)Ramelteon (Rozerem)

Question 20

A client has recently experienced the loss of a mate.The client is having difficulty falling asleep, and does not want to take any prescription medications to induce sleep.The nurse will respond as follows: (Select all that apply.)
1)"There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy."
2)"Walking 2-3 miles, or other exercise, every morning can enhance sleep."
3)"Eating a large meal at bedtime will help induce sleep."
4)"Count sheep after lying down to enhance sleep."
5)"Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime."

Question 21

The nurse is presenting discharge instructions to a client who has been started on a monoamine oxidase inhibitor (MAOI).Which of the following statements would indicate that the client needs further teaching?
1)"I'm not sure how I am going to wake up without my morning coffee."
2)"I sure would like to stop by Pizza Hut for a pizza on my way home from the hospital."
3)"I might need to monitor my blood sugars more closely."
4)"I will try to get out of bed more slowly."

Question 22

Long-term use of phenobarbital can lead to osteomalacia.Education for a client on long-term phenobarbital therapy should include consuming foods high in vitamin D, vitamin K, and folic acid.Which of the following indicates the client understands which foods should be consumed for prevention of osteomalacia?
1)"I need to eat more fish, green vegetables, and milk."
2)"I need to eat more dried fruits, cantaloupe, and dairy products."
3)"I need to eat more broiled poultry, turnip greens, and nuts."
4)"I need to eat more fruits, beef, and milk."

Question 23

The nurse is caring for a client who is postop for a colon resection.The client has been experiencing difficulty sleeping, so the physician has ordered zolpidem (Ambien)p.o.p.r.n.HS for sleep.The client has PT scheduled for 8 p.m.It is best to give the Ambien:
1)Prior to PT, as it takes 30-60 minutes to produce effects.
2)With food, as it could cause stomach upset if given on an empty stomach.
3)Crushed in a small amount of food and swallowed with water.
4)Immediately prior to expected sleep.

Question 24

Lorazepam (Ativan)is ordered IV for a client who was just admitted to the ED with status epilepticus.The client currently has an IV with D5NS infusing at 125 cc/hr.The nurse demonstrates the correct administration of IV Ativan by:
1)Injecting the Ativan quickly IV push.
2)Clamping IV tubing above the injection port, injecting 1cc of NS, injecting the Ativan, and injecting another 1cc of NS.
3)Administering Ativan by slow IV injection over a 2-4-minute period.
4)Mixing the Ativan in a 50cc bag of NS and administering piggyback over 30 minutes.

Question 25

The nurse is caring for a client who is hospitalized with new-onset seizures.The client has been started on phenobarbital 60 mg p.o.b.i.d.for control of the seizures and for complaints of insomnia.Upon entering the client's room to give the p.m.dose of phenobarbital, the nurse assesses that the client has a temperature of 102°F, has periorbital and oral edema, and has a morbilliform, erythematous rash over the entire body.The nurse's next action(s)should be:
1)Give the phenobarbital and notify the physician of the client's condition.
2)Give the phenobarbital as ordered.It is not necessary to notify the physician.
3)Hold the phenobarbital and notify the physician of the client's condition.
4)Hold the phenobarbital and inquire of family members if these symptoms have been present previous to hospitalization.

Question 26

A client is sitting in a busy ED waiting room.The receptionist notifies the nurse that this client is starting to hyperventilate; complains of difficulty breathing and tightness in the chest; and is diaphoretic.This client has been seen within the past month for diagnosis of panic attack.A cardiac workup at the last ED visit was negative.Which should the nurse implement first?
1)Move the client from the waiting area to a private ED cubicle.
2)Prepare to administer lorazepam (Ativan).
3)Administer oxygen via nasal cannula at 2-4 L/min.
4)Order a 12-lead EKG and notify the physician of the client's status.

Question 27

A client who was admitted with excessive blood alcohol levels is now being treated with parenteral lorazepam (Ativan).This is the client's second hospital day.The CBC is within normal limits; the liver function tests are elevated, consistent with cirrhosis; VS are within normal parameters; and there are no visible signs of cirrhosis, such as jaundice.The client becomes combative and confused whenever the Ativan begins to wear off.It is most important for the nurse to complete which of the following involving the administration of parenteral Ativan?
1)Aspirate prior to injection.
2)Assess for a history of smoking.
3)Instruct patient to change positions slowly, especially from lying to standing.
4)Assess for seizure activity.