Deck 17: Antianxiety Drugs

Question 1

The nurse would expect a patient with which co-morbid diagnosis to have a magnified response to the usual dose of a benzodiazepine drug?

A) Rheumatoid arthritis
B) Migraine headache
C) Hepatic cirrhosis
D) Osteoporosis

Answer 1

Hepatic cirrhosis

Question 2

Which patient has the greatest risk for overdose with a benzodiazepine? A patient who:

A) takes the drug with antacids.
B) takes the drug before meals.
C) combines the drug with alcohol.
D) experiences depression as well as anxiety.

Answer 2

combines the drug with alcohol.

Question 3

A health care provider prescribes lorazepam (Ativan) for an anxious older adult. What is the nurse's best action?

A) Assess for a history of drug abuse.
B) Administer the drug as prescribed.
C) Confer with the health care provider.
D) Assess the patient's pupillary reaction to light.

Answer 3

Administer the drug as prescribed.

Question 4

The half-life of a benzodiazepine drug is 20 hours for a young adult, but for an older adult it is likely to be:

A) 10 hours.
B) 30 hours.
C) 40 hours.
D) 80 hours.

Question 5

A patient has taken diazepam (Valium) for 1 week for back spasms. The patient complains of "feeling sleepy all the time." The nurse should tell the patient:

A) "The dosage probably needs to be decreased."
B) "Drowsiness indicates a paradoxical reaction to the drug."
C) "Tolerance to the sedative effect of the drug will develop quickly."
D) "Sleepiness is an unavoidable side effect of non-benzodiazepine drugs."

Question 6

The nurse would expect to administer flumazenil (Romazicon) for a patient:

A) in acute alcohol withdrawal.
B) with a benzodiazepine overdose.
C) with benzodiazepine-resistant anxiety.
D) with anxiety associated with a psychotic disorder.

Question 7

A patient took a benzodiazepine for 4 weeks but will now change to buspirone (BuSpar) for long-term treatment of anxiety. The benzodiazepine is tapered off as the buspirone is begun. Important information the patient should receive about buspirone is that it:

A) produces profound sedation.
B) will be effective in 7 to 10 days.
C) has a high risk for development of dependence.
D) is often associated with cross-tolerance with other CNS depressants.

Question 8

A patient has taken clonazepam (Klonopin) for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's priority action?

A) Begin seizure precautions.
B) Refer the patient for addiction counseling.
C) Institute a behavior modification program.
D) Prepare to administer flumazenil (Romazicon).

Question 9

A patient received one dose of flumazenil (Romazicon). What is the nurse's next action?

A) Carefully observe for pre-flumazenil symptoms.
B) Teach the patient about dietary restrictions.
C) Prevent injury during seizure activity.
D) Force 500 ml oral fluids over 2 hours.

Question 10

Lorazepam ( Ativan ) reduces anxiety by:

A) increasing serotonin levels.
B) blocking dopamine receptors.
C) depressing norepinephrine levels.
D) potentiating gamma-aminobutyric acid ( GABA ).

Question 11

A patient diagnosed with agoraphobia took alprazolam (Xanax) 0.5 mg three times daily for 3 months and then discontinued it. The next day the patient called the nurse reporting insomnia, shakiness, and sweating. The nurse's assessment questions should focus on whether the patient:

A) may have also been drinking alcohol or taking antihistamines.
B) has built up tolerance to alprazolam and needs an increased dose.
C) is having withdrawal symptoms from abrupt discontinuation of the drug.
D) has progressed to panic attacks and needs a non-benzodiazepine medication.

Question 12

An emergency room patient was very anxious after a serious car accident. Lorazepam (Ativan) 2 mg intramuscularly was administered. One hour later, which finding indicates to the nurse that the medication was effective?

A) Impaired problem-solving skills
B) Increased alertness and attention
C) Increased verbalization and activity
D) Reduced agitation and environmental scanning

Question 13

A patient started diazepam (Valium) 5 mg twice daily 6 months ago. Now, the patient requires 10 mg to achieve the same effect. This phenomenon results from:

A) addiction.
B) tolerance.
C) dependence.
D) disinhibition.

Question 14

The teaching plan for a patient beginning buspirone (BuSpar) should include information identifying this drug as a:

A) norepinephrine inhibitor.
B) serotonergic antagonist.
C) serotonin agonist.
D) GABA inhibitor.

Question 15

A patient states, "I have the same thoughts over and over. I feel compelled to count all my footsteps." The nurse can expect the health care provider to prescribe:

A) alprazolam (Xanax).
B) propranolol (Inderal).
C) clonazepam (Klonopin).
D) clomipramine (Anafranil).

Question 16

A patient who has been taking a benzodiazepine for panic attacks is to be started on buspirone (BuSpar). Which instruction should the nurse provide?

A) "Take decreasing doses of the benzodiazepine for several days until the buspirone becomes effective."
B) "Stop taking the benzodiazepines immediately. Wait 2 days, and then start the buspirone."
C) "You should take buspirone only once a day. More frequent dosing can cause dependency."
D) "Tolerance to buspirone may develop in about a month, requiring larger doses to be prescribed."

Question 17

A patient in the emergency room has status epilepticus. The nurse should anticipate administration of:

A) diazepam (Valium).
B) buspirone (BuSpar).
C) clorazepate (Tranxene).
D) chlordiazepoxide (Librium).

Question 18

A patient diagnosed with social phobia begins propranolol (Inderal). The nurse should teach the patient to expect:

A) that sympathetic nervous system symptoms of anxiety will be reduced.
B) to experience a sense of euphoria for 30 minutes after taking the drug.
C) to have amnesia for the social situations that are most intimidating.
D) to feel a little drowsy but have no orthostatic hypotension.

Question 19

A patient had five emergency room visits in the past month and reports, "I feel so nervous. I think I'm having heart attacks." The patient is diagnosed with panic attacks. Which comment by the nurse shows understanding of treatment for panic attacks?

A) "SSRI antidepressants are often helpful for long-term treatment and prevention of panic attacks."
B) "Benzodiazepine tranquilizers are therapeutic for long-term treatment and prevention of panic attacks."
C) "No medications are particularly helpful for panic attacks. Let's work on some strategies to help you manage your fears."
D) "Panic attacks result from an instability of the neurotransmitter acetylcholine. Meditation will be more helpful than drugs."

Question 20

A patient seeking treatment for anxiety says, "I can't think. My job depends on my ability to think. I need medicine, but the drugs I took a few years ago made me too sleepy. I could lose my job." What information is most important for the nurse to consider when formulating a response?

A) All antianxiety medication has sedating properties.
B) Buspirone (BuSpar) alleviates anxiety without sedation or cognitive clouding.
C) The patient's description of anxiety does not warrant treatment with medication.
D) The patient may be trying to manipulate the nurse to assist with getting the desired prescription.

Question 21

A patient in the emergency room is suspected to have an overdose of benzodiazepines. Which assessment findings validate this diagnosis? Select all that apply.

A) Blood pressure 180/94 mm Hg
B) Diminished reflexes
C) Hypervigilance
D) Somnolence
E) Confusion

Question 22

Which individual would be most likely to experience a paradoxical reaction to a benzodiazepine drug?

A) A child with attention deficit-hyperactivity disorder ( ADHD )
B) An adult with obsessive-compulsive disorder
C) A teenager with an eating disorder
D) An adult with major depression

Question 23

A patient takes antacids, cimetidine (Tagamet), and phenytoin (Dilantin). The health care provider prescribes a benzodiazepine for anxiety. Which drug interactions would the nurse anticipate? Select all that apply.

A) Increased plasma level of benzodiazepine related to cimetidine therapy
B) Increased absorption of the benzodiazepine if taken with the antacid
C) Euphoria and disinhibition associated with phenytoin therapy
D) Serotonin syndrome associated with cimetidine use
E) Potential phenytoin toxicity

Question 24

Singer Michael Jackson allegedly abused alprazolam (Xanax) and propofol (Diprivan), an anesthetic. Which inference applies?

A) The singer had a substance dependence problem, but these medications had no interaction.
B) Potentially lethal sedation and CNS depression would be expected with this drug combination.
C) Tolerance to propofol probably developed very quickly in the presence of alprazolam.
D) This drug combination was safe, but the singer needed closer medical supervision.

Question 25

The teaching plan for a patient beginning oxazepam (Serax) should include instructions to (select all that apply):

A) take the drug on an empty stomach.
B) avoid discontinuing the drug abruptly.
C) stop taking the drug if side effects occur.
D) drink only moderate amounts of alcohol.
E) avoid herbal preparations.