Deck 48: Antianxiety and Insomnia Agents

Question 1

An adolescent patient comes to the clinic and reports anxiety and poor sleep that have persisted since experiencing a hurricane 8 months prior.The patient has been receiving cognitive-behavioral therapy,which has helped a little.The primary care NP should order:

A) doxepin.
B) fluoxetine.
C) alprazolam.
D) clonazepam.

Answer 1

fluoxetine.

Question 2

A patient is in the clinic with acute symptoms of anxiety.The patient is restless and has not slept in 3 days.The primary care NP observes that the patient is irritable and has moderate muscle tension.The patient's spouse reports that similar symptoms have occurred before in varying degrees for several years.The NP should refer the patient to a psychologist and should prescribe which drug for short-term use?

A) Alprazolam
B) Buspirone
C) Melatonin
D) Zolpidem

Answer 2

Alprazolam

Question 3

A patient reports difficulty falling asleep and staying asleep every night and has difficulty staying awake during the commute to work every day.The NP should:

A) suggest the patient try diphenhydramine first.
B) perform a thorough history and physical examination.
C) teach about avoiding caffeine and good sleep hygiene.
D) suggest melatonin and consider prescribing Ambien if this is not effective.

Answer 3

perform a thorough history and physical examination.

Question 4

A patient reports difficulty returning to sleep after getting up to go to the bathroom every night.A physical examination and a sleep hygiene history are noncontributory.The primary care NP should prescribe:

A) zaleplon.
B) ZolpiMist.
C) ramelteon.
D) chloral hydrate.

Question 5

A patient reports going to bed at 10:00 pm every night but often lays awake until midnight.The primary care NP instructs the patient to practice good sleep hygiene and to avoid caffeine in the evening.After 1 week of this regimen,the patient reports still lying awake until 11:00 PM.The NP should:

A) order a sleep study.
B) consider short-term zolpidem.
C) order ramelteon for several weeks.
D) reassure the patient and re-evaluate in 1 week.

Question 6

A patient tells the primary care NP about having difficulty giving presentations at work.The patient experiences anxiety and often feels faint or vomits.The NP should:

A) prescribe buspirone.
B) prescribe alprazolam.
C) order a selective serotonin reuptake inhibitor (SSRI) antidepressant.
D) recommend cognitive-behavioral therapy.

Question 7

A patient comes to the clinic and reports having insomnia that began within the last year.The primary care nurse practitioner (NP)learns that the patient often lies awake worrying about problems at work.The patient feels fatigued during the day and experiences frequent stomach discomfort.The NP should prescribe:

A) buspirone.
B) melatonin.
C) alprazolam.
D) diphenhydramine.