Question 1

A patient taking a drug for insomnia reports becoming sunburned even when only minimally exposed to the sun.What is your best action?&#10;A) Ask the patient whether he or she usually burns when exposed to the sun.&#10;B) Instruct the patient to stop the drug and notify the prescriber immediately.&#10;C) Teach the patient to use sunscreen and wear protective clothing when outdoors.&#10;D) Document the report as the only action and reassure the patient that this problem is temporary.

Accepted Answer

Most drugs for insomnia cause an increase in sensitivity to the sun or other sources of ultraviolet light and the patient can become severely sunburned.Even patients with dark skin who usually do not burn with sun exposure can have problems.This expected side effect is temporary and usually resolves within weeks after the patient stops taking the drug;however,it is most important for the patient to learn about sun protection while on the drug.

Question 2

Why is more than one dose of Flumazenil (Romazicon)often needed to reverse a benzodiazepine overdose?&#10;A) It must be administered only by the intravenous route.&#10;B) It depresses the drug metabolizing effects of the liver.&#10;C) It has a shorter duration of action than most benzodiazepines.&#10;D) It must be given in low doses to avoid respiratory depression.

Accepted Answer

Although flumazenil is administered intravenously and can reverse the effects of a benzodiazepine overdose,its duration of action is short.Therefore,more doses are needed to counteract the effects of the benzodiazepines.

Question 3

A patient is scheduled for a procedure to test mental function at 6a.m.the patient requests something for sleep.What is your best response?&#10;A)&#34;I'll call your prescriber and request an order for something to help you sleep.&#34; &#10;B)&#34;Your prescriber has ordered temazepam (Restoril).I will give you a dose now.&#34;&#10;C)&#34;I'm sorry,but there is not enough time for sleep now before your procedure.&#34;&#10;D)&#34;I'm sorry,but you already received a dose of temazepam last evening at 9.&#34;

Accepted Answer

Drugs for insomnia should not be taken unless there is adequate time to sleep (4 to 8 hours).Inadequate time for sleep can cause side effects including drowsiness or adverse effects such as amnesia.This is especially important when the patient needs to be alert.

Question 4

A patient who has been taking flurazepam (Dalmane)for insomnia is now prescribed zolpidem (Ambien)instead.The patient asks why the prescription was changed.What is your best response?&#10;A) &#34;Zolpidem (Ambien)is a first-line drug for the treatment of insomnia.&#34;&#10;B) &#34;Flurazepam (Dalmane)is a benzodiazepine drug that can be habit-forming.&#34;&#10;C) &#34;Zolpidem (Ambien)is also used to treat any anxiety or stress that may contribute to your insomnia.&#34;&#10;D) &#34;Flurazepam (Dalmane)has both hypnotic and sedative effects that are less effective in the treatment of insomnia.&#34;

Accepted Answer

Flurazepam (Dalmane)is a benzodiazepine with hypnotic and sedative effects,used mostly to treat anxiety or stress.The benzodiazepines are schedule IV drugs,which means that abuse of these drugs or their long-term use may lead to limited physical dependence or psychological dependence.These drugs can be habit-forming when used for prolonged periods (2 to 4 weeks)and are no longer first-line drugs for treatment of insomnia.Zolpidem (Ambien)is a benzodiazepine receptor agonist and is less likely to be addictive.

Question 5

What is the most important precaution to teach a patient who is prescribed a drug for insomnia?&#10;A) &#34;Avoid drinking fluids with caffeine before bedtime.&#34;&#10;B) &#34;Rinse your mouth frequently with water or saline.&#34;&#10;C) &#34;Avoid driving within 8 hours of taking this drug.&#34;&#10;D) &#34;Do not take this drug for more than 1 week.&#34;

Accepted Answer

All drugs for insomnia produce drowsiness,blurred vision,and can impair judgment.Driving or operating dangerous equipment within 6 to 8 hours after taking any of these drugs can result in accident or injury.Tasks that require mental alertness also should be delayed until these effects have subsided.

Question 6

What adjustment should you expect to be made for an 82-year-old patient who is newly prescribed chloral hydrate for insomnia?&#10;A) Seizure precautions should be implemented.&#10;B) The first dose should be given with a meal or a substantial snack.&#10;C) The initial dose should be lower than that for a younger adult.&#10;D) The patient should have continuous electrocardiography monitoring.

Accepted Answer

Older adults should be given lower doses of drugs for insomnia because they are more sensitive to the effects of these drugs and more likely to experience side effects.This is especially true for the first dose of a newly prescribed drug until the patient knows how the drug will affect him or her.

Question 7

Which drug can increase the risk for seizures in a patient who has epilepsy?&#10;A) Pentobarbital (Nembutal)&#10;B) Romazicon (Flumazenil)&#10;C) Secobarbital (Seconal)&#10;D) Triazolam (Halcion)

Accepted Answer

Pentobarbital and secobarbital are barbiturates that can raise the seizure threshold and prevent seizures.Triazolam is a benzodiazepine that can reduce seizures.Romazicon is a reversal agent for a benzodiazepine overdose and can lower the seizure threshold in an individual who has epilepsy.

Question 8

Which problems are the two most common side effects of drugs for insomnia?&#10;A) Increased bleeding and reduced sense of taste&#10;B) Inability to fall asleep and stay asleep&#10;C) Dry mouth and drowsiness&#10;D) Hiccoughs and diarrhea

Accepted Answer

The drugs for insomnia are sedating and do not cause insomnia.They do not interfere with blood clotting or the sense of taste.The most common side effects for drugs that induce sleep are dry mouth and drowsiness.Although hiccoughs and diarrhea may occur,these are rare.

Question 9

How do benzodiazepines depress the central nervous system and induce sleep?&#10;A) Raising the seizure threshold&#10;B) Reducing the number of neurotransmitter receptors in the brain&#10;C) Decreasing the amount of excitatory neurotransmitters in the brain&#10;D) Increasing the amount of gamma amino butyric acid present in the brain

Accepted Answer

Benzodiazepines are drugs that depress the CNS by increasing the amount of GABA (gamma amino butyric acid)in the brain,which is an inhibitory neurotransmitter that results in hypnotic and sedating effects.Although they are mainly used to treat anxiety or stress,a few are used as a short-term treatment of insomnia.

Question 10

What is the most important assessment to perform before giving the first dose of any drug to treat insomnia?&#10;A) The patient's self-reported score on a pain scale&#10;B) Heart rate and rhythm&#10;C) Level of consciousness&#10;D) Deep tendon reflexes

Accepted Answer

All drugs for insomnia cause some degree of central nervous system depression.To better monitor for effectiveness and for side effects,assess the level of consciousness before giving any drug for insomnia.

Question 11

An adult patient is prescribed 0.5 mg of triazolam (Halcion)as a one-time order.The available drug is triazolam 0.125 mg/tablet.How many tablets should be given?

Accepted Answer

The answer of An adult patient is prescribed 0.5 mg...

Question 12

What precaution is needed in managing the care of a patient with insomnia who also has liver disease?&#10;A) Monitor carefully for increased side effects and adverse effects.&#10;B) Teach the patient that a higher dose is needed for effective action.&#10;C) Check the patient's electrolytes before administering the drug.&#10;D) Assess the patient's gag reflex every hour.

Accepted Answer

The answer of What precaution is needed in managing the...

Question 13

Which unusual side effect should you teach patients and families to monitor for when eszopiclone (Lunesta)is prescribed for insomnia?&#10;A) Dizziness&#10;B) Drowsiness&#10;C) Somnambulism&#10;D) Headache

Accepted Answer

The answer of Which unusual side effect should you teach...

Question 14

Which drugs used to treat insomnia belong to the benzodiazepine class? (select all that apply)&#10;A) Chloral hydrate (Somnote)&#10;B) Estazolam (ProSom)&#10;C) Eszopiclone (Lunesta)&#10;D) Flurazepam (Dalmane)&#10;E) Secobarbital (Seconal)&#10;F) Triazolam (Halcion)

Accepted Answer

The answer of Which drugs used to treat insomnia belong...

Question 15

Which symptoms are expected to be seen in a patient with insomnia? (select all that apply)&#10;A) Difficulty falling asleep&#10;B) Sleeping too much&#10;C) Waking often during the night&#10;D) Feeling unrested after sleep&#10;E) Uncontrollable urge to sleep

Accepted Answer

The answer of Which symptoms are expected to be seen...

Question 16

Which class of drugs used to treat insomnia has the lowest likelihood to be habit forming or addictive?&#10;A) Barbiturates&#10;B) Benzodiazepines&#10;C) Sedating antidepressants&#10;D) Benzodiazepine receptor agonists

Accepted Answer

The answer of Which class of drugs used to treat...

Question 17

What is the most important information that should be included when teaching a patient who has been prescribed zaleplon (Sonata)about the action of this drug?&#10;A) &#34;This drug may take from 30 minutes to an hour to work.&#34;&#10;B) &#34;Go to bed immediately after taking a dose of this drug.&#34;&#10;C) &#34;Be sure to report any side effects to your prescriber.&#34;&#10;D) &#34;This drug can make glaucoma worse.&#34;

Accepted Answer

The answer of What is the most important information that...

Question 18

Which drug for insomnia can cause amnesia?&#10;A) Amitriptyline (Elavil)&#10;B) Diphenhydramine (Benadryl)&#10;C) Temazepam (Restoril)&#10;D) Trazodone (Desyrel)

Accepted Answer

The answer of Which drug for insomnia can cause amnesia?&#10;A)...

Question 19

In which drug category for insomnia does zaleplon (Sonata)belong?&#10;A) Antihistamines&#10;B) Benzodiazepines&#10;C) Sedating antidepressants&#10;D) Benzodiazepine receptor agonists

Accepted Answer

The answer of In which drug category for insomnia does...

Question 20

Why should women avoid using benzodiazepine receptor agonists during lactation?&#10;A) The mother could become so sleepy that she endangers her infant.&#10;B) The sedating effects also occur in the infant.&#10;C) The infant's teeth will be discolored.&#10;D) The infant may have a seizure.

Accepted Answer

The answer of Why should women avoid using benzodiazepine receptor...

Question 21

A child who weighs 56 lb is prescribed to receive chloral hydrate 40 mg/kg.The available drug is 250 mg/5 mL.How many milliliters should you give for the correct dose?

Accepted Answer

The answer of A child who weighs 56 lb is...

Deck 28: Drug Therapy for Insomnia