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?

Accepted Answer

Tricyclic antidepressants like Doxepin can cause anticholinergic side effects such as dry mouth, hence the suggestion of sucking on sugar-free hard candy is an indication of understanding these potential side effects.

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.)

Accepted Answer

A thorough history helps identify substances that could exacerbate anxiety (A), determine the most appropriate pharmacotherapy (C), and assess the suitability of individual or group therapy (D).

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?

Accepted Answer

Buspirone (BuSpar), a non-benzodiazepine anxiolytic, can affect sleep patterns and the results of a sleep study by potentially altering the stages of sleep or affecting the ability to fall or stay asleep.

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?

Accepted Answer

The symptoms and the acute presentation are indicative of a panic attack, which is characteristic of panic disorder. The normal cardiac workup rules out cardiac causes, supporting a diagnosis of 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?

Accepted Answer

Thiopental sodium (Pentobarbital) is a barbiturate used as a sedative-hypnotic for the induction of anesthesia due to its rapid onset of action and short duration, making it suitable for procedures requiring anesthesia.

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.)

Accepted Answer

The answer of A client has been in the ICU...

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.)

Accepted Answer

Post-traumatic stress disorder (PTSD) is characterized by symptoms such as nightmares, flashbacks, and severe anxiety, as well as uncontrollable thoughts about the traumatic event. These symptoms can lead to physical reactions like a racing heart, sweating, and shortness of breath, which are consistent with the description in option D. Options A, B, and C describe behaviors and symptoms more commonly associated with other disorders such as obsessive-compulsive disorder (A), social anxiety disorder (B), and claustrophobia or panic disorder (C), rather than PTSD.

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.)

Accepted Answer

The answer of Signals routed through the amygdala ultimately connect...

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.)

Accepted Answer

Valerian root is a herbal remedy often used for sleep disorders, including insomnia. Diphenhydramine is an antihistamine with sedative properties, commonly used for short-term relief of sleep difficulties. Flurazepam, Zolpidem, and Ramelteon are prescription medications specifically indicated for insomnia, with each working through different mechanisms to promote sleep.

Question 10

The client is diagnosed with post-traumatic stress syndrome.The nurse would expect which of the following conditions? (Select all that apply.)

Accepted Answer

Post-traumatic stress syndrome (PTSD) often involves re-experiencing the traumatic event through hallucinations, nightmares, or flashbacks (A). It can also cause physical symptoms such as tachycardia, extreme nervousness, or panic attacks (B). Additionally, PTSD can lead to comorbid conditions like depression, which may result in difficulty finding energy to perform daily activities (E). Fears of crowds (C) or germs (D) are not typically associated with PTSD.

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:

Accepted Answer

Alprazolam (Xanax) can increase the risk of suicidal thoughts or behavior, especially when first starting the medication or adjusting the dose. It is crucial for the nurse to assess for any thoughts of suicide to ensure the client's safety.

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:

Accepted Answer

Antidepressants, including Paxil (a selective serotonin reuptake inhibitor or SSRI), are often prescribed for anxiety disorders, which can also help alleviate insomnia associated with anxiety. This is because they can address the underlying anxiety contributing to the sleep problem, rather than just treating the symptom of 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.)

Accepted Answer

The answer of The spouse of a client complains that...

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.)

Accepted Answer

The answer of A client who has recently experienced the...

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?

Accepted Answer

Given the normal lab results and EKG, it's important to explore non-cardiac causes for the symptoms, such as anxiety or drug abuse, before proceeding with more invasive or specific cardiac treatments.

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?

Accepted Answer

Exercising late in the evening can increase alertness and body temperature, making it harder to fall asleep, while caffeine intake in the evening can disrupt sleep patterns by blocking adenosine receptors that promote sleep. Both factors can interfere with the non-rapid eye movement (NREM) sleep phase, which is crucial for restorative sleep, potentially leading to the client's 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:

Accepted Answer

CSelective Serotonin Reuptake Inhibitors (SSRIs) are used in the treatment of narcolepsy to manage symptoms such as cataplexy (sudden loss of muscle tone, which could manifest as slurred speech, sagging of the jaw, and nodding of the head, as described in option A) and to improve sleep quality, which can indirectly address behaviors like sleepwalking (option C). SSRIs work by increasing the levels of serotonin in the brain, which can help regulate mood, sleep, and other functions. However, their primary use in narcolepsy is not directly to elevate energy levels or act as stimulants, but rather to manage these specific symptoms.

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?

Accepted Answer

The answer of The nurse is obtaining the medication history...

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?

Accepted Answer

Eszopiclone (Lunesta) is indicated for patients who have difficulty staying asleep as well as difficulty falling asleep. It can help improve sleep maintenance and is thus suitable for someone who wakes up frequently during the night.

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.)

Accepted Answer

Alternative methods like yoga, meditation, and massage therapy (A), regular morning exercise (B), and avoiding stimulants like caffeine, nicotine, and alcohol before bedtime (E) are all recognized strategies to improve sleep without the use of prescription medications. Eating a large meal at bedtime (C) can actually disrupt sleep, and while counting sheep (D) is a popular suggestion, its effectiveness is not universally supported by evidence.

Quiz 22: Pharmacotherapy of Anxiety and Insomnia