NURSING 6005 CHAPTER 34: SEDATIVE-HYPNOTIC DRUGS

NURSING 6005 CHAPTER 34: SEDATIVE-HYPNOTIC DRUGS Test Bank MULTIPLE CHOICE 1. A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement? a. “Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia.” b. “Benzodiazepines depress neuronal functions by acting at a single site in the brain.” c. “Benzodiazepines induce muscle relaxation by acting on sites outside the central nervous system.” d. “Benzodiazepines promote sleep through effects on the limbic system.” ANS: A All beneficial and most adverse effects of benzodiazepines occur from depressant actions in the central nervous system (CNS); the various effects depend on the site of action. Anterograde amnesia is the result of effects in the hippocampus and the cerebral cortex. Benzodiazepines act at multiple sites in the CNS. Muscle relaxant effects are the result of actions on supraspinal motor areas in the CNS. Benzodiazepines promote sleep through effects on cortical areas and on the sleep-wakefulness “clock.” DIF: Cognitive Level: Analysis REF: Benzodiazepines | Overview of Pharmacologic Effects | Central Nervous System TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam (Restoril) because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam: a. does not depress the central nervous system. b. shows no respiratory depression, even in toxic doses. c. mimics the actions of a central nervous system inhibitory neurotransmitter. d. only potentiates the action of endogenous gamma-aminobutyric acid (GABA). ANS: D Benzodiazepines potentiate the actions of GABA, and because the amount of GABA in the CNS is finite, these drugs’ depressive effect on the CNS is limited. Benzodiazepines depress the CNS but not to the extent that barbiturates do. Benzodiazepines are weak respiratory depressants at therapeutic doses and moderate respiratory depressants at toxic doses. Barbiturates mimic GABA; therefore, because they produce CNS depression, this effect is limited only by the amount of barbiturate administered. DIF: Cognitive Level: Application REF: Benzodiazepines | Overview of Pharmacologic Effects | Central Nervous System | Respiratory System | Molecular Mechanism of Action TOP: Nursing Process: ImplementationMSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug’s half-life is only 2 to 3 hours. Which response by the nurse is correct? a. “Benzodiazepines commonly cause residual effects lasting into the day after the dose is given.” b. “The patient is having a paradoxical reaction to this medication.” c. “This patient must have developed a previous tolerance to benzodiazepines.” d. “When this drug is metabolized, the resulting compound has longer lasting effects.” ANS: D Flurazepam has a half-life of 2 to 3 hours; however, its metabolite has a long half-life, so giving the drug results in long-lasting effects. Barbiturates, not benzodiazepines, are commonly associated with residual, or hangover, effects. A paradoxical reaction to a sedative would manifest as insomnia, euphoria, and excitation, not drowsiness. Tolerance means that the patient would need increased amounts of a drug to get the desired effects and would not have prolonged effects of the medication. DIF: Cognitive Level: Application REF: Benzodiazepines | Pharmacokinetics | Adverse Effects | Paradoxical Effects | Tolerance | Barbiturates | Adverse Effects | Hangover TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A nursing student asks a nurse what criteria are used to determine which benzodiazepine is prescribed in different situations. The nurse correctly states that selection is based on differences in the onset and duration of effects, as well as on: a. differences in sites of action in the central nervous system. b. marketing decisions of pharmaceutical companies. c. relative differences in abuse potential. d. variations in adverse effects and drug interactions. ANS: B The principal factors determining the applications of a particular benzodiazepine are the pharmacokinetic properties having to do with absorption, metabolism, and excretion and the research and marketing decisions of the drug makers. All of the benzodiazepines produce a similar spectrum of responses, and all act at various sites in the CNS. All benzodiazepines have a lower abuse potential than barbiturates. Drug effects and drug interactions are similar for all benzodiazepines. DIF: Cognitive Level: Analysis REF: Benzodiazepines | Pharmacokinetics | Therapeutic Uses | Adverse Effects TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient takes temazepam (Restoril) for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do? a. Ask the patient about any alcohol consumption in conjunction with the benzodiazepine.b. Contact the prescriber to request an order for a benzodiazepine with a shorter duration. c. Reassure the patient that this is most likely caused by a paradoxical reaction to the benzodiazepine. d. Tell the patient that this is an example of anterograde amnesia, which is an expected effect of benzodiazepine. ANS: A This patient is describing complex sleep-related behavior, which occurs when patients carry out complex behaviors while taking benzodiazepines but have no memory of their actions. These actions can occur with normal doses but are more likely with excessive doses or when benzodiazepines are combined with alcohol or other CNS depressants, so the nurse is correct in evaluating this possibility. The duration of the benzodiazepine does not contribute to this phenomenon. Paradoxical effects of benzodiazepines include insomnia, excitation, euphoria, anxiety, and rage. Anterograde amnesia occurs when patients have impaired recall of events that occur after dosing. DIF: Cognitive Level: Application REF: Benzodiazepines | Adverse Effects TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 6. A patient has been taking high doses of clorazepate (Tranxene) for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do? a. Double-check the chart to make sure the last dose was given. b. Request an order for a longer acting benzodiazepine. c. Suspect a possible paradoxical reaction to the clorazepate. d. Withhold the next dose until a drug level can be drawn. ANS: C Patients taking benzodiazepines for anxiety sometimes develop paradoxical responses to the drug, which include insomnia, excitation, euphoria, heightened anxiety, and rage. A missed dose would trigger withdrawal symptoms, which would include anxiety, insomnia, sweating, tremors, and dizziness. Because this is a paradoxical reaction to the drug, a longer acting drug would make the symptoms worse. This is not caused by overdose, which would manifest as drowsiness, lethargy, and confusion, so a drug level is not warranted. DIF: Cognitive Level: Application REF: Benzodiazepines | Adverse Effects | Tolerance and Physical Dependence TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 7. A patient in the emergency department is given intravenous diazepam (Valium) for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following? a. Flumazenil (Romazicon) b. Gastric lavage c. Respiratory support d. Toxicology testingANS: C When benzodiazepines are administered IV, severe effects, including profound hypotension,