Clayton’s Basic Pharmacology for Nurses

Chapter 13: Drugs Used for Sedation and Sleep Willihnganz: Clayton’s Basic Pharmacology for Nurses MULTIPLE CHOICE 1. Which initial action should the nurse take when finding a patient extremely agitated, yelling frequently, and attempting to get out of bed without assistance? a. Administer zolpidem after taking the patient‘s vital signs. b. Close the patient‘s door for privacy after administering Tylenol. c. Administer benzodiazepine before calling the healthcare provider. d. Spend uninterrupted time listening to the patient. ANS: D Assessing the patient‘s level of anxiety is important. The patient may only need someone to listen to what stressors he or she is facing. The nurse must assess the patient before medication can be administered. 2. An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance. Which type of medication effect is the patient exhibiting? a. Allergic b. Hypersensitivity c. Paradoxical d. Therapeutic ANS: C A paradoxical effect may occur in older adult patients. This includes periods of excitement, confusion, restlessness, and euphoria. Allergies to medications tend to manifest in skin or respiratory symptoms. A patient who is hypersensitive to a hypnotic would be difficult to rouse. A therapeutic effect for a hypnotic would be sedation. 3. Which condition indicates the need for benzodiazepines to be prescribed? a. Chronic amnesia b. Chronic insomnia c. Preoperative sedation d. Psychotic episode ANS: C The sedative-hypnotic effect of benzodiazepines facilitates surgical sedation. Short-acting benzodiazepines are administered intramuscularly for preoperative sedation. They are also given intravenously for conscious sedation before short diagnostic procedures or for the induction of general anesthesia. Benzodiazepines are not recommended for long-term use and do not affect amnesia. Benzodiazepines are a poor choice for the treatment of chronic insomnia because of their risk for habituation. Benzodiazepines do not have an antipsychotic effect. 4. Which type of blood work will be performed when a patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundice? a. Renal function tests b. Liver function tests c. Clotting times d. Electrolyte panels ANS: B Liver function tests will be performed because nausea, vomiting, and jaundice can be indicative of hepatotoxicity. Abnormal liver function test results (i.e., elevated bilirubin, aspartate transaminase [AST], alanine transaminase [ALT], gamma-glutamyl transferase [GGT], and alkaline phosphatase levels, as well as prothrombin time) are indicative of hepatotoxicity. Benzodiazepines do not affect the kidneys, clotting times, and electrolytes. 5. Which benefit applies to the use of sedatives? a. Increased pain control postoperatively b. Reduced bronchial secretions c. Decreased patient anxiety d. Increased patient alertness ANS: C Preoperatively, sedatives will help decrease patient anxiety and facilitate sleep. Sedatives are not long acting enough to affect postoperative pain control. Sedatives do not affect bronchial secretions. Sedatives diminish patient alertness. 6. Which two phases make up normal sleep? a. Hypnagogic and hypnopompic b. Rapid eye movement (REM) and non REM c. Alpha and beta d. Delta and theta ANS: B Normal sleep can be divided into two phases, REM and non REM. Hypnagogic is the state between waking and sleeping; hypnopompic is the transition between sleeping and waking states. Beta waves are those associated with day to day wakefulness. During periods of relaxation while still awake, our brain waves become slower, increase in amplitude, and become more synchronous. These types of waves are called alpha waves. The first stage of sleep is characterized by theta waves. During a normal night‘s sleep, a sleeper passes from the theta waves of stages 1 and 2 to the delta waves of stages 3 and 4. Delta waves are the slowest and highest amplitude brain waves. 7. Which sleep pattern stage diminishes as an effect of aging? a. Stage I b. Stage II c. Stage III d. Stage IV ANS: D As we age, stage IV sleep diminishes. Many people older than 75 years do not demonstrate any stage IV sleep patterns. Between 2% and 5% of sleep is stage I. Stage II comprises about 50% of normal sleep time. Stage III is a transition between lighter sleep and deeper sleep.