Test Bank - for Introductory Mental Health Nursing
Fifth, Edition by Cynthia Kincheloe, All Chapters |
Complete Guide A+
Lorazepam (Ativan) reduces anxiety by:
a. increasing serotonin levels.
b. blocking dopamine receptors.
c. depressing norepinephrine levels.
d. potentiating gamma-aminobutyric acid (GABA). - ANSWER ANS: D
Benzodiazepines enhance the effects of the inhibitory neurotransmitter GABA,
slowing neuronal firing. They do not affect dopamine, serotonin, or norepinephrine.
A patient started diazepam (Valium) 5 mg b.i.d. 6 months ago. Now, the patient
requires 10 mg to achieve the same effect. This phenomenon results from:
a. addiction.
b. tolerance.
c. dependence.
d. disinhibition. - ANSWER ANS: B
Tolerance is the need for increasing amounts of a substance to achieve the same
effects. The other terms, defined in the text, do not account for this phenomenon
3. A patient with agoraphobia took alprazolam (Xanax) 0.5 mg t.i.d. for 3 months and
then discontinued it. The next day, the patient called the nurse complaining of
insomnia, shakiness, and sweating. The nurse's assessment questions should focus
on whether the patient:
a. may have also been drinking alcohol or taking antihistamines.
b. has built up tolerance to alprazolam and needs an increased dose.
c. is having withdrawal symptoms from abrupt discontinuation of the drug.
d. has progressed to panic attacks and needs a nonbenzodiazepine medication. -
ANSWER ANS: C
The patient's symptoms suggest benzodiazepine withdrawal. The nurse knows that
patients often attempt to manage their own care by discontinuing medication when
they begin to feel better. Benzodiazepines should be slowly withdrawn if withdrawal
symptoms are to be avoided. Drinking alcohol would result in different symptoms.
Development of tolerance and panic attack symptoms would be different from those
mentioned.
An emergency room patient was very anxious after a serious car accident.
Lorazepam (Ativan) 2 mg IM was administered. One hour later, which finding
indicates to the nurse that the medication was effective?
a. Impaired problem-solving skills
b. Increased alertness and attention
c. Increased verbalization and activity
,d. Reduced agitation and environmental scanning - ANSWER ANS: D
Benzodiazepines mute incoming stimuli and evoke less reaction. The hyperalertness
and environmental scanning that accompany high anxiety are notably decreased
when the drug is effective. Impaired problem solving is a negative outcome. Because
of its sedating properties, the individual might not be more alert, talkative, or active.
5. A patient has taken diazepam (Valium) for one week for back spasms. The patient
complains of "feeling sleepy all the time." The nurse should tell the patient:
a."The dosage probably needs to be decreased."
b."Drowsiness indicates a paradoxical reaction to the drug."
c."Tolerance to the sedative effect of the drug will develop quickly."
d."Sleepiness is an unavoidable side effect of nonbenzodiazepine drugs." -
ANSWER ANS: C
Tolerance to most side effects of benzodiazepines, including drowsiness, develops
quickly. There is no need to decrease the dosage. Drowsiness is an expected
reaction, not a paradoxical one. Valium is a benzodiazepine.
6. A patient has taken clonazepam (Klonopin) for years to manage panic attacks but
impulsively stopped the drug. Thirty hours later, the patient comes to the emergency
room in distress. What is the nurse's priority action?
a. Begin seizure precautions.
b. Refer the patient for addiction counseling.
c. Institute a behavior modification program.
d. Prepare to administer flumazenil (Romazicon) - ANSWER ANS: A
There is evidence to suggest that abrupt withdrawal of clonazepam might precipitate
status epilepticus. With this in mind, withdrawal from long-term use warrants seizure
precautions. The patient does not have an overdose, so flumazenil (Romazicon) is
not indicated. The other options are inappropriate.
7. Which patient has the greatest risk for overdose with a benzodiazepine? A patient
who:
a. takes the drug with antacids
b. takes the drug before meals
c. combines the drug with alcohol
d. experiences depression as well as anxiety - ANSWER ANS: C
Benzodiazepines taken with alcohol produce marked CNS depression, even death.
Antacids prevent absorption. Larger doses of benzodiazepines by themselves are
rarely lethal. Depression in and of itself is not an indicator of overdose risk. Suicidal
ideation might be present, but benzodiazepines by themselves are rarely lethal.
8. The nurse would expect to administer flumazenil (Romazicon) for a patient:
a.in acute alcohol withdrawal.
b.with a benzodiazepine overdose.
c.with benzodiazepine-resistant anxiety.
d.with anxiety associated with a psychotic disorder. - ANSWER ANS: B
Flumazenil is a benzodiazepine receptor antagonist. Response occurs within 30 to
60 seconds; however, it might not reverse associated respiratory depression.
Because it has a short duration of action and does not speed metabolism of
benzodiazepines, administration of flumazenil might need to be repeated several
times. Flumazenil is not indicated for treatment of any of the other conditions.
,9. A patient received one dose of flumazenil (Romazicon). What is the nurse's next
action?
a. Carefully observe for preflumazenil symptoms.
b. Teach the patient about dietary restrictions.
c. Prevent injury during seizure activity.
d. Force 500 ml oral fluids over 2 hours. - ANSWER ANS: A
Flumazenil, which is given to patients who have overdosed with benzodiazepines, is
a benzodiazepine receptor antagonist. Response occurs within 30 to 60 seconds;
however, it might not reverse associated respiratory depression. Because it has a
short duration of action and does not speed metabolism of benzodiazepines, the
nurse must be vigilant for signs that the patient is reverting to the preflumazenil state.
Administration of flumazenil might need to be repeated several times.
10. The nurse would expect a patient with which comorbid diagnosis to have a
magnified response to the usual dose of a benzodiazepine drug?
a. Rheumatoid arthritis
b. Migraine headache
c. Hepatic cirrhosis
d. Osteoporosis - ANSWER ANS: C
Benzodiazepines are metabolized in the liver. The cirrhotic liver will slow the
metabolism rate of the drugs, leading to an exaggerated response. The distracters
are not associated with decreased hepatic function.
11. A patient in the emergency room has status epilepticus. The nurse should
anticipate administration of:
a. diazepam (Valium).
b. buspirone (BuSpar).
c. clorazepate (Tranxene).
d. chlordiazepoxide (Librium). - ANSWER ANS: A
Valium is the drug of choice in status epilepticus because of its rapid action. Each of
the other benzodiazepines has a slower onset of action. Buspirone is not indicated to
treat seizures.
The teaching plan for a patient beginning buspirone (BuSpar) should include
information identifying this drug as a:
a. norepinephrine inhibitor.
b. serotonergic antagonist.
c. serotonin agonist.
d. GABA inhibitor. - ANSWER ANS: C
It is believed that buspirone is a serotonin agonist. Because buspirone is not a
benzodiazepine, it does not bind to benzodiazepine receptor sites, affect GABA, or
affect norepinephrine. This accounts for its different effects and lack of CNS
depression as side effects.
13. A patient seeking treatment for anxiety says, "I can't think. My job depends on
my ability to think. I need medicine, but the drugs I took a few years ago made me
too sleepy. I could lose my job." What information is most important for the nurse to
consider when formulating a response?
a. All antianxiety medication has sedating properties.
, b. Buspirone (BuSpar) alleviates anxiety without sedation or cognitive clouding.
c. The patient's description of anxiety does not warrant treatment with medication.
d. The patient may be trying to manipulate the nurse to assist with getting the
desired prescription. - ANSWER ANS: B
Buspirone's action is entirely different from that of the benzodiazepines. It reduces
anxiety, with its accompanying concentration and cognitive problems, but without
CNS depression. The patient's description of anxiety indicates that it is interfering
with daily life, so medication may be helpful. There is no evidence that the patient is
trying to manipulate the nurse.
14. A patient diagnosed with social phobia begins propranolol (Inderal). The nurse
should teach the patient to expect:
a. that sympathetic nervous system symptoms of anxiety will be reduced.
b. to experience a sense of euphoria for 30 minutes after taking the drug.
c. to have amnesia for the social situations that are most intimidating.
d. to feel a little drowsy but have no orthostatic hypotension. - ANSWER ANS: A
Propranolol is a beta blocker that interrupts the physiologic responses of anxiety
associated with social phobias, such as sweaty palms. Bradycardia may be
associated with lightheadedness. The other options are not likely.
15. A patient complains, "I have the same thoughts over and over. I feel compelled to
count all my footsteps." The nurse can expect the health care provider to prescribe:
a. alprazolam (Xanax).
b. propranolol (Inderal).
c. clonazepam (Klonopin).
d. clomipramine (Anafranil). - ANSWER ANS: D
Clomipramine is an antidepressant that has proven effective for obsessive-
compulsive disorder (OCD). The other drugs have no proven effectiveness in
treating OCD.
16. A patient is to receive lorazepam (Ativan) 1 mg PO t.i.d. for 4 days. The nurse
understands that this drug was prescribed for a short period because:
a. hypoglycemic reactions occur with continued use.
b. therapeutic dose dependence develops quickly.
c. neutropenia is likely with long-term use.
d. glaucoma results from long-term therapy. - ANSWER ANS: B
Dependence to benzodiazepines develops rather quickly. Even when taking
prescribed doses, individuals develop a psychological need for the drug. Prescribing
for only several days circumvents this problem. The other options are incorrect.
17. A patient took a benzodiazepine for 4 weeks but will now change to buspirone
(BuSpar) for long-term treatment of anxiety. The benzodiazepine is tapered off as
the buspirone is begun. Important information the patient should receive about
buspirone is that it:
a. produces profound sedation.
b. will be effective in 7 to 10 days.
c. has a high risk for development of dependence.
d. is often associated with cross-tolerance with other CNS depressants. - ANSWER
ANS: B
