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Holland/Adams/Brice, Core Concepts in Pharmacology 4th Edition
Test Bank
Chapter 9
Question 1
Type: MCSA
A client complains of restlessness, fatigue, nervousness, and sleep disturbances. The nurse
knows these are symptoms of which clinical disorder?
1.
2.
3.
4.
Obsessive compulsive disorder
Generalized anxiety disorder
Panic disorder
Post-traumatic stress disorder
Correct Answer: 2
Rationale 1: Obsessive compulsive disorder is incorrect because OCD describes recurrent,
disturbing thoughts or repetitive behaviors that interfere with a person's normal activities or
relationships.
Rationale 2: Generalized anxiety disorder symptoms include restlessness, fatigue, nervousness,
and sleep disturbances.
Rationale 3: Panic disorder is incorrect because these are symptoms of a generalized anxiety
disorder. Panic disorder is characterized by intense feelings of immediate apprehension,
fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system
activity.
Rationale 4: Post-traumatic stress disorder is incorrect because PTSD is a type of anxiety that
develops in response to re-experiencing a previous traumatic life event, such as combat
experience, physical or sexual abuse, a natural disaster, or a murder. The person might dream
about the event or be constantly reminded of the event by common occurrences. This reexperiencing of the trauma leads to feelings of helplessness and anxiety that affect the person's
ability to function normally.
Global Rationale: Generalized anxiety disorder symptoms include restlessness, fatigue,
nervousness, and sleep disturbances. Obsessive compulsive disorder is incorrect because OCD
describes recurrent, disturbing thoughts or repetitive behaviors that interfere with a person's
normal activities or relationships. Panic disorder is incorrect because these are symptoms of a
generalized anxiety disorder. Panic disorder is characterized by intense feelings of immediate
apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic
nervous system activity. Post-traumatic stress disorder is incorrect because PTSD is a type of
anxiety that develops in response to re-experiencing a previous traumatic life event, such as
combat experience, physical or sexual abuse, a natural disaster, or a murder. The person might
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
dream about the event or be constantly reminded of the event by common occurrences. This reexperiencing of the trauma leads to feelings of helplessness and anxiety that affect the person's
ability to function normally.
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-1 Identify the major categories of anxiety disorders.
Question 2
Type: MCSA
A client has returned from combat, and is re-experiencing combat in dreams and feels helpless
and anxious. What disorder does the nurse suspect this client is experiencing?
1.
2.
3.
4.
Generalized anxiety disorder
Obsessive compulsive disorder
Post-traumatic stress disorder
Panic disorder
Correct Answer: 3
Rationale 1: Generalized anxiety disorder is incorrect because the symptoms include
restlessness, fatigue, nervousness, and sleep disturbances.
Rationale 2: Obsessive compulsive disorder is incorrect because OCD describes recurrent,
disturbing thoughts or repetitive behaviors that interfere with a person's normal activities or
relationships.
Rationale 3: Post-traumatic stress disorder is a type of anxiety that develops in response to reexperiencing a previous traumatic life event, such as combat experience, physical or sexual
abuse, a natural disaster, or a murder. The person might dream about the event or be constantly
reminded of the event by everyday occurrences. This re-experiencing of the trauma leads to
feelings of helplessness and anxiety that affect the person's ability to function normally.
Rationale 4: Panic disorder is incorrect because these are symptoms of post-traumatic stress
disorder. Panic disorder is characterized by intense feelings of immediate apprehension,
fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system
activity.
Global Rationale: Post-traumatic stress disorder is a type of anxiety that develops in response
to re-experiencing a previous traumatic life event, such as combat experience, physical or
sexual abuse, a natural disaster, or a murder. The person might dream about the event or be
constantly reminded of the event by everyday occurrences. This re-experiencing of the trauma
leads to feelings of helplessness and anxiety that affect the person's ability to function normally.
Generalized anxiety disorder is incorrect because the symptoms include restlessness, fatigue,
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
nervousness, and sleep disturbances. Obsessive compulsive disorder is incorrect because OCD
describes recurrent, disturbing thoughts or repetitive behaviors that interfere with a person's
normal activities or relationships. Panic disorder is incorrect because these are symptoms of
post-traumatic stress disorder. Panic disorder is characterized by intense feelings of immediate
apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic
nervous system activity.
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-1 Identify the major categories of anxiety disorders.
Question 3
Type: MCSA
According to an evidence-based approach, what is the most productive way to treat anxiety
disorders?
1.
2.
3.
4.
Provide the client with a powerful medication.
Allow the client to self-medicate with OTC medications.
Immediately start multiple-drug therapy.
Uncover and address the cause of anxiety.
Correct Answer: 4
Rationale 1: Provide the client with a powerful medication is incorrect because uncovering and
addressing the cause of the anxiety is more productive than merely treating the symptoms with
medications.
Rationale 2: Allow the client to self-medicate with OTC medications is incorrect because
uncovering and addressing the cause of the anxiety is more productive than merely treating the
symptoms with medications.
Rationale 3: Immediately start multiple-drug therapy is incorrect because uncovering and
addressing the cause of the anxiety is more productive than merely treating the symptoms with
medications.
Rationale 4: Uncovering and addressing the cause of the anxiety is more productive than
merely treating the symptoms with medications.
Global Rationale: Uncovering and addressing the cause of the anxiety is more productive than
merely treating the symptoms with medications. Provide the client with a powerful medication
is incorrect because uncovering and addressing the cause of the anxiety is more productive than
merely treating the symptoms with medications. Allow the client to self-medicate with OTC
medications is incorrect because uncovering and addressing the cause of the anxiety is more
productive than merely treating the symptoms with medications. Immediately start multiple-
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
drug therapy is incorrect because uncovering and addressing the cause of the anxiety is more
productive than merely treating the symptoms with medications.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-2 Discuss factors contributing to anxiety and explain some
nonpharmacologic therapies used to cope with this disorder.
Question 4
Type: MCMA
Which instructions should the nurse provide to the client who is prescribed a benzodiazepine?
(Select all that apply.)
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1.
2.
3.
4.
5.
Report significant mood changes.
Avoid OTC medications used to induce sleep.
Avoid alcoholic beverages.
If a dose is missed, the client should take a double dose as soon as possible.
Avoid caffeine.
Correct Answer: 1, 2, 3
Rationale 1: A client taking a benzodiazepine should report significant mood changes.
Rationale 2: A client taking a benzodiazepine should avoid OTC medications used to induce
sleep.
Rationale 3: A client taking a benzodiazepine should avoid alcoholic beverages.
Rationale 4: The client should never double the dose of a benzodiazepine.
Rationale 5: The client taking a benzodiazepine does not need to avoid caffeine.
Global Rationale: A client taking a benzodiazepine should report significant mood changes. A
client taking a benzodiazepine should avoid OTC medications used to induce sleep. A client
taking a benzodiazepine should avoid alcoholic beverages. The client should never double the
dose of a benzodiazepine. The client taking a benzodiazepine does not need to avoid caffeine.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Question 5
Type: MCSA
The risk for physical and psychological dependence is high from which class of medications,
which is rarely used to treat insomnia or anxiety?
1.
2.
3.
4.
SSRIs
MAOIs
Benzodiazepines
Barbiturates
Correct Answer: 4
Rationale 1: These medications do not have a high risk for physical and psychological
dependence.
Rationale 2: MAOIs do not have a high risk for physical and psychological dependence.
Rationale 3: Benzodiazepines do not have a high risk for physical and psychological
dependence.
Rationale 4: Barbiturates have a high risk for physical and psychological dependence.
Global Rationale: Barbiturates have a high risk for physical and psychological dependence.
SSRIs, MAOIs, and benzodiazepines do not have a high risk for physical and psychological
dependence.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Question 6
Type: MCSA
A benzodiazepine has been prescribed for a client with short-term insomnia. Which
benzodiazepine is appropriate to treat insomnia?
1.
2.
3.
4.
Diazepam (Valium)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Temazepam (Restoril)
Correct Answer: 4
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 1: Diazepam (Valium) is incorrect because it is used for alcohol withdrawal and
seizures.
Rationale 2: Chlordiazepoxide (Librium) is incorrect because it is used for anxiety.
Rationale 3: Clonazepam (Klonopin) is incorrect because it is used for panic disorders.
Rationale 4: Temazepam (Restoril) is used to treat insomnia.
Global Rationale: Temazepam (Restoril) is used to treat insomnia. Diazepam (Valium) is
incorrect because it is used for alcohol withdrawal and seizures. Chlordiazepoxide (Librium) is
incorrect because it is used for anxiety. Clonazepam (Klonopin) is incorrect because it is used
for panic disorders.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Question 7
Type: MCMA
A client is being treated for an anxiety disorder. Which types of medications are used to treat
anxiety disorders?
(Select all that apply.)
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1.
2.
3.
4.
5.
Barbiturates
Beta blockers
Benzodiazepines
Alpha blockers
SSRIs
Correct Answer: 1, 2, 3, 5
Rationale 1: Barbiturates are used to treat anxiety.
Rationale 2: Beta blockers are used to treat anxiety.
Rationale 3: Benzodiazepines are used to treat anxiety.
Rationale 4: Alpha blockers are not used to treat anxiety. They are used to treat hypertension.
Rationale 5: SSRIs are used to treat anxiety.
Global Rationale: Barbiturates, beta blockers, benzodiazepines, and SSRIs are used to treat
anxiety. Alpha blockers are not used to treat anxiety. They are used to treat hypertension.
Cognitive Level: Applying
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Question 8
Type: MCSA
The client asks the nurse why a tricyclic antidepressant has not been prescribed for depression.
What is the best response by the nurse?
1. "Tricyclic antidepressants have many side effects, including orthostatic hypotension,
headache, and diarrhea."
2. "Tricyclic antidepressants cause sexual dysfunction."
3. "Tricyclic antidepressants are not recommended for a client with a history of heart
attack."
4. "Tricyclic antidepressants cause weight gain."
Correct Answer: 3
Rationale 1: "Tricyclic antidepressants have many side effects including orthostatic
hypotension, headache, and diarrhea" is incorrect because this is a side effect of MAOIs.
Rationale 2: "Tricyclic antidepressants cause sexual dysfunction" is incorrect because this is a
side effect of SSRIs.
Rationale 3: Tricyclic antidepressants are not recommended for a client with a history of heart
attack.
Rationale 4: Tricyclic antidepressants are not recommended for a client with a history of heart
attack.
Global Rationale: Tricyclic antidepressants are not recommended for a client with a history of
heart attack. "Tricyclic antidepressants have many side effects including orthostatic
hypotension, headache and diarrhea" is incorrect because this is a side effect of MAOIs.
"Tricyclic antidepressants cause sexual dysfunction" is incorrect because this is a side effect of
SSRIs. Tricyclic antidepressants are not recommended for a client with a history of heart attack.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Question 9
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Type: MCSA
The physician ordered an MAOI for a client with depression. The nurse expects which
medication to be ordered?
1.
2.
3.
4.
Citalopram (Celexa)
Fluoxetine (Prozac)
Tranylcypromine (Parnate)
Amitriptyline (Elavil)
Correct Answer: 3
Rationale 1: Citalopram (Celexa) is incorrect because this medication is an SSRI.
Rationale 2: Fluoxetine (Prozac) is incorrect because it is an SSRI.
Rationale 3: Tranylcypromine (Parnate) is an MAOI.
Rationale 4: Amitriptyline (Elavil) is incorrect because this medication is a tricyclic
antidepressant.
Global Rationale: Tranylcypromine (Parnate) is an MAOI. Citalopram (Celexa) is incorrect
because this medication is an SSRI. Fluoxetine (Prozac) is incorrect because it is an SSRI.
Amitriptyline (Elavil) is incorrect because this medication is a tricyclic antidepressant.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Question 10
Type: MCSA
A client taking an MAOI should be instructed to avoid which item?
1.
2.
3.
4.
Foods that contain tyramine and caffeine
A diet that is high in fat
Large amounts of water
A diet that is high in salt
Correct Answer: 1
Rationale 1: Foods that contain tyramine and caffeine should be avoided by a client taking an
MAOI.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 2: A diet that is high in fat is incorrect. The client needs to avoid foods that contain
tyramine and caffeine.
Rationale 3: Large amounts of water is incorrect. The client needs to avoid foods that contain
tyramine and caffeine.
Rationale 4: A diet that is high in salt is incorrect. The client needs to avoid foods that contain
tyramine and caffeine.
Global Rationale: Foods that contain tyramine and caffeine should be avoided by a client
taking an MAOI. A diet that is high in fat is incorrect. The client needs to avoid foods that
contain tyramine and caffeine. Large amounts of water is incorrect. The client needs to avoid
foods that contain tyramine and caffeine. A diet that is high in salt is incorrect. The client needs
to avoid foods that contain tyramine and caffeine.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Question 11
Type: MCSA
A female client has been prescribed a tricyclic antidepressant. The nurse will educate this client
that most of these medications belong to which pregnancy categories?
1.
2.
3.
4.
B and C
C and D
A and D
A and B
Correct Answer: 2
Rationale 1: Most tricyclic antidepressants are pregnancy categories C and D.
Rationale 2: Most tricyclic antidepressants are pregnancy categories C and D.
Rationale 3: Most tricyclic antidepressants are pregnancy categories C and D.
Rationale 4: Most tricyclic antidepressants are pregnancy categories C and D.
Global Rationale: Most tricyclic antidepressants are pregnancy categories C and D. The other
options are incorrect.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and
sleep disorders.
Question 12
Type: MCSA
A client has been taking an SNRI, and complains of confusion, anxiety, tremors, and sweating.
What does the nurse understand about these symptoms?
1.
2.
3.
4.
Will diminish with continued use of the medication
Indicate too high a dose has been given
Indicate too low a dose has been given
Are normal with SNRIs
Correct Answer: 2
Rationale 1: These symptoms indicate the client has received too high a dose of the
medication.
Rationale 2: These symptoms indicate the client has received too high a dose of the
medication.
Rationale 3: These symptoms indicate the client has received too high a dose of the
medication.
Rationale 4: These symptoms indicate the client has received too high a dose of the
medication.
Global Rationale: These symptoms indicate the client has received too high a dose of the
medication. These symptoms will not diminish with continued use of the medication, they don’t
indicate that the dose is too low, and they are not normal with SNRIs.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-4 Explain the pharmacologic management of anxiety and insomnia.
Question 13
Type: MCSA
A teenage client is taking duloxetine (Cymbalta) for a generalized anxiety disorder. The dose
has been changed by the physician. What adverse effects will the nurse advise the client and
family to watch?
1. Warning signs of suicide
2. Irritability
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
3. Weight gain
4. Fatigue
Correct Answer: 1
Rationale 1: The FDA issued a black box warning for Cymbalta. When the dose is changed,
teenagers need to be monitored for warning signs of suicide.
Rationale 2: The FDA issued a black box warning for Cymbalta. When the dose is changed,
teenagers need to be monitored for warning signs of suicide.
Rationale 3: The FDA issued a black box warning for Cymbalta. When the dose is changed,
teenagers need to be monitored for warning signs of suicide.
Rationale 4: The FDA issued a black box warning for Cymbalta. When the dose is changed,
teenagers need to be monitored for warning signs of suicide.
Global Rationale: The FDA issued a black box warning for Cymbalta. When the dose is
changed, teenagers need to be monitored for warning signs of suicide. Irritability, weight gain,
and fatigue are not black box warning that must be watched for with this medication.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-4 Explain the pharmacologic management of anxiety and insomnia.
Question 14
Type: MCMA
A nurse is caring for a client who reports frequent insomnia. Based on the client's assessment,
what are the possible causes of insomnia?
(Select all that apply.)
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1.
2.
3.
4.
5.
Darkened room
Stress
Caffeine
Quiet sleeping area
Early morning exercise
Correct Answer: 2, 3
Rationale 1: A quiet, dark room promotes sleep.
Rationale 2: Stress can be a cause of insomnia.
Rationale 3: Caffeine intake can be a cause of insomnia.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 4: A quiet, dark room promotes sleep.
Rationale 5: Exercise done early in the morning does not cause insomnia.
Global Rationale: Stress and caffeine intake can be causes of insomnia. A darkened room and
a quiet, dark sleep environment promote sleep. Early morning exercise is not a known cause of
insomnia.
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-4 Explain the pharmacologic management of anxiety and insomnia.
Question 15
Type: MCSA
A client has abruptly stopped taking a CNS depressant, and is experiencing withdrawal
symptoms. Which symptoms should the nurse expect to see?
1. Hypothermia, psychosis, seizures, decreased heart rate, increased blood pressure, and
panic anxiety
2. Fever, euphoria, headache, increased heart rate, and fatigue
3. Fever, psychosis, seizures, increased heart rate, decreased blood pressure, panic, and
anxiety
4. Euphoria, fever, tremor, relaxation, and coma
Correct Answer: 3
Rationale 1: The nurse would expect to see fever, psychosis, seizures, increased heart rate,
decreased blood pressure, panic, and anxiety.
Rationale 2: The nurse would expect to see fever, psychosis, seizures, increased heart rate,
decreased blood pressure, panic, and anxiety.
Rationale 3: Fever, psychosis, seizures, increased heart rate, decreased blood pressure, panic,
and anxiety are symptoms of CNS withdrawal.
Rationale 4: The nurse would expect to see fever, psychosis, seizures, increased heart rate,
decreased blood pressure, panic, and anxiety.
Global Rationale: Fever, psychosis, seizures, increased heart rate, decreased blood pressure,
panic, and anxiety are symptoms of CNS withdrawal. Hypothermia, fatigue, and euphoria are
not expected symptoms of CNS withdrawal.
Cognitive Level: Analyzing
Client Need: Physiological integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-4 Explain the pharmacologic management of anxiety and insomnia.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Question 16
Type: MCSA
What would the nurse teach a client to avoid when taking barbiturates?
1.
2.
3.
4.
Bananas
Alcohol
Caffeine
Nicotine
Correct Answer: 2
Rationale 1: Alcohol and barbiturates can result in death.
Rationale 2: Alcohol and barbiturates can result in death.
Rationale 3: Alcohol and barbiturates can result in death.
Rationale 4: Alcohol and barbiturates can result in death.
Global Rationale: Alcohol and barbiturates can result in death. Bananas, caffeine, and nicotine
do not need to be avoided when a client is taking barbiturates.
Cognitive Level: Applying
Client Need: Physiological integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-4 Explain the pharmacologic management of anxiety and insomnia.
Question 17
Type: MCSA
An elderly client receives temazepam (Restoril) for sleep. Which assessment data is indicative
of a potentially serious complication?
1.
2.
3.
4.
The client reports a dry mouth.
The client becomes agitated.
The client sleeps for 1 hour longer than usual.
The client reports a decrease in appetite.
Correct Answer: 2
Rationale 1: While dry mouth could be a side effect, it is easily managed, and not a serious
complication.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 2: Medication can accumulate in the system of elderly clients and produce
generalized brain dysfunction. This can result in agitation.
Rationale 3: Sleeping 1 extra hour would be a positive benefit.
Rationale 4: This medication is not an appetite suppressant, so it would not affect appetite.
Global Rationale: Medication can accumulate in the system of elderly clients and produce
generalized brain dysfunction. This can result in agitation. While dry mouth could be a side
effect, it is easily managed, and not a serious complication. Sleeping 1 extra hour would be a
positive benefit. This medication is not an appetite suppressant, so it would not affect appetite.
Cognitive Level: Applying
Client Need: Physiological integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome:
Question 18
Type: MCSA
The client will be receiving amitriptyline (Elavil), a tricyclic antidepressant, for chronic
anxiety. Which nursing assessment is a priority for this client?
1.
2.
3.
4.
History of alcoholism
History of heart disease
History of ulcers
History of diabetes mellitus
Correct Answer: 2
Rationale 1: A history of alcoholism is not a priority, because tricyclic antidepressants are not
addictive.
Rationale 2: History of heart disease is a priority assessment because tricyclic antidepressants
are not recommended in clients with a history of heart attack, heart block, or abnormal heart
rhythm.
Rationale 3: A history of ulcers is not a priority, because tricyclic antidepressants do not alter
gastrointestinal mucosa.
Rationale 4: A history of diabetes mellitus is not a priority, because tricyclic antidepressants do
not alter glucose metabolism.
Global Rationale: History of heart disease is a priority assessment because tricyclic
antidepressants are not recommended in clients with a history of heart attack, heart block, or
abnormal heart rhythm. A history of alcoholism is not a priority, because tricyclic
antidepressants are not addictive. A history of ulcers is not a priority, because tricyclic
antidepressants do not alter gastrointestinal mucosa. A history of diabetes mellitus is not a
priority, because tricyclic antidepressants do not alter glucose metabolism.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-5 Categorize drugs used for anxiety and insomnia based on their
classification and mechanism of action.
Question 19
Type: MCSA
The nurse instructs the client that buspirone (BuSpar) has which common side effects?
1.
2.
3.
4.
Nausea and vomiting
Cognitive impairment
Decreased heart rate and blood pressure
Dizziness, headache, and drowsiness
Correct Answer: 4
Rationale 1: This medication causes dizziness, headache, and drowsiness.
Rationale 2: This medication causes dizziness, headache, and drowsiness.
Rationale 3: This medication causes dizziness, headache, and drowsiness.
Rationale 4: Dizziness, headache, and drowsiness all are common side effects of BuSpar.
Global Rationale: Dizziness, headache, and drowsiness all are common side effects of BuSpar.
Nausea, vomiting, cognitive impairment, decreased heart rate and decreased blood pressure are
not common side effects of BuSpar.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-5 Categorize drugs used for anxiety and insomnia based on their
classification and mechanism of action.
Question 20
Type: MCSA
The client receives buspirone (BuSpar) for chronic anxiety. At time of discharge, what is a
priority for the nurse to teach this client about the medication?
1. "You can only take this for a few weeks, as dependence is very high with this drug."
2. "It will take a few weeks before you feel a reduction in anxiety."
3. "This drug must be taken on an empty stomach."
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
4. "Therapeutic blood levels are required with this drug."
Correct Answer: 2
Rationale 1: "You can only take this for a few weeks, as dependence is very high with this
drug" is incorrect because it is safe to take buspirone for longer than a few weeks, and the risk
of dependence is low.
Rationale 2: Therapy can take several weeks to achieve optimal results. It is safe to take
buspirone for longer than a few weeks, and the risk of dependence is low.
Rationale 3: "This drug must be taken on an empty stomach" is incorrect because buspirone
(BuSpar) can be taken with or without food.
Rationale 4: "Therapeutic blood levels are required with this drug" is incorrect. Therapeutic
blood levels are not required with buspirone (BuSpar).
Global Rationale: Therapy can take several weeks to achieve optimal results. It is safe to take
buspirone for longer than a few weeks, and the risk of dependence is low. "You can only take
this for a few weeks, as dependence is very high with this drug" is incorrect because it is safe to
take buspirone for longer than a few weeks, and the risk of dependence is low. "This drug must
be taken on an empty stomach" is incorrect because buspirone (BuSpar) can be taken with or
without food. Therapeutic blood levels are required with this drug" is incorrect. Therapeutic
blood levels are not required with buspirone (BuSpar).
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-5 Categorize drugs used for anxiety and insomnia based on their
classification and mechanism of action.
Question 21
Type: MCSA
The client has been taking clonazepam (Klonopin) for chronic anxiety for three years. The
client tells the nurse he wants to stop the medication. What is the best response by the nurse?
1.
2.
3.
4.
"You will need to gradually decrease your dose before stopping."
"I don't think it is a good idea to stop your medication."
"There are not any serious complications to stopping this drug."
"Medications for anxiety must be taken for the rest of your life."
Correct Answer: 1
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 1: Clonazepam (Klonopin) is a CNS depressant drug. Abrupt cessation can result in
serious withdrawal symptoms. Clients must be gradually decreased in their dose before
stopping the drug.
Rationale 2: "I don't think it is a good idea to stop your medication" is incorrect because it is
the patient's decision to stop medications, and it is inappropriate for the nurse to give advice
before doing an assessment.
Rationale 3: "There are not any serious complications to stopping this drug" is incorrect
because abrupt cessation can result in serious withdrawal symptoms.
Rationale 4: "Medications for anxiety must be taken for the rest of your life" is incorrect
because anti-anxiety medications are indicated for short-term relief of anxiety while the client
focuses on problem-solving techniques, so medications need not be taken for the rest of a
client's life.
Global Rationale: Clonazepam (Klonopin) is a CNS depressant drug. Abrupt cessation can
result in serious withdrawal symptoms. Clients must be gradually decreased in their dose before
stopping the drug. "I don't think it is a good idea to stop your medication" is incorrect because it
is the patient's decision to stop medications, and it is inappropriate for the nurse to give advice
before doing an assessment. "There are not any serious complications to stopping this drug" is
incorrect because abrupt cessation can result in serious withdrawal symptoms. "Medications for
anxiety must be taken for the rest of your life" is incorrect because anti-anxiety medications are
indicated for short-term relief of anxiety while the client focuses on problem-solving
techniques, so medications need not be taken for the rest of a client's life.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-5 Categorize drugs used for anxiety and insomnia based on their
classification and mechanism of action.
Question 22
Type: MCSA
The client receives temazepam (Restoril) at bedtime for sleep. The client tells the nurse that he
also has a glass of wine before bed to help him sleep. What is the nurse's best response?
1. "One glass of wine is okay, but be sure not to have more than that."
2. "Combining wine with your medication will decrease the effectiveness of your
medication."
3. "This is okay as long as you have a high-fat meal with your wine."
4. "Combining wine with your medication can sedate you and cause breathing problems."
Correct Answer: 4
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 1: "One glass of wine is okay, but be sure not to have more than that" is incorrect
because alcohol potentiates, and does not decrease, the effect of benzodiazepines.
Rationale 2: "Combining wine with your medication will decrease the effectiveness of your
medication" is incorrect because alcohol potentiates, and does not decrease, the effect of
benzodiazepines.
Rationale 3: "This is okay as long as you have a high-fat meal with your wine" is incorrect
because consuming a high-fat meal with alcohol will not change the potentiating effects of the
alcohol. Alcohol potentiates, and does not decrease, the effect of benzodiazepines.
Rationale 4: Alcohol is a CNS depressant, and combining it with benzodiazepines potentiates
CNS depression, and can result in respiratory depression. Clients should not consume any
alcohol with benzodiazepines.
Global Rationale: Alcohol is a CNS depressant, and combining it with benzodiazepines
potentiates CNS depression, and can result in respiratory depression. Clients should not
consume any alcohol with benzodiazepines. "One glass of wine is okay, but be sure not to have
more than that" is incorrect because alcohol potentiates, not decreases, the effect of
benzodiazepines. "Combining wine with your medication will decrease the effectiveness of
your medication" is incorrect because alcohol potentiates, not decreases, the effect of
benzodiazepines. "This is okay as long as you have a high-fat meal with your wine" is incorrect
because consuming a high-fat meal with alcohol will not change the potentiating effects of the
alcohol. Alcohol potentiates, not decreases, the effect of benzodiazepines.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-5 Categorize drugs used for anxiety and insomnia based on their
classification and mechanism of action.
Question 23
Type: MCSA
The client receives zaleplon (Sonata) for sleep. What is the priority teaching by the nurse at the
time of discharge?
1.
2.
3.
4.
"This drug can be taken indefinitely."
"Drinking a cup of tea with this drug will promote relaxation."
"It will take about a week for this drug to be effective."
"Avoid taking OTC sleep-inducing antihistamines."
Correct Answer: 4
Rationale 1: "This drug can be taken indefinitely" is incorrect because zaleplon is indicated for
short-term treatment of insomnia, and works immediately.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 2: "Drinking a cup of tea with this drug will promote relaxation" is incorrect because
tea contains caffeine, a stimulant. Drinking tea with zaleplon will reduce the effectiveness of
the drug.
Rationale 3: "It will take about a week for this drug to be effective" is incorrect because
zaleplon is indicated for short-term treatment of insomnia, and works immediately.
Rationale 4: Combining OTC sleep-inducing antihistamines with zaleplon can cause excessive
drowsiness.
Global Rationale: Combining OTC sleep-inducing antihistamines with zaleplon can cause
excessive drowsiness. "This drug can be taken indefinitely" is incorrect because zaleplon is
indicated for short-term treatment of insomnia, and works immediately. "Drinking a cup of tea
with this drug will promote relaxation" is incorrect because tea contains caffeine, a stimulant.
Drinking tea with zaleplon will reduce the effectiveness of the drug. "It will take about a week
for this drug to be effective" is incorrect because zaleplon is indicated for short-term treatment
of insomnia, and works immediately.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-5 Categorize drugs used for anxiety and insomnia based on their
classification and mechanism of action.
Question 24
Type: MCSA
The client receives lorazepam (Ativan) for chronic anxiety. The nurse determines that
medication education has been most effective when the client makes which statement?
1.
2.
3.
4.
"I will probably always need this medication for my anxiety."
"This medication will help me relax so I can focus on problem solving."
"This medication is not addictive."
"My anxiety will be eliminated when I take this medication."
Correct Answer: 2
Rationale 1: "I will probably always need this medication for my anxiety" is incorrect because
benzodiazepines provide short-term relief of anxiety while the client focuses on alternative
therapies. Clients should be encouraged to explore and develop coping strategies for dealing
with stress.
Rationale 2: "This medication will help me relax so I can focus on problem solving."
Benzodiazepines do not cure anxiety; they provide short-term relief of anxiety while the client
focuses on alternative therapies. Clients should be encouraged to explore and develop coping
strategies for dealing with stress.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 3: "This medication is not addictive" is incorrect because all benzodiazepines are
addictive, but most clients should not need to take benzodiazepines indefinitely for anxiety.
Rationale 4: "My anxiety will be eliminated when I take this medication" is incorrect because
benzodiazepines provide short-term relief of anxiety while the client focuses on alternative
therapies. Clients should be encouraged to explore and develop coping strategies for dealing
with stress.
Global Rationale: "This medication will help me relax so I can focus on problem solving."
Benzodiazepines do not cure anxiety; they provide short-term relief of anxiety while the client
focuses on alternative therapies. Clients should be encouraged to explore and develop coping
strategies for dealing with stress. "I will probably always need this medication for my anxiety"
is incorrect because benzodiazepines provide short-term relief of anxiety while the client
focuses on alternative therapies. Clients should be encouraged to explore and develop coping
strategies for dealing with stress. "This medication is not addictive" is incorrect because all
benzodiazepines are addictive, but most clients should not need to take benzodiazepines
indefinitely for anxiety. "My anxiety will be eliminated when I take this medication" is
incorrect because benzodiazepines provide short-term relief of anxiety while the client focuses
on alternative therapies. Clients should be encouraged to explore and develop coping strategies
for dealing with stress.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-6 For each of the classes listed in the Drug Snapshot, know
representative drugs and explain their related clinical uses.
Question 25
Type: MCSA
Which nursing statement regarding onset of action for zolpidem (Ambien) is the most
appropriate?
1.
2.
3.
4.
Rapidly, and should be taken just before bedtime
Four hours after dosing
Sixty minutes after dosing
Two hours after dosing
Correct Answer: 1
Rationale 1: Zolpidem (Ambien) begins to work rapidly, and should be taken just before
bedtime.
Rationale 2: This medication works rapidly, and should be taken just before bedtime.
Rationale 3: This medication works rapidly, and should be taken just before bedtime.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Rationale 4: This medication works rapidly, and should be taken just before bedtime.
Global Rationale: Zolpidem (Ambien) begins to work rapidly, and should be taken just before
bedtime. Four hours after dosing, 60 minutes after dosing, and two hours after doing are not
appropriate statements.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-6 For each of the classes listed in the Drug Snapshot, know
representative drugs and explain their related clinical uses.
Question 26
Type: MCSA
A client has been prescribed a medication to help him fall asleep but wake early. Which drug
would the nurse expect to find ordered for this client?
1.
2.
3.
4.
Diphenhydramine (Nytol)
Eszopiclone (Lunesta)
Remelton (Rozerum)
Zaleplon (Sonata)
Correct Answer: 4
Rationale 1: Diphenhydramine (Nytol) is incorrect because it is an antihistamine, and causes
significant drowsiness.
Rationale 2: Eszopiclone (Lunesta) is incorrect because this medication has a long half-life,
and decreases early-morning waking.
Rationale 3: Remelton (Rozerum) is incorrect because this is a melatonin receptor agent, and is
used to induce sleep.
Rationale 4: Zaleplon (Sonata) allows the client to fall asleep but still wake early. It is often
used for travel.
Global Rationale: Zaleplon (Sonata) allows the client to fall asleep but still wake early. It is
often used for travel. Diphenhydramine (Nytol) is incorrect because it is an antihistamine, and
causes significant drowsiness. Eszopiclone (Lunesta) is incorrect because this medication has a
long half-life, and decreases early-morning waking. Remelton (Rozerum) is incorrect because
this is a melatonin receptor agent, and is used to induce sleep.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition
Learning Outcome: 9-6 For each of the classes listed in the Drug Snapshot, know
representative drugs and explain their related clinical uses.
Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition