Chapter 53 Drug Therapy to Reduce Anxiety and Produce Hypnosis

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Chapter 53  Drug Therapy to Reduce Anxiety and Produce Hypnosis

 

 

Complete chapter Questions And Answers
 

Sample Questions

 

 

1. A patient is having seizure activity, and the physician has ordered diazepam (Valium) to be given parenterally. If this medication is administered intravenously, when will its onset of action be observed?

  1. A)  1 to 5 minutes
  2. B)  7 to 10 minutes
  3. C)  More than 10 minutes
  4. D)  Less than 1 minute

Ans: A
Feedback:
Intravenous diazepam (Valium) is administered intravenously to decrease seizure activity and has a 1- to 5-minute onset of action. Diazepam (Valium) decreases seizure activity in less than 7 to 10 minutes. Diazepam (Valium) should decrease seizure activity in less than 10 minutes. Diazepam (Valium) will take more than 1 minute to begin working.

2. A patient suffers from insomnia and is prescribed flurazepam. This medication has a longer half-life than 24 hours. Which of the following contributes to the long half-life of this medication and other benzodiazepines?

  1. A)  Metabolism by cytochrome P450
  2. B)  Presence of active metabolites
  3. C)  Excretion by the renal system
  4. D)  Movement of calcium in the cell

Ans: B

Feedback:

Benzodiazepines differ mainly in their plasma half-lives, production of active metabolites, and clinical uses. Drugs with half-lives longer than 24 hours form active metabolites that also have long half-lives and tend to accumulate, especially in older adults and people with impaired liver function. Flurazepam is not metabolized by cytochrome P450. Flurazepam is excreted in the renal system but does not contribute to the effect on the half-life. Flurazepam does not contribute to movement of calcium in the cell.

3. A patient is given midazolam (Versed) in combination with an opioid in the preoperative phase before a laparoscopic cholecystectomy. What does the administration of midazolam (Versed) assist in minimizing?

  1. A)  Oral secretions
  2. B)  Anxiety
  3. C)  Hypotension
  4. D)  Muscle tone

Ans: B
Feedback:
Midazolam (Versed) provides preoperative sedation and mechanical ventilation. It does not reduce secretions, increase blood pressure, or reduce muscle tone.

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  1. A patient’s medication regimen for treatment of anxiety has been changed from a benzodiazepine. The patient asks the nurse what likely prompted his care provider to change his medication. What is the nurse’s best response?
    1. A)  “Your doctor may have been concerned about causing depression.”
    2. B)  “Your doctor may have been worried about the possibility of convulsions.”
    3. C)  “Long-term use of benzodiazepines can result in dependency.”
    4. D)  “Long-term use of benzodiazepines can cause insomnia.”

    Ans: C

    Feedback:

    Although benzodiazepines are effective anxiolytics, long-term use is associated with concerns over tolerance, dependency, withdrawal, lack of efficacy for treating the depression that often accompanies anxiety disorders, and the need for multiple daily dosing with some agents. They do not cause insomnia, convulsions, or depression.

  2. A patient has developed excessive sedation and respiratory depression. The patient has been taking a benzodiazepine and has diminished liver function. Which of the following medications will reduce the effects of sedation and respiratory depression in this patient?
    1. A)  Olmesartan medoxomil (Benicar)
    2. B)  Pancrelipase (Pancrease)
    3. C)  Pamidronate disodium (Aredia)
    4. D)  Flumazenil (Romazicon)

Ans: D

Feedback:

Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Romazicon) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Olmesartan medoxomil (Benicar) is an angiotensin II receptor antagonist that is used to treat hypertension. Pancrelipase (Pancrease) is used for enzyme replacement therapy. Pamidronate disodium is used as a bone metabolism regulator.

6. A patient is being observed for acute benzodiazepine withdrawal symptoms. Which of the following symptoms is characteristic of this problem?

  1. A)  Bradycardia
  2. B)  Agitation
  3. C)  Lethargy
  4. D)  Diaphoresis

Ans: B
Feedback:
Common signs and symptoms of withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Bradycardia, lethargy, and diaphoresis are uncharacteristic.

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