Holland/Adams/Brice, Core Concepts in Pharmacology 5th Edition Test Bank
Chapter 10

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. Obsessive-compulsive disorder
2. Generalized anxiety disorder
3. Panic disorder
4. Post-traumatic stress disorder

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Page Number: 122

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-1 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. Generalized anxiety disorder
2. Obsessive-compulsive disorder
3. Post-traumatic stress disorder
4. Panic disorder

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Page Number: 123

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-1 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. Provide the client with a powerful medication
2. Allow the client to self-medicate with OTC medications
3. Immediately start multiple-drug therapy
4. Uncover and address the cause of anxiety

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 124

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Explain the pharmacologic and nonpharmacologic strategies used to manage anxiety and anxiety-related symptoms.

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. Report significant mood changes
2. Avoid OTC medications used to induce sleep
3. Avoid alcoholic beverages
4. If a dose is missed, the client should take a double dose as soon as possible
5. Avoid caffeine

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 129

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-7 Identify the role benzodiazepines play in treating anxiety disorders and insomnia, their mechanisms of action, primary actions, and important adverse effects.

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. SSRIs
2. MAOIs
3. Benzodiazepines
4. Barbiturates

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 131

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-8 Explain the sedative-hypnotic properties of barbiturates and their historic role in treating anxiety and restlessness.

Question 6

Type: MCSA

A benzodiazepine has been prescribed for a client with short-term insomnia. Which benzodiazepine is appropriate to treat insomnia?

1. Diazepam (Valium)
2. Chlordiazepoxide (Librium)
3. Clonazepam (Klonopin)
4. Temazepam (Restoril)

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 129

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Identify the four categories of central nervous system 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. Barbiturates
2. Beta blockers
3. Benzodiazepines
4. Alpha blockers
5. SSRIs

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Numbers: 128 and 132

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Introduce the major classes of antidepressants and describe how they control anxiety.

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 aid with digestion and elimination.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 128

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-6 Introduce the major classes of antidepressants and describe how they control anxiety.

Question 9

Type: MCSA

The physician ordered an MAOI for a client with depression. The nurse expects which medication to be ordered?

1. Citalopram (Celexa)
2. Fluoxetine (Prozac)
3. Tranylcypromine (Parnate)
4. Amitriptyline (Elavil)

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Page Number: 127

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Introduce the major classes of antidepressants and describe how they control anxiety.

Question 10

Type: MCSA

A client taking an MAOI should be instructed to avoid which item?

1. Foods that contain tyramine and caffeine
2. A diet that is high in fat
3. Large amounts of water
4. A diet that is high in salt

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 128

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Introduce the major classes of antidepressants and describe how they control anxiety.

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. B and C
2. C and D
3. A and D
4. A and B

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 128

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Introduce the major classes of antidepressants and describe how they control anxiety.

Question 12

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
3. Weight gain
4. Fatigue

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 128

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Introduce the major classes of antidepressants and describe how they control anxiety.

Question 13

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. Darkened room
2. Stress
3. Caffeine
4. Quiet sleeping area
5. Early morning exercise

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Page Number: 125

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-4 Discuss why we sleep and how normal sleep patterns can be interrupted.

Question 14

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

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 126

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-5 Identify the four categories of central nervous system drugs used to treat anxiety and sleep disorders.

Question 15

Type: MCSA

What would the nurse teach a client to avoid when taking barbiturates?

1. Bananas
2. Alcohol
3. Caffeine
4. Nicotine

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 131

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-8 Explain the sedative-hypnotic properties of barbiturates and their historic role in treating anxiety and restlessness.

Question 16

Type: MCSA

An elderly client receives temazepam (Restoril) for sleep. Which assessment data is indicative of a potentially serious complication?

1. The client reports a dry mouth.
2. The client becomes agitated.
3. The client sleeps for 1 hour longer than usual.
4. The client reports a decrease in appetite.

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 129

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-7 Identify the role benzodiazepines play in treating anxiety disorders and insomnia, their mechanisms of action, primary actions, and important adverse effects.

Question 17

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. History of alcoholism
2. History of heart disease
3. History of ulcers
4. History of diabetes mellitus

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 128

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6 Introduce the major classes of antidepressants and describe how they control anxiety.

Question 18

Type: MCSA

The nurse instructs the client that buspirone (BuSpar) has which common side effects?

1. Nausea and vomiting
2. Cognitive impairment
3. Decreased heart rate and blood pressure
4. Dizziness, headache, and drowsiness

Cognitive Level: Understanding

Client Need: Physiological Integrity

Page Number: 132

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-9 Identify anti-anxiety drugs chemically unrelated to benzodiazepines or barbiturates.

Question 19

Type: MCSA

The client receives buspirone (BuSpar) for chronic anxiety. At time of discharge, what is a priority for the nurse to teach the 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.”
4. “Therapeutic blood levels are required with this drug.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 132

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-9 Identify anti-anxiety drugs chemically unrelated to benzodiazepines or barbiturates.

Question 20

Type: MCSA

A client has been taking clonazepam (Klonopin) for chronic anxiety for three years. The client tells the nurse they want to stop the medication. What is the best response by the nurse?

1. “You will need to gradually decrease your dose before stopping.”
2. “I don’t think it is a good idea to stop your medication.”
3. “There are not any serious complications to stopping this drug.”
4. “Medications for anxiety must be taken for the rest of your life.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 129

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-7 Identify the role benzodiazepines play in treating anxiety disorders and insomnia, their mechanisms of action, primary actions, and important adverse effects.

Question 21

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.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 129

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-7 Identify the role benzodiazepines play in treating anxiety disorders and insomnia, their mechanisms of action, primary actions, and important adverse effects.

Question 22

Type: MCSA

The client receives zaleplon (Sonata) for sleep. What is the priority teaching by the nurse at the time of discharge?

1. “This drug can be taken indefinitely.”
2. “Drinking a cup of tea with this drug will promote relaxation.”
3. “It will take about a week for this drug to be effective.”
4. “Avoid taking OTC sleep-inducing antihistamines.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 135

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-9 Identify anti-anxiety drugs chemically unrelated to benzodiazepines or barbiturates.

Question 23

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. “I will probably always need this medication for my anxiety.”
2. “This medication will help me relax so I can focus on problem solving.”
3. “This medication is not addictive.”
4. “My anxiety will be eliminated when I take this medication.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 129

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-3 Explain the pharmacologic and nonpharmacologic strategies used to manage anxiety and anxiety-related symptoms.

Question 24

Type: MCSA

Which nursing statement regarding onset of action for zolpidem (Ambien) is the most appropriate?

1. Rapidly, and should be taken just before bedtime
2. Four hours after dosing
3. Sixty minutes after dosing
4. Two hours after dosing

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 133

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-9 Identify anti-anxiety drugs chemically unrelated to benzodiazepines or barbiturates.

Question 25

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. Diphenhydramine (Nytol)
2. Eszopiclone (Lunesta)
3. Ramelteon (Rozerem)
4. Zaleplon (Sonata)

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 134

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-9 Identify anti-anxiety drugs chemically unrelated to benzodiazepines or barbiturates.

Question 26

Type: MCSA

Which area of the brain is responsible for sleeping and wakefulness?

1. Cerebral cortex

2. Diencephalon

3. Hypothalamus

4. Reticular activating system

Cognitive Level: Understanding

Client Need: Physiological Integrity

Page Number: 124

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-2 Identify areas of the brain responsible for feelings of emotion and restlessness.

Question 27

Type: MCMA

Which areas of the brain control anxiety and restlessness? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Limbic system

2. Hypothalamus

3. Sympathetic nervous system

4. Reticular activating system

5. Cholinergic receptors

Cognitive Level: Understanding

Client Need: Physiological Integrity

Page Number: 124

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-2 Identify areas of the brain responsible for feelings of emotion and restlessness.

Question 28

Type: MCMA

A client is discussing with the nurse ways to promote a sleeping environment. Which factors should be included in the plan of care? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Avoid foods, caffeinated beverages, and alcohol prior to going to sleep.

2. Ask the prescriber for a medication to assist in falling asleep.

3. Eat a large meal with high protein and fat close to bedtime.

4. Stressful conditions such as too much light or warm temperature should be avoided.

5. Central nervous medications can aid to staying asleep.

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 125

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-4 Discuss why we sleep and how normal sleep patterns can be interrupted.