Anxiolytics and Sedative-Hypnotics

Every question here, with the answer

1. A client received IV midazolam for a procedure and is now difficult to arouse with slow, shallow breathing. Which medication should the nurse have available?

   1. Cimetidine
   2. Naloxone
   3. Flumazenil
   4. Diazepam

   Answer: Flumazenil

   Flumazenil is a specific benzodiazepine receptor antagonist and should be available to reverse the effects of benzodiazepines given for sedation. Naloxone is not the benzodiazepine reversal agent named in the section, cimetidine increases sedative toxicity, and diazepam is another benzodiazepine.

2. A client who has taken lorazepam for several months tells the nurse he plans to stop it today because he feels calmer. What should the nurse explain?

   1. Stopping today is safe because he feels better.
   2. He can stop it if he drinks a glass of wine at night instead.
   3. He should double the dose for one day before stopping.
   4. The drug must be tapered slowly, or he will experience withdrawal symptoms.

   Answer: The drug must be tapered slowly, or he will experience withdrawal symptoms.

   Benzodiazepines must be tapered slowly when discontinued, or withdrawal symptoms occur, including a risk of seizures. Abrupt stopping, substituting alcohol (which intensifies CNS depression), or doubling the dose are unsafe.

3. Which client conditions should make the nurse question an order for a benzodiazepine? Select all that apply.

   1. Muscle tension from anxiety
   2. History of psychosis
   3. Impaired hepatic function
   4. Pregnancy
   5. Acute narrow-angle glaucoma

   Answer: History of psychosis, Impaired hepatic function, Pregnancy, Acute narrow-angle glaucoma

   Benzodiazepines can raise intraocular pressure in acute narrow-angle glaucoma, cross the placenta, worsen psychosis, and accumulate when liver function is impaired because they are metabolized by the liver. Muscle tension is a symptom of anxiety that the drug is used to relieve.

4. A 4-year-old given diazepam becomes agitated and excited instead of calm. How should the nurse interpret this?

   1. This is a paradoxical reaction of CNS stimulation that children may have.
   2. The child is allergic to all sedatives.
   3. The child needs a higher dose.
   4. This shows the drug is working as intended.

   Answer: This is a paradoxical reaction of CNS stimulation that children may have.

   Children are more sensitive to diazepam and may have paradoxical CNS stimulation and excitation instead of a calming effect. Giving more drug is not supported, excitation is not the intended effect, and nothing indicates an allergy.

5. The nurse is teaching a client who is prescribed zolpidem for insomnia. Which instructions are correct? Select all that apply.

   1. Do not drink alcohol while taking it.
   2. Take it just before going to bed.
   3. Take it every night for years to prevent tolerance.
   4. Take a daytime nap if you feel drowsy.
   5. Do not take it with a high-fat meal.

   Answer: Do not drink alcohol while taking it., Take it just before going to bed., Do not take it with a high-fat meal.

   The sedative-hypnotic is taken just before bed so the client is lying down when it starts to work, high-fat meals delay absorption, and alcohol intensifies CNS and respiratory depression. Long-term use should be avoided and daytime naps are discouraged.

6. A client with sleep apnea asks for a sleeping pill. Why should the nurse use caution with nonbenzodiazepine sedative-hypnotics for this client?

   1. They increase sleep latency.
   2. They must be given intramuscularly.
   3. They can cause respiratory depression.
   4. They cause high blood pressure.

   Answer: They can cause respiratory depression.

   Because of the potential for respiratory depression, clients with a history of COPD or sleep apnea should use caution with these drugs. The other options are not effects described in the section; these drugs reduce sleep latency.