Chapter 21: Central Nervous System Depressants Nursing School Test Banks

Chapter 21: Central Nervous System Depressants
Test Bank

MULTIPLE CHOICE

1. A patient describes having vivid dreams to the nurse. The nurse understands that these occur during which stage of sleep?
a. Rapid eye movement (REM) sleep
b. Stage 2 nonrapid eye movement sleep
c. Stage 3 nonrapid eye movement sleep
d. Stage 4 nonrapid eye movement sleep
ANS: A
Vivid dreams occur during REM sleep.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 296
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance

2. Children who experience nightmares have these during which stage of sleep?
a. Early morning sleep
b. Nonrapid eye movement sleep
c. Rapid eye movement sleep
d. Sleep induction
ANS: B
Nightmares that occur in children take place during NREM sleep.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 292
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance

3. A patient reports difficulty falling asleep most nights and is constantly fatigued. The patient does not want to take medications to help with sleep. What nonpharmacologic measure will the nurse recommend?
a. Exercise in the evening to promote bedtime fatigue.
b. Get out of bed at the same time each morning.
c. Have a glass of wine at bedtime to help you relax.
d. Take daytime naps to minimize daytime fatigue.
ANS: B
To promote sleep, patients should be advised to arise at the same time each morning to establish a routine. Patients should avoid strenuous exercise before bedtime. Patients should not consume alcohol 6 hours before bedtime. Patients should not take daytime naps.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 292
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Health Promotion and Maintenance

4. The nurse is caring for a patient who reports being able to fall asleep but has difficulty staying asleep. The nurse will contact the provider to obtain an order for which medication?
a. Butabarbital (Butisol)
b. Flurazepam (Dalmane)
c. Secobarbital (Seconal)
d. Temazepam (Restoril)
ANS: A
Butabarbital is an intermediate-acting barbiturate and is useful as a sleep sustainer to maintain long periods of sleep. They have an onset of 1 hour, so are not useful for those who have trouble falling asleep. Flurazepam and temazepam are benzodiazepines and are used to induce sleep. Secobarbital is used for preoperative sedation.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 293
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is teaching a patient who will begin taking butabarbital (Butisol). What information will the nurse include when teaching this patient?
a. Avoid alcohol while taking this drug.
b. This drug may be used long-term.
c. This medication will take effect immediately.
d. You will not experience a hangover effect.
ANS: A
Patients who are taking barbiturates should avoid alcohol. Barbiturates are for short-term use. Butabarbital has a sleep onset time of 1 hour, so it will not help patients fall asleep. Patients who take barbiturates frequently experience a hangover effect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 294
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is caring for a young adult patient who is receiving a first dose of flurazepam (Dalmane) as a sedative-hypnotic medication. What intervention will be included in the nurses plan of care for this patient?
a. Instituting a bed alarm system to prevent falls
b. Reassuring the patient that nightmares are not a usual effect
c. Reporting a urine output greater than 1500 mL/day
d. Teaching the patient that this drug may be used for 6 to 8 weeks
ANS: A
The nurse should use a bed alarm for older patients and younger patients receiving a hypnotic for the first time. Patients may experience vivid dreams and nightmares. Urine output should be greater than 1500 mL/day, so this does not warrant reporting. This drug should be used short-term.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 294
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. An older adult has difficulty falling asleep. The nurse understands that which sedative hypnotic is appropriate for this patient?
a. Butabarbital (Butisol)
b. Flurazepam (Dalmane)
c. Secobarbital (Seconal)
d. Temazepam (Restoril)
ANS: D
Short- to intermediate-acting benzodiazepines such as temazepam are recommended for older adults and are considered safer than barbiturates.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 294
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A patient asks the nurse about taking over-the-counter sleeping aids. The nurse will tell the patient that the active ingredient in these products is often a(n)
a. antiemetic.
b. antihistamine.
c. barbiturate.
d. benzodiazepine.
ANS: B
The primary ingredient in OTC sleep aids is an antihistamine such as diphenhydramine, not barbiturates or benzodiazepines.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 292
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. An older adult patient reports frequent nighttime awakening because of arthritis pain and asks the nurse about taking an over-the-counter product to help with this problem. The nurse will recommend that the patient discuss which medication with the provider?
a. Ibuprofen (Motrin)
b. Nytol
c. Sominex
d. Tylenol PM
ANS: D
The main sleep problem experienced by older adults is frequent nighttime awakening. To alleviate pain and aid sleep, the OTC drug Tylenol PM, which contains diphenhydramine and acetaminophen may be taken. Ibuprofen occasionally helps if it can alleviate the discomfort that hinders sleep.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 292
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient who has been taking butabarbital (Butisol) for several weeks reports being drowsy and having difficulty performing tasks at work most mornings. The nurse suspects that which drug effects have occurred?
a. Dependence
b. Hangover
c. Tolerance
d. Withdrawal
ANS: B
Intermediate-acting hypnotics, such as butabarbital, are useful for sustaining sleep, but patients often experience residual drowsiness in the morning, or hangover. Drug dependence occurs when patients develop a need for the drug. Tolerance refers to a reduced drug effect requiring larger amounts of drug to get the desired effect. Withdrawal occurs when stopping the drug causes symptoms that can only be alleviated by taking the drug.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 293
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is providing teaching for a patient who will begin taking zolpidem tartrate (Ambien) 10 mg at bedtime as a sleep aid. Which statement by the patient indicates understanding of the teaching?
a. I should take this medication with food to avoid stomach upset.
b. I will take this medication within 30 minutes of bedtime.
c. If this medication is not effective, I may increase the dose to 15 mg.
d. Tolerance and drug dependence do not occur with this medication.
ANS: B
Zolpidem is a nonbenzodiazepine sleep aid. It should be taken 30 minutes before desired sleep. Food decreases the absorption, so it should be taken on an empty stomach. The maximum dose is 10 mg. Tolerance and dependence may occur.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 298
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient who has been taking a benzodiazepine as a sleep aid for several months wishes to stop taking the medication. The nurse will suggest that the patient taper the dose gradually to avoid which effect?
a. Depression
b. Hangover
c. Hypnotic rebound
d. Withdrawal
ANS: D
Benzodiazepines cause tolerance which means that abrupt cessation can result in withdrawal symptoms such as tremors and muscle twitching. A hangover is residual drowsiness that occurs the day after taking a hypnotic.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 293
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is preparing a patient for surgery. The patient received a hypnotic medication the night prior and the nurse is administering midazolam (Versed) and atropine. The patient asks why all of these medications are necessary. The nurse will tell the patient that they are given for which reason?
a. To decrease the amount of general anesthesia needed
b. To minimize post-operative drowsiness
c. To prolong the anesthetized state
d. To speed up anesthesia induction
ANS: A
Balanced anesthesia includes giving a hypnotic the night prior to surgery, premedication with an opioid analgesic or benzodiazepine plus an anticholinergic, and then a short-acting barbiturate, an inhaled gas, and a muscle relaxant. One effect of this is to decrease the amount of general anesthetic needed. It may reduce post-operative nausea and vomiting, but does not decrease drowsiness. It does not affect the duration of anesthesia, which is dependent on the length of time the inhaled gas is given, or the rate of induction.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 299
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. During balanced anesthesia, which type of medication is given while the surgery is performed?
a. Anticholinergics
b. Benzodiazepines
c. Hypnotics
d. Inhaled anesthetic
ANS: D
An inhaled anesthetic is given to induce anesthesia and is maintained throughout the surgical procedure. The other medications are given prior to anesthesia induction.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 299
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse performs a preoperative assessment on a patient and asks about alcohol use. The patient asks why this information is important. The nurse will explain that patients who consume increased amounts of alcohol
a. may have a prolonged postoperative recovery time.
b. may not be eligible for surgery.
c. may not receive inhaled gases for anesthesia.
d. may require changes in anesthesia drug doses.
ANS: D
The type and amount of anesthetics may need to be adjusted if patients consume large amounts of alcohol as well as for those who smoke, who are pregnant, or who are obese. These questions are asked prior to surgery so providers can plan for this.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 300
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The nurse is caring for a patient in the post-anesthesia care unit and notes that the patient received isoflurane (Forane) to induce anesthesia. When will the nurse expect the patient to recover consciousness?
a. Immediately
b. In 15 to 30 minutes
c. In 1 hour
d. In hours
ANS: C
Upon discontinuation of isoflurane, recovery of consciousness usually occurs in 1 hour.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 302
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The nurse is caring for a patient in the post-anesthesia care unit who has received a spinal anesthetic. Which action will the nurse perform?
a. Ambulate the patient as soon as consciousness returns.
b. Elevate the head of the bed to a semi-Fowlers position.
c. Have the patient lay flat for 6 to 8 hours after the surgery.
d. Turn the patient from side to side every 15 minutes.
ANS: C
Patients who have had spinal anesthesia should remain flat for 6 to 8 hours to decrease the likelihood of losing spinal fluid, causing a headache.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 302
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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