The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will

suspect worsening of the anxiety disorder.

contact the provider to discuss changing to another benzodiazepine.

understand that the patient has developed tolerance to this drug.

notify the provider and discuss increasing the dose of lorazepam.

Answer and Explanation

The Correct Answer is C

A) Suspect worsening of the anxiety disorder:
While it is possible that the patient's anxiety disorder is worsening, the more likely explanation for the reduced effectiveness of lorazepam is the development of drug tolerance. Over time, patients may require higher doses of a medication to achieve the same therapeutic effect, especially with medications like lorazepam that are used chronically.

B) Contact the provider to discuss changing to another benzodiazepine:
Changing to another benzodiazepine might be an option, but it is more likely that tolerance to lorazepam is the cause of the reduced effect, not an issue with the specific drug. Tolerance is common with long-term use of benzodiazepines, and switching drugs may not address the underlying issue. The first step would be to assess the current medication regimen and discuss possible adjustments with the provider.

C) Understand that the patient has developed tolerance to this drug:
Tolerance occurs when the body becomes accustomed to the effects of a medication over time, requiring higher doses to achieve the same therapeutic effect. This is a common phenomenon with benzodiazepines like lorazepam, which are often used for long periods to manage anxiety. As the patient has been taking lorazepam for six months, this reduced effectiveness is likely due to the development of tolerance, rather than a worsening of the anxiety disorder.

D) Notify the provider and discuss increasing the dose of lorazepam:
While increasing the dose of lorazepam could temporarily relieve symptoms, it is not the most appropriate first step. The nurse should first consider the possibility of tolerance and discuss this with the provider before increasing the dose. Long-term increases in benzodiazepine dosages can increase the risk of side effects, dependency, and withdrawal symptoms.

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Correct Answer is A

Explanation

A) Beta 1: Beta-1 adrenergic receptors are primarily located in the heart and are responsible for increasing heart rate (chronotropy), the force of contraction (inotropy), and the conduction speed of electrical impulses within the heart (dromotropy). When a drug is given to increase heart rate and myocardial activity, it is stimulating the beta-1 receptors, which enhance the heart's performance..

B) Beta 2: Beta-2 receptors are predominantly found in smooth muscles, such as those
in the bronchi, blood vessels, and uterus. Stimulation of beta-2 receptors leads to relaxation of these muscles, including bronchodilation and vasodilation, which would not have a direct effect on increasing heart rate or myocardial activity.

C) Alpha 2: Alpha-2 receptors are primarily located in the central nervous system (CNS) and act to inhibit the release of norepinephrine, leading to a reduction in sympathetic nervous system activity. They have the opposite effect of what is desired in this case, as stimulation of alpha-2 receptors would actually lower heart rate and decrease myocardial activity, not increase it.

D) Alpha 1: Alpha-1 receptors are found in the smooth muscle of blood vessels and when stimulated, cause vasoconstriction, which increases blood pressure. While alpha-1 receptors do affect the cardiovascular system, they do not directly influence heart rate or myocardial contractility.

A. Norepinephrine, dopamine, and serotonin B. Epinephrine, Norepinephrine, and Acetylcholine C. Acetylcholine, gamma-aminobutyric acid, and serotonin D. gamma-aminobutyric acid, dopamine, and epinephrine

Correct Answer is A

Explanation

A) Norepinephrine, dopamine, and serotonin:
Depression has been strongly linked to deficiencies in certain neurotransmitters in the brain, specifically norepinephrine, dopamine, and serotonin. These neurotransmitters play significant roles in regulating mood, emotions, and behavior. When their levels are low, individuals may experience symptoms of depression, such as sadness, low energy, anhedonia (inability to feel pleasure), and difficulty concentrating. Antidepressant medications often work by increasing the availability of these neurotransmitters in the brain.

B) Epinephrine, Norepinephrine, and Acetylcholine:
While norepinephrine plays a key role in depression, epinephrine and acetylcholine are not typically highlighted as the primary neurotransmitters involved in depression. Epinephrine (also known as adrenaline) is more associated with the body’s stress response and fight-or-flight reaction. Acetylcholine is involved in memory and learning processes, but it is not the primary neurotransmitter related to depression.

C) Acetylcholine, gamma-aminobutyric acid, and serotonin:
Acetylcholine and gamma-aminobutyric acid (GABA) are involved in many brain functions, but they are not the primary neurotransmitters linked to depression. While GABA may play a role in mood regulation, it is not typically associated with depression in the same way that serotonin, norepinephrine, and dopamine are. Serotonin is the exception in this answer

D) Gamma-aminobutyric acid, dopamine, and epinephrine:
Although dopamine is involved in depression, gamma-aminobutyric acid (GABA) and epinephrine are not the key neurotransmitters associated with the pathophysiology of depression. Epinephrine primarily affects the stress response, and while GABA does influence mood and anxiety, it is not the main neurotransmitter linked to depression itself.

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The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will

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Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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