Review Practice Exercise 2

Drugs Used for Sedation and Sleep > Pharmacology

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Practice Exercise 2

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Total Questions : 4

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Question 1:

A nurse in a provider’s office is providing instructions to a client who has a new prescription for lorazepam (Ativan). The nurse should inform the client that which of the following are adverse effects of lorazepam? Select all that apply

A. Incoordination B. Euphoria C. Pruritus D. Flatus E. Amnesia

Answer and Explanation

Choice A:

Incoordination:Lorazepam causes CNS depression, which can impair motor control, balance, and coordination. This increases the risk of falls and accidents, especially in older adults.

Choice B:

Euphoria:Some clients experience a sense of euphoria, which contributes to lorazepam’s potential for misuse and dependence. This reinforces the need for close monitoring and short-term prescribing.

Choice C:

Pruritus:Itching is not a common or expected adverse effect of lorazepam. While possible with some medications, it is not typically associated with benzodiazepines.

Choice D:

Flatus:Increased intestinal gas is unrelated to lorazepam’s pharmacologic action and is not considered an adverse effect of this medication.

Choice E:

Amnesia:Lorazepam can cause anterograde amnesia, where new memories are impaired after the drug is taken. This effect is especially noted when the drug is used for sedation or preoperative purposes.Rationales for incorrect answers:

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Question 2:

A nurse is caring for a client who is receiving moderate sedation with diazepam (Valium) IV. The client is over-sedated. Which of the following medications should the nurse anticipate administering to this client?

A. Ketamine (Ketalar) B. Naltrexone (ReVia) C. Flumazenil (Romazicon) D. Fluvoxamine (Luvox)

Answer and Explanation

Choice A:

Ketamine (Ketalar):
This is a dissociative anesthetic, not an antidote. Administering ketamine would worsen sedation rather than reverse it.

Choice B:

Naltrexone (ReVia):Naltrexone is an opioid antagonist used to treat opioid and alcohol dependence. It does not affect benzodiazepine receptors and would have no benefit in reversing diazepam sedation.

Choice C:

Flumazenil (Romazicon):Flumazenil works by competitively binding to benzodiazepine receptor sites, thereby reversing their sedative, hypnotic, and respiratory-depressant effects. It acts quickly, usually within minutes, and is administered intravenously. The nurse should anticipate giving this medication when a client receiving diazepam becomes overly sedated. Because flumazenil has a shorter half-life than many benzodiazepines, clients require close monitoring for resedation and recurrence of symptoms after initial reversal.Rationales for incorrect answers:

Choice D:

Fluvoxamine (Luvox):
This is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and obsessive-compulsive disorder. It has no role in reversing benzodiazepine overdose.

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Question 3:

A patient taking lorazepam (Ativan) asks the nurse how this drug works. The nurse should respond by stating that it is a benzodiazepine that acts by which mechanism?

A. Depressing the central nervous system (CNS), leading to a loss of consciousness B. Depressing the CNS, including the motor and sensory activities C. Increasing the action of the inhibitory neurotransmitter gamma-aminobutyric acid(GABA) to GABA receptors D. Creating an epidural block by placement of the local anesthetic in the outer covering of the spinal cord

Answer and Explanation

Choice A:

Depressing the central nervous system (CNS), leading to a loss of consciousness:
This describes the effect of general anesthetics, not lorazepam. While lorazepam causes sedation, it does not routinely induce complete loss of consciousness at therapeutic doses.

Choice B:

Depressing the CNS, including the motor and sensory activities:This explanation aligns more with barbiturates or high-dose anesthetics that cause widespread CNS suppression. Lorazepam acts selectively by potentiating GABA, not by indiscriminate CNS depression.

Choice C:

Increasing the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to GABA receptors:Lorazepam and other benzodiazepines do not directly stimulate GABA receptors but potentiate GABA’s natural inhibitory effect. By increasing the frequency of chloride channel opening at the receptor site, these drugs enhance neuronal hyperpolarization, leading to reduced excitability of the CNS. This mechanism provides therapeutic benefits in anxiety, seizure control, muscle relaxation, and sedation.Rationales for incorrect answers:

Choice D:

Creating an epidural block by placement of the local anesthetic in the outer covering of the spinal cord:
This is the mechanism of local anesthetics used in regional anesthesia, not benzodiazepines. Lorazepam has no role in creating nerve blocks or spinal anesthesia.

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Question 4:

A patient is taking triazolam (Halcion). Which instructions about this drug are important for the nurse to include?

A. It may be used as a barbiturate for only 4 weeks. B. Use as a nonbenzodiazepine to reduce anxiety. C. This drug does not lead to vivid dreams or nightmares. D. Avoid alcohol and smoking while taking this drug.

Answer and Explanation

Choice A:

It may be used as a barbiturate for only 4 weeks.
Triazolam is a benzodiazepine, not a barbiturate. Additionally, treatment duration is usually limited to 7–10 days, not 4 weeks, due to risks of dependence and rebound insomnia.

Choice B:

Use as a nonbenzodiazepine to reduce anxiety.Triazolam is classified as a benzodiazepine, not a nonbenzodiazepine. While it has anxiolytic effects, its main therapeutic role is in treating insomnia, not general anxiety management.

Choice C:

This drug does not lead to vivid dreams or nightmares.
Triazolam can actually cause vivid dreams, nightmares, or abnormal sleep behaviors (such as sleepwalking or sleep-driving) in some clients, particularly with prolonged use or higher doses.

Choice D:

Avoid alcohol and smoking while taking this drug.Alcohol has a synergistic depressant effect when combined with triazolam, greatly increasing the risk of respiratory depression, excessive sedation, and impaired coordination. Smoking induces hepatic enzymes that can increase drug metabolism, lowering its effectiveness. Teaching the client to avoid both alcohol and smoking ensures optimal therapeutic effect and safety.Rationales for incorrect answers:

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Practice Exercise 2

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