Review Practice Exercise 3

Drugs Used for Sedation and Sleep > Pharmacology

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Practice Exercise 3

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Total Questions : 4

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Question 1:

Zolpidem (Ambien) has been ordered for a client for the treatment of insomnia. What information will the nurse provide for this client? Select all that apply

A. Be cautious when performing morning activities because it may cause a significant “hangover” effect with drowsiness and dizziness. B. Take the drug with food; this enhances the absorption for quicker effects. C. Take the drug immediately before going to bed; it has a quick onset of action. D. If the insomnia is long-lasting, this drug may safely be used for up to one year. E. Alcohol and other drugs that cause CNS depression (e.g., antihistamines) should be avoided while taking this drug.

Answer and Explanation

Choice A:

Be cautious when performing morning activities because it may cause a significant “hangover” effect with drowsiness and dizziness.Zolpidem can cause next-day sedation, dizziness, and impaired coordination, which is why clients must use caution when driving or performing activities that require alertness the following morning. This residual effect is an adverse reaction and can increase the risk of falls and accidents.

Choice B:

Take the drug with food; this enhances the absorption for quicker effects.Food actually delays the absorption of zolpidem, leading to a slower onset of action. Clients should take the drug on an empty stomach to ensure rapid effectiveness in promoting sleep.

Choice C:

Take the drug immediately before going to bed; it has a quick onset of action.Zolpidem has a rapid onset (within 15–30 minutes) and a short half-life, making it effective for initiating sleep quickly. For maximum effectiveness and safety, clients should only take the medication when they are ready to sleep and can remain in bed for at least 7–8 hours

Choice D:

If the insomnia is long-lasting, this drug may safely be used for up to one year.Zolpidem is intended for short-term use only (typically 7–10 days) because of risks such as dependence, tolerance, and rebound insomnia. Long-term use is generally avoided unless under very specific medical supervision.

Choice E:

Alcohol and other drugs that cause CNS depression (e.g., antihistamines) should be avoided while taking this.Zolpidem exerts its effects by enhancing GABA-mediated CNS depression. Combining it with alcohol, opioids, benzodiazepines, or sedating antihistamines can result in additive respiratory depression, excessive sedation, confusion, or even coma.Rationales for incorrect answers:

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Question 2:

A nurse is providing instructions to a female client who has a new prescription for zolpidem (Ambien). Which of the following instructions should the nurse include?

A. Notify the provider if you plan to become pregnant. B. Take the medication 1 hr before you plan to go to sleep. C. Allow at least 6 hr for sleep when taking zolpidem. D. To increase the effectiveness of zolpidem, take it with a bedtime snack.

Answer and Explanation

Choice A:

Notify the provider if you plan to become pregnant:Zolpidem may cause fetal harm when administered during pregnancy. Clients planning pregnancy or who become pregnant must consult their provider to evaluate whether the drug should be discontinued or replaced with a safer alternative.Rationales for incorrect answers:

Choice B:

Take the medication 1 hr before you plan to go to sleep:Zolpidem has a rapid onset of action and should be taken immediately before bedtime, not 1 hour earlier. Taking it too soon may lead to unnecessary drowsiness before the client is ready for sleep.

Choice C:

Allow at least 6 hr for sleep when taking zolpidem:The correct recommendation is to allow at least 8 hr of sleep time after taking zolpidem. If the client awakens earlier, there may be residual drowsiness, dizziness, or impaired alertness.

Choice D:

To increase the effectiveness of zolpidem, take it with a bedtime snack:Food, especially a high-fat meal, delays the absorption of zolpidem and reduces its effectiveness in promoting sleep onset. It should be taken on an empty stomach for optimal effect.

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Question 3:

A patient is taking zolpidem (Ambien) for insomnia. The nurse prepares a care plan that includes monitoring of the patient for side effects/adverse reactions of this drug. Which is a side effect of zolpidem?

A. Insomnia B. Headache C. Laryngospasm D. Blood dyscrasias

Answer and Explanation

Choice A:

Insomnia:
Zolpidem is prescribed to treat insomnia, not cause it. While rebound insomnia can occur if the drug is discontinued abruptly after long-term use, insomnia itself is not considered a direct side effect during therapy.

Choice B:

Headache:Headache is a common side effect of zolpidem due to its central nervous system activity. Other mild side effects may include dizziness, nausea, or next-day drowsiness. Clients should be informed about these possible effects and encouraged to report persistent or severe headaches to their healthcare provider.Rationales for incorrect answers:

Choice C:

Laryngospasm:Laryngospasm is not associated with zolpidem use. This adverse effect is more commonly related to anesthetic agents rather than hypnotics like zolpidem.

Choice D:

Blood dyscrasias:
Zolpidem does not cause hematologic adverse effects such as anemia, leukopenia, or thrombocytopenia. Blood dyscrasias are more likely linked to other classes of drugs, such as certain antipsychotics or chemotherapy agents.

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Question 4:

A nurse is teaching a patient about zolpidem. Which is important for the nurse to include in the teaching of this drug?

A. The maximum dose is 20 mg/d. B. It may lead to psychological dependence. C. For older adults, the dose is 15 mg at bedtime. D. The drug should only be used for 21 days or less.

Answer and Explanation

Choice A:

The maximum dose is 20 mg/d.
The recommended maximum dose for zolpidem is typically 10 mg once daily at bedtime for adults, and often lower (5 mg) for older adults or those with hepatic impairment. A 20 mg/day dose would exceed safety limits and increase the risk of adverse effects such as next-day drowsiness, confusion, and impaired coordination.

Choice B:

It may lead to psychological dependence.Zolpidem, though structurally different from benzodiazepines, acts on the GABA-A receptor complex and can cause dependence when used beyond the recommended period or at higher-than-prescribed doses. Psychological dependence means the client may feel unable to sleep without the drug, which can create problematic reliance.Rationales for incorrect answers:

Choice C:

For older adults, the dose is 15 mg at bedtime.Older adults are more sensitive to zolpidem, so they are prescribed lower doses (commonly 5 mg at bedtime) to reduce the risk of excessive sedation, falls, and confusion. A 15 mg dose would be unsafe and contraindicated.

Choice D:

The drug should only be used for 21 days or less.
While zolpidem is recommended for short-term use, usually no longer than 7–10 days, the statement of “21 days or less” is misleading and not consistent with prescribing guidelines. Prolonged use increases the risk of dependence, rebound insomnia, and withdrawal symptoms.

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