Chapter 16: Drugs Used for Anxiety Disorders My Nursing Test Banks

Chapter 16: Drugs Used for Anxiety Disorders

Test Bank

MULTIPLE CHOICE

1. What is the recommended time over which antianxiety medications must be gradually tapered before discontinuation?

a.

1 week

b.

1 month

c.

6 months

d.

1 year

ANS: B

Withdrawal from medication should be done under a health care providers supervision. Withdrawal usually takes 4 weeks and requires a gradual reduction in dosage and greater intervals between medication administrations. One week is an inadequate interval for cessation of antianxiety medication therapy. Six months to 1 year is much longer than necessary for cessation of antianxiety medication therapy.

DIF: Cognitive Level: Knowledge REF: p. 246 OBJ: 5

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Psychosocial Integrity

2. Which is a benzodiazepine of choice when treating anxiety associated with alcohol withdrawal?

a.

Chlordiazepoxide (Librium)

b.

Oxazepam (Serax)

c.

Diazepam (Valium)

d.

Clorazepate (Tranxene)

ANS: B

Oxazepam and lorazepam are the drugs of choice in treating anxiety disorders because they have no active metabolites. Chlordiazepoxide and clorazepate are not the drugs of choice when treating anxiety associated with alcohol withdrawal. Diazepam has not been studied as fully as oxazepam in treating patients who have hepatic function impairment.

DIF: Cognitive Level: Knowledge REF: pp. 245-246 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

3. Which is the drug of choice to treat a patient with obsessive compulsive disorder (OCD)?

a.

Lorazepam (Ativan)

b.

Buspirone (BuSpar)

c.

Fluvoxamine (Luvox)

d.

Hydroxyzine (Vistaril)

ANS: C

Fluvoxamine inhibits the reuptake of serotonin at the nerve endings, thus prolonging serotonin activity. Fluvoxamine is used for the treatment of OCD when the obsessions or compulsions cause marked distress or interfere substantially with social or occupational responsibilities. Fluvoxamine does not prevent the obsessions or compulsions; the therapeutic outcome of this drug is to assist the patient in their management. Lorazepam, buspirone, and hydroxyzine do not treat the symptoms of OCD.

DIF: Cognitive Level: Comprehension REF: p. 243 OBJ: 1

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

4. The outcome statement for a patient suffering from anxiety disorder reads, After 1 week on alprazolam (Xanax) therapy, patient will exhibit a manageable level of anxiety. Which assessment finding validates that this outcome is met?

a.

Patient is unable to participate in group therapy conversations.

b.

Patient reports persistent fear about dying of a rare illness.

c.

Patient verifies that family reunions trigger anxiety and excessive drinking.

d.

Patient reports sleeping better and increased interest in activities.

ANS: D

The primary therapeutic outcome expected from benzodiazepine antianxiety agents is a decrease in the level of anxiety to a manageable level. Physical signs of anxiety have decreased, and coping is improved. Being unable to participate in group therapy, persistent fears, and choosing inappropriate coping mechanisms for noncatastrophic events indicate that the anxiety is not manageable.

DIF: Cognitive Level: Application REF: p. 244 | p. 246

OBJ: 4 TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

5. Which is true regarding psychological drug dependence?

a.

It is easier to treat than physiological dependence.

b.

It is not considered a true addiction.

c.

It is easily controlled by influencing the patients perceptions.

d.

It requires medical intervention to treat.

ANS: D

Medical intervention is required to treat psychological drug dependence. Psychological addictions are often more difficult to overcome than physiological addictions. Psychological drug dependence can be very difficult to treat.

DIF: Cognitive Level: Comprehension REF: p. 246 OBJ: 5

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Psychological Integrity

6. The nurse is preparing to educate a patient and significant other about antianxiety medications before the patients discharge. What is pertinent information to be included in the teaching plan?

a.

Discuss, review, and validate the behavior monitoring system and intervention flow sheet the patient and significant other will continue to use following discharge.

b.

Discuss the possible dependence associated with the medication at length to make sure the patient does not overuse the drug.

c.

Instruct the patient to educate family members about the medication therapy, based on recollection of discussions with the nurse.

d.

Provide all instructions verbally, with repetition as needed when requested by the patient.

ANS: A

It is the responsibility of the nurse to educate patients about their therapy, monitoring for therapeutic benefit and adverse effects to expect and report, and intervening whenever possible to optimize therapeutic outcomes. Making the patient fearful of the medication therapy defeats the purpose of using the drug to control anxiety. The topic should be mentioned because it is important, but it should not be emphasized. Family members or significant others should participate in discussions with the nurse whenever possible, and the patient should be given written instructions to refer to after discharge. Verbal instruction should be backed up with written documents for the patient to refer to after discharge.

DIF: Cognitive Level: Application REF: p. 244 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

7. What will the nurse caution a patient about when providing information about the prescribed azaspirone antidepressant?

a.

Risk for addiction

b.

Adverse effect of nausea

c.

Risk of injury when using machinery

d.

Additive effects of central nervous system (CNS) depression with alcohol

ANS: C

The most common adverse effects of azaspirone therapy include dizziness, nervousness, drowsiness, and lightheadedness. Azaspirones do not have a risk for abuse or addiction.

Nausea and vomiting are not common adverse effects of treatment with azaspirones. Azaspirones do not have CNS depression, but it is recommended that they not be combined with alcohol or sedatives.

DIF: Cognitive Level: Comprehension REF: p. 246 | p. 247

OBJ: 3 TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. Which patient is most likely to respond quickly to antianxiety therapy with benzodiazepines?

a.

Patient with a history of long-term anxiety

b.

Patient with recent anxiety reactions

c.

Patient with severe depression in addition to being anxious

d.

Patient with incidents of auditory hallucinations

ANS: B

Patients with anxiety reactions to recent events and those with a treatable medical illness that induces anxiety respond most readily to benzodiazepine therapy. Long term anxiety is best treated with medications other than benzodiazepines (e.g., prescription medications such as Zoloft, Paxil, Prozac, Effexor, and Wellbutrin). Severe depression does not improve with treatment of benzodiazepines. Patients who are having psychotic symptoms do not respond to benzodiazepines.

DIF: Cognitive Level: Comprehension REF: p. 245 OBJ: 4

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

9. What instruction is most important for the nurse to teach the patient who has recently been prescribed alprazolam (Xanax)?

a.

The medication needs to be taken on an empty stomach.

b.

You may feel dizzy or unsteady when rising to a standing position.

c.

Smoking will require a reduction in dosage of the medication.

d.

Over the counter medications are safe to take while on this medication.

ANS: B

Patients may experience a transient episode of hypotension on arising. This medication does not need to be taken on an empty stomach. Smoking enhances the metabolism of benzodiazepines; larger doses may be necessary to maintain effects. Over the counter medications are to be approved by the health care provider. Antihistamines, for example, increase toxic effects.

DIF: Cognitive Level: Application REF: p. 246 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. The nurse is developing a teaching plan for patients prescribed buspirone (BuSpar). Which information about this medication should be included?

a.

There is minimal potential for abuse.

b.

Signs of improvement can be seen within 3 days.

c.

Sedation is increased compared with other antianxiety medications.

d.

It stimulates the action of gamma-aminobutyric acid (GABA).

ANS: A

There is minimal potential for abuse with buspirone. It takes longer than 3 days to see signs of improvement. Buspirone has lower sedative properties and does not affect GABA receptors.

DIF: Cognitive Level: Application REF: p. 247 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

11. A newly admitted psychiatric patient repetitively states, I wish I were dead. I just want to kill myself. The priority nursing at this time is to:

a.

establish a trusting relationship.

b.

encourage a nonstimulating environment.

c.

provide for patient safety.

d.

identify signs of increased anxiety.

ANS: C

If the patient has suicidal ideas, intervention to provide patient safety is the priority nursing action. Although establishing a trusting relationship should occur, safety is the nursing priority. Once safety is established, support and reassurance may be provided. A nonstimulating environment should be encouraged once safety is established. Once patient safety is established signs of increased anxiety can be identified.

DIF: Cognitive Level: Application REF: p. 244 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

12. The nurse transcribes an order for lorazepam for a patient experiencing nausea and vomiting as a result of alcohol withdrawal. The most appropriate route of administration for lorazepam with this patient would be:

a.

by mouth.

b.

rectally.

c.

intramuscularly.

d.

subcutaneously.

ANS: C

The use of lorazepam is somewhat limited for use with symptoms of alcohol withdrawal for those who cannot tolerate oral administration because of nausea and vomiting. The most appropriate route in this situation would be intramuscularly.

DIF: Cognitive Level: Analysis REF: pp. 245-246 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

MULTIPLE RESPONSE

13. A female patient is admitted to the adult psychiatric floor with a diagnosis of generalized anxiety disorder. Anxiolytic medications and group therapy have been prescribed. Evaluation of therapeutic outcomes related to her acute stay can be measured by which assessment(s)? (Select all that apply.)

a.

She is able to sleep 5 hours during the night.

b.

The tremor and pacing she exhibited on admission are reduced.

c.

She is able to attend and actively participate in group sessions.

d.

She is eating only 10% of her meals.

e.

She complains of chest pain before group therapy.

ANS: A, B, C

A primary therapeutic outcome expected from antianxiety therapy agents is a decreased level of anxiety to a manageable level with the ability to get adequate rest and nourishment, a decrease or elimination of somatic complaints, and active and appropriate participation in group therapy. Improved appetite would be a sign of decreased anxiety. Chest pain may be an example of somatization, especially when experienced during emotionally stressful times, such as group therapy.

DIF: Cognitive Level: Application REF: p. 243 OBJ: 4

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Psychological Integrity

14. Which substance(s) may increase the toxic effects of benzodiazepines? (Select all that apply.)

a.

Alcohol

b.

Antihistamines

c.

Analgesics

d.

Sedatives

e.

Vitamins

f.

Hypnotics

ANS: A, B, C, D, F

Alcohol, antihistamines, analgesics, sedatives, and hypnotics may cause excessive sedation and impaired psychomotor function when taken concurrently with benzodiazepines. Vitamins do not cause excessive sedation and impaired psychomotor function when taken concurrently with benzodiazepines.

DIF: Cognitive Level: Comprehension REF: p. 246 OBJ: 4

TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Evaluation

15. In addition to the relief of mild to moderate anxiety, hydroxyzine (Vistaril) has which additional therapeutic outcome(s)? (Select all that apply.)

a.

Reduced need for sedation and analgesia before and after surgery

b.

Elimination of psychotic thinking

c.

Control of itching in allergic reactions

d.

Control of vomiting

e.

Control of obsessive compulsive thoughts

f.

Prevention of extrapyramidal adverse effects and tardive dyskinesia

ANS: A, C, D

Hydroxyzine has sedative, antihistamine, and antiemetic effects in addition to antianxiety activity. Hydroxyzine does not control psychotic thinking, obsessive compulsive thinking, or movement disorders caused by other medications.

DIF: Cognitive Level: Comprehension REF: p. 248 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. Which assessment(s) would be included in the evaluation of a patient with anxiety? (Select all that apply.)

a.

Physical examination

b.

Psychological evaluation

c.

History of precipitation stressors

d.

Medication history

e.

Substance abuse history

f.

Blood glucose level

ANS: A, B, C, D, E

Physical examination, psychological evaluation, history of precipitation stressors, medication history, and substance abuse history are important in evaluating a patient with anxiety to get a complete background on the patient. The blood glucose level is not included in evaluation of a patient with anxiety.

DIF: Cognitive Level: Comprehension REF: p. 243 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Psychological Integrity

17. The prenatal nurse is educating a woman regarding preconception care. The patient informs the nurse that she is currently taking a benzodiazepine drug for management of anxiety. Appropriate teaching for this patient will include that benzodiazepines: (Select all that apply.)

a.

readily cross into breast milk.

b.

are safe to take throughout pregnancy.

c.

enter fetal circulation.

d.

are not associated with ill effects on the infant following birth.

e.

may increase newborn muscle tone.

ANS: A, C

It is recommended that benzodiazepines not be administered during at least the first trimester of pregnancy. There may be an increased incidence of birth defects because these agents readily cross the placenta and enter fetal circulation. Mothers who are breast feeding should not receive benzodiazepines regularly. The benzodiazepines readily cross into breast milk and exert a pharmacologic effect on the infant. If benzodiazepines are taken regularly during pregnancy, the infant should be monitored closely after delivery for signs of withdrawal, including hypotonia.

DIF: Cognitive Level: Application REF: p. 246 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

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