Holland/Adams/Brice, Core Concepts in Pharmacology 4th Edition Test BankChapter 9
Question 1
Type:MCSA
A client complains of restlessness, fatigue, nervousness, and sleep disturbances. The nurse knows these are symptoms of which clinical disorder?
- Obsessive compulsive disorder
- Generalized anxiety disorder
- Panic disorder
- Post-traumatic stress disorder
Correct Answer:2
Rationale 1: Obsessive compulsive disorder is incorrect because OCD describes recurrent, disturbing thoughts or repetitive behaviors that interfere with a person's normal activities or relationships.
Rationale 2: Generalized anxiety disorder symptoms include restlessness, fatigue, nervousness, and sleep disturbances.
Rationale 3: Panic disorder is incorrect because these are symptoms of a generalized anxiety disorder. Panic disorder is characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity.
Rationale 4: Post-traumatic stress disorder is incorrect because PTSD is a type of anxiety that develops in response to re-experiencing a previous traumatic life event, such as combat experience, physical or sexual abuse, a natural disaster, or a murder. The person might dream about the event or be constantly reminded of the event by common occurrences. This re-experiencing of the trauma leads to feelings of helplessness and anxiety that affect the person's ability to function normally.
Global Rationale: Generalized anxiety disorder symptoms include restlessness, fatigue, nervousness, and sleep disturbances. Obsessive compulsive disorder is incorrect because OCD describes recurrent, disturbing thoughts or repetitive behaviors that interfere with a person's normal activities or relationships. Panic disorder is incorrect because these are symptoms of a generalized anxiety disorder. Panic disorder is characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity. Post-traumatic stress disorder is incorrect because PTSD is a type of anxiety that develops in response to re-experiencing a previous traumatic life event, such as combat experience, physical or sexual abuse, a natural disaster, or a murder. The person might dream about the event or be constantly reminded of the event by common occurrences. This re-experiencing of the trauma leads to feelings of helplessness and anxiety that affect the person's ability to function normally.
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-1 Identify the major categories of anxiety disorders.
Question 2
Type:MCSA
A client has returned from combat, and is re-experiencing combat in dreams and feels helpless and anxious. What disorder does the nurse suspect this client is experiencing?
- Generalized anxiety disorder
- Obsessive compulsive disorder
- Post-traumatic stress disorder
- Panic disorder
Correct Answer:3
Rationale 1: Generalized anxiety disorder is incorrect because the symptoms include restlessness, fatigue, nervousness, and sleep disturbances.
Rationale 2: Obsessive compulsive disorder is incorrect because OCD describes recurrent, disturbing thoughts or repetitive behaviors that interfere with a person's normal activities or relationships.
Rationale 3: Post-traumatic stress disorder is a type of anxiety that develops in response to re-experiencing a previous traumatic life event, such as combat experience, physical or sexual abuse, a natural disaster, or a murder. The person might dream about the event or be constantly reminded of the event by everyday occurrences. This re-experiencing of the trauma leads to feelings of helplessness and anxiety that affect the person's ability to function normally.
Rationale 4: Panic disorder is incorrect because these are symptoms of post-traumatic stress disorder. Panic disorder is characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity.
Global Rationale: Post-traumatic stress disorder is a type of anxiety that develops in response to re-experiencing a previous traumatic life event, such as combat experience, physical or sexual abuse, a natural disaster, or a murder. The person might dream about the event or be constantly reminded of the event by everyday occurrences. This re-experiencing of the trauma leads to feelings of helplessness and anxiety that affect the person's ability to function normally. Generalized anxiety disorder is incorrect because the symptoms include restlessness, fatigue, nervousness, and sleep disturbances. Obsessive compulsive disorder is incorrect because OCD describes recurrent, disturbing thoughts or repetitive behaviors that interfere with a person's normal activities or relationships. Panic disorder is incorrect because these are symptoms of post-traumatic stress disorder. Panic disorder is characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity.
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-1 Identify the major categories of anxiety disorders.
Question 3
Type:MCSA
According to an evidence-based approach, what is the most productive way to treat anxiety disorders?
- Provide the client with a powerful medication.
- Allow the client to self-medicate with OTC medications.
- Immediately start multiple-drug therapy.
- Uncover and address the cause of anxiety.
Correct Answer:4
Rationale 1: Provide the client with a powerful medication is incorrect because uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications.
Rationale 2: Allow the client to self-medicate with OTC medications is incorrect because uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications.
Rationale 3: Immediately start multiple-drug therapy is incorrect because uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications.
Rationale 4: Uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications.
Global Rationale: Uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications. Provide the client with a powerful medication is incorrect because uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications. Allow the client to self-medicate with OTC medications is incorrect because uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications. Immediately start multiple-drug therapy is incorrect because uncovering and addressing the cause of the anxiety is more productive than merely treating the symptoms with medications.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-2 Discuss factors contributing to anxiety and explain some nonpharmacologic therapies used to cope with this disorder.
Question 4
Type:MCMA
Which instructions should the nurse provide to the client who is prescribed a benzodiazepine?
(Select all that apply.)
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
- Report significant mood changes.
- Avoid OTC medications used to induce sleep.
- Avoid alcoholic beverages.
- If a dose is missed, the client should take a double dose as soon as possible.
- Avoid caffeine.
Correct Answer:1, 2, 3
Rationale 1: A client taking a benzodiazepine should report significant mood changes.
Rationale 2: A client taking a benzodiazepine should avoid OTC medications used to induce sleep.
Rationale 3: A client taking a benzodiazepine should avoid alcoholic beverages.
Rationale 4: The client should never double the dose of a benzodiazepine.
Rationale 5: The client taking a benzodiazepine does not need to avoid caffeine.
Global Rationale: A client taking a benzodiazepine should report significant mood changes. A client taking a benzodiazepine should avoid OTC medications used to induce sleep. A client taking a benzodiazepine should avoid alcoholic beverages. The client should never double the dose of a benzodiazepine. The client taking a benzodiazepine does not need to avoid caffeine.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 5
Type:MCSA
The risk for physical and psychological dependence is high from which class of medications, which is rarely used to treat insomnia or anxiety?
- SSRIs
- MAOIs
- Benzodiazepines
- Barbiturates
Correct Answer:4
Rationale 1: These medications do not have a high risk for physical and psychological dependence.
Rationale 2: MAOIs do not have a high risk for physical and psychological dependence.
Rationale 3: Benzodiazepines do not have a high risk for physical and psychological dependence.
Rationale 4: Barbiturates have a high risk for physical and psychological dependence.
Global Rationale: Barbiturates have a high risk for physical and psychological dependence. SSRIs, MAOIs, and benzodiazepines do not have a high risk for physical and psychological dependence.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 6
Type:MCSA
A benzodiazepine has been prescribed for a client with short-term insomnia. Which benzodiazepine is appropriate to treat insomnia?
- Diazepam (Valium)
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin)
- Temazepam (Restoril)
Correct Answer:4
Rationale 1: Diazepam (Valium) is incorrect because it is used for alcohol withdrawal and seizures.
Rationale 2: Chlordiazepoxide (Librium) is incorrect because it is used for anxiety.
Rationale 3: Clonazepam (Klonopin) is incorrect because it is used for panic disorders.
Rationale 4: Temazepam (Restoril) is used to treat insomnia.
Global Rationale: Temazepam (Restoril) is used to treat insomnia. Diazepam (Valium) is incorrect because it is used for alcohol withdrawal and seizures. Chlordiazepoxide (Librium) is incorrect because it is used for anxiety. Clonazepam (Klonopin) is incorrect because it is used for panic disorders.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 7
Type:MCMA
A client is being treated for an anxiety disorder. Which types of medications are used to treat anxiety disorders?
(Select all that apply.)
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
- Barbiturates
- Beta blockers
- Benzodiazepines
- Alpha blockers
- SSRIs
Correct Answer:1, 2, 3, 5
Rationale 1: Barbiturates are used to treat anxiety.
Rationale 2: Beta blockers are used to treat anxiety.
Rationale 3: Benzodiazepines are used to treat anxiety.
Rationale 4: Alpha blockers are not used to treat anxiety. They are used to treat hypertension.
Rationale 5: SSRIs are used to treat anxiety.
Global Rationale: Barbiturates, beta blockers, benzodiazepines, and SSRIs are used to treat anxiety. Alpha blockers are not used to treat anxiety. They are used to treat hypertension.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 8
Type:MCSA
The client asks the nurse why a tricyclic antidepressant has not been prescribed for depression. What is the best response by the nurse?
- "Tricyclic antidepressants have many side effects, including orthostatic hypotension, headache, and diarrhea."
- "Tricyclic antidepressants cause sexual dysfunction."
- "Tricyclic antidepressants are not recommended for a client with a history of heart attack."
- "Tricyclic antidepressants cause weight gain."
Correct Answer:3
Rationale 1: "Tricyclic antidepressants have many side effects including orthostatic hypotension, headache, and diarrhea" is incorrect because this is a side effect of MAOIs.
Rationale 2: "Tricyclic antidepressants cause sexual dysfunction" is incorrect because this is a side effect of SSRIs.
Rationale 3: Tricyclic antidepressants are not recommended for a client with a history of heart attack.
Rationale 4: Tricyclic antidepressants are not recommended for a client with a history of heart attack.
Global Rationale: Tricyclic antidepressants are not recommended for a client with a history of heart attack. "Tricyclic antidepressants have many side effects including orthostatic hypotension, headache and diarrhea" is incorrect because this is a side effect of MAOIs. "Tricyclic antidepressants cause sexual dysfunction" is incorrect because this is a side effect of SSRIs. Tricyclic antidepressants are not recommended for a client with a history of heart attack.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 9
Type:MCSA
The physician ordered an MAOI for a client with depression. The nurse expects which medication to be ordered?
- Citalopram (Celexa)
- Fluoxetine (Prozac)
- Tranylcypromine (Parnate)
- Amitriptyline (Elavil)
Correct Answer:3
Rationale 1: Citalopram (Celexa) is incorrect because this medication is an SSRI.
Rationale 2: Fluoxetine (Prozac) is incorrect because it is an SSRI.
Rationale 3: Tranylcypromine (Parnate) is an MAOI.
Rationale 4: Amitriptyline (Elavil) is incorrect because this medication is a tricyclic antidepressant.
Global Rationale: Tranylcypromine (Parnate) is an MAOI. Citalopram (Celexa) is incorrect because this medication is an SSRI. Fluoxetine (Prozac) is incorrect because it is an SSRI. Amitriptyline (Elavil) is incorrect because this medication is a tricyclic antidepressant.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 10
Type:MCSA
A client taking an MAOI should be instructed to avoid which item?
- Foods that contain tyramine and caffeine
- A diet that is high in fat
- Large amounts of water
- A diet that is high in salt
Correct Answer:1
Rationale 1: Foods that contain tyramine and caffeine should be avoided by a client taking an MAOI.
Rationale 2: A diet that is high in fat is incorrect. The client needs to avoid foods that contain tyramine and caffeine.
Rationale 3: Large amounts of water is incorrect. The client needs to avoid foods that contain tyramine and caffeine.
Rationale 4: A diet that is high in salt is incorrect. The client needs to avoid foods that contain tyramine and caffeine.
Global Rationale: Foods that contain tyramine and caffeine should be avoided by a client taking an MAOI. A diet that is high in fat is incorrect. The client needs to avoid foods that contain tyramine and caffeine. Large amounts of water is incorrect. The client needs to avoid foods that contain tyramine and caffeine. A diet that is high in salt is incorrect. The client needs to avoid foods that contain tyramine and caffeine.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 11
Type:MCSA
A female client has been prescribed a tricyclic antidepressant. The nurse will educate this client that most of these medications belong to which pregnancy categories?
- B and C
- C and D
- A and D
- A and B
Correct Answer:2
Rationale 1: Most tricyclic antidepressants are pregnancy categories C and D.
Rationale 2: Most tricyclic antidepressants are pregnancy categories C and D.
Rationale 3: Most tricyclic antidepressants are pregnancy categories C and D.
Rationale 4: Most tricyclic antidepressants are pregnancy categories C and D.
Global Rationale: Most tricyclic antidepressants are pregnancy categories C and D. The other options are incorrect.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Identify the four categories of CNS drugs used to treat anxiety and sleep disorders.
Question 12
Type:MCSA
A client has been taking an SNRI, and complains of confusion, anxiety, tremors, and sweating. What does the nurse understand about these symptoms?
- Will diminish with continued use of the medication
- Indicate too high a dose has been given
- Indicate too low a dose has been given
- Are normal with SNRIs
Correct Answer:2
Rationale 1: These symptoms indicate the client has received too high a dose of the medication.
Rationale 2: These symptoms indicate the client has received too high a dose of the medication.
Rationale 3: These symptoms indicate the client has received too high a dose of the medication.
Rationale 4: These symptoms indicate the client has received too high a dose of the medication.
Global Rationale: These symptoms indicate the client has received too high a dose of the medication. These symptoms will not diminish with continued use of the medication, they don’t indicate that the dose is too low, and they are not normal with SNRIs.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-4 Explain the pharmacologic management of anxiety and insomnia.
Question 13
Type:MCSA
A teenage client is taking duloxetine (Cymbalta) for a generalized anxiety disorder. The dose has been changed by the physician. What adverse effects will the nurse advise the client and family to watch?
- Warning signs of suicide
- Irritability
- Weight gain
- Fatigue
Correct Answer:1
Rationale 1: The FDA issued a black box warning for Cymbalta. When the dose is changed, teenagers need to be monitored for warning signs of suicide.
Rationale 2: The FDA issued a black box warning for Cymbalta. When the dose is changed, teenagers need to be monitored for warning signs of suicide.
Rationale 3: The FDA issued a black box warning for Cymbalta. When the dose is changed, teenagers need to be monitored for warning signs of suicide.
Rationale 4: The FDA issued a black box warning for Cymbalta. When the dose is changed, teenagers need to be monitored for warning signs of suicide.