Nokea
A nurse suspects that a client is experiencing anxiety. Which physical assessment findings would support the nurse's suspicion? Select all that apply.
- A. Hypotension
- B. Decreased respiratory rate
- C. Increased muscle tension
- D. Pale skin
- E. Bradycardia
Correct Answer: C,D
Rationale: Physiological manifestations of anxiety can include hypertension, tachycardia, increased rate and depth of respirations, increased muscle tension, and cool, pale skin.
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An older adult client is experiencing anxiety. Which anxiolytic drug would the nurse identify as being relatively safe to administer to this client at a normal dose? Select all that apply.
- A. Buspirone
- B. Lorazepam
- C. Oxazepam
- D. Alprazolam
- E. Diazepam
Correct Answer: A,B,C
Rationale: Lorazepam, oxazepam, and buspirone are relatively safer for older adult clients when given at normal doses.
The nurse is assessing an infant at a well-child visit and notices that the infant has been losing weight and is lethargic. The mother is breastfeeding the child. The nurse questions the mother about any medications that she might be taking. Which of the following, if being taken by the mother, would alert the nurse to a problem? Select all that apply.
- A. Alprazolam
- B. Buspirone
- C. Hydroxyzine
- D. Chlordiazepoxide
- E. Lorazepam
Correct Answer: A,D,E
Rationale: Benzodiazepines like alprazolam, chlordiazepoxide, and lorazepam taken by a breastfeeding mother can result in lethargy and weight loss in the infant. Buspirone and hydroxyzine do not appear to have the same effect.
A client who is prescribed an anxiolytic tells the nurse that she is constipated. Which of the following would be most appropriate for the nurse to suggest? Select all that apply.
- A. Stop taking the drug.
- B. Increase fluid intake.
- C. Increase fiber intake.
- D. Ask to have the drug given by injection.
- E. Take the drug on an empty stomach.
Correct Answer: B,C
Rationale: Clients receiving an anxiolytic should be advised to increase fluid and fiber intake to address constipation. The drug should not be stopped or changed to an injectable form. Taking the drug on an empty stomach may lead to GI upset.
A client who was receiving a benzodiazepine for treatment of anxiety tells the nurse that he has decided to discontinue the treatment. Which of the following would the nurse include in the teaching plan for this client?
- A. Be sure to gradually decrease the dosage over time.
- B. It's fine to just stop taking the medication.
- C. You need to first increase the dose and then stop.
- D. It's important that you continue the medication even if you want to stop.
Correct Answer: A
Rationale: The nurse should suggest the client gradually decrease the dosage schedule to avoid withdrawal symptoms. It is not advisable for the nurse to suggest just stopping the medication, increasing the dosage, or continuing with the medication as prescribed.
A client admitted to the health care facility for alcohol withdrawal has been prescribed an antianxiety medication. The nurse instructs the client about the need for cessation of alcohol consumption based on the understanding that the client would be at increased risk for which of the following?
- A. Antianxiety drug toxicity
- B. Respiratory depression
- C. Sedation
- D. CNS depression
Correct Answer: D
Rationale: The nurse should suggest that the client stop consuming alcohol while therapy is going on because such consumption increases the risk for CNS depression. Increased risk for digitalis toxicity is identified when the client is taking digoxin for management of cardiac problems. Increased risk for sedation and respiratory depression is identified when tricyclic antidepressants or antipsychotics are being used simultaneously with an antianxiety agent.