Nokea
A nurse would cautiously administer sedatives and hypnotics to which of the following clients?
- A. Clients who are lactating
- B. Clients with heart trouble
- C. Clients with hypertension
- D. Clients with gastrointestinal upset
Correct Answer: A
Rationale: The nurse should exercise caution when administering sedatives and hypnotics to lactating clients. Sedatives and hypnotics are not contraindicated in clients with heart trouble, hypertension, or gastrointestinal problems, nor do they require cautious use.
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The nurse should withhold the hypnotic drug if assessment reveals which of the following?
- A. Respiratory rate is below 10 breaths/min.
- B. Blood glucose is above 200 mg/dL.
- C. The client appears lethargic.
- D. Blood pressure drops significantly.
- E. The client is having trouble sleeping.
Correct Answer: A,C,D
Rationale: The nurse should hold the hypnotic drug if the respiratory rate is below 10 breaths/min, the client appears lethargic, or the blood pressure drops significantly. Difficulty sleeping is the indication for administering the drug. Blood glucose is unrelated to the use of hypnotics.
In addition to obtaining the clients vital signs, which of the following questions should the nurse use to assess the clients status when the client is receiving temazepam for a sleep disturbance?
- A. Is the client uncomfortable?
- B. Is it too early for the client to receive the drug?
- C. Has a consent form been signed for the procedure?
- D. Does the client receive insulin to treat hyperglycemia?
- E. Are there disturbances in the environment that may keep the client awake?
Correct Answer: A,B,E
Rationale: In addition to obtaining the client's vital signs, the nurse should ask the following questions to assess the client's status when the client is receiving temazepam for a sleep disturbance: Is the client uncomfortable? Is it too early for the client to receive the drug? Are there disturbances in the environment that may keep the client awake? There is no need for a consent form to be signed. Asking about insulin use has no impact on the use of the drug.
Which nursing diagnosis would most likely be a priority for a client receiving a hypnotic who is experiencing confusion and excessive drowsiness in the morning?
- A. Ineffective Breathing Pattern
- B. Risk for Injury
- C. Ineffective Coping
- D. Impaired Self Health Management
Correct Answer: B
Rationale: Confusion and excessive morning drowsiness would impact the client's ability to function safely, thereby placing the client at risk for injury. Ineffective Breathing Pattern would be appropriate if the client experienced respiratory depression. Ineffective Coping would be appropriate if more than short-term use of the agent would be required. Impaired Self Health Management would be appropriate if the client was unable to comply with or adhere to the prescribed medication regimen.
A nurse is preparing to administer a sedative and hypnotic drug to a client. The nurse identifies the drug as a nonbenzodiazepine-type hypnotic and sedative drug. Which of the following might the nurse be preparing to administer?
- A. Temazepam
- B. Eszopiclone
- C. Zolpidem
- D. Triazolam
- E. Zaleplon
Correct Answer: B,C,E
Rationale: Eszopiclone, zolpidem, and zaleplon are examples of nonbenzodiazepine-type hypnotic and sedative drugs. Temazepam and triazolam are benzodiazepines.
A nurse emphasizes the need to avoid caffeine and caffeinated beverages with a client undergoing treatment for insomnia based on the nurse's understanding that caffeine will most likely have which effect?
- A. Wakefulness
- B. Depression
- C. Delirium
- D. Restlessness
Correct Answer: A
Rationale: Clients with insomnia should not drink beverages containing caffeine because it can cause wakefulness. Caffeine does not causeexplains why avoiding caffeine is important for clients with insomnia, as it can counteract the sedative effects of medications, leading to wakefulness.