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A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that -the least little thingll bothers him now. Which is the correct explanation for this problem?
- A. These are adverse effects that usually subside after a few weeks.
- B. The drug must be stopped immediately because of possible adverse effects.
- C. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness.
- D. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
Correct Answer: D
Rationale: Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation. Rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect.
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A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation?
- A. Diazepam
- B. Zolpidem
- C. Phenobarbital
- D. Cyclobenzaprine
Correct Answer: A
Rationale: Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety.
A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention?
- A. Starting an intravenous infusion of diluted bicarbonate solution
- B. Administering medications to increase blood pressure
- C. Implementing measures to maintain the airway and support respirations
- D. Administering naloxone (Narcan) as an antagonist
Correct Answer: C
Rationale: There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate.
The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine. Based on this finding, the nurse interprets that the patient has which disorder?
- A. A musculoskeletal injury
- B. Insomnia
- C. Epilepsy
- D. Agitation
Correct Answer: A
Rationale: Cyclobenzaprine is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.
The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that interactions may occur with which drugs?
- A. Antihistamines
- B. Opioids
- C. Diuretics
- D. Anticoagulants
- E. Oral contraceptives
- F. Insulin
Correct Answer: A,B,D,E
Rationale: The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin.
A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia?
- A. Secobarbital, a barbiturate
- B. Diazepam, a benzodiazepine
- C. Midazolam, a benzodiazepine
- D. Eszopiclone, a nonbenzodiazepine sleep aid
Correct Answer: D
Rationale: Eszopiclone is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia: midazolam is used for procedural (moderate) sedation.