Nokea
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.
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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.
The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs?
- A. Gout
- B. Pregnancy
- C. Epilepsy
- D. Severe chronic obstructive pulmonary disease
- E. Severe liver disease
- F. Diabetes mellitus
Correct Answer: B,D,E
Rationale: Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver or renal disease. The other disorders are not contraindications.
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.
Ramelteon is prescribed for a patient with insomnia. The nurse checks the patient's medical history, knowing that this medication is contraindicated in which disorder?
- A. Coronary artery disease
- B. Renal insufficiency
- C. Liver disease
- D. Anemia
Correct Answer: C
Rationale: Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not contraindications.
A patient is taking flurazepam three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient?
- A. Providing a quiet environment
- B. Exercising before bedtime to become tired
- C. Consuming heavy meals in the evening to promote sleepiness
- D. Drinking hot tea or coffee just before bedtime
Correct Answer: A
Rationale: Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime.