Nokea
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.
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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 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.
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 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.
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.