Chapter 12: Central Nervous System Depressants and Muscle Relaxants

Multiple Choice

1. 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 (Valium) b. Zolpidem (Ambien) c. Phenobarbital d. Cyclobenzaprine (Flexeril)

ANS: A

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.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 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.

2. 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 thing” bothers him now. Which is the correct explanation for this problem?

ANS: D

Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A 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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of aspirin. d. He developed an allergy to the drug.

3. A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose the correct number of pills is in the bottle. The nurse suspects that which of these may have happened?

ANS: B

Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “Long-term use of this drug results in a sedative effect.” b. “If you take the drug every night, this hangover effect will be reduced.” c. “These drugs affect the sleep cycle, resulting in daytime sleepiness.” d. “These drugs increase the activity of the central nervous system, making you tired the next day.”

4. A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels “so tired.” Which explanation by the nurse is correct?

ANS: C

Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and, thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. Risk for injury related to decreased sensorium b. Risk for addiction related to psychologic dependency c. Decreased fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug’s interference with REM sleep

5. A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him?

ANS: A

Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. “Risk for addiction” is not a NANDA nursing diagnosis. The other nursing diagnoses are not appropriate for this situation.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Nursing Diagnosis

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 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

6. A patient is taking flurazepam (Dalmane) 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?

ANS: A

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.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 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. Administrating naloxone (Narcan) as an antagonist

7. 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?

ANS: C

There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Coronary artery disease b. Renal insufficiency c. Liver disease d. Anemia

8. Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient’s medical history, knowing that this medication is contraindicated in which disorder?

ANS: C

Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not contraindications.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. A musculoskeletal injury b. Insomnia c. Epilepsy d. Agitation

9. The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder?

ANS: A

Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Secobarbital (Seconal), a barbiturate b. Diazepam (Valium), a benzodiazepine c. Midazolam (Versed), a benzodiazepine d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid

10. 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?

ANS: D

Eszopiclone (Lunesta) 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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “I will not drink wine with the kava tea.” b. “If I notice my skin turning yellow, I will stop taking the tea.” c. “I will not take sleeping pills if I have this tea in the evening.” d. “I will be able to drive my car after drinking this tea.”

11. A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed?

ANS: D

Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

Multiple Response

1. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.)

a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus

ANS: B, D, E

Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin

2. 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? (Select all that apply.)

ANS: A, B, D, E

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. Coadministration 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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies