Chapter 48: Antianxiety and Insomnia Agents

Chapter 48: Antianxiety and Insomnia Agents

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient comes to the clinic and reports having insomnia that began within the last year. The primary care nurse practitioner (NP) learns that the patient often lies awake worrying about problems at work. The patient feels fatigued during the day and experiences frequent stomach discomfort. The NP should prescribe:

ANS:  A

This patient is having insomnia because of anxiety. Alprazolam has a high abuse potential, so starting therapy with an antianxiety medication is a good choice. Melatonin and diphenhydramine are given for insomnia.

DIF:    Cognitive Level: Applying (Application)                           REF:   541

2. A patient tells the primary care NP about having difficulty giving presentations at work. The patient experiences anxiety and often feels faint or vomits. The NP should:

ANS:  D

The patient is describing a phobic disorder. Cognitive-behavioral therapy is recommended as first-line treatment, with SSRI medications as adjunct therapy.

DIF:    Cognitive Level: Applying (Application)                           REF:   540 – 541

3. An adolescent patient comes to the clinic and reports anxiety and poor sleep that have persisted since experiencing a hurricane 8 months prior. The patient has been receiving cognitive-behavioral therapy, which has helped a little. The primary care NP should order:

ANS:  B

This patient has posttraumatic stress disorder. If cognitive-behavioral therapy has not been effective, the patient should be given an SSRI as second-line treatment. Doxepin is a tricyclic antidepressant. The other two choices are benzodiazepines.

DIF:    Cognitive Level: Applying (Application)                           REF:   542

4. A patient reports difficulty falling asleep and staying asleep every night and has difficulty staying awake during the commute to work every day. The NP should:

ANS:  B

Before treating insomnia with drug therapy, it is important first to rule out any physiologic causes of a sleep disorder. The other interventions may be tried if no serious cause of the disorder is found.

DIF:    Cognitive Level: Applying (Application)                           REF:   541