Chapter 12: Central Nervous System Depressants and Muscle Relaxants Test Bank

Chapter 12: Central Nervous System Depressants and Muscle Relaxants
Test Bank
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) REF: p. 190

TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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?
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.
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) REF: p. 194

TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
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 the following may have happened?
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.
ANS: B
Alcohol has an additive effect when combined with barbiturates and causes central nervous
system depression. Multivitamins and aspirin do not interact with barbiturates, and this
situation does not illustrate an allergic reaction.

TOP: NURSING PROCESS: Assessment
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?
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 (CNS), making
you tired the next day.”
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.

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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?
a. Risk for falls related to decreased sensorium
b. Risk for addiction related to psychological dependency
c. Decreased fluid volume related to potential adverse effects
d. Disturbed sleep pattern related to the drug’s interference with REM sleep
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.

TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
6. A patient is taking flurazepam (Dalmane) 3 to 4 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
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.

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
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?
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
ANS: C
There are no antagonists/antidotes for barbiturates. Treatment supports respirations and
maintains the airway. The other interventions are not appropriate.

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?
a.Coronary artery disease
b.Renal insufficiency
c.Liver disease
d.Anemia
ANS: C
Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not
contraindications.

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?
a. A musculoskeletal injury
b. Insomnia
c. Epilepsy
d. Agitation
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.

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?
a. secobarbital (Seconal), a barbiturate
b. diazepam (Valium), a benzodiazepine
c. midazolam (Versed), a benzodiazepine
d. eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
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.

TOP: NURSING PROCESS: Planning
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?
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.”
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.

TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
12. A patient has been admitted to the emergency department for an overdose of oral
benzodiazepines. He is very drowsy but still responsive, with a respiration rate of 12 breaths
per minute. The nurse will prepare for which immediate intervention?
a. Hemodialysis to remove the medication
b. Administration of flumazenil (Romazicon)
c. Administration of naloxone (Narcan)
d. Intubation and mechanical ventilation
ANS: B
Flumazenil (Romazicon), a benzodiazepine antidote, can be used to acutely reverse the
sedative effects of benzodiazepines. Hemodialysis is not useful for benzodiazepine overdose,
and naloxone is used for opioid overdose, not benzodiazepine overdose. Intubation and
mechanical ventilation are not appropriate because the patient is still responsive and breathing
on his own.

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.

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.)
a. Antihistamines
b. Opioids
c. Diuretics
d. Anticoagulants
e. Oral contraceptives
f. Insulin
ANS: A, B, D, E
The coadministration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids,
and tranquilizers may result in additive CNS depression. Coadministration 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.

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

Chapter 12: Central Nervous System Depressants and Muscle Relaxants Test Bank

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Chapter 12: Central Nervous System Depressants and Muscle Relaxants

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 190

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 194

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 195

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 191

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 198

6. A patient is taking flurazepam (Dalmane) 3 to 4 nights a week for sleeplessness. She is

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 201

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 194

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 193

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 197

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 193

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 192

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 191

1. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 194

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 195

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