The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will

suspect worsening of the anxiety disorder.

contact the provider to discuss changing to another benzodiazepine.

understand that the patient has developed tolerance to this drug.

notify the provider and discuss increasing the dose of lorazepam.

Answer and Explanation

The Correct Answer is C

A) Suspect worsening of the anxiety disorder:
While it is possible that the patient's anxiety disorder is worsening, the more likely explanation for the reduced effectiveness of lorazepam is the development of drug tolerance. Over time, patients may require higher doses of a medication to achieve the same therapeutic effect, especially with medications like lorazepam that are used chronically.

B) Contact the provider to discuss changing to another benzodiazepine:
Changing to another benzodiazepine might be an option, but it is more likely that tolerance to lorazepam is the cause of the reduced effect, not an issue with the specific drug. Tolerance is common with long-term use of benzodiazepines, and switching drugs may not address the underlying issue. The first step would be to assess the current medication regimen and discuss possible adjustments with the provider.

C) Understand that the patient has developed tolerance to this drug:
Tolerance occurs when the body becomes accustomed to the effects of a medication over time, requiring higher doses to achieve the same therapeutic effect. This is a common phenomenon with benzodiazepines like lorazepam, which are often used for long periods to manage anxiety. As the patient has been taking lorazepam for six months, this reduced effectiveness is likely due to the development of tolerance, rather than a worsening of the anxiety disorder.

D) Notify the provider and discuss increasing the dose of lorazepam:
While increasing the dose of lorazepam could temporarily relieve symptoms, it is not the most appropriate first step. The nurse should first consider the possibility of tolerance and discuss this with the provider before increasing the dose. Long-term increases in benzodiazepine dosages can increase the risk of side effects, dependency, and withdrawal symptoms.

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Correct Answer is C

Explanation

A) Excessive salivation: Neostigmine (Prostigmin) is a cholinesterase inhibitor, which works by increasing the levels of acetylcholine at neuromuscular junctions. If a dose is missed, excessive salivation can be a side effect of too much acetylcholine activity, but it is not the most immediate symptom in this case. Muscle weakness is a more direct consequence of a missed dose.

B) Respiratory paralysis: While respiratory weakness or paralysis can occur in myasthenia gravis, it is usually associated with a severe form of the disease or if the patient is in a myasthenic crisis. A single missed dose of neostigmine typically does not result in respiratory failure unless the patient is already in a very fragile state.

C) Muscle weakness: Neostigmine helps to improve neuromuscular transmission by inhibiting the breakdown of acetylcholine, which is crucial for muscle contraction. A missed dose would directly lead to a reduction in acetylcholine levels, exacerbating the characteristic muscle weakness of myasthenia gravis. Muscle weakness is the most anticipated symptom when neostigmine is not administered on time.

D) Muscle spasms: Muscle spasms are typically not a symptom of missed neostigmine therapy. Instead, muscle weakness occurs due to impaired neuromuscular transmission. Spasms might occur if there is significant overstimulation of the muscles, but this is more associated with electrolyte imbalances or other neuromuscular issues

A. Decreased bowel sound B. Increased blood glucose level C. Decreased immune reaction D. Increased blood pressure

Correct Answer is A

Explanation

A) Decreased bowel sounds:
When the sympathetic nervous system (SNS) is activated, such as during stress or a "fight-or-flight" response, blood is redirected away from the gastrointestinal (GI) tract to vital organs like the heart and muscles. This results in decreased gastrointestinal motility and function, which is reflected in a reduction in bowel sounds. Decreased bowel sounds are a direct consequence of reduced blood flow and decreased activity in the GI system.

B) Increased blood glucose level:
While it is true that SNS activation can lead to an increase in blood glucose due to the release of catecholamines (e.g., epinephrine), this response is related to the body’s preparation for physical exertion and not directly a result of blood being diverted from the GI tract. The increase in glucose levels is more about energy mobilization rather than an effect on blood flow to the GI tract.

C) Decreased immune reaction:
Sympathetic stimulation can indeed have effects on immune function, typically suppressing immune responses during a stress response. However, this is not directly linked to blood being diverted away from the GI tract. Immune suppression is more about the body prioritizing immediate survival (e.g., diverting energy to muscles for fight-or-flight) rather than a specific physiological consequence of GI blood flow changes.

D) Increased blood pressure:
Sympathetic nervous system activation does lead to an increase in blood pressure due to vasoconstriction and increased heart rate. However, increased blood pressure is a broader systemic response to SNS stimulation, and it is not directly related to blood being diverted from the GI tract. Blood pressure increases as part of the general "fight-or-flight" response, but it does not specifically indicate changes in GI blood flow.

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The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will

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Naxlex Comprehensive Predictor Exams

The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms?

Correct Answer is C

Explanation

When there is stimulation of the sympathetic nervous system (SNS), blood is diverted away from the gastrointestinal (GI) tract. What might the nurse assess that would indicate this diversion of blood flow to the GI tract?

Correct Answer is A

Explanation

An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient?

Identify one indicator for a narcotic antagonist to be prescribed?

The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimer disease (AD). Which statement by the family member indicates understanding of the teaching?

Which patient may require a higher-than-expected dose of an opioid analgesic?

A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The nurse will give the patient which instruction?

Which of the following catecholamines may have a vasodilator effect on renal blood vessels and be prescribed for a client in shock who are experiencing renal insufficiency manifestations?

The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with parkinsonism. The nurse would notify the patient’s provider if the patient had a history of which condition?

A patient reports weakness of the extremities and diplopia. The nurse knows that these symptoms are characteristic of which condition?