Problem:

Question 1: What is true of hypnotics?

a. Mechanisms of action include suppression of the reticular activating system that controls wakefulness in our brains.
b. Nursing implications include warning against an adverse effect of zolpidem in which some patients sleep-walk and perform activities that are not remembered the next morning.
c. The effect of benzodiazepines in the motor cortex helps to relax muscles, thus helping with sleep.
d. All the above.

Question 2: The phrase "start low, go slow" can apply to ________, because ____________.

a. titration of pain medications for the elderly : the diminished function of liver and kidneys increase risk of drug toxicity.
b. instructions for patients weaning off of chronic opioid use : if they try to stop cold turkey it will be immediately life-threatening.
c. narcotic abuse definition : it shows that even if you slowly begin opioid use, it can cause your life to become "low" because of high risk of addiction.
d. use of adjuvant medications : they should only be used by themselves and not with any other analgesic.

Question 3: A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The patient's nurse will expect
a. lab results showing a high serum creatinine level, indicating renal failure.
b. joint pain and hyperuricemia, indicating rapid onset of gout.
c. agitation and anxiety, since this drug blocks reuptake of adrenergic neurotransmitters from neural synapses.
d. lab results showing high liver enzyme levels, indicating hepatic failure.

Question 4: The patient in the previous question will likely receive as an antidote
a. naloxone (Narcan) since it blocks the acetaminophen molecules from attaching to opioid receptor sites.
b. acetylcysteine (Mucomyst) since it increases glutathione, a substance which enhances the ability of the liver cells to metabolize acetaminophen molecules.
c. flumazenil (Romazicon) since it increases GABA, a substance which is important in CYP450 enzymatic function.
d. midalozam (Versed), a benzodiazepine which will decrease the patient's agitation and allow the liver to clear the acetaminophen molecules more quickly.

Question 5: An RN is speaking to an addiction-cessation group about ways to decrease or stop their addictive substance. Which instructions by the nurse are correct?

a. The best way to use a nicotine patch is a step-wise progression of increasing dosage.
b. Chewing nicotine gum will rapidly, temporarily relieve a craving for a tobacco product.
c. Disulfiram (Antabuse) creates acetaldehyde syndrome and is the best first-line drug for treating DT's (delirium tremens) in an alcoholic.
d. The opioid agonist naltrexone (Revia) is a good treatment for alcohol craving.

Provide the correct answer and justification for your choice.