A patient reports difficulty falling asleep and staying asleep ...

[WWatsford]

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:
 
  a. suggest the patient try diphenhydramine first.
  b. perform a thorough history and physical examination.
  c. teach about avoiding caffeine and good sleep hygiene.
  d. suggest melatonin and consider prescribing Ambien if this is not effective.

Question 2

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: a. doxepin.
  b. fluoxetine.
  c. alprazolam.
  d. clonazepam.

[strudel15]

Answer to Question 1

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.

Answer to Question 2

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.

[WWatsford]

Thanks for the timely response, appreciate it

[Viet Thy]

Gracias!