A patient with a history of depression and suicidal ideation is ...

[lak]

A patient with a history of depression and suicidal ideation is taking fluoxetine (Prozac). The patient reports difficulty maintaining sleep and is prescribed secobarbital (Seconal) as a sedative-hypnotic.
 
  The nurse preparing this patient for discharge from the hospital will:
  a. contact the provider to suggest an order for ramelteon (Rozerem).
  b. instruct the patient to use alcohol in moderation.
  c. request an order to change to trazodone (Desyrel) for sleep.
  d. suggest that the patient try alternative remedies for sleep.

Question 2

A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be:
 
  a. alternative medications.
  b. improved sleep hygiene.
  c. short-term barbiturates.
  d. triazolam (Halcion).

[amandanbreshears]

Answer to Question 1

ANS: C
Trazodone is an atypical antidepressant with sedative actions and can be used to prolong sleep duration. It is useful for treating insomnia related to antidepressants such as Prozac. Ramelteon is not a drug of choice to treat patients who have difficulty maintaining sleep. Patients who are depressed or at increased risk for suicide should not take barbiturates, because overdose can readily cause death. Alcohol is contraindicated when taking barbiturates. Alternative remedies have not shown effectiveness in treating insomnia.

Answer to Question 2

ANS: B
Research has shown that cognitive behavioral therapy is superior to drug therapy for both short-term and long-term management of chronic insomnia in older adults. Alternative remedies have not been proven effective. Barbiturates may elicit paradoxical effects in elderly patients. Triazolam does not help to maintain sleep.

[lak]

Thanks

[amandanbreshears]

Welcome