A nurse is caring for a patient who has been taking lorazepa… | 마이메르시 MyMerci
마이메르시 — 문제와 상세 해설까지 전부 무료 무료로 시작하기
Pharmacology
문제

A nurse is caring for a patient who has been taking lorazepam (Ativan) 2 mg twice daily for anxiety for the past 6 months. The patient reports wanting to discontinue the medication. What is the most important nursing action?

해설
Benzodiazepines like lorazepam require gradual tapering under medical supervision to prevent dangerous withdrawal symptoms such as seizures. Other options risk abrupt withdrawal or inappropriate substitution.
같은 주제 다음 문제A nurse is caring for a client who has been prescribed lorazepam (Ativan) for anxiety. Whi…

심화 해설

Core Nursing Explanation This question tests the nurse's knowledge of safe medication management for a patient on long-term Benzodiazepine therapy. The core principle is understanding the significant risk of Benzodiazepine withdrawal syndrome and the nurse's role in ensuring patient safety through collaboration and education. Key Concept Analysis The patient has been taking lorazepam (Ativan), a benzodiazepine, for anxiety for six months. Long-term use leads to physiological dependence. Abrupt discontinuation can trigger a withdrawal syndrome ranging from rebound anxiety and insomnia to severe, life-threatening complications like Key Point! grand mal seizures and delirium. Therefore, the primary nursing concern is preventing this dangerous withdrawal. Answer Rationale Key Point! The correct action is to Collaborate with the healthcare provider to develop a gradual tapering schedule. This is the evidence-based, safe standard of care. The nurse's role is to advocate for the patient's safety by facilitating communication with the prescriber. The tapering schedule is individualized based on the dose, duration of use, and the patient's response, and must be medically supervised. Distractor Analysis Watch out for confusion! Option ① is dangerously incorrect. Advising immediate cessation ignores the fundamental pharmacology of benzodiazepines and puts the patient at direct risk for seizures. Option ② is inappropriate and unsafe. Over-the-counter (OTC) sleep aids (often containing antihistamines like diphenhydramine) do not prevent benzodiazepine withdrawal and can cause anticholinergic side effects or dangerous interactions. They do not address the underlying need for a structured taper. Option ③ might seem logical but is a Key Point! nursing action error. While the dose should be reduced, the nurse should not suggest a specific, self-directed tapering plan. The rate of taper must be determined by the healthcare provider (physician, nurse practitioner) based on clinical judgment. The nurse's action is to facilitate that professional collaboration. Related Concepts This scenario highlights the nursing responsibilities of Patient education on medication safety and Collaboration within the healthcare team. It also touches on the principles of managing substance dependence and withdrawal in a therapeutic context.
Concept Summary
ConceptExplanation
Benzodiazepine WithdrawalA potentially life-threatening condition from abrupt cessation after prolonged use. Symptoms: anxiety, insomnia, tremors, sweating, hallucinations, seizures.
Gradual TaperingThe safe method to discontinue benzodiazepines. Dose is slowly reduced over weeks to months to allow the CNS to adapt.
Nurse's RoleAssess for dependence/withdrawal signs, educate patient on risks of abrupt stop, collaborate with provider on taper plan, monitor during taper.
Lorazepam (Ativan)Intermediate-acting benzodiazepine. Used for anxiety, sedation, seizures. High risk for dependence with long-term use.

Side-by-Side Comparison!
ScenarioSafe Nursing ActionUnsafe / Incorrect Action
Patient wants to stop long-term benzodiazepineCollaborate with provider for a gradual taper schedule.Advise stopping immediately or suggest an OTC substitute.
Patient misses 1-2 doses of short-term (

임상 시나리오

Nursing Clinical Practice Guide Clinical Scenario You are a nurse on a medical-surgical unit. Mr. Jones, 58, is admitted for elective surgery. During medication reconciliation, he mentions he's been taking "a pill for his nerves" (identified as lorazepam 2mg BID) for about 8 months but ran out a week ago and didn't refill it. He is now visibly anxious, tremulous, and reports severe insomnia and "hearing things" at night. Nursing Intervention Strategy 1. Assessment: Perform a thorough assessment including vital signs, CIWA (Clinical Institute Withdrawal Assessment for Alcohol) scale (often adapted for benzodiazepine withdrawal), neurological checks, and history of seizure disorder. 2. Communication & Collaboration: Immediately notify the surgeon and/or hospitalist. Report your findings: "Patient with suspected benzodiazepine withdrawal, exhibiting anxiety, tremors, and perceptual disturbances." Collaborate to obtain an order for lorazepam or a suitable long-acting benzodiazepine (like diazepam) for a controlled taper. 3. Implementation & Monitoring: Administer the ordered taper medication. Monitor for reduction of withdrawal symptoms and for over-sedation. Ensure a safe environment (bed in low position, seizure precautions). Provide reassurance and non-pharmacological comfort measures. 4. Patient Education & Discharge Planning: Prior to discharge, educate the patient and family on the dangers of abrupt discontinuation. Ensure a clear, written tapering schedule is provided by the prescriber. Discuss the need for follow-up appointments. Patient Safety and Precautions * Key Point! Never advise a patient to stop a benzodiazepine cold turkey. * Be aware that withdrawal can be delayed with long-acting benzodiazepines but is more rapid and severe with short-acting ones like lorazepam. * Use caution with other CNS depressants (opioids, alcohol) during taper.
Nursing Procedure & Medication Flow When Administering a Tapering Dose: 1. Verify the provider's specific tapering order (e.g., "Lorazepam 1.5 mg twice daily for 3 days, then 1 mg twice daily for 5 days..."). 2. Double-check the dose against the taper schedule. Accuracy is critical. 3. Administer and document precisely. 4. Assess and document the patient's response (symptom control, sedation level) before the next dose. 5. Report any significant breakthrough withdrawal symptoms or excessive sedation to the provider for possible schedule adjustment.
A Word from Your Senior Nurse "Managing benzodiazepine therapy is a classic example of where your knowledge directly saves lives. That patient wanting to stop their Ativan isn't being difficult—they might be scared of dependency, which is a valid concern. Your job is to bridge that gap: validate their concern, educate them on the real, physical danger of stopping suddenly, and be the link to the provider who can create a safe exit plan. In clinical practice, you'll see this not just with benzodiazepines but with many CNS-acting drugs. Always think: 'What is the safe way off this medication?' That mindset makes you a true patient advocate and a safe practitioner."

핵심 개념

  • Benzodiazepine — A class of psychoactive drugs that enhance the effect of the neurotransmitter GABA, producing sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant effects. Examples include lorazepam, diazepam, alprazolam.
  • Withdrawal Syndrome — The set of symptoms that occur upon the abrupt discontinuation or dosage reduction of a substance the body has become dependent on. For benzodiazepines, this can include anxiety, insomnia, tremors, and seizures.
  • Gradual Tapering — The process of slowly reducing the dose of a medication over time to minimize withdrawal symptoms and allow the body to adjust. It is the standard of care for discontinuing many psychotropic and analgesic medications.
  • Lorazepam — An intermediate-acting benzodiazepine commonly used for the short-term management of anxiety disorders, insomnia, and as a pre-anesthetic sedative. It has a high potential for tolerance and dependence.
  • Collaboration — In nursing, the process of working with other healthcare professionals (e.g., physicians, pharmacists) to plan, implement, and evaluate patient care. It is essential for complex issues like medication tapering.
Practice Questions 3,332 문제 · 로그인 없이 바로 볼 수 있어요

마이메르시로 국가고시 완벽 대비

기출문제와 상세 해설을 무료로. 내 약점을 분석하고 진도를 관리하며 더 똑똑하게 공부하세요.

무료로 시작하기
App Store Google Play

학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요.