Exam 1: Ch 21

You might question an order for a monoamine oxidase inhibitor (MAOI) as a first step in the tx of depression, remembering that these drugs are reserved for use in cases in which there has been no response to other agents because a. MAOIs can cause hair loss b. MAOIs are associated with potentially serious drug-food interactions c. MAOIs are mostly recommended for use in surgical pts d. MAOIs are more expensive than other agents

b. MAOIs are associated with potentially serious drug-food interactions

The drug of choice for a pt with a documented obsessive-compulsive disorder who is also suffering from depression and occasional panic disorder would be a. Celexa b. Paxil c. Luvox d. Prozac

b. Paxil

Depression is an affective disorder that is a. always precipitated by a specific event b. most common in pts with head injuries c. characterized by overwhelming sadness, despair, and hopelessness d. very evident and easy to diagnose in the clinical setting

c. characterized by overwhelming sadness, despair, and hopelessness

The biogenic amine theory of depression states that depression is a result of a. an unpleasant childhood b. GABA inhibition c. deficiency of norepinephrine, dopamine, or 5HT in key areas of the brain d. blockages within the limbic system, which controls emotions and affect

c. deficiency of norepinephrine, dopamine, or 5HT in key areas of the brain

When teaching a pt receiving tricyclic anidepressants (TCAs), it is important to remember that TCAs are associated with many anticholinergic adverse effects. Teaching about these drugs should include anticipation of a. increased libido and increased appetite b. polyuria and polydipsia c. urinary retention, arrhythmias, and constipation d. hearing changes, cataracts, and nightmares

c. urinary retention, arrhythmias, and constipation

A client reports that he thinks he is taking an antidepressant, but he is not sure. In reviewing his medication history, which of the following drugs would be considered antidepressants a. tetracyclic drugs b. cholinergics c. SSRIs d. MAOIs e. angiotensin II receptor blockers f. benzodiazepines

a,c,d

Depression is a very common affective disorder that strikes many people. In assessing a client who might be suffering from depression, the nurse would expect to find which of the following a. lack of energy b. hyperactivity c. sleep disturbances d. libido problems e. confusion f. decreased reflexes

a,c,d

The nurse is working on the telemetry unit and has noted that many postmyocardial- infarction (MI) patients experience depression. What medication would the nurse question if ordered for one of these patients? A) Amitriptyline B) Escitalopram C) Fluoxetine D) Fluvoxamine

Ans: A Feedback: Amitriptyline is a tricyclic antidepressant (TCA). One contraindication to the use of TCAs includes recent myocardial infarction because of the potential occurrence of reinfarction or extension of the infarct with the cardiac effects of the drug. Selective serotonin reuptake inhibitors would be the safest antidepressant to give so there would be no need to question an order for escitalopram, fluoxetine, or fluvoxamine.

The nurse is caring for a young female patient who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate? A) Antidepressants are used very cautiously during pregnancy and only when benefit outweighs risk. B) Antidepressants are contraindicated and must be discontinued if pregnancy occurs. C) Antidepressants must be chosen carefully because only a few are safe during pregnancy. D) Most antidepressants are safe during pregnancy but those that are contraindicated should be avoided.

Ans: A Feedback: Antidepressants should be used very cautiously during pregnancy and lactation because of the potential for adverse effects on the fetus and possible neurological effects on the baby. Use should be reserved for situations in which the benefits to the mother far outweigh the potential risks to the neonate.

A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). Page 1 The patient is confused and does not understand why his medication was changed. The nurse's best response to the patient would be what? A) These drugs are similar but some patients respond better to one drug than another. B) Did you take the amitriptyline like you should have? C) Maybe the old medicine wasn't working anymore. D) Clomipramine is newer and will be much better for you.

Ans: A Feedback: Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse effects. A patient who does not respond to one TCA may respond to another drug from this class. In addition, the nurse might inform the physician of the patient's question so the physician can explain his or her rationale for changing medications. By asking the patient if he took the medication as prescribed, the nurse is insinuating that he may not have and could damage the trusting nursepatient relationship. The nurse has no basis for commenting that the medication might not be working or that another drug would work better

Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What tricyclic antidepressant is now approved by the Food and Drug Administration to treat OCD? A) Clomipramine B) Imipramine C) Nortriptyline D) Amitriptyline

Ans: A Feedback: Clomipramine is now also approved for use in the treatment of OCD. Imipramine, nortriptyline, and amitriptyline are not approved for use in treating OCD.

A patient is admitted to the unit with obsessive-compulsive disorder (OCD). What drug might the nurse administer that has been found to be effective for treating OCD? A) Fluvoxamine B) Phenelzine C) Desipramine D) Amitriptyline

Ans: A Feedback: Fluvoxamine is indicated for the treatment of OCD and is classified as a selective serotonin reuptake inhibitor (SSRI). SSRIs are indicated for the treatment of depression, OCD, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorder, social phobias, and social anxiety disorders. Phenelzine is indicated for depression not responsive to other agents. Desipramine and amitriptyline are tricyclic antidepressants indicated for treatment of depression especially if accompanied by anxiety or sleep disturbances.

A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression. What interaction will the nurse assess for with this drug combination? A) Increased risk of hypoglycemia B) Increased risk of hyperglycemia C) Increase in appetite D) Increased total cholesterol

Ans: A Feedback: MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral diabetic agents. This patient would have to be monitored closely and appropriate dosage adjustments made; he should be taught the importance of more frequent blood sugar monitoring. The drug combination in this question would not cause an increase in appetite or increased total cholesterol.

The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking? A) Monoamine oxidase inhibitors (MAOIs) B) Selective serotonin reuptake inhibitors (SSRIs) C) Tricyclic antidepressants (TCAs) D) Antianxiety antidepressants

Ans: A Feedback: MAOIs have several serious adverse effects that can be fatal. This patient's symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke. SSRIs and TCAs Page 4 are not associated with these particular symptoms. Antianxiety antidepressants are not a classification of antidepressants

A 75-year-old male patient is brought to the emergency department by his family because he is talking to people who aren't there. During the initial admission assessment, his daughter mentions that her mother died 4 months ago and Dad just hasn't been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication. What would the nurse suspect is happening to this patient? A) The patient is having hallucinations as an adverse effect of his antidepressant medication. B) The mental status change is due to the patient's age. C) The patient probably has a urinary tract infection. D) The patient is having delusions because of his depression over the loss of his wife.

Ans: A Feedback: Older patients may be more susceptible to the adverse effects of antidepressants from unanticipated central nervous system effects to increased sedation, dizziness, and even hallucinations. Although an infection cannot be ruled out without further testing, the history would lead the nurse to the antidepressants as the most likely cause.

The nurse is caring for an 8-year-old clinic patient who takes imipramine. The nurse assesses the patient who does not have a history for or signs of depression, so the nurse suspects this drug was prescribed as treatment for what? A) Enuresis B) Obsessive compulsive disorder (OCD) C) Peripheral neuropathy D) Panic disorder

Ans: A Feedback: One of the indications for use of the drug imipramine is enuresis in children older than 6 years. Imipramine is not indicated for the treatment of OCD, peripheral neuropathy, or panic disorder.

A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is seeing her gynecologist for premenopausal symptoms and during the interview with the nurse she says that she would like to try Sarafem because her friend is taking it and she says it works great. The nurse's best response is what? A) Sarafem and Prozac are different brand names for the same generic medication. B) Before changing drugs it is important to consider how well you responded to Prozac. C) You cannot take both drugs at the same time so it will be important to decide which is best. D) When taking both of these drugs, it is best to take one in the morning and one at night.

Ans: A Feedback: Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in changing the patient's medication regimen and, if taken together, would result in a drug overdose. The other three responses are incorrect or inappropriate because they do not recognize that both drugs are the same.

What drugs would the nurse consider contraindicated for the patient taking a monoamine oxidase inhibitor (MAOI)? A) Selective serotonin reuptake inhibitor (SSRI) B) Insulin C) Acetaminophen D) Docusate (Colace)

Ans: A Feedback: SSRIs are contraindicated because of a life-threatening serotonin syndrome that could occur. If a patient requires insulin the benefit outweighs the risk but careful monitoring of glucose levels is needed because effects of insulin may be additive with an MAOI. There is no known contraindication for acetaminophen or docusate.

The nurse works in a mental health clinic. When a new patient arrives reporting feelings of depression, what conditions are screened for before prescribing antidepressants? (Select all that apply.) A) Thyroid disease B) Hormonal imbalance C) Cardiovascular disorders D) Parkinson's disease E) Diabetes mellitus

Ans: A, B, C Feedback: Adults using these drugs should have physical causes for their depression ruled out before therapy is begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. There is no indication that Parkinson's disease or diabetes is manifested by depression.

The nurse interviews the family of a patient hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessment data are important in planning this patient's plan of care? (Select all that apply.) A) Recent suicide attempts B) Gastrointestinal (GI) obstruction C) Affect D) Physical pain E) Personal responsibilities

Ans: A, B, C Feedback: When caring for a patient with a diagnosis of depression it is always important for the nurse to assess for recent suicide attempts, suicidal ideation, and any suicidal plans. After starting the medication, as the patient begins to feel better, risk of suicide increases, so ongoing assessment is essential to the patient's safety. Other assessments include allergies, liver and kidney function, glaucoma, benign prostatic hypertrophy, cardiac dysfunction, GI obstruction, surgery, or recent myocardial infarction, all of which could be exacerbated by the effects of the drug. Assess history of psychiatric problems, or myelography within the past 24 hours or in the next 48 hours, or is taking a monoamine oxidase inhibitor to avoid potentially serious adverse reactions. Physical pain and personal responsibilities may be assessed but are not priority assessments unless indicated by other diagnoses.

It has been postulated that depression may be a syndrome that reflects either activity or lack of activity in what areas of the brain? (Select all that apply.) A) Limbic system B) Corpus callosum C) Reticular activating system (RAS) D) Substantia nigra E) Basal ganglia

Ans: A, C, E Feedback: Depression also may occur as a result of other, yet unknown causes. This condition may be a syndrome that reflects either activity or lack of activity in a number of sites in the brain, including the arousal center (i.e., RAS), the limbic system, and basal ganglia. It is not theorized that depression is associated with the corpus callosum or the substantia nigra.

A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Select all that apply.) A) Agitation B) Agglutination C) Insomnia D) Intermittent tachycardia E) Dry mouth

Ans: A, C, E Feedback: The adverse effects associated with selective serotonin reuptake inhibitors, which are related to the effects of increased 5-hydroxytriptamine levels, include central nervous system effects (e.g., headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, seizures). Gastrointestinal effects (e.g., nausea, vomiting, diarrhea, dry mouth, anorexia, constipation, changes in taste) often occur, as do genitourinary effects (e.g., painful menstruation, cystitis, sexual dysfunction, urgency, impotence). Adverse effects of sertraline do not include agglutination of blood cells or intermittent tachycardia

Antidepressants carry a black box warning about the increased risk of suicide in what age group? A) Infants and children B) Children and adolescents C) Adolescents and adults D) Adults and older adults

Ans: B Feedback: A black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. Therefore, the other age groups are incorrect.

The mental health nursing instructor is talking with the class about depression. What deficiency does the instructor explain will result in depression? A) Epinephrine, norepinephrine, and acetylcholine B) Norepinephrine, dopamine, and serotonin C) Acetylcholine, gamma-aminobutyric acid, and serotonin D) Gamma-aminobutyric acid, dopamine, and epinephrine

Ans: B Feedback: A current hypothesis regarding the cause of depression is a deficiency of norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of the brain. Acetylcholine is a neurotransmitter that communicates between nerves and muscles. Epinephrine is a catecholamine that serves as a neurotransmitter that is released in the sympathetic branch of the autonomic nervous system and can be hormones when released from cells in the adrenal medulla. Gamma-aminobutyric acid is a neurotransmitter that inhibits nerve activity and prevents over excitability or stimulation.

The patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patient's chart before administering the medication. What preexisting condition would require cautious use of this drug? A) Osteosarcoma B) Cardiovascular disorders C) Closed head injury D) Bleeding ulcer

Ans: B Feedback: Caution should be used with tricyclic antidepressants in patients with preexisting cardiovascular (CV) disorders because of the cardiac stimulatory effects of the drug and with any condition that would be exacerbated by the anticholinergic effects (e.g., angle-closure glaucoma, urinary retention, prostate hypertrophy, GI or genitourinary surgery). There is no indication that caution is needed with patients diagnosed with osteosarcoma, closed head injury, or bleeding ulcer.

A 10-year-old patient is being seen by a physician for severe depression. The physician prescribes an antidepressant. What antidepressant could the nurse safely administer to a child? A) Trazodone B) Nortriptyline C) Fluvoxamine D) Phenelzine

Ans: B Feedback: Nortriptyline has established pediatric doses and can be used in children older than 6 years but such children should be monitored closely for adverse effects. Phenelzine is a monoamine oxidase inhibitor (MAOI), a class of drugs that should be avoided in children if at all possible because of the potential for drugfood interactions and the serious adverse effects. Trazodone can be used with children but is not a first-line drug because it has many adverse effects on the central nervous system associated with its use. Luvox is an SSRI that can be used in children to treat obsessive-compulsive disorder but selective serotonin reuptake inhibitors can cause serious adverse effects in children

A patient comes to the clinic because she is feeling depressed and has gained some weight. The physician prescribes oral tranylcypromine (Parnate) 10 mg twice daily for an atypical depression. When prescribed in this manner, when would the nurse tell the patient to expect the drug to reach peak levels in the body? A) 1 to 2 hours B) 2 to 3 hours C) 3 to 4 days D) 4 to 5 weeks

Ans: B Feedback: The monoamine oxidase inhibitors are well absorbed from the GI tract, reaching peak levels in 2 to 3 hours. The other time frames are incorrect.

What drug, if prescribed for the patient, would indicate the need to assess the patient for depression characterized by anxiety and addictive behaviors? A) Imipramine (Tofranil) B) Venlafaxine (Effexor) C) Fluvoxamine (Luvox) D) Tranylcypromine (Parnate)

Ans: B Feedback: Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, social anxiety disorder; it also diminishes addictive behavior. Fluvoxamine is a selective serotonin reuptake inhibitor, tranylcypromine is a monoamine oxidase inhibitor, and imipramine is a tricyclic antidepressant that are not indicated for treatment of anxiety disorder and addictive behavior.

A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (Select all that apply.) A) Fever B) Myocardial Infarction C) Stroke D) Dry mouth E) Gynecomastia

Ans: B, C, D Feedback: Use of tricyclic antidepressants may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea. Cardiovascular effects (e.g., orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, stroke) may occur. Fever and gynecomastia are not normally attributed to amitriptyline therapy.

What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (Select all that apply.) A) Take medication at bedtime. B) Monitor blood pressure. C) Do not take over-the-counter (OTC) drugs without talking to physician. D) Report double vision right away E) Reduce tyramine intake

Ans: B, C, E Feedback: MAOIs can cause drugdrug and drugfood interactions, which can precipitate cardiovascular effects that include orthostatic hypotension, arrhythmias, palpitations, angina, and the potentially fatal hypertensive crisis. Priority teaching points include monitoring blood pressure which will elevate with tyramine ingestion and the importance of not taking any OTC without physician or pharmacist consultation due to multiple drugdrug interactions. When taking an MAOI, you would not necessarily take the drug at bedtime or drink lots of fluid. Blurred, but not double, vision is an adverse effect of an MAOI.

The nurse is caring for a patient who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the patient monitor for adverse effects? A) If chest pain occurs an over-the-counter pain reliever will help. B) Nasal congestion indicates a respiratory virus is beginning. C) Measure and record your blood pressure daily. D) Adverse effects will subside as you adjust to the medication.

Ans: C Feedback: Cardiovascular effects of amitriptyline include orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, and stroke. Miscellaneous reported effects include alopecia, weight gain or loss, flushing, chills, and nasal congestion. Teaching the patient how and when to monitor blood pressure would be an important teaching point. Chest pain could be a serious finding and patients should be taught to call 911. Nasal congestion is a possible adverse effect of the drug and not an indication of a respiratory virus infection. Adverse effects often will not subside and may continue so long as the drug is taken.

A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child? A) Phenelzine (Nardil) B) Amitriptyline (Elavil) C) Fluvoxamine (Prozac) D) Isocarboxazid (Marplan)

Ans: C Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use because of the potential drugfood interactions and other serious adverse effects. Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.

The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient? A) Risk for infection B) Establish suicide precautions C) Disturbed thought processes related to central nervous system (CNS) effects of medication D) Dysfunctional Family Processes

Ans: C Feedback: Nursing diagnoses related to SSRI therapy might include: Disturbed thought processes related to central nervous system effects because adverse effects of SSRIs include headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures. There would be no reason to expect the patient is at increased risk for infection, there is not enough information known about the patient's family to know if processes are dysfunctional. Establishing suicide precautions is an intervention and not a nursing diagnosis.

The biogenic amine theory of depression states that depression results from a deficiency of biogenic amines in key areas of the brain. Why might a deficiency of these biogenic amines exist? A) A slowing of the action of the neurons may lead to their depletion. B) Monoamine oxidase (MAO) strengthens the impact of biogenic amines. C) The number or sensitivity of postsynaptic receptors may increase. D) Norepinephrine may be depleted because biogenic amines feed off of loose particles of the neurotransmitter.

Ans: C Feedback: The three reasons for depression according to the biogenic amine theory include (1) MAO may break down biogenic amine to be recycled or restored in the neuron. (2) Rapid fire of the neurons may lead to their depletion. (3) The number or sensitivity of postsynaptic receptors may increase, thus depleting neurotransmitter levels.

A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take? A) Teaching the patient about healthy eating to maintain weight B) Congratulating the patient on his weight loss and commenting how well he looks C) Encouraging the patient to increase fluid intake to avoid further weight loss D) Reassuring the patient that a decrease in weight is a common adverse effect with this medication

Ans: D Feedback: Adverse effects of fluoxetine include anorexia and weight loss. Although teaching about healthy eating is a good idea, it is more important to teach the patient how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The patient should increase caloric intake, not just fluid intake. The patient should continue the medication to see whether therapeutic effects are obtained and adjust nutritional intake if necessary. More information about the patient's baseline weight is needed before congratulating the patient because a patient who is already too thin would not appreciate the nurse's comment.

A patient receives a new prescription for fluvoxamine (Luvox). What will the nurse instruct the patient about taking the medication? A) Take medication after eating breakfast. B) Take medication with at least 8 ounces of liquid. C) The dosage may need to be increased if the patient is not feeling better in 2 weeks. D) The medication should be taken once a day before bedtime.

Ans: D Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that should be taken once a day before bedtime. The medication does not require 8 ounces of fluid for absorption. It should be taken for at least 4 weeks before a therapeutic effect is noted.

The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the patient understands a low tyramine diet when what meal is chosen? A) A chop salad with blue cheese, sardines, and pepperoni B) A sandwich with turkey, avocado, and Swiss cheese C) Corned beef hash, eggs, and hash browns D) A hamburger, French fries, and a strawberry milkshake

Ans: D Feedback: Hamburger, French fries, and a strawberry milkshake do not contain tyramine and, although high in fat, it would not be contraindicated for a patient taking an MAOI. Blue cheese, sardines, pepperoni, Swiss cheese, and corned beef are all high in tyramine and would indicate further teaching was needed.

A patient is admitted with a presumed diagnosis of colon cancer who takes a monoamine oxidase inhibitor for depression. What drug will the nurse keep on hand for this patient in case of the onset of an adverse reaction? A) Epinephrine B) Injectable naloxone (Narcan) C) Phenylalanine D) Phentolamine

Ans: D Feedback: Have phentolamine or another adrenergic blocker on standby as treatment in case of hypertensive crisis. The other options are distracters for this question.

The nurse is caring for a patient who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication does the nurse consider appropriate for this patient? A) Chlorpromazine (Thorazine) 25 mg three times daily orally B) Benztropine (Cogentin) 2 mg twice daily orally C) Clozapine (Clozaril) 200 mg twice daily orally D) Paroxetine (Paxil) 10 mg once daily orally

Ans: D Feedback: Paroxetine is a selective serotonin reuptake inhibitor indicated for the treatment of depression, obsessive compulsive disorder, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorders, social phobias, and social anxiety disorders. Chlorpromazine and clozapine are antipsychotic medications whereas benztropine is a drug used to treat Parkinson's disease. None of these would be appropriate options to treat anxiety disorders.

A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient? A) Monitor food intake for levels of tyramine. B) Assess for weight loss and difficulty sleeping. C) Monitor the patient for severe headaches. D) Implement suicide precautions.

Ans: D Feedback: Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the patient. Severe headache and reactions to tyramine- containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patient's safety.

What is the physiological action of tricyclic antidepressants (TCAs)? A) Inhibiting monoamine oxidase inhibitors that break down norepinephrine B) Inhibiting nerve activity, which prevents over excitability or stimulation C) Blocking the reuptake of serotonin, which increases the levels of norepinephrine D) Inhibiting reuptake of norepinephrine and serotonin

Ans: D Feedback: TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an accumulation of the neurotransmitters that is thought to create the antidepressant effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.

What reason might the nurse give for why venlafaxine (Effexor) has become more popular with adults in treating their depression? A) It is taken orally. B) It does not have adverse effects. C) It can be taken during pregnancy. D) An extended release form is available.

Ans: D Feedback: Venlafaxine mildly blocks reuptake of norepinephrine, 5-hydroxytriptamine, and dopamine. It has fewer adverse central nervous system effects than trazodone. Its popularity has increased with the introduction of an extended-release form that does away with the multiple daily doses that are required with the regular form. Venlafaxine is readily absorbed from the gastrointestinal (GI) tract, extensively metabolized in the liver, and excreted in urine. Adequate studies have not been done in pregnancy and lactation, so that it should be used during those times only if the benefit to the mother clearly outweighs the potential risk to the neonate. It is taken orally, which is the case with most antidepressants

Your pt is being treated for depression and is started on a regimen of Prozac (fluoxetine). She calls you 10 days after the drug therapy has started to report that nothing has changed and she wants to try a different drug. You should a. tell her to try sertraline (Zoloft) because some pts respond to one selective serotonin reuptake inhibitor (SSRI) and not another b. ask her to try a few days without the drug to see whether there is any difference c. add an MAOI to her drug regimen to get an increased antidepressant effect d. encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect

d. encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect

Venlafaxine (Effexor) is a relatively new antidepressant that might be very effective for use in pts who a. have proven to be responsive to other antidepressants b. can tolerate multiple side effects c. are reliable at taking multiple daily dosings d. have not responded to other antidepressants and would benefit from once-a-day dosing

d. have not responded to other antidepressants and would benefit from once-a-day dosing

Adverse effects may limit the usefulness of TCAs with some pts. Nursing interventions that could alleviate some of the unpleasant aspects of these adverse effects include a. always administering the drug when the pt has an empty stomach b. reminding the pt not to void before taking the drug c. increasing the dose to override the adverse effects d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects

d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects