NU271 Chapter 21: Antidepressant Agents
A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, "I'm relieved to have some medication to help with my mood, because it's my daughter's wedding next weekend and I'll be feeling better." What is the nurse's best response? "This is very good timing for you, but remember that you might have some side effects, especially for the first couple of weeks." "Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." "Antidepressants help relieve the lack of energy and concentration during depression but your mood might not be affected." "You'll likely be feeling significantly better by the weekend, but remember to avoid drinking alcohol at the wedding."
"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." Explanation: Peak benefits of SSRIs can take up to six weeks to be realized, and a client is unlikely to notice an effect within a few days. Antidepressants improve mood, not just energy and concentration.
A client comes to the clinic with a possible mood disorder diagnosis of unipolar depression. What question by the nurse will best help in assessing this client's mental status? "Can you name six things you would like to change in your life?" "Why are you feeling sad?" "Have you felt hopeless anytime lately?" "What have you eaten in the last two days?"
"Have you felt hopeless anytime lately?" Explanation: A quick depression assessment involves asking the client if he/she has felt helpless or hopeless over the last two weeks. The other questions will not be helpful in assessing the client's current mental status.
The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize? "How are you feeling today?" "How would you describe your mood and energy level today?" "On a scale from zero to ten, how would you rate your anxiety level?" "Are you feeling happier today than in the past?"
"How would you describe your mood and energy level today?" Explanation: Mirtazapine is an antidepressant and it is prudent for the nurse to assess the client's mood and level of energy. Anxiety is not synonymous with depression and is not treated with this medication. Asking a client how the client feels is often too vague and open-ended to obtain meaningful data. Asking a client if she or she feels "happier" is a closed-ended (yes/no) question and could easily be interpreted by the client as downplaying the severity of depression.
A client has been taking fluoxetine (Prozac) for the last ten days. Today the client is reporting not feeling any better. What is the nurse's best response to this client? "I will tell the healthcare provider and see if there is another medication that would be better." "Please come to the clinic immediately so you can be reassessed for suicidal thoughts." "It may take another two to three weeks before the medication is completely effective." "I realize this is frustrating but most medications for mood disorders aren't fully effective for two to three months."
"It may take another two to three weeks before the medication is completely effective." Explanation: Fluoxetine may take up to four weeks to be completely effective. It would not be appropriate for the nurse to ask the healthcare provider to change the medication, and the client has not given any indication of suicidal ideation.
The nurse is caring for an older adult client who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the client monitor for adverse effects? "Adverse effects will subside as you adjust to the medication." "Measure and record your blood pressure daily." "If mild chest pain occurs, an over-the-counter pain reliever will help." "Nasal congestion suggests that the drug might not be effective."
"Measure and record your blood pressure daily." Explanation: 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 client how and when to monitor blood pressure would be an important teaching point. Chest pain could be a serious finding and clients should be taught to call 911. Nasal congestion is a possible adverse effect of the drug and not an indication of ineffectiveness. Adverse effects often will not subside and may continue so long as the drug is taken.
A 33-year-old woman has been diagnosed with major depression and has recently begun treatment with citalopram. What teaching point should the nurse emphasize when providing health education for this patient? "You'll need to make some important changes to your diet while you're on this drug, but it will certainly be worth it." "Most people experience significant relief of their depression within 2 to 3 days of starting this drug." "It's important that you not take any over-the-counter medications while you're taking this drug." "Most people don't experience severe side effects with this drug, but it may have an effect on your sexual functioning."
"Most people don't experience severe side effects with this drug, but it may have an effect on your sexual functioning." Explanation: SSRIs such as citalopram tend to have fewer adverse effects than many other medications for mood disorders. However, sexual functioning is often affected. OTC medications should be taken with caution but not all of these must necessarily be avoided. Symptom relief takes longer than 2 to 3 days, and significant dietary changes are not normally required with SSRIs.
A client is prescribed transdermal selegiline. What health education should the nurse provide? "Put the patch on the back of your hand where you'll be reminded of it." "Gently massage the area after you put a new patch on your skin." "Leave the old patch in place for no more than one hour after placing a new one." "Place the patch on dry skin on your torso that has no cuts or openings."
"Place the patch on dry skin on your torso that has no cuts or openings."Transdermal selegiline should be applied to dry intact skin on the upper torso, upper thigh, or upper arm. The old patch should be removed before placing the new one and there is no need to massage the area.
A client has been diagnosed with depression. The provider has ordered sertraline. The client asks, "How soon will it be until I feel better?" What would be the best response by the nurse? "The medication will improve your energy in 1 to 2 days, but the symptoms of sadness will not improve for a week." "The medication will start to work in about 10 days, but it may take up to 4 weeks to be fully effective." "The medication will decrease only your visible symptoms of depression." "The medication will start to work immediately."
"The medication will start to work in about 10 days, but it may take up to 4 weeks to be fully effective." Explanation: Achieving antidepressant effects from sertraline, as with other antidepressants, can take anywhere from 10 days to 4 weeks. Some symptoms of depression, such as loss of energy, may be corrected before the mood is fully elevated.
A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response? "It's very important that you comply with your prescribed treatment." "Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." "It's very important that you not take the St. John's wort at the same time of day as your antidepressant."
"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." Explanation: The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rationale. It is true that many herbal remedies contain inconsistent doses, but this is not the primary risk of combining SSRIs with St. John's wort. Taking them at different times of day does not mitigate the risks of an unsafe reaction.
A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response? "Most experts agree that St. John's wort is effective in treating depression but that it can contribute to hypertension." "It's not clear that St. John's wort is effective in treating depression, but it won't cause any harm." "St. John's wort is a natural and safe alternative to prescription antidepressants." "There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."
"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive." Explanation: Most experts agree that there is insufficient evidence to establish that St. John's wort is effective in treating depression. The herb has some side effects (such as photosensitivity, dizziness, and nausea), though they are usually infrequent and mild. Drug interactions, however, may be extensive. St. John's wort may decrease the effectiveness of some drugs, and combining it with others, such as cold and flu medications, may result in severe hypertension.
What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline? "Be sure to eat a low fiber diet to prevent diarrhea." "Limit your fluid intake so you don't have to urinate during the night." "Take the drug daily in the morning for maximum benefit." "Use sugarless hard candies and gum to deal with dry mouth."
"Use sugarless hard candies and gum to deal with dry mouth."Explanation:Sugar-free hard candies and gums would help to alleviate dry mouth that may occur due to anticholinergic effects. The client should take a major portion of the dose at bedtime if drowsiness and anticholinergic effects are severe. Fluid restriction should not be encouraged, and would have no benefit. Similarly, a higher fiber diet would be beneficial for maintaining normal bowel function.
A client is at the clinic for a follow-up appointment related to treatment for depression. The client had began taking fluoxetine 2 weeks ago. The client states, "This medication must not be working, because I don't feel better at all." What would be the nurse's best response? "I'll talk to the health care provider about increasing your dosage." "You may just be one of those people who don't get better with this drug." "I'll talk to the health care provider about ordering a different drug." "You may have to take this drug for a few more days before you feel its effects."
"You may have to take this drug for a few more days before you feel its effects." Explanation: Steady-state levels of fluoxetine are achieved over several weeks. As a rule, clients may have to take antidepressants for 2 to 4 weeks before they feel any improvement in symptoms. Speaking to the physician to change the medication or dosage increase is premature since it has not been taken long enough. Stating that the medication probably will not work on this client is inappropriate.
How long does a patient need to wait after stopping a phenelzine before starting paroxetine? 14 days 10 days 7 days 1 day
14 days Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.
A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period? 2 weeks 1 week 3 weeks 4 weeks
4 weeks Explanation: It may take up to 4 weeks before the full effect of an SSRI is noted.
A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider? A client who takes sertraline 24 mg PO daily says he has noticed some sexual dysfunction since starting the drug A client who takes amitriptyline reports a dry mouth and occasional urinary hesitation A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug A client taking isocarboxazid with whom the nurse needed to review dietary restrictiona
A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug Explanation: Worsening mood that accompanies the use of an SSRI could constitute an increased risk for suicidality. The nurse should communicate this to the provider promptly so the client can be reassessed. The client taking amitriptyline is experiencing anticholinergic effects which the nurse can likely manage. A client's sexual dysfunction should be addressed but this is not a safety risk. The fact that the nurse needed to review a client's dietary restrictions is not necessarily problematic and could indicate the client's firm commitment to adhering to the restrictions.
A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his health care provider to order? More frequent doses of the antidepressant A lower dose of the antidepressant No antidepressants, because they would be contraindicated for this client. A higher dose of the antidepressant
A lower dose of the antidepressant Explanation: Hepatic impairment leads to reduced first-pass metabolism of most antidepressant drugs, resulting in higher plasma levels. The drugs should be used cautiously in clients with severe liver impairment. Cautious use means lower doses, longer intervals between doses, and slower dose increases than usual.
A client on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize to best evaluate therapeutic effect of the treatment in the care of this client? Monitoring the client's hepatic and renal status Assessment of the client's behaviors and thought processes Assessing the client's vital signs Monitoring the client for indications of bone marrow suppression
Assessment of the client's behaviors and thought processes Explanation: The nurse's priority should be to assess the signs and symptoms of the client's underlying health problem in order to identify therapeutic effects. The client's vital signs are not likely to be volatile, and hepatic and renal status are not commonly affected by Risperidone. Bone marrow suppression is not an expected adverse effect.
A client with a longstanding diagnosis of depression is being treated with phenelzine. The client reports the recent use of some over-the-counter flu and cold remedies and has consequently been admitted for observation and client teaching. What assessment should the nurse prioritize? Pain assessment Pulse oximetry Blood pressure monitoring Monitoring the client for tardive dyskinesia
Blood pressure monitoring Explanation: The drug-drug interactions that exist with the use of monoamine oxidase inhibitors create a high risk for hypertensive crisis. Blood pressure monitoring is thus among the priority assessments. Tardive dyskinesia is not among the varied signs and symptoms that can result from drug-drug interactions with MAOIs. The nurse should certainly monitor the client's pain and oxygenation, but blood pressure monitoring is the highest priority due to the likelihood and safety risks associated with hypertensive crisis.
The nurse is caring for a 12-year-old child who has been hospitalized with depression, and the health care provider has elected to treat the child with a TCA. The nurse understands that what laboratory test will be routinely ordered by the provider? Blood pressure, ECG, and plasma drug levels CBC and chemistry panel and plasma drug levels Hemoglobin and hematocrit and plasma drug levels Chest x-ray and plasma drug levels
Blood pressure, ECG, and plasma drug levels Explanation: Amitriptyline, desipramine, imipramine, and nortriptyline are the TCAs most commonly prescribed to treat depression in children older than 12 years of age. Because of potentially serious adverse effects, blood pressure, ECG, and plasma drug levels should be monitored.
A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed? Amoxapine Clomipramine Maprotiline Desipramine
Clomipramine Explanation: Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.
A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder. Maprotiline Clomipramine Amoxapine Desipramine
Clomipramine Explanation: Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.
The nurse is providing care for a client who has been prescribed trazodone for the treatment of depression. What assessment should the nurse prioritize? Cognition and level of consciousness Urine output and creatinine clearance Skin integrity and peripheral perfusion Oxygen saturation and respiratory rate
Cognition and level of consciousness Explanation: Trazodone (Desyrel) is effective in some forms of depression but has many CNS effects associated with its use. For this reason, the nurse should prioritize the assessment of neurologic status over respiratory, renal or integumentary status.
The nurse in a long-term care facility is providing care for an 83-year-old client who has depression and who has been prescribed clomipramine. The client has twice reported urinary hesitation since starting this treatment and required intermittent urinary catheterization overnight to relieve bladder distention. What is the nurse's best action? Contact the provider to obtain an order for an indwelling urinary catheter. Contact the care provider promptly to advocate for a change in the medication regimen. Monitor the client's urinary function closely over the next 48 hours. Provide the client with increased opportunities for fluid intake.
Contact the care provider promptly to advocate for a change in the medication regimen. Explanation: Urinary hesitancy that requires catheterization suggests that the client cannot likely tolerate the anticholinergic effects of this medication. A dose reduction or a change to a different class of antidepressants may be necessary. Increasing fluid intake may exacerbate, rather than relieve, the problem. Indwelling catheters create high risks for infection and loss of function; a change in medication would be a preferred approach. The nurse should monitor the client closely, but interventions are needed in addition to this assessment.
Besides being prescribed as an antidepressant, imipramine helps treat which disorder in children? Attention deficit hyperactivity disorder Night terrors Weight loss Enuresis
Enuresis Explanation:Besides being prescribed as an antidepressant, imipramine is used to treat enuresis in children older than age 6.
A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? Extreme sadness Drowsiness Dilated pupils Severe headache
Extreme sadness The nurse should monitor the patient for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are the symptoms of hypertensive crisis.
Which agent would a nurse identify as a selective serotonin reuptake inhibitor? Selegiline Nefazodone Fluvoxamine Mirtazapine
Fluvoxamine Explanation: Fluvoxamine is classified as a selective serotonin reuptake inhibitor. Selegiline is not classified as a selective serotonin reuptake inhibitor; it is a MAO-type B inhibitor. Nefazodone is not classified as a selective serotonin reuptake inhibitor. Mirtazapine is not classified as a selective serotonin reuptake inhibitor.
A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors? Respiratory congestion Hypertension Anemia Decreased urinary output
Hypertension Explanation: MAO inhibitors may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Clients who take MAO inhibitors should avoid foods that contain tyramine, such as aged cheeses and fava beans.
The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI? Diabetic ketoacidosis Renal dysfunction Orthostatic hypotension Hypoglycemia
Hypoglycemia Explanation: MAOIs interact with oral antidiabetic agents, increasing the client's risk for hypoglycemia. Diabetic ketoacidosis would be associated with hyperglycemia. Orthostatic hypotension, urinary retention, dysuria, and incontinence may occur with MAOI therapy, but these are not associated with the interaction of an oral antidiabetic agent and an MAOI.
The psychiatric nurse would recognize that venlafaxine's therapeutic effect is achieved by what means? Increasing levels of both serotonin and norepinephrine Slowing the reuptake of endorphins in the central nervous system Stimulating synthesis and potentiating the action of dopamine Slowing the reuptake of acetylcholine in brain synapses
Increasing levels of both serotonin and norepinephrine Explanation: Venlafaxine increases the levels of serotonin and norepinephrine in the brain by preventing the reuptake of these neurotransmitters known to play an important part in mood. It does not directly affect endorphins or acetylcholine. The drug weakly inhibits dopamine reuptake.
A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client? The drug requires six to eight weeks before it reaches peak levels The client's pessimism is likely a symptom of the underlying depression Improvements are likely evident to others even if not to the client It may take up to two more weeks before the client feels better
It may take up to two more weeks before the client feels better Explanation:It may take up to 4 weeks before the full effect of a SSRI such as escitalopram is noted. This phenomenon is the most likely cause of the client's appraisal, not a lack of perspective or worsening symptoms.
A tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions? Assess the client's blood pressure every six hours for the first week of therapy. Ask the client at each meal about any episodes of gastresophageal reflux. Monitor the client closely for bleeding and review coagulation indices when available. Monitor the client for tetany and review serum calcium levels when available.
Monitor the client closely for bleeding and review coagulation indices when available. Explanation: Combining TCAs with warfarin creates a risk for bleeding, which should be addressed in the nursing care plan. There is no known interaction between TCAs and calcium supplements or bisphosphonates that would create a risk for hypocalcemia. TCAs do not heighten the risk of gastresophageal reflux. TCAs can affect blood pressure, but this is unrelated to any known drug-drug interactions.
While reviewing the medication history of an older adult client, the nurse learns that the client is taking amitriptyline 25 mg three times per day. What adverse effect should the nurse prioritize when incorporating safety measures into the care plan? Urinary retention Incontinence Dry mouth Orthostatic hypotension
Orthostatic hypotension Explanation: Orthostatic hypotension is an adverse effect related to amitriptyline. The nurse should incorporate falls precautions into the care plan. Incontinence is not an adverse effect of amitriptyline. Urinary retention and dry mouth are adverse effects of amitriptyline but do not present the same safety risks posed by orthostatic hypotension.
The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten? Phenelzine Paroxetine Triazolam Diazepam
Phenelzine Explanation: MAOIs are drugs used in the treatment of mood disorders. They require that the client follow a strict diet that restricts tyramine to prevent a hypertensive crisis. Nardil is an MAOI. Diazepam and triazolam are benzodiazepines and paroxetine is an SSRI.
A client is to receive a tricyclic antidepressant. The nurse is reviewing the client's medical record. What would alert the nurse to a possible contraindication? Recent myocardial infarction Renal dysfunction Prostatic hypertrophy Glaucoma
Recent myocardial infarction Explanation: A recent myocardial infarction would be a contraindication for use because of the potential occurrence of reinfarction or extension of the infarction due to the drug's cardiac effects. Cautious use and close monitoring would be appropriate for the client with glaucoma and prostatic hypertrophy due to the anticholinergic effects. Cautious use in renal dysfunction also is warranted because the drugs are excreted in the urine.
A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating? Apples Salami Leafy greens Ice cream
Salami Explanation: When taking a monoamine oxidase inhibitor, such as phenelzine, foods high in tyramine or tyrosine should be avoided. Salami, like other cured and aged meats, is high in tyramine. None of the other listed foods are problematic.
Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant? Monoamine oxidase inhibitor Tricyclic Benzodiazepine Selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitor Explanation: SSRIs are the most commonly prescribed antidepressants, due to their effectiveness and relatively low levels of adverse effects.
Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant? Tricyclic Selective serotonin reuptake inhibitor Monoamine oxidase inhibitor Benzodiazepine
Selective serotonin reuptake inhibitor Explanation: SSRIs are the most commonly prescribed antidepressants, due to their effectiveness and relatively low levels of adverse effects.
After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin? Monoamine oxidase inhibitors Tricyclic antidepressants Atypical antidepressants Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Monoamine oxidase inhibitors, classified as MAOIs inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug, it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder.
After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin? Atypical antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Tricyclic antidepressants
Selective serotonin reuptake inhibitorsSelective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Monoamine oxidase inhibitors, classified as MAOIs inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug, it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder.
A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired? Insulin Serotonin Acetylcholine Epinephrine
Serotonin Explanation: Serotonin helps regulate several behaviors that are disturbed in depression. Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle. Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas to regulate blood sugar.
To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued? It will be important that the client avoid stressful situations until another selective serotonin reuptake inhibitor (SSRI) can be prescribed. A monoamine oxidase (MAO) inhibitor will be prescribed concurrently with the fluoxetine for 2 to 3 weeks. Electroconvulsive therapy (ECT) will be prescribed 2 to 3 weeks before stopping the fluoxetine. The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.
The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. Explanation:To avoid antidepressant discontinuation syndrome, it is essential to taper the dosage of the antidepressant and discontinue it gradually, over 6 to 8 weeks, unless severe drug toxicity, anaphylactic reaction, or another life-threatening condition is present. ECT will not avoid this syndrome. Concurrent use of an MAO inhibitor is dangerous. Avoiding stress is advisable but will not minimize the risk of injury in this situation.
female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication? The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. She should have an ultrasound of the liver to check for disease. The client should have monthly evaluation of liver function to monitor the disease progression. The client should not take any medications because of her liver dysfunction.
The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. Explanation:Sertraline should be administered with caution in clients with compromised liver function. Adjustments such as a lower dosage or less-frequent dosing schedule may be made for these clients.
Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression? The onset of action is sooner than with other medications. The medications have fewer anticholinergic effects than alternatives. The medications have no sexual side effects. The medications eliminate the risk of suicide during treatment.
The medications have fewer anticholinergic effects than alternatives. Explanation: Currently, the selective serotonin reuptake inhibitors (SSRIs) are the first choice for treating depression. They are preferred over the tricyclic drugs and the MAOIs because they can be less damaging to the heart and have minimal anticholinergic and hypotensive effects. The selection of one SSRI over another is based on individual patient response to a drug and prescriber preference. Adverse effects, which are mild and brief, include gastrointestinal distress (anorexia, nausea, vomiting, and diarrhea), headache, fatigue, insomnia, and sexual dysfunction (delayed ejaculation, inability to achieve orgasm). SSRIs do not necessarily eliminate the risk of suicide.
A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid? Milk Butter Yogurt Rice
Yogurt Explanation: The nurse should ask the patient to avoid yogurt because yogurt contains tyramine, which interacts with MAOIs and causes hypertensive crisis. Milk, butter, and rice do not contain tyramine and hence can be consumed when undergoing treatment with MAOIs.
A client recently started on fluoxetine for the treatment of depression asks the nurse if there are any adverse effects to be aware of. The nurse should inform the client to be alert for what effects? Select all that apply. anxiety visual disturbances tinnitus nervousness insomnia restless legs
anxiety insomnia nervousness Explanation: Most selective serotonin reuptake inhibitors cause some degree of central nervous system stimulation (e.g., anxiety, nervousness, insomnia), which is most prominent with fluoxetine. Increased muscle tone, visual disturbances, and tinnitus are atypical reactions.
A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client? adhere to combination drug therapy. avoid taking the drug on an empty stomach. avoid use of soy sauce in the diet. discuss the cultural significance of taking an MAOI.
avoid use of soy sauce in the diet. Explanation: The client should be instructed to avoid soy sauce, which contains high levels of tyramine. Potentially fatal pharmacodynamic interactions can occur with MAOIs when they are combined with foods rich in tyramine. The client's willingness to adhere to the combination therapy and the cultural significance of taking an MAOI, although important factors to be assessed, are not as important as this safety-related dietary consideration.
A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction? Worsened symptoms of depression Hemostatic instability Dangerous drug interactions Development of blood dyscrasias
dangerous drug interactions Explanation:Combining St. John's wort with antidepressants can cause serious drug-to-drug interactions. These effects do not typically include worsened depression, alterations in coagulation, or dyscrasias.
A 12-year-old client who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which? weight loss. feelings of grandiosity. onset of suicidal ideation. decreased sleep.
onset of suicidal ideation. Explanation: The nurse should closely assess the client for evidence of worsening depression or onset of suicidal ideation. The most critical time to monitor for behavioral changes is during the first few weeks of drug therapy. Although sertraline is not approved by the FDA for treating depression in children at this time, the SSRI is widely used on an unlabeled basis to treat pediatric depression. While it is important to monitor for weight loss, it is not critical. Feelings of grandiosity and decreased sleep are symptoms of mania and are not adverse effects related to this drug.
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline? visual disturbances urinary frequency orthostatic hypotension urinary retention
orthostatic hypotension Explanation: Orthostatic hypotension, a common cause for falls, is an adverse effect related to tricyclic antidepressants like amitriptyline. Urinary retention (not frequency) is an adverse effect of amitriptyline but is not related to the falls. Visual disturbances are not a common adverse effect.
A client prescribed fluoxetine 1 week ago presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety? presence of suicidal ideation indications of a type IV hypersensitivity reaction improvement in the ability to concentrate cardiac rate and rhythm
presence of suicidal ideation Explanation: It is essential to assess for suicidal thoughts or plans, especially at the beginning of selective serotonin reuptake inhibitor (SSRI) therapy or when dosages are increased or decreased. This supersedes the need to assess for concentration, cardiac function, or hypersensitivity.
A black box warning alerts health care providers to risks in young adults 18 to 24 years of age when taking antidepressant medications. Which symptoms of concern should be included? reports of headaches, sleepiness, and apathy alternating periods of hypomania and depression statements or resignation and futility and a desire to die paranoia, rapid speech, and difficulty with concentration
statements or resignation and futility and a desire to die Explanation: A black box warning alerts health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications. Consequently, statements alluding to a desire to die should be acted on promptly.
The nurse is caring for a client suspected of developing serotonin syndrome. What frequent assessments should the nurse include in the client's plan of care? Select all that apply. temperature respiratory function blood pressure cardiac function level of consciousness
temperature blood pressure level of consciousness Serotonin syndrome, a serious and sometimes fatal reaction characterized by hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium and coma, muscle rigidity, and seizures, may occur due to combined therapy with an drugs that potentiate serotonin neurotransmission. While worthy of assessment, neither cardiac nor respiratory functions are usually affected.
