Pharm Chapter 21 - Antidepressant Agents

The nurse is interviewing the client who is to receive a tricyclic antidepressant. Which client statement should alert the nurse to a likely contraindication? "I had a myelogram yesterday." "I've had glaucoma for several years." "My doctor says that I have an enlarged prostate." "My kidneys aren't functioning like they should."

"I had a myelogram yesterday." A myelogram given within the previous 24 hours or to be given in the next 48 hours is a contraindication for the use of tricyclic antidepressants because of possible drug-drug interaction with the dyes used for the study. A history of glaucoma would require cautious use of the drug. Prostatic hypertrophy would require cautious use of the drug. Renal dysfunction would require cautious use of the drug.

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? 1."Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." 2."This is very good timing for you, but remember that you might have some side effects, especially for the first couple of weeks." 3."Antidepressants help relieve the lack of energy and concentration during depression but your mood might not be affected." 4."You'll likely be feeling significantly better by the weekend, but remember to avoid drinking alcohol at the wedding."

1."Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." 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.

The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity? 1.8 mEq/L 0.6 mEq/L 0.8 mEq/L 1.2 mEq/L

1.8 mEq/L Therapeutic serum lithium levels range from 0.6 mEq/L to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic. All of the other levels would be considered therapeutic.

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)? 1. 7 days 2. 14 days 3. 10 days 4. 1 day

2. 14 days

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? 1."It's not clear that St. John's wort is effective in treating depression, but it won't cause any harm." 2."There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive." 3."St. John's wort is a natural and safe alternative to prescription antidepressants." 4."Most experts agree that St. John's wort is effective in treating depression but that it can contribute to hypertension."

2."There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline? 1."Limit your fluid intake so you don't have to urinate during the night." 2."Use sugarless hard candies and gum to deal with dry mouth." 3."Be sure to eat a low fiber diet to prevent diarrhea." 4."Take the drug daily in the morning for maximum benefit."

2."Use sugarless hard candies and gum to deal with dry mouth."

An adult resident of a long-term care facility has been diagnosed with depression and the provider has prescribed selegiline. When preparing to administer the medication, what is the nurse's best action? 1.Educate the client about the risk for extrapyramidal effects. 2.Assess the integrity of the client's skin. 3.Ensure the client sits upright during and immediately after administration. 4.Assess the client's mood and plan to reassess in two hours.

2.Assess the integrity of the client's skin. Selegiline is administered by a transdermal patch, which requires dry, intact skin. It cannot be administered orally so there is no need for the client to sit upright. Effects on a client's mood and affect will not be evident just two hours after the initial dose. This drug is not associated with antipyramidal effects.

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? 1.Respiratory congestion 2.Hypertension 3.Decreased urinary output 4.Anemia

2.Hypertension 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.

A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching? 1."There may be an increased risk of socialization while taking this drug." 2."Clients may lose all inhibitions while on this drug." 3."There may be an increased risk of suicide while taking this drug." 4."If you miss a dose of this drug, double the dose the next time you take it."

3."There may be an increased risk of suicide while taking this drug."

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? 1.A client who takes sertraline 24 mg PO daily says he has noticed some sexual dysfunction since starting the drug 2.A client who takes amitriptyline reports a dry mouth and occasional urinary hesitation 3.A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug 4.A client taking isocarboxazid with whom the nurse needed to review dietary restrictions

3.A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug 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 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. 1.Desipramine 2.Maprotiline 3.Clomipramine 4.Amoxapine

3.Clomipramine Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.

Which agent would a nurse identify as a selective serotonin reuptake inhibitor? 1.Mirtazapine 2.Selegiline 3.Fluvoxamine 4.Nefazadone

3.Fluvoxamine

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time? 1.Forty-eight hours after being weaned from the paroxetine 2.Immediately upon stopping the paroxetine. 3.In 4 to 6 weeks after stopping the paroxetine 4.Concurrently with the paroxetine as it is being tapered

3.In 4 to 6 weeks after stopping the paroxetine Paroxetine, a SSRI, and phenelzine, an MAOI, should not be given together because of the risk for serotonin syndrome. At least 4 to 6 weeks should be allowed between the use of the two drugs when switching from one to the other.

Anticholinergic effects such as dry mouth, sedation, and urinary retention are common adverse events occurring with the use of which classes of antidepressants? 1.Selective serotonin reuptake inhibitors 2.Atypical antidepressants 3.Tricyclic antidepressants 4.Monoamine oxidase inhibitors

3.Tricyclic antidepressants Anticholinergic side effects commonly occur with the use of the tricyclic class of antidepressants. Common adverse effects for selective serotonin reuptake inhibitors are somnolence, dizziness, headache, insomnia, tremor, and weakness. Monoamine oxidase inhibitors' most common side effects include orthostatic hypotension, dizziness, vertigo, headache, and blurred vision. Adverse effects of lithium include tremors, nausea, vomiting, thirst, and polyuria. Toxic reactions may occur when serum lithium levels are greater than 1.5 mEq/L.

A 30-year-old client is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which? 1.increased secretions. 2.facial flushing. 3.dizziness. 4.diarrhea.

3.dizziness.

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? 1."Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." 2."It's very important that you not take the St. John's wort at the same time of day as your antidepressant." 3."It's very important that you comply with your prescribed treatment." 4."There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."

4."There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." 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 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? 1.A higher dose of the antidepressant 2.No antidepressants, because they would be contraindicated for this client. 3.More frequent doses of the antidepressant 4.A lower dose of the antidepressant

4.A lower dose of the antidepressant

The client has been perscribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid? 1.Herbal stimulants, caffeine, navy beans, and cheese 2.Herbal stimulants, pasta, organ meats, and egg products 3.Coffee, chocolate, organ meats, pasta, and navy beans 4.Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

4.Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

The nurse is providing care for a client who has been prescribed trazodone for the treatment of depression. What assessment should the nurse prioritize? 1.Oxygen saturation and respiratory rate 2.Urine output and creatinine clearance 3.Skin integrity and peripheral perfusion 4.Cognition and level of consciousness

4.Cognition and level of consciousness

A client is receiving a selective serotonin reuptake inhibitor (SSRI) and is being switched to a monoamine oxidase inhibitor (MAOI) due to lack of response. When would the nurse teach the client to begin the MAOI? 1.The MAOI would be started immediately after stopping the SSRI. 2.The MAOI would start in 48 hours after weaning the client from the SSRI. 3.The MAOI would be started as the SSRI is being tapered. 4.The MAOI would be started 2 to 4 weeks after stopping the SSRI.

4.The MAOI would be started 2 to 4 weeks after stopping the SSRI.

A 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? 1.The client should not take any medications because of her liver dysfunction. 2.She should have an ultrasound of the liver to check for disease. 3.The client should have monthly evaluation of liver function to monitor the disease progression. 4.The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

4.The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

Which medications exert their effects by inhibiting reuptake of norepinephrine and serotonin? 1.Atypical antidepressants 2.Monoamine oxidase inhibitors 3.Selective serotonin reuptake inhibitors 4.Tricyclic antidepressants

4.Tricyclic antidepressants

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? 1.Butter 2.Rice 3.Milk 4.Yogurt

4.Yogurt

A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications? A client has dysphagia A client has an intense fear of injections A client has a history of pulling out her IV cannula A client actively resists IM injections

A client has dysphagia Antidepressants are almost exclusively administered in oral form not IV or IM. For clients with dysphagia, they have the potential for aspiration.

The client has been prescribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid? Herbal stimulants, caffeine, navy beans, and cheese Coffee, chocolate, organ meats, pasta, and navy beans Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans Herbal stimulants, pasta, organ meats, and egg products

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine. Normally, tyramine is deactivated in the GI tract and liver so that large amounts do not reach the systemic circulation. When deactivation is blocked by MAO inhibitors, tyramine is absorbed systemically and transported to adrenergic nerve terminals, where it causes a sudden release of large amounts of norepinephrine. Foods that should be avoided include aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans.

Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular? It is an oral drug. It doesn't have side effects. It can be taken during pregnancy. An extended release form is available.

An extended release form is available. Venlafaxine mildly blocks reuptake of NE, 5HT, and dopamine and has fewer adverse CNS 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 GI tract, extensively metabolized in the liver, and excreted in urine. Adequate studies have not been done in pregnancy and lactation, and it should be used during those times only if the benefit to the mother clearly outweighs the potential risk to the neonate. It is an oral drug, but so are most of the antidepressants It does have side effects.

The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension? Instructing the client to double the dosage until the adverse effect goes away Consulting with the physician to change the medication Asking the client to sit on the side of the bed for 1 minute before getting up Informing the client this adverse reaction should be gone in a week

Asking the client to sit on the side of the bed for 1 minute before getting up Cardiovascular effects such as orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, and stroke may also pose problems. Miscellaneous reported effects include alopecia, weight gain or loss, flushing, chills, and nasal congestion. It would not be appropriate to tell the client to double their dose or telling the client the adverse effect would go away in a week. Consulting the physician might be an appropriate thing to do, but it would not be the most appropriate response.

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 care provider promptly to advocate for a change in the medication regimen. Provide the client with increased opportunities for fluid intake. Contact the provider to obtain an order for an indwelling urinary catheter. Monitor the client's urinary function closely over the next 48 hours.

Contact the care provider promptly to advocate for a change in the medication regimen. 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.

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 Development of blood dyscrasias Dangerous drug interactions Hemostatic instability

Dangerous drug interactions 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.

An 8-year-old client has been diagnosed with enuresis. What medication does the nurse suspect the health care provider will prescribe? Amitriptyline Duloxetine Imipramine Venlafaxine

Imipramine Imipramine is approved for treating childhood enuresis in children older than 6 years. Amitriptyline is a tricyclic antidepressant but is not used for childhood enuresis. Duloxetine and venlafaxine are serotonin-norepinephrine reuptake inhibitor used for depression.

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication? SSRIs block GABA function. SSRIs prevent serotonin from being reabsorbed. SSRIs increase serotonin synthesis. SSRIs increase the number of serotonin binding sites.

SSRIs prevent serotonin from being reabsorbed. Fluoxetine and the other SSRIs block the reabsorption of the neurotransmitter serotonin in the brain. This helps elevate mood. SSRIs do not increase serotonin synthesis or the number of binding sites. They do not influence the role of GABA.

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? a. Selective serotonin reuptake inhibitor b. Monoamine oxidase inhibitor c. Tricyclic d. Benzodiazepine

Selective serotonin reuptake inhibitor SSRIs are the most commonly prescribed antidepressants, due to their effectiveness and relatively low levels of adverse effects.

Tricyclic antidepressants reduce the reuptake of serotonin and norepinephrine. True False

True

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? a. It may take up to two more weeks before the client feels better b. The drug requires six to eight weeks before it reaches peak levels c. The client's pessimism is likely a symptom of the underlying depression d. Improvements are likely evident to others even if not to the client

a. It may take up to two more weeks before the client feels better

Which food should the client avoid eating when prescribed phenelzine sulfate? a. aged Swiss cheese and bratwurst b. tortellini in cream sauce mashed potatoes and roast beef c. anise cookies and milk

a. aged Swiss cheese and bratwurst

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client the clinic reporting not feeling any better. What is the nurse's best response to this client? a. "Please come to the clinic immediately so you can be reassessed for suicidal thoughts." b. "It may take another two to three weeks before the medication is completely effective." c. "I realize this is frustrating but most medications for mood disorders aren't fully effective for two to three months." d. "I will tell the healthcare provider and see if there is another medication that would be better."

b. "It may take another two to three weeks before the medication is completely effective." 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.

When a client is started on an antidepressant, it is important for the nurse to explain to the client that it may take time to see a change in mood. How long can it take for the client to see the beneficial effects of an antidepressant? a. 2 months b. 4 weeks c. 3 days d. 6 months

b. 4 weeks

A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed? a. Desipramine b. Clomipramine c. Maprotiline d. Amoxapine

b. Clomipramine

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued? a. A monoamine oxidase (MAO) inhibitor will be prescribed concurrently with the fluoxetine for 2 to 3 weeks. b. The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. c. It will be important that the client avoid stressful situations until another selective serotonin reuptake inhibitor (SSRI) can be prescribed. d. Electroconvulsive therapy (ECT) will be prescribed 2 to 3 weeks before stopping the fluoxetine.

b. The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which? a. facial flushing. b. dizziness. c. increased secretions. d. diarrhea.

b. dizziness. The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.

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? a. decreased sleep. b. onset of suicidal ideation. c. weight loss. d. feelings of grandiosity.

b. onset of suicidal ideation. 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.

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? a. paranoia, rapid speech, and difficulty with concentration b. statements or resignation and futility and a desire to die c. reports of headaches, sleepiness, and apathy d. alternating periods of hypomania and depression

b. statements or resignation and futility and a desire to die 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.

An adult client, diagnosed with depression several weeks ago, has begun taking citalopram 10 days ago. The client has told the nurse of the intent to stop taking the drug, stating, "I don't feel any less depressed than I did before I started taking these pills." How should the nurse best respond to the client's statement? a. "It could be that one of the other medications or supplements you're taking is negating the effects of citalopram." b. "I'll pass that information along to your care provider; a different drug might be more appropriate for you." c. "I'd encourage you to continue with the drug; it can take several weeks before it improves your mood." d. "People often have unrealistic expectations about how the drug will make them feel."

c. "I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."

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? a. 2 weeks b. 1 week c. 4 weeks d. 3 weeks

c. 4 weeks

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? a. Severe headache b. Drowsiness c. Extreme sadness d. Dilated pupils

c. Extreme sadness

A client taking phenelzine (Nardil) is at a dinner party and has several glasses of red wine. The client begins to feel nauseated and develops a terrible headache. The client is taken to the nearest emergency department. This client might be experiencing a hypertensive crisis. As the nurse in the ED, what other symptoms might the client experience if they are having a hypertensive crisis? (Select all that apply.) a. Chills b. Constricted pupils c. Tachycardia d. Stiff neck e. Chest pain

c. Tachycardia d. Stiff neck e. Chest pain A client experiencing a hypertensive crisis can exhibit the following symptoms: stiff or sore neck, nausea, vomiting, headache, sweating, fever, chest pain, dilated pupils, and bradycardia or tachycardia.

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression? a. The medications eliminate the risk of suicide during treatment. b. The medications have no sexual side effects. c. The medications have fewer anticholinergic effects than alternatives. d. The onset of action is sooner than with other medications.

c. The medications have fewer anticholinergic effects than alternatives. 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 preparing a presentation about the use of antidepressants in children and adolescents. What would the nurse need to keep in mind? a. Children typically demonstrate a predictable response to the drugs. b. The majority of antidepressants approved for use in adults can be used with children. c. The smallest amount of drug that is feasible should be dispensed. d. Studies have shown a clear link between suicide and the use of antidepressants.

c. The smallest amount of drug that is feasible should be dispensed.

The nurse should prioritize which assessment when caring for a teenager who has recently been prescribed a selective serotonin reuptake inhibitor (SSRI)? a. cardiac rate and rhythm b. hypomanic state c. suicidal ideation d. venous thromboembolism (VTE)

c. suicidal ideation

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client? a. discuss the cultural significance of taking an MAOI. b. adhere to combination drug therapy. c.avoid use of soy sauce in the diet. d. avoid taking the drug on an empty stomach.

c.avoid use of soy sauce in the diet.

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse? a. A 32-year-old man who is obese b. An 11-year-old child with no other illnesses c. A 38-year-old woman who has diabetes d. A 45-year-old man with liver impairment

d. A 45-year-old man with liver impairment Caution must be used when administering sertraline in clients with compromised liver function; therefore, the client with the liver impairment would require the closest monitoring. Adjustments such as a lower dosage or less-frequent dosing schedule may need to be made for these clients because the drug is extensively metabolized by the liver. The dosing schedule need not be adjusted in children or in clients with obesity or diabetes.

When assessing a client's medication history, the use of which herb would alert the nurse to the potential for adverse reactions when taken with antidepressants? a. Ginseng b. Feverfew c. Eucalyptus d. St. John's wort

d. St. John's wort

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline? urinary frequency urinary retention visual disturbances orthostatic hypotension

orthostatic hypotension 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? cardiac rate and rhythm presence of suicidal ideation improvement in the ability to concentrate indications of a type IV hypersensitivity reaction

presence of suicidal ideation 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.

After teaching a client who is prescribed isocarboxazid, the nurse determines that additional teaching is needed when the client states a need to avoid what food? whole milk. red wine. sausage. Parmesan cheese

whole milk. Whole milk is not high in tyramine and thus does not need to be avoided during treatment with an MAOI. Red wine, sausage, and aged cheeses are high in tyramine and should be avoided.