Antidepressant Agents
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?
"Have you felt hopeless anytime lately?"
When teaching a patient on an MAO inhibitor, what would be important to include in the teaching?
Do not take OTC drugs.
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?
dizziness.
A client's depression has not responded to conservative treatment so the provider has prescribed phenelzine 15 mg PO t.i.d. What dietary guidelines should the nurse provide to the client? (Select all that apply.)
"Don't eat types of cheese that have been aged." "In general, avoid any type of food or drink that's been fermented." "Most meats that have been smoked would be unsafe for you."
A client reports that the selective serotonin reuptake inhibitor (SSRI) prescribed originally has been replaced with venlafaxine. What assessment question should the nurse ask the client to best determine the reason for the change?
"Have you been feeling anxious lately?"
An adult client, diagnosed with depression several weeks ago, began 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?
"I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."
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?
"Most people don't experience severe side effects with this drug, but it may have an effect on your sexual functioning."
A client is prescribed transdermal selegiline. What health education should the nurse provide?
"Place the patch on dry skin on your torso that has no cuts or openings."
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?
"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."
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?
"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?
"Use sugarless hard candies and gum to deal with dry mouth."
How long does a patient need to wait after stopping a phenelzine before starting paroxetine?
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?
4 weeks
The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?
A 45-year-old man with angina pectoris
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 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 began taking escitalopram two weeks ago says her mood has worsened since starting the drug
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?
A lower dose of the antidepressant
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?
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?
An extended release form is available.
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?
Assessment of the client's behaviors and thought processes
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?
Blood pressure monitoring
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
A nurse educating a client starting phenelzine should educate the client to avoid which foods? (Select all that apply.)
Blue cheese Pepperoni Chocolate
A client taking phenelzine 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.)
Chest pain Tachycardia Stiff neck
A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed?
Clomipramine
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.
Clomipramine
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
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.
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?
Dangerous drug interactions
A nurse is caring for a patient with depression. The patient has been prescribed amitriptyline, a tricyclic antidepressant. What should the nurse identify as the effect of this antidepressant on the patient's body?
Decreased reuptake of norepinephrine
A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?
Dry mouth
Besides being prescribed as an antidepressant, imipramine helps treat which disorder in children?
Enuresis
A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?
Extreme sadness
Which agent would a nurse identify as a selective serotonin reuptake inhibitor?
Fluvoxamine
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?
Hypertension
A client has been prescribed a monoamine oxidase inhibitor (MAOI) by the health care provider. Before administration of the drug, the client wants to know about possible adverse reactions. Which would the nurse expect to describe?
Hypertensive crisis
The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI?
Hypoglycemia
The psychiatric nurse would recognize that venlafaxine's therapeutic effect is achieved by what means?
Increasing levels of both serotonin and norepinephrine
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?
It may take up to two more weeks before the client feels better
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?
Monitor the client closely for bleeding and review coagulation indices when available.
The emergence of psychotropic medications has given us the ability to target specific actions in the brain as treatment for mental illness. What psychotropic medication is an MAO inhibitor?
Nardil
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?
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
A client has been diagnosed with depression and prescribed fluoxetine 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription?
Question the prescriber about the dose
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
A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?
Salami
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?
Selective serotonin reuptake inhibitor
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?
Selective serotonin reuptake inhibitors
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?
Serotonin
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?
Several weeks after stopping the paroxetine
To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?
The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.
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?
The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.
A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication?
The medication should be taken once a day in the morning.
What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?
They may cause dangerous interactions with some foods and drugs.
A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?
Venlafaxine
What should the nurse's pre-administration assessment for a client receiving an antidepressant include? (Select all that apply.)
Vital signs assessment Presence of suicidal ideation Complete medical history Weight Mental status assessment
The nurse is caring for a group of clients in a long-term care facility. The nurse is aware that SSRIs are associated with what side effect that is especially undesirable in older adults?
Weight loss
What statement should the nurse rely upon to describe to a client the general characteristic associated with antidepressant therapy? Select all that apply.
While all of these drugs are effective in relieving depression, the drugs differ in adverse effects. These drugs are metabolized by the body's cytochrome P450 enzymes. Antidepressants are commonly administrated by the oral route.
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?
Yogurt
The psychiatric-mental health nurse is providing care for several clients. Which client should the nurse monitor most closely for adverse medication effects?
a client who has depression and who began taking phenelzine 15 mg PO t.i.d. last month
A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?
avoid use of soy sauce in the diet.
A client's mood, concentration and energy level have been declining for several months and the client has been diagnosed with depression. The provider has prescribed fluoxetine 200 mg PO daily, to be taken each morning. Before providing education about this prescription to the client, the nurse should:
contact the provider to question the dose.
A client being treated for schizophrenia with a traditional antipsychotic medication is taking an herbal preparation for arthritis. The client buys the herbal remedy at the local retail store. Which herbal medication should the nurse caution the client about taking for arthritic pain?
evening primrose
Which laboratory value would prevent a client from being prescribed duloxetine?
increased alanine aminotransferase level (ALT)
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?
orthostatic hypotension
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
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.
