Antidepressant Agents; Chapter 21
A severely depressed 14-year-old client who is receiving inpatient care
The psychiatric-mental health nurse is overseeing care of several clients who are being treated with selective serotonin reuptake inhibitors. Which client should the nurse monitor most closely for adverse effects?
"There may be an increased risk of suicide while taking this drug."
A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching?
Monitor the client closely for bleeding and review coagulation indices when available
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?
Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans
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?
orthostatic hypotension
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?
"Have you been feeling anxious lately?"
What assessment question should the nurse ask a client whose original selective serotonin reuptake inhibitor (SSRI) has been replaced with venlafaxine to best determine the reason for the change?
"Use sugarless hard candies and gum to deal with dry mouth."
What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?
imipramine
What medication is effective in treating enuresis in children older than 6 years of age?
Vital signs assessment Presence of suicidal ideation Complete medical history Weight Mental status assessment
What should the nurse's pre-administration assessment for a client receiving an antidepressant include? (Select all that apply.)
Painful continued erection
Which adverse effects would the nurse instruct a client to report to the health care provider immediately when taking trazodone?
Fluvoxamine
Which agent would a nurse identify as a selective serotonin reuptake inhibitor?
increased alanine aminotransferase level (ALT)
Which laboratory value would prevent a client from being prescribed duloxetine?
sexual dysfunction
Which side effect of fluoxetine is most commonly the cause for poor client adherence?
SSRIs prevent serotonin from being reabsorbed.
A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?
Selective serotonin reuptake inhibitors
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?
Hypertensive crisis
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?
dizziness
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?
"Most people don't experience severe side effects with this drug, but it may have an effect on your sexual functioning."
A 33-year-old woman has been diagnosed with major depression and has recently begun treatment with citalopram (Celexa). What teaching point should the nurse emphasize when providing health education for this patient?
"Have you felt hopeless anytime lately?"
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?
Question the prescriber about the dose
A client has been diagnosed with depression and prescribed fluoxetine (Prozac) 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription?
"Are you still taking your medication consistently?" Discontinuation of a TCA can cause a withdrawal syndrome characterized by nausea, headache, vertigo, malaise and nightmares. An increase in dose would exacerbate adverse effects but would not cause this syndrome. The nurse should assess the client's mood in the context of the overall treatment for depression but this is unlikely to relate to these specific physiological issues. Blood levels of TCA are not normally drawn.
A client has been taking amitriptyline for the treatment of depression for several months. The client has been experiencing significant anticholinergic effects and has now presented to the emergency department reporting recent nausea, vomiting, dizziness and malaise. What assessment question should the nurse prioritize?
It may take up to two more weeks before the client feels better
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 another two to three weeks before the medication is completely effective."
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?
"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits."
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?
"You may have to take this drug for a few more days before you feel its effects."
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?
"Place the patch on dry skin on your torso that has no cuts or openings."
A client is prescribed transdermal selegiline. What health education should the nurse provide?
The MAOI would be started 2 to 4 weeks after stopping the SSRI
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?
Clomipramine
A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed?
4 weeks
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?
Recent MI
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?
Assessment of the client's behaviors and thought processes
A client on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone (Risperdal). What assessment should the nurse prioritize in the care of this client?
dangerous drug interactions
A client prescribed a selective serotonin reuptake inhibitor (SSRI) has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?
anxiety insomnia nervousness
A client recently started on fluoxetine for the treatment of depression asks the nurse ask if there are any side effects to be aware of. The nurse should inform the client to be alert for what adverse effect? Select all that apply.
In 4 to 6 weeks after stopping the paroxetine
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?
bleeding
A client with a history of coronary artery disease has been diagnosed with depression and has been prescribed escitalopram 10 mg PO daily. The client's current drug regimen includes clopidogrel. The nurse recognizes that this combination creates a need to monitor the client closely for signs of:
blood pressure monitoring (MAOIs + antihistamines = r/o hypertensive crisis)
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?
"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."
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?
Risk for injury related to adverse drug effects
A client with major depression has not experienced an improvement after treatment with SSRIs and electroconvulsive therapy. Consequently, the provider has prescribed isocarboxazid. When planning this client's care, what nursing diagnosis should the nurse prioritize?
presence of suicidal ideation
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?
A client who began taking escitalopram two weeks ago says her mood has worsened since starting the 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?
The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects
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?
Phenelzine
A group of students are reviewing information about antidepressants that inhibit the activity of monoamine oxidase, leading to increase in epinephrine, norepinephrine, dopamine, and serotonin. The students demonstrate understanding when they identify which drug as acting in this manner?
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.
A lower dose of the antidepressant
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
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?
"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."
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?
sexual dysfunction, insomnia, somnolence, diarrhea, constipation
A nurse caring for a client starting treatment with paroxetine (Paxil) should be educated on which adverse effects? (Select all that apply.)
Blue cheese Pepperoni Chocolate
A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid which foods? (Select all that apply.)
Hypertension
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?
Yogurt
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?
Decreased reuptake of norepinephrine
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?
extreme sadness
A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?
A client has dysphagia
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?
avoid use of soy sauce in the diet
A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?
Clients with cardiac disease Elderly clients
A nurse should be cautious when administering amitriptyline (Elavil) to which clients? (Select all that apply.)
whole milk
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?
"I can apply a new patch to my upper arm, thigh, or torso."
After teaching a client who is to receive transdermal selegiline, which client statement would indicate to the nurse that the client has understood the instructions?
suicidal ideation
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?
Orthostatic hypotension
An elderly patient is admitted to the medical division after a fall. At home he is taking amitriptyline (Elavil) 25 mg three times per day. What adverse effect could be related to the patient's fall?
Tricyclic antidepressants
Anticholinergic effects such as dry mouth, sedation, and urinary retention are common adverse events occurring with the use of which classes of antidepressants?
Enuresis
Besides being prescribed as an antidepressant, imipramine helps treat which disorder in children?
Selective serotonin reuptake inhibitor
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?
14 days
How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)?
A 45-year-old man with liver impairment (avoid SSRI in liver impairment)
Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?
A 45-year-old man with angina pectoris
The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?
Contact the care provider promptly to advocate for a change in the medication regimen
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?
Phenelzine (Nardil)
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?
Blood pressure, ECG, and plasma drug levels
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?
"How would you describe your mood and energy level today?"
The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize?
Cognition and level of consciousness
The nurse is providing care for a client who has been prescribed trazodone for the treatment of depression. What assessment should the nurse prioritize?
A client who is taking phenelzine (Nardil)
The nurse is providing care on an inpatient psychiatric unit. Which adult client should the nurse monitor most closely for signs of adverse drug effects?
Hypoglycemia
The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI?
increasing levels of both serotonin and norepinephrine
The psychiatric nurse would recognize that venlafaxine's therapeutic effect is achieved by what means?
The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.
To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?
The medications have fewer anticholinergic effects than alternatives
Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?
