Ch 21 PrepUs: Antidepressant Agents

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression? 1.The medications eliminate the risk of suicide during treatment. 2.The medications have fewer anticholinergic effects than alternatives. 3.The medications have no sexual side effects. 4.The onset of action is sooner than with other medications.

2.The medications have fewer anticholinergic effects than alternatives.

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

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? 1.Dilated pupils 2.Severe headache 3.Drowsiness 4.Extreme sadness

4.Extreme sadness

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."

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

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse? 1.A 45-year-old man with liver impairment 2.A 38-year-old woman who has diabetes 3.An 11-year-old child with no other illnesses 4.A 32-year-old man who is obese

1.A 45-year-old man with liver impairment (avoid SSRI in liver impairment)

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? 1.It may take up to two more weeks before the client feels better 2.The client's pessimism is likely a symptom of the underlying depression 3.The drug requires six to eight weeks before it reaches peak levels 4.Improvements are likely evident to others even if not to the client

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

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? 1.St. John's wort 2.Feverfew 3.Eucalyptus 4.Ginseng

1.St. John's wort

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.

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

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? 1.paranoia, rapid speech, and difficulty with concentration 2.statements or resignation and futility and a desire to die 3.alternating periods of hypomania and depression 4.reports of headaches, sleepiness, and apathy

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

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

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

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

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? 1.Monoamine oxidase inhibitor 2.Tricyclic 3.Selective serotonin reuptake inhibitor 4.Benzodiazepine

3.Selective serotonin reuptake inhibitor

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.) 1.Constricted pupils 2.Chills 3.Stiff neck 4.Chest pain 5.Tachycardia

3.Stiff neck 4.Chest pain 5.Tachycardia

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client? 1.avoid taking the drug on an empty stomach. 2.adhere to combination drug therapy. 3.avoid use of soy sauce in the diet. 4.discuss the cultural significance of taking an MAOI.

3.avoid use of soy sauce in the diet.

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 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 1 week 3 weeks 2 weeks

4 weeks

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."

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

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

True