ch21: antidepressants

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?" "Have you felt hopeless anytime lately?" "Why are you feeling sad?" "What have you eaten in the last two days?"

"Have you felt hopeless anytime lately?" 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.

A nurse educating a client starting phenelzine should educate the client to avoid which foods? (Select all that apply.) Apples Pepperoni Blue cheese Chocolate Celery

Pepperoni Blue cheese Chocolate A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid containing tyramine (aged cheese, sour cream, yogurt, beef, chicken livers, pickled herring, fermented meat, undistilled alcoholic beverages, caffeinated beverages, chocolate, certain fruits and vegetables, yeast extract, and soy sauce) as the combination can result in a life-threatening hypertensive crisis.

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: renal failure. jaundice. cerebral ischemia. bleeding.

bleeding Concurrent use of SSRIs and antiplatelet medications creates a risk for bleeding. The client's risks of cerebral ischemia, renal failure or jaundice are not likely increased to the same degree.

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?" "How long have you been taking the SSRI?" "Are you feeling more comfortable in social situations now?" "Were you finding it difficult to adhere to your SSRI therapy?"

"Have you been feeling anxious lately?" Venlafaxine is a standard first-line treatment for depression as well as generalized anxiety disorder, social phobia, and panic disorder. It would be prescribed if the client was now expressing anxiety in addition to depression. The medication would not be prescribed if progress was being made with social phobias. Questions about SSRI therapy would not be relevant.

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 would you describe your mood and energy level today?" "On a scale from zero to ten, how would you rate your anxiety level?" "How are you feeling today?" "Are you feeling happier today than in the past?"

"How would you describe your mood and energy level today?" 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 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? "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." "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."

"Most people don't experience severe side effects with this drug, but it may have an effect on your sexual functioning." 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.s

A client is prescribed transdermal selegiline. What health education should the nurse provide? "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." "Gently massage the area after you put a new patch on your skin." "Put the patch on the back of your hand where you'll be reminded of it."

"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.

The nurse is caring for a client who is prescribed a tricyclic antidepressant for depression. Which teaching will the nurse provide to the client about this medication? Select all that apply. "A skin rash is a common side effect." "Report urinary retention." "Call the health care provider if you experience confusion." "Take the medication at bedtime." "Expect to develop an irregular heartbeat."

"Report urinary retention." "Call the health care provider if you experience confusion." "Take the medication at bedtime." Tricyclic antidepressants are the oldest antidepressants and are the second-line drugs for the treatment of depression. Teaching for tricycle antidepressants includes reporting urinary retention, as this could indicate a potentially serious adverse drug effect. The medication should be taken at bedtime to aid with sleep and to decrease adverse effects. Confusion is not expected and should be reported to the health care provider. A skin rash is not an adverse effect of tricyclic antidepressant, but is an adverse effect of selective serotonin reuptake inhibitors. An irregular heartbeat is an adverse effect that needs to be reported to the health care provider.

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 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." "The medication will decrease only your visible symptoms of depression." "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." 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 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." "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." "Most experts agree that St. John's wort is effective in treating depression but that it can contribute to hypertension."

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

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? 1 week 3 weeks 4 weeks 2 weeks

4 weeks It may take up to 4 weeks before the full effect of an SSRI is noted.

The nurse at an outpatient mental health unit is reviewing the black box warning that applies to clients who are taking antidepressants. To which of the nurse's clients would the black box warning apply? A client who once experienced an anaphylactic reaction to a blood transfusion A 33 year-old female client who has been diagnosed with post-partum depression A 14 year-old client who has been diagnosed with major depression A depressed client who is in the second trimester of pregnancy

A 14 year-old client who has been diagnosed with major depression In 2006, a black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. This warning does not apply to adults.

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 20-year-old woman with renal dysfunction A 44-year-old woman with a seizure disorder A 19-year-old man with organic brain disease

A 45-year-old man with angina pectoris Patients with cardiovascular disease are especially sensitive to the potential cardiotoxicity of nortriptyline and need to be monitored closely. Patients with a history of seizure activity, organic brain disease, and renal dysfunction do not face as high a risk of cardiotoxicity as patients with a preexisting cardiovascular disease.

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 a history of pulling out her IV cannula A client has dysphagia A client actively resists IM injections A client has an intense fear of 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.

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 taking isocarboxazid with whom the nurse needed to review dietary restrictions 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 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.

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? A 79-year-old client who has a comorbidity of early stage dementia A 60-year-old female client who is also taking hormone replacement therapy A severely depressed 14-year-old client who is receiving inpatient care A client whose treatment regimen also includes electroconvulsive therapy (ECT)

A severely depressed 14-year-old client who is receiving inpatient care The use of SSRIs in adolescents requires caution and careful monitoring due to the increased risk for suicidality. Dementia greatly complicates the overall treatment of a client with dementia, but it does not necessarily increase the risk for adverse drug effects. Similarly, ECT and hormone therapy do not increase the likelihood of adverse effects.

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 Herbal stimulants, pasta, organ meats, and egg products 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 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 doesn't have side effects. It can be taken during pregnancy. An extended release form is available. It is an oral drug.

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.

What statement should the nurse rely upon to describe to a client the general characteristic associated with antidepressant therapy? Select all that apply. Antidepressants are commonly administrated by the oral route. It may take 10 days to 2 weeks before depressive symptoms improve. 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. The metabolism of antidepressants is facilitated by the kidneys.

Antidepressants are commonly administrated by the oral route. 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 metabolized by the cytochrome P450 enzymes in the liver. They are administered orally and have differing adverse effects. Two to four weeks are usually necessary for the relief of symptoms.

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? Hemoglobin and hematocrit and plasma drug levels Chest x-ray and plasma drug levels CBC and chemistry panel and plasma drug levels Blood pressure, ECG, and plasma drug levels

Blood pressure, ECG, and plasma drug levels 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 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 Amoxapine Clomipramine Desipramine

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

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. 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.

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.

cWhen teaching a patient on an MAO inhibitor, what would be important to include in the teaching? Do not take OTC drugs. Report double vision right away. Drink lots of fluid. Take at bedtime.

Do not take OTC drugs. MAO inhibitors can cause drug-drug and drug-food interactions, which can cause cardiovascular effects that can include orthostatic hypotension, arrhythmias, palpitations, angina, and the potentially fatal hypertensive crisis. When taking an MAO inhibitor, you would not necessarily take the drug at bedtime or drink lots of fluid. Blurred vision is an adverse effect of the MAO inhibitor.

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 Decreased B/P Hypertension Fever

Dry mouth Use of TCAs may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea.

Besides being prescribed as an antidepressant, imipramine helps treat which disorder in children? Weight loss Enuresis Night terrors Attention deficit hyperactivity disorder

Enuresis Besides being prescribed as an antidepressant, imipramine is used to treat enuresis in children older than age 6.

The nurse is preparing a client for discharge who is taking phenelzine. The nurse instructs the client that which foods cause serious complications? (Select all that apply.) Fava beans Shrimp Rice American cheese Deer meat

Fava beans Shrimp Deer meat Clients who are taking phenelzine must avoid certain foods to prevent serious complications. The client must avoid game meats, soy products, sesame seeds, brewers yeast, sauerkraut, seafood, aged cheeses and meats, and fava beans.

A client is admitted to the nursing unit with OCD. What drug has been found to be effective for treating OCD? Fluvoxamine Phenelzine Amitriptyline Desipramine

Fluvoxamine SSRIs are indicated for the treatment of depression, OCDs, panic attacks, bulimia, PMDD, posttraumatic stress disorders, social phobias, and social anxiety disorders. Phenelzine, desipramine, and amitriptyline are not SSRIs.

The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI? Renal dysfunction Diabetic ketoacidosis Hypoglycemia Orthostatic hypotension

Hypoglycemia 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.

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

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 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? 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 The client's pessimism is likely a symptom of the underlying depression The drug requires six to eight weeks before it reaches peak levels

It may take up to two more weeks before the client feels better 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? Ask the client at each meal about any episodes of gastresophageal reflux. Monitor the client for tetany and review serum calcium levels when available. Assess the client's blood pressure every six hours for the first week of therapy. Monitor the client closely for bleeding and review coagulation indices when available.

Monitor the client closely for bleeding and review coagulation indices when available. 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.

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? Urinary retention related to anticholinergic effects Insomnia related to CNS stimulation Risk for injury related to adverse drug effects Risk for imbalanced nutrition (less than body requirements) related to dietary restrictions

Risk for injury related to adverse drug effects. MAOIs such as isocarboxazid have a very high risk for injury because of the serious and diverse adverse effects. MAOIs do not typically cause anticholinergic effects. Insomnia is a possibility but less of a safety risk than many other adverse effects. Dietary modifications are necessary but these do not normally threaten the client's nutritional status because prohibited foods are not the staples of most individuals' diets.

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? Concurrently with the paroxetine as it is being tapered Forty-eight hours after being weaned from the paroxetine Several weeks after stopping the paroxetine Immediately upon stopping the paroxetine.

Several 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 2 weeks and up to 6 weeks should be allowed between the use of the two drugs when switching from one to the other.

When providing medication information to a client prescribed a serotonin and norepinephrine reuptake inhibitor (SNRI), what herbal supplement should the client be cautioned to avoid? primrose St. John's wort valerian ginseng

St. John's wort Clients being treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are at an increased risk of developing a severe reaction, including serotonin syndrome, as well as increased sensitivity to light if they are also taking St. John's wort. Because this herbal therapy is often used to self-treat depression, it is important to forewarn any client who is taking an SSRI not to combine it with taking St. John's wort. Also caution clients that there is an increased risk of seizures if evening primrose is used with antidepressants. Interactions, not necessarily serotonin syndrome, have also been reported when antidepressants are combined with ginkgo, ginseng, and valerian.

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued? A monoamine oxidase (MAO) inhibitor will be prescribed concurrently with the fluoxetine for 2 to 3 weeks. It will be important that the client avoid stressful situations until another selective serotonin reuptake inhibitor (SSRI) can be prescribed. 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. 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.

A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication? The dosage may need to be increased if they are not feeling better in 2 weeks. It needs to be taken with 8 ounces of liquid. The medication should be taken once a day in the morning. The dosage cannot be divided.

The medication should be taken once a day in the morning. A selective serotonin reuptake inhibitor should be taken once a day in the morning unless the dosage is increased or the patient is having severe GI effects. The medication will not require 8 ounces of fluid for absorption and it should be taken for at least 4 weeks before a therapeutic effect is noted.

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

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 patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed? Mirtazapine Selegiline Nefazodone Venlafaxine

Venlafaxine Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, as treatment for social anxiety disorder, and to help decrease addictive behaviors. Nefazodone is used to treat depression. Mirtazapine is used to treat depression. Selegiline is used to treat depression.

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 Butter Milk Rice

Yogurt 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 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. avoid taking the drug on an empty stomach. adhere to combination drug therapy. discuss the cultural significance of taking an MAOI.

avoid use of soy sauce in the diet. 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.

Which laboratory value would prevent a client from being prescribed duloxetine? decreased hemoglobin level decreased potassium level increased alanine aminotransferase level (ALT) increased erythrocyte sedimentation rate (ESR)

increased alanine aminotransferase level (ALT) Duloxetine is highly protein bound, extensively metabolized by CYP2D6 and CYP1A2 enzymes in the liver, and excreted by the kidneys. It is not recommended for use in clients with severe renal or any degree of liver impairment indicated by an increased ALT result. Low hemoglobin, elevated potassium, and increased ESR do not necessarily preclude the use of duloxetine.

The nurse is caring for a 12-year-old client diagnosed with depression. Which category of medication would the nurse question before giving to this client? serotonin norepinephrine inhibitor (SNRI) selective serotonin reuptake inhibitor (SSRI) tricyclic antidepressant (TCA) monoamine oxidase inhibitor (MAOI)

monoamine oxidase inhibitor (MAOI) The use of antidepressant drugs in children is challenging; however, monoamine oxidase inhibitors (MAOIs) should be avoided in children if possible because of the potential for drug-food interactions and the serious adverse effects. For some tricyclic antidepressants (TCAs), there are specific doses identified for children over the age of 6 years. The selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine inhibitors (SNRIs) can cause serious adverse effects in children; however, these medications are considered first line for pediatric clients.

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 cardiac rate and rhythm indications of a type IV hypersensitivity reaction improvement in the ability to concentrate

presence of suicidal ideation 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.