Chapter 22 pharmacology
The client has been depressed since the client's father died 6 months ago and the health care provider has prescribed amitriptyline. What aspect of this client's health history should prompt the nurse to contact the health care provider?
Ischemic heart disease
The nurse is caring for a young female client who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate?
"Antidepressants are used very cautiously during pregnancy and only when benefit outweighs risk."
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 severely depressed 14-year-old client who is receiving inpatient care
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?
Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans
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?
"It may take another two to three weeks before the medication is completely effective."
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 liver impairment
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 nurse is preparing to administer selective serotonin reuptake inhibitors (SSRIs) to a group of clients. The nurse would administer the drug cautiously to which clients?
Clients with diabetes mellitus
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.
The nurse is caring for an 8-year-old client who takes imipramine. The nurse should assess this child for a history of which health problem?
enuresis (bed-wetting)
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?
onset of suicidal ideation.
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
A client comes to the mental health clinic for a regular appointment. The client tells the nurse he has been taking oral fluoxetine 20 mg daily for the past 3 weeks and that he has lost 3 lbs during that time due to a loss of appetite. What action should the nurse take?
reassuring the client that this is a common adverse effect with this medication
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
The health care provider would not prescribe duloxetine (Cymbalta) for a client with a mood disorder if the client took which other medication?
A medication for hypertension
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?
Asking the client to sit on the side of the bed for 1 minute before getting up
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
A client is admitted to the nursing unit with OCD. What drug has been found to be effective for treating OCD?
Fluvoxamine
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 is admitting a client who has a possible diagnosis of mood disorder. The nurse assesses the client for symptoms of what medical condition that may be mistaken for a mood disorder?
Hypothyroidism
An 11-year-old client has been hospitalized on the adolescent psychiatry unit with severe depression. For the past several weeks, the client has been prescribed a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action?
Implement suicide precautions.
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.
A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?
SSRIs prevent serotonin from being reabsorbed.
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 nurse is caring for a client with suicidal tendencies and severe depression. Which would the nurse be alert for when monitoring the client's condition?
Signs of insomnia
A client receives a new prescription for fluvoxamine. What is important for the nurse to teach the client about taking the medication?
The medication should be taken once a day before bedtime.
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 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 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?
dangerous drug interactions
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
The nurse is teaching a client taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the client understands a low tyramine diet when what meal is chosen?
hamburger, French fries, and a strawberry milkshake
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 middle-aged client was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, the client was prescribed phenelzine. When planning this client's subsequent care, what nursing diagnosis should the nurse prioritize?
Risk for Injury related to drug-drug interactions or drug-nutrient interactions
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?
"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits."
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."
A 28-year-old client asks his nurse how phenelzine therapy will help him. Which would be an appropriate response by the nurse?
"This therapy will improve your overall mood and increase your social activity."
A male client explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to paroxetine (Paxil). The client is confused and doesn't understand why the medication was changed. The nurse's best response to the client would be:
"Would you like to talk with your physician about this?"
What drug should the nurse consider contraindicated for the client taking a monoamine oxidase inhibitor (MAOI)?
escitalopram
A client while experiencing depression is reluctant to start on antidepressant medication. What information should be the basis for the nurse's best response?
Antidepressant therapy may be indicated if depressive symptoms impair social relationships or work performance and occur independently of life events.
A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed?
Clomipramine
An older adult was diagnosed with depression several decades ago and has been taking tricyclic antidepressants (TCAs) ever since, with good effect. The nurse should recognize what therapeutic action of this client's medication?
inhibiting reuptake of norepinephrine and serotonin
