NCLEX Unit 7
Adverse Effects of Tricyclic Antidepressants
- Anticholinergic effects: dry mouth, difficulty voiding, dilated pupils and blurred vision, constipation - Photosensitivity - Cardia disturbances - Sedation - Weight gain
Tricyclic Antidepressants
- Block the reuptake of norepinephrine and serotonin and used to treat depression - May reduce effectiveness of antihypertensive agents - Concurrent use with MAOIs can cause hypertensive crisis - Concurrent use with alcohol or antihistamines can cause CNS depression
Monoamine Oxidase Inhibitors (MAOIs)
- Can cause hypertensive crisis - Used for patients with depression if other classes of medications do not work
Adverse Effects of SSRIs
- Dry mouth - CNS stimulation - Increased sweating - Blood pressure changes - Photosensitivity - Weight loss or gain - Decreased libido
Lithium Toxicity
- Occurs when ingested lithium cannot be detoxified and excreted by the kidneys - Symptoms begin to appear when the serum lithium level is 1.5 to 2. - Mild toxicity: lethargy, slight muscle weakness, diminished concentration - Moderate toxicity: nausea, vomiting, slurred speech, muscle twitching, blurred vision Severe toxicity: hallucinations, anuria, impaired level of consciousness
Selective Serotonin Reuptake Inhibitors (SSRIs)
-Inhibit serotonin uptake and elicit an antidepressant response - The potential for medication interactions with herbal therapies (especially St. John's wort)
The nurse is assigned to care for a client experiencing disturbed thought processes. The nurse is told that the client believes that the food is being poisoned. Which communication technique should the nurse plan to use to encourage the client to eat? 1. Open-ended questions and silence 2. Focusing on self-disclosure regarding food preferences 3. Stating the reasons that the client may not want to eat 4. Offering opinions about the necessity of adequate nutrition
1. Open-ended questions and silence
When teaching a client who is being started on imipramine hydrochloride (Tofranil), when should the nurse tell the client that the medication should have the desired effects? 1. Desired effects start during the first week of administration. 2. Desired effects do not occur for 2 to 3 weeks of administration. 3. Desired effects start immediately following initial administration. 4. Desired effects do not occur until after 2 months of administration.
2. Desired effects do not occur for 2 to 3 weeks of administration.
A client is taking a monoamine oxidase (MAO) inhibitor. The nurse plans care, knowing which information? 1. This classification of medications increases the amount of MAO in the liver. 2. Hypotensive crisis may be precipitated by foods that contain tyramine and tryptophan. 3. Symptomatology of drug toxicity includes headache, hypertension, and nausea and vomiting. 4. Increased salivation, bradycardia, constipation, and mild insomnia are expected side effects.
3. Symptomatology of drug toxicity includes headache, hypertension, and nausea and vomiting.
A client with lung cancer says to the nurse, "I'm sick and tired of my family telling me not to worry and that a cure will be discovered before I know it." Which response by the nurse is therapeutic? 1. "Have you told your family how you feel?" 2. "They are right. You shouldn't be so worried." 3. "You certainly have enough to worry about right now." 4. "You're feeling angry that your family is hoping for a cure?"
4. "You're feeling angry that your family is hoping for a cure?"
A client diagnosed with depression is starting therapy with imipramine hydrochloride (Tofranil). The nurse is concerned that the client will not comply with the medication regimen. To encourage the client to continue taking the medication, the nurse tells the client that it is normal not to feel beneficial effects of the medication for which amount of time? 1. 3 to 5 days 2. 5 to 7 days 3. 1 to 2 weeks 4. 2 to 3 weeks
4. 2 to 3 weeks
A client who is on lithium carbonate (Lithobid) will be discharged at the end of the week. In reinforcing a discharge teaching plan, the nurse should include which instructions? 1. Avoid soy sauce, wine, and aged cheese. 2. Have the lithium level checked every week. 3. Take medication only as prescribed because it can become addicting. 4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.
4. Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications.
Delusions
A fixed belief that is not shared by others in the person's cultural background and that can't be changed by reasonable argument (false belief).
Hallucination
A sense perception not founded on objective reality (false perception).
Panic attack
Acute episode that may or may not be prompted by a stressful situation.
Positive behavior
Added behaviors that don't normally exist with the individual, talking to themselves, compulsive, hallucinations, echolalia.
Mania
Alert but distracted, feeling of being "on top of the world", insomnia, may resist treatment because they don't think anything is wrong.
Bipolar disorder
Alternating between manic and depressive states.
Mood disorders
Depression, mania, bipolar
Schizophrenia
Disorganized behavior and speech, delusions and/or hallucinations (visual or auditory).
Anxiety
Dominate mood is fear and apprehension. Can lead to a panic attack.
Tricyclic antidepressants - list them Indications/MOA
Doxepine Amitriptyline Desipramine clomipramine imipramine nortriptyline amoxapine GAD, Bulimia, & PTSD Inhibits the reuptake of both Serotonin & norepinephrine
Neurotic Disorder
General anxiety or panic attack; SOB, palpitations, sweating, GI symptoms, dizziness, chest discomfort, choking feeling, carpal spams, trembling, detached feeling.
Depression
Leading cause of disability for ages 15-44 years old. Can be acute, chronic or have reoccurring thoughts of suicide.
Negative behavior
Missing behavior that the patient would normally have, mutism, flat affect, lack of hygiene, poor house keeping.
Disorganized behavior
Pacing, screaming, agitation, compulsion, restless, stereotyped movements.
