Pharm Chapter 21 - Antidepressant Agents
A
Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What tricyclic antidepressant is now approved by the Food and Drug Administration to treat OCD? A) Clomipramine B) Imipramine C) Nortriptyline D) Amitriptyline
B
A 10-year-old patient is being seen by a physician for severe depression. The physician prescribes an antidepressant. What antidepressant could the nurse safely administer to a child? A) Trazodone B) Nortriptyline C) Fluvoxamine D) Phenelzine
D
A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient? A) Monitor food intake for levels of tyramine. B) Assess for weight loss and difficulty sleeping. C) Monitor the patient for severe headaches. D) Implement suicide precautions.
d
A 30-year-old client is taking phenelzine 30mg PO t.i.d. The nurse knows that at that dosage, the client will need to be carefully monitored for which? a. facial flushing. b. diarrhea. c. increased secretions. d. dizziness.
A
A 75-year-old male patient is brought to the emergency department by his family because he is talking to people who aren't there. During the initial admission assessment, his daughter mentions that her mother died 4 months ago and Dad just hasn't been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication. What would the nurse suspect is happening to this patient? A) The patient is having hallucinations as an adverse effect of his antidepressant medication. B) The mental status change is due to the patient's age. C) The patient probably has a urinary tract infection. D) The patient is having delusions because of his depression over the loss of his wife.
b
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? a. paranoia, rapid speech, and difficulty with concentration b. statements or resignation and futility and a desire to die c. alternating periods of hypomania and depression d. reports of headaches, sleepiness, and apathy
b
A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating? a. Leafy greens b. Salami c. Apples d. Ice cream
b
A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication? a. SSRIs block GABA function. b. SSRIs prevent serotonin from being reabsorbed. c. SSRIs increase serotonin synthesis. d. SSRIs increase the number of serotonin binding sites.
a
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? a. "Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." b. "This is very good timing for you, but remember that you might have some side effects, especially for the first couple of weeks." c. "Antidepressants help relieve the lack of energy and concentration during depression but your mood might not be affected." d. "You'll likely be feeling significantly better by the weekend, but remember to avoid drinking alcohol at the wedding."
a
A client is prescribed a tricyclic antidepressant. The nurse would anticipate administering this drug by which route? a. Oral b. Topical c. Intramuscular d. Intravenous
a
A client is prescribed transdermal selegiline. What health education should the nurse provide? a. "Place the patch on dry skin on your torso that has no cuts or openings." b. "Put the patch on the back of your hand where you'll be reminded of it." c. "Leave the old patch in place for no more than one hour after placing a new one." d. "Gently massage the area after you put a new patch on your skin."
d
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? a. 1 week b. 2 weeks c. 3 weeks d. 4 weeks
c
A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction? a. Worsened symptoms of depression b. Development of blood dyscrasias c. Dangerous drug interactions d. Hemostatic instability
b
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? a. cardiac rate and rhythm b. presence of suicidal ideation c. improvement in the ability to concentrate d. indications of a type IV hypersensitivity reaction
d
A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired? a. Acetylcholine b. Epinephrine c. Insulin d. Serotonin
a, c, d
A client reports that he thinks he is taking an antidepressant, but he is not sure. In reviewing his medication history, which drugs would be considered antidepressants? a. Tetracyclic drugs b. Cholinergics c. SSRIs d. MAOIs e. Angiotensin II receptor blockers f. Benzodiazepine
b
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? a. Concurrently with the paroxetine as it is being tapered b. Several weeks after stopping the paroxetine c. Immediately upon stopping the paroxetine. d. Forty-eight hours after being weaned from the paroxetine
d
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? a. Fever b. Hypertension c. Decreased B/P d. Dry mouth
b
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? a. She should have an ultrasound of the liver to check for disease. b. The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. c. The client should have monthly evaluation of liver function to monitor the disease progression. d. The client should not take any medications because of her liver dysfunction.
b
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. A higher dose of the antidepressant b. A lower dose of the antidepressant c. More frequent doses of the antidepressant d. No antidepressants, because they would be contraindicated for this client.
b
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? a. "St. John's wort is a natural and safe alternative to prescription antidepressants." b. "There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive." c. "Most experts agree that St. John's wort is effective in treating depression but that it can contribute to hypertension." d. "It's not clear that St. John's wort is effective in treating depression, but it won't cause any harm."
d
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? a. Milk b. Butter c. Rice d. Yogurt
b
A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? a. Drowsiness b. Extreme sadness c. Severe headache d. Dilated pupils
C
A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child? A) Phenelzine (Nardil) B) Amitriptyline (Elavil) C) Fluvoxamine (Prozac) D) Isocarboxazid (Marplan)
a
A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client? a. avoid use of soy sauce in the diet. b. adhere to combination drug therapy. c. discuss the cultural significance of taking an MAOI. d. avoid taking the drug on an empty stomach.
B
A patient comes to the clinic because she is feeling depressed and has gained some weight. The physician prescribes oral tranylcypromine (Parnate) 10 mg twice daily for an atypical depression. When prescribed in this manner, when would the nurse tell the patient to expect the drug to reach peak levels in the body? A) 1 to 2 hours B) 2 to 3 hours C) 3 to 4 days D) 4 to 5 weeks
D
A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take? A) Teaching the patient about healthy eating to maintain weight B) Congratulating the patient on his weight loss and commenting how well he looks C) Encouraging the patient to increase fluid intake to avoid further weight loss D) Reassuring the patient that a decrease in weight is a common adverse effect with this medication
A
A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression. What interaction will the nurse assess for with this drug combination? A) Increased risk of hypoglycemia B) Increased risk of hyperglycemia C) Increase in appetite D) Increased total cholesterol
A
A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). The patient is confused and does not understand why his medication was changed. The nurse's best response to the patient would be what? A) These drugs are similar but some patients respond better to one drug than another. B) Did you take the amitriptyline like you should have? C) Maybe the old medicine wasn't working anymore. D) Clomipramine is newer and will be much better for you.
A
A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is seeing her gynecologist for premenopausal symptoms and during the interview with the nurse she says that she would like to try Sarafem because her friend is taking it and she says it works great. The nurse's best response is what? A) Sarafem and Prozac are different brand names for the same generic medication. B) Before changing drugs it is important to consider how well you responded to Prozac. C) You cannot take both drugs at the same time so it will be important to decide which is best. D) When taking both of these drugs, it is best to take one in the morning and one at night.
A
A patient is admitted to the unit with obsessive-compulsive disorder (OCD). What drug might the nurse administer that has been found to be effective for treating OCD? A) Fluvoxamine B) Phenelzine C) Desipramine D) Amitriptyline
D
A patient is admitted with a presumed diagnosis of colon cancer who takes a monoamine oxidase inhibitor for depression. What drug will the nurse keep on hand for this patient in case of the onset of an adverse reaction? A) Epinephrine B) Injectable naloxone (Narcan) C) Phenylalanine D) Phentolamine
A, C, E
A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Select all that apply.) A) Agitation B) Agglutination C) Insomnia D) Intermittent tachycardia E) Dry mouth
D
A patient receives a new prescription for fluvoxamine (Luvox). What will the nurse instruct the patient about taking the medication? A) Take medication after eating breakfast. B) Take medication with at least 8 ounces of liquid. C) The dosage may need to be increased if the patient is not feeling better in 2 weeks. D) The medication should be taken once a day before bedtime.
B, C, D
A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (Select all that apply.) A) Fever B) Myocardial Infarction C) Stroke D) Dry mouth E) Gynecomastia
c
A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching? a. "There may be an increased risk of socialization while taking this drug." b. "Clients may lose all inhibitions while on this drug." c. "There may be an increased risk of suicide while taking this drug." d."If you miss a dose of this drug, double the dose the next time you take it."
d
Adverse effects may limit the usefulness of TCAs with some patients. Nursing interventions that could alleviate some of the unpleasant aspects of these adverse effects include: a. always administering the drug when the patient has an empty stomach. b. reminding the patient not to void before taking the drug. c. increasing the dose to override the adverse effects. d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects.
a
After failing to respond to treatment with SSRIs and tricyclic antidepressants, a client with major depression has been started on phenelzine. The client's current drug regimen also includes levothyroxine, metformin and simvastatin. What assessment should the nurse prioritize when monitoring for drug-drug interactions? a. Assessing the client's blood glucose levels frequently b. Monitoring the client for fatigue, constipation and other signs of hypothyroidism c. Monitoring the client for agitation, weight loss and insomnia d. Assessing the client's respiratory rate and oxygen saturation q4h
a
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? a. Selective serotonin reuptake inhibitors b. Tricyclic antidepressants c. Monoamine oxidase inhibitors d. Atypical antidepressants
B
Antidepressants carry a black box warning about the increased risk of suicide in what age group? A) Infants and children B) Children and adolescents C) Adolescents and adults D) Adults and older adults
a, c, d
Depression is a common affective disorder that strikes many people. In assessing a client who might be suffering from depression, the nurse would expect to find which conditions? a. Lack of energy b. Hyperactivity c. Sleep disturbances d. Libido problems e. Confusion f. Decreased reflexes
c
Depression is an affective disorder that is: a. always precipitated by a specific event. b. most common in patients with head injuries. c. characterized by overwhelming sadness, despair, and hopelessness. d. very evident and easy to diagnose in the clinical setting.
a
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? a. Selective serotonin reuptake inhibitor b. Tricyclic c. Monoamine oxidase inhibitor d. Benzodiazepine
A, C, E
It has been postulated that depression may be a syndrome that reflects either activity or lack of activity in what areas of the brain? (Select all that apply.) A) Limbic system B) Corpus callosum C) Reticular activating system (RAS) D) Substantia nigra E) Basal ganglia
c
The biogenic amine theory of depression states that depression is a result of: a. an unpleasant childhood. b. gamma-aminobutyric acid (GABA) inhibition. c. deficiency of NE, dopamine, or 5HT in key areas of the brain. d. blockages within the limbic system, which controls emotions and affect.
C
The biogenic amine theory of depression states that depression results from a deficiency of biogenic amines in key areas of the brain. Why might a deficiency of these biogenic amines exist? A) A slowing of the action of the neurons may lead to their depletion. B) Monoamine oxidase (MAO) strengthens the impact of biogenic amines. C) The number or sensitivity of postsynaptic receptors may increase. D) Norepinephrine may be depleted because biogenic amines feed off of loose particles of the neurotransmitter.
b
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? a. Herbal stimulants, pasta, organ meats, and egg products b. Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans c. Herbal stimulants, caffeine, navy beans, and cheese d. Coffee, chocolate, organ meats, pasta, and navy beans
B
The mental health nursing instructor is talking with the class about depression. What deficiency does the instructor explain will result in depression? A) Epinephrine, norepinephrine, and acetylcholine B) Norepinephrine, dopamine, and serotonin C) Acetylcholine, gamma-aminobutyric acid, and serotonin D) Gamma-aminobutyric acid, dopamine, and epinephrine
a, e
The nurse instructs a client with depression about the drug phenelzine. Which client statements indicate that teaching has been effective? Select all that apply. a. "I will not eat any aged cheese." b. "I have to limit eating chocolate." c. "I can have wine a few days of the week." d. "I can use a half of a banana on my cereal." e. "I cannot drink coffee with this medication."
A, B, C
The nurse interviews the family of a patient hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessment data are important in planning this patient's plan of care? (Select all that apply.) A) Recent suicide attempts B) Gastrointestinal (GI) obstruction C) Affect D) Physical pain E) Personal responsibilities
C
The nurse is caring for a patient who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the patient monitor for adverse effects? A) If chest pain occurs an over-the-counter pain reliever will help. B) Nasal congestion indicates a respiratory virus is beginning. C) Measure and record your blood pressure daily. D) Adverse effects will subside as you adjust to the medication.
D
The nurse is caring for a patient who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication does the nurse consider appropriate for this patient? A) Chlorpromazine (Thorazine) 25 mg three times daily orally B) Benztropine (Cogentin) 2 mg twice daily orally C) Clozapine (Clozaril) 200 mg twice daily orally D) Paroxetine (Paxil) 10 mg once daily orally
A
The nurse is caring for a young female patient who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate? A) Antidepressants are used very cautiously during pregnancy and only when benefit outweighs risk. B) Antidepressants are contraindicated and must be discontinued if pregnancy occurs. C) Antidepressants must be chosen carefully because only a few are safe during pregnancy. D) Most antidepressants are safe during pregnancy but those that are contraindicated should be avoided.
A
The nurse is caring for an 8-year-old clinic patient who takes imipramine. The nurse assesses the patient who does not have a history for or signs of depression, so the nurse suspects this drug was prescribed as treatment for what? A) Enuresis B) Obsessive compulsive disorder (OCD) C) Peripheral neuropathy D) Panic disorder
C
The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient? A) Risk for infection B) Establish suicide precautions C) Disturbed thought processes related to central nervous system (CNS) effects of medication D) Dysfunctional Family Processes
D
The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the patient understands a low tyramine diet when what meal is chosen? A) A chop salad with blue cheese, sardines, and pepperoni B) A sandwich with turkey, avocado, and Swiss cheese C) Corned beef hash, eggs, and hash browns D) A hamburger, French fries, and a strawberry milkshake
A
The nurse is working on the telemetry unit and has noted that many post myocardial-infarction (MI) patients experience depression. What medication would the nurse question if ordered for one of these patients? A) Amitriptyline B) Escitalopram C) Fluoxetine D) Fluvoxamine
A, B, C
The nurse works in a mental health clinic. When a new patient arrives reporting feelings of depression, what conditions are screened for before prescribing antidepressants? (Select all that apply.) A) Thyroid disease B) Hormonal imbalance C) Cardiovascular disorders D) Parkinson's disease E) Diabetes mellitus
B
The patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patient's chart before administering the medication. What preexisting condition would require cautious use of this drug? A) Osteosarcoma B) Cardiovascular disorders C) Closed head injury D) Bleeding ulcer
A
The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking? A) Monoamine oxidase inhibitors (MAOIs) B) Selective serotonin reuptake inhibitors (SSRIs) C) Tricyclic antidepressants (TCAs) D) Antianxiety antidepressants
tyramine
This is an amine found in food that causes vasoconstriction and raises blood pressure; ingesting foods high in this substance while taking an MAOI poses the risk of a severe hypertensive crisis:
a
To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued? a. The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. b. Electroconvulsive therapy (ECT) will be prescribed 2 to 3 weeks before stopping the fluoxetine. c. A monoamine oxidase (MAO) inhibitor will be prescribed concurrently with the fluoxetine for 2 to 3 weeks. d. It will be important that the client avoid stressful situations until another selective serotonin reuptake inhibitor (SSRI) can be prescribed.
d
Venlafaxine (Effexor) is an antidepressant that might be very effective for use in patients who: a. are being treated effectively with a SSRI. b. can tolerate multiple side effects. c. are reliable at taking multiple daily dosings. d. have not responded to other antidepressants and would benefit from once-a-day dosing.
a
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline? a. orthostatic hypotension b. urinary frequency c. visual disturbances d. urinary retention
B
What drug, if prescribed for the patient, would indicate the need to assess the patient for depression characterized by anxiety and addictive behaviors? A) Imipramine (Tofranil) B) Venlafaxine (Effexor) C) Fluvoxamine (Luvox) D) Tranylcypromine (Parnate)
A
What drugs would the nurse consider contraindicated for the patient taking a monoamine oxidase inhibitor (MAOI)? A) Selective serotonin reuptake inhibitor (SSRI) B) Insulin C) Acetaminophen D) Docusate (Colace)
D
What is the physiological action of tricyclic antidepressants (TCAs)? A) Inhibiting monoamine oxidase inhibitors that break down norepinephrine B) Inhibiting nerve activity, which prevents over excitability or stimulation C) Blocking the reuptake of serotonin, which increases the levels of norepinephrine D) Inhibiting reuptake of norepinephrine and serotonin
B, C, E
What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (Select all that apply.) A) Take medication at bedtime. B) Monitor blood pressure. C) Do not take over-the-counter (OTC) drugs without talking to physician. D) Report double vision right away E) Reduce tyramine intake
D
What reason might the nurse give for why venlafaxine (Effexor) has become more popular with adults in treating their depression? A) It is taken orally. B) It does not have adverse effects. C) It can be taken during pregnancy. D) An extended release form is available.
a
When a client is started on an antidepressant, it is important for the nurse to explain to the client that it may take time to see a change in mood. How long can it take for the client to see the beneficial effects of an antidepressant? a. 4 weeks b. 3 days c. 2 months d. 6 months
c
When teaching a patient receiving TCAs, it is important to remember that TCAs are associated with many anticholinergic adverse effects. Teaching about these drugs should include anticipation of: a. increased libido and increased appetite. b. polyuria and polydipsia. c. urinary retention, arrhythmias, and constipation. d. hearing changes, cataracts, and nightmares
a
Which agent would a nurse identify as a selective serotonin reuptake inhibitor? a. Fluvoxamine b. Selegiline c. Nefazodone 'd. Mirtazapine
d
Which of the following medications is NOT indicated for obsessive-compulsive disorder, depression, and panic disorder? a. citalopram (Celexa) b. paroxetine (Paxil) c. fluvoxamine (Luvox) d. vortioxetine (Brintellix)
b
You might question an order for a MAOI as a first step in the treatment of depression remembering that these drugs are reserved for use in cases in which there has been no response to other agents because MAOIs: a. can cause hair loss. b. are associated with potentially serious drug-food interactions. c. are mostly recommended for use in surgical patients. d. are more expensive than other agents.
d
Your patient is being treated for depression and is started on a regimen of fluoxetine (Prozac). She calls you 10 days after the drug therapy has started to report that nothing has changed and she wants to try a different drug. You should: a. tell her to try sertraline (Zoloft) because some patients respond to one SSRI and not another. b. ask her to try a few days without the drug to see whether there is any difference. c. add an MAOI to her drug regimen to get an increased antidepressant effect. d. encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect.
