Pharmacology Chapter 21 Antidepressants

What should the nurse's pre-administration assessment for a client receiving an antidepressant include? (Select all that apply.)

Vital signs assessment Presence of suicidal ideation Complete medical history Weight Mental status assessment

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

Which food should the client avoid eating when prescribed phenelzine sulfate?

aged Swiss cheese and bratwurst

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

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

The normal function of which neurotransmitter is most likely impaired when a client expresses feelings of gloom and the inability to perform activities of daily living?

serotonin

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?

statements or resignation and futility and a desire to die

The nurse should prioritize which assessment when caring for a teenager who has recently been prescribed a selective serotonin reuptake inhibitor (SSRI)?

suicidal ideation

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

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 14 year-old client who has been diagnosed with major depression

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

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 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

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

The nurse is providing care on an inpatient psychiatric unit. Which adult client should the nurse monitor most closely for signs of adverse drug effects?

A client who is taking phenelzine

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."

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?"

An adult client, diagnosed with depression several weeks ago, has begun taking citalopram 10 days ago. The client has told the nurse of the intent to stop taking the drug, stating, "I don't feel any less depressed than I did before I started taking these pills." How should the nurse best respond to the client's statement?

"I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."

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."

A client is prescribed transdermal selegiline. What health education should the nurse provide?

"Place the patch on dry skin on your torso that has no cuts or openings."

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."

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?

"Use sugarless hard candies and gum to deal with dry mouth."

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 on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize to best evaluate therapuetic effect of the treatment in the care of this client?

Assessment of the client's behaviors and thought processes

A client with a longstanding diagnosis of depression is being treated with phenelzine. The client reports the recent use of some over-the-counter flu and cold remedies and has consequently been admitted for observation and client teaching. What assessment should the nurse prioritize?

Blood pressure monitoring

A nurse is preparing to administer an antidepressant that affects the neurotransmission of norepinephrine, serotonin, and dopamine. Which drug would the nurse be most likely to administer?

Bupropion

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.

Clomipramine

The antidepressant drug paroxetine (Paxil) can be used to treat which medical conditions? (Select all that apply.)

Depressive episodes Obsessive-compulsive disorders Bulimia nervosa

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?

Extreme sadness

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 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?

In 4 to 6 weeks after stopping the paroxetine

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

Which medications should not be administered to clients receiving monoamine oxidase inhibitors (MAOIs) because of the increased risk of hypertensive episodes? (Select all that apply.)

Meperidine (Demerol) Sertraline (Zoloft) Amitriptyline (Elavil)

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.

An elderly patient is admitted to the medical division after a fall. At home he is taking amitriptyline 25 mg three times per day. What adverse effect could be related to the patient's fall?

Orthostatic hypotension

The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten?

Phenelzine

A client is to receive a tricyclic antidepressant. The nurse is reviewing the client's medical record. What would alert the nurse to a possible contraindication?

Recent myocardial infarction

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.

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?

Selective serotonin reuptake inhibitor

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 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?

The MAOI would be started 2 to 4 weeks after stopping the SSRI.

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.

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.

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.

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)?

14 days