Adaptive Quizzing for Drugs For Mood Disorders

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? "When was your last bowel movement?" "Have you noticed dry mouth or blurred vision?" "Have you had any changes in your urine function?" "Have you had any changes in your mood or anxiety level or thoughts of suicide?"

"Have you had any changes in your mood or anxiety level or thoughts of suicide?" (In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.)

The nurse is caring for a patient who has been prescribed Bupropion HCL [Wellbutrin] for seasonal affective disorder. What should the nurse teach the patient about this medication? "Do not take this medication every day." "This medication may suppress your appetite." "Be careful of weight gain with this medication." "This medication will depress your sexual desire."

"This medication may suppress your appetite."

The nurse is caring for a patient who has depression and has been prescribed isocarboxazid [Marplan]. What will the nurse teach the patient about the reason for this therapy? "This medication is only used for short-term therapy." "This medication is the only one that will treat your disorder." "This medication is being used as the risk of side effects is very low." "You have been prescribed this medication because you did not respond to others."

"You have been prescribed this medication because you did not respond to others." (Monoamine oxidase inhibitors are generally reserved for patients who have not responded to other, safer drugs. )

The nurse is seeing several patients in the outpatient clinic. Which patient most requires the nurse's immediate attention? A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg A female patient with bipolar disorder (BPD) who takes valproic acid [Depakene] and who reports nausea and vomiting

A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L (Lithium levels above 1.5 mEq/L should be reported because this level may indicate impending, serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.)

A nurse teaches a patient taking a monoamine oxidase inhibitor (MAOI) about important dietary restrictions. Which foods will the nurse caution the patient to avoid? Potato and corn chips Coffee, colas, and tea Aged cheese and Chianti Grapefruit and other citrus juice

Aged cheese and Chianti (Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods, such as cheese, contain tyramines.)

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? Aspirin (ASA) for mild headache Ibuprofen [Motrin] for muscle pain Hydrochlorothiazide (HCTZ) for edema Diphenhydramine [Benadryl] for cold symptoms

Aspirin (ASA) for mild headache

elective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? By increasing the placebo effect By increasing alertness levels in the brain By blocking the reuptake of neurotransmitters at nerve endings By decreasing levels of epinephrine and serotonin at nerve endings

By blocking the reuptake of neurotransmitters at nerve endings (SSRIs block the reuptake of serotonin. TCAs block the reuptake of norepinephrine and serotonin.)

When teaching a patient about the use of tricyclic antidepressants (TCAs), what will the nurse emphasize? Dietary restrictions of beer and chocolate are needed to prevent a hypertensive crisis. The drugs are often given with monoamine oxidase inhibitors (MAOIs) for a synergistic effect. Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy. The patient should notify the healthcare provider if therapeutic effects are not noted within 10 days.

Common side effects can be relieved by increasing fluid and fiber intake and sucking hard candy.

Which activity should the patient be cautioned to avoid while taking an monoamine oxidase inhibitor (MAOI)? Eating aged cheese Sunbathing at the pool Participating in a bowling league Smoking a low-nicotine cigarette

Eating aged cheese

The nurse notes that the healthcare provider is considering starting the patient on a selective serotonin reuptake inhibitor (SRRI) drug. The nurse recognizes that the healthcare provider will select which drug below? Doxepin [Sinequan] Amitriptyline [Elavil] Imipramine [Tofranil]

Fluvoxamine [Luvox] (Of the drugs listed, the only SRRI drug is fluvoxamine [Luvox]. There are five other SSRI medications available including citalopram, escitalopram, paroxetine, and sertraline. All five are very similar to fluoxetine. Patients should be taught about potential side effects such as nausea, insomnia, headaches, nervousness, weight gain, sexual dysfunction, and hyponatremia.)

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used to do what in the treatment of severe manic episodes? Elevate mood during the severe manic episode Help control symptoms during the severe manic episode Produce sedating effects during the severe manic episode Reduce the amount of physical pain the patient experiences during the severe manic episode

Help control symptoms during the severe manic episode (Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.)

he nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? It increases the risk of suicide in the early phase. It is less effective than the tricyclic antidepressants. It increases the risk of psychoses and parkinsonism. It has more hazardous side effects and drug interactions

It has more hazardous side effects and drug interactions (henelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine)

A patient who has depression is prescribed duloxetine [Cymbalta]. Which tests will the nurse suggest to the provider before the therapy is started? Liver function test Renal function test Complete blood count Complete urine examination

Liver function test (Duloxetine [Cymbalta] tends to cause liver toxicity; therefore, a liver function test should be done before starting the therapy.)

The patient has been started on a treatment regimen that includes imipramine [Tofranil]. The patient tells the nurse that he also is being treated with diazepam [Valium] for a separate condition. What is the nurse's highest priority action? Notify the healthcare provider because central nervous system (CNS) depression may result. Notify the healthcare provider because the patient may experience an anaphylactic reaction. Notify the pharmacy because the dosage of the imipramine [Tofranil] will need to be increased. Notify the pharmacy because the dosage of the imipramine [Tofranil] will need to be decreased.

Notify the healthcare provider because central nervous system (CNS) depression may result. (The combination of the imipramine [Tofranil] and the diazepam [Valium] will potentiate CNS depression. Patients should be cautious with any other CNS depressant medication, not just diazepam. In addition, alcohol and antihistamines should be avoided.)

The nurse identifies which most common serious adverse effect of tricyclic antidepressant (TCA) therapy? Skin rash Excitation Sexual dysfunction Orthostatic hypotension

Orthostatic hypotension

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? Insomnia and diarrhea Sedation and dry mouth Tachypnea and wheezing Blood pressure of 160/90 mm Hg

Sedation and dry mouth

The nurse monitors the patient taking imipramine [Tofranil] for what potential side effect? Seizures Diuresis Dry skin Hyperkalemia

Seizures (Imipramine [Tofranil] causes urinary retention, sedation, and diaphoresis. It also lowers the seizure threshold. It does not typically elevate potassium, cause diuresis, or dry skin.)

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? Cholinergic crisis Serotonin syndrome Depressive psychosis Escitalopram overdose

Serotonin syndrome

A patient asks the nurse how long it will take for escitalopram [Lexapro] to be completely effective. Which time frame should the nurse include in patient teaching? 1 week 2 or 3 days 2 or 3 months Several weeks

Several weeks (The nurse instructs the patient to adhere to therapy for several weeks to determine whether escitalopram [Lexapro] will be an effective antidepressant. Escitalopram [Lexapro] is a selective serotonin reuptake inhibitor (SSRI), and a delay in therapeutic effectiveness is characteristic of SSRIs.)

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? Dry mouth Bradycardia Sexual dysfunction Orthostatic hypotension

Sexual dysfunction (Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.)

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? Sodium level of 128 mEq/L Prothrombin time of 8 seconds Potassium level of 5.6 mEq/L Blood urea nitrogen level of 25 mg/dl

Sodium level of 128 mEq/L (Proper range is 135 to 145)

A patient currently prescribed duloxetine [Cymbalta] comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? Gingko Ibuprofen St. John's wort Glucosamine chondroitin

St. John's wort (Serotonin syndrome may occur with selective serotonin reuptake inhibitors (SSRIs) when they are combined with herbal products such as ginseng and St. John's wort. )

The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of bipolar disorder (BPD). The nurse anticipates which dosing schedule? Starting at a low dose and titrating up Starting at a high dose and titrating down Starting at a high dose to quickly control mania Starting with a loading dose and then a low maintenance dose

Starting at a low dose and titrating up

While assessing a patient who is being treated for post-traumatic stress disorder, the nurse finds that the patient has developed confusion, agitation, anxiety, incoordination, and excessive sweating. What is the nurse's priority action? Call the healthcare provider. Keep the patient cool and dry. Make certain the patient stays on bed rest. Stop administration of monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs).

Stop administration of monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). (The description of symptoms matches that of serotonin syndrome. This syndrome usually begins 2 to 72 hours after treatment onset. Signs and symptoms include altered mental status, anxiety, hallucinations, poor concentration, incoordination, hyperreflexia, tremors, and fever. The syndrome resolves spontaneously after discontinuing the drug. MAOIs increase the risk of this reaction in patients taking SSRIs.)

The nurse prepares a patient who has a prescription for sertraline (Zoloft) for discharge. Which instruction should the nurse include in patient education? Report any increase in mania. Expect to feel better in 4 to 6 days. Avoid overheating and direct sun exposure. Take sertraline (Zoloft) at the same time each day

Take sertraline (Zoloft) at the same time each day (Sertraline (Zoloft) is a selective serotonin reuptake inhibitor, and the patient is most likely to experience therapeutic effectiveness if the medication is taken at the same time every day.)

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremors, nausea, vomiting, and diarrhea. The patient's gait is unsteady. What is the most likely explanation for these symptoms? The patient developed lithium toxicity. The patient developed tolerance to the lithium. The patient did not take the lithium as directed. The patient consumed some foods high in tyramine.

The patient developed lithium toxicity. (Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.)

The nurse is assessing a patient who has been undergoing treatment for bipolar disorder for the past year. The nurse finds that the patient's sodium level is 110 mEq/L and the glucose level is 70 mg/dL. The patient also exhibits signs of neurotoxicity. What should the nurse expect as the reason for these signs? The patient is taking vilazodone [Viibryd]. The patient is taking paroxetine HCl [Paxil]. The patient is taking mirtazapine [Remeron]. The patient is taking lithium citrate [Eskalith]

The patient is taking lithium citrate [Eskalith] (Long-term administration of lithium citrate may lead to adverse effects such as hyponatremia as it depletes the sodium levels. It is used for treatment of bipolar disorder)

The nurse is caring for a patient with acute mania who has been prescribed lithium carbonate [Lithobid]. The blood tests of the patient indicate the serum lithium level to be 1.2 mEq/L. What does the nurse interpret from this? Patient will have persistent manic symptoms. The patient may have cardiac dysrhythmia and tremors. The patient may have impaired liver and renal functioning. The patient should have effective relief from the manic symptoms.

The patient should have effective relief from the manic symptoms. ( serum lithium level of 1 to 1.4 mEq/L is optimum for the treatment of acute mania. Therefore, a serum lithium level of 1.2 mEq/L indicates that the patient will have effective relief from the manic symptoms. If the serum lithium level is less than 1 mEq/L, then the patient may have persistent manic symptoms. If the lithium serum level is more than 1.5 mEq/L, then the patient may have lithium toxicity)

The nurse is caring for a patient who has bipolar disorder and has been administered lithium citrate [Eskalith]. The primary healthcare provider asks the nurse to constantly monitor the patient's blood sodium levels. What is the reason for giving such an instruction? To ensure proper nourishment in the patient To prevent renal toxicity caused by the drug To maintain normal cholesterol levels in the body To maintain therapeutic concentration of lithium

To maintain therapeutic concentration of lithium (the serum lithium concentration is altered with changes in the sodium concentration. Therefore, in order to maintain a constant therapeutic level, a normal concentration of sodium is required in the body.)

A patient takes sertraline [Zoloft] for depression related to chronic pain. The nurse avoids administering which analgesic agent to help prevent serotonin syndrome? Ibuprofen [Motrin] Tramadol [Ultram] Fentanyl [Duragesic] Oxycodone [OxyContin]

Tramadol [Ultram] (The nurse avoids administering tramadol [Ultram] to a patient who takes a selective serotonin reuptake inhibitor because it increases the risk for serotonin syndrome. )

The nurse is caring for a patient with bruxism due to selective serotonin reuptake inhibitor (SSRI) therapy. What will the nurse teach the patient about management of this side effect? Your healthcare provider can prescribe pain medication Your healthcare provider can prescribe low-dose buspirone Your healthcare provider can increase the dose of the SSRI Your healthcare provider can prescribe a monoamine oxidase inhibitor (MAOI)

Your healthcare provider can prescribe low-dose buspirone (Buspirone [BuSpar] can be used to treat a patient with bruxism due to SSRI therapy)