Chapter 23 EAQ

The nurse notes lithium (Eskalith) on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with? Obsessive-compulsive disorder Absence seizures Bipolar disorder Paranoid schizophrenia

Bipolar disorder Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorder.

What is the maximum daily dose of duloxetine (Cymbalta) that can be safely administered to a patient who is experiencing major depression? 20 mg/day 60 mg/day 80 mg/day 100 mg/day

60 mg/day Duloxetine (Cymbalta) is a serotonin and norepinephrine reuptake inhibitor, which is used to treat major depression in a patient. This medication can be given in a dose of up to 60 mg/day to elicit the desired therapeutic action in the patient. A dose of 20 mg/day is safe, but it may not be sufficient to elicit an effective therapeutic effect in the patient. Doses of 80 mg/day and 100 mg/day are excessive doses, which may cause hyponatremia, bleeding, or hypertension in the patient.

A patient who has taken fluoxetine (Prozac) for 2 weeks to treat an anxiety disorder complains of dissatisfaction with the therapy. What is the best information for the nurse to include in patient education to promote adherence to the therapeutic regimen? The adverse effects can be managed well. This medication usually requires titration. Relaxation exercises can offer some relief. A therapeutic effect can be expected in another 2 to 4 weeks.

A therapeutic effect can be expected in another 2 to 4 weeks The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to occur, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the time frame offers the patient realistic hope and provides a justification for adherence to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

Which actions are associated with safe administration of tricyclic antidepressants (TCAs)? Select all that apply. Administer at night to reduce the risk of sedation and risk for falls. Taper dose to reduce withdrawal symptoms when discontinuing. Avoid foods containing tyramine such as aged cheese and nuts. Avoid central nervous system (CNS) stimulants or sympathomimetics. Avoid sausage, chocolate, bananas, raisins, and yogurt.

Administer at night to reduce the risk of sedation and risk for falls. Taper dose to reduce withdrawal symptoms when discontinuing. TCAs are administered at night to minimize problems caused by their sedative action. When discontinuing a TCA, dosage is reduced gradually to minimize withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. Foods containing tyramine can interact with monoamine oxidase inhibitors (MAOIs), not TCAs, causing a hypertensive crisis. Additionally, MAOIs can interact with CNS stimulants and sympathomimetics causing a hypertensive crisis.

Which food will the nurse teach the patient to avoid while taking a monoamine oxidase inhibitor (MAOI)? Milk White bread Aged cheese White meat

Aged cheese Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs. Drinking milk and eating white bread or white meat should not cause any interactions.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? Blocking the reuptake of neurotransmitters at nerve endings Increasing alertness levels in the brain Decreasing levels of epinephrine and serotonin at nerve endings Increasing the placebo effect

Blocking the reuptake of neurotransmitters at nerve endings SSRIs block the reuptake of serotonin. TCAs block the reuptake of norepinephrine and serotonin

The nurse is caring for a patient who has been diagnosed with seasonal affective disorder. Which medication should the nurse expect a primary health care provider to prescribe to the patient? Amoxapine (Asendin) Trazodone HCl (Desyrel) Maprotiline HCl (Ludiomil) Bupropion HCl (Wellbutrin)

Bupropion HCl (Wellbutrin) Seasonal affective disorder is a psychotic disorder in which the patient experiences symptoms of depression only in a particular season. Bupropion HCl (Wellbutrin) treats seasonal affective disorder by inhibiting the reuptake of norepinephrine and dopamine by the uptake pumps into presynaptic neurons, thus increasing the concentration of these neurotransmitters that are essential in the regulation of motivation and mood. Amoxapine (Asendin) is used to treat patients diagnosed with depression along with anxiety. Trazodone HCl (Desyrel) and maprotiline HCl (Ludiomil) are used to treat depression.

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

Eating aged cheese Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs.

A patient suffering from chronic anxiety is prescribed tranylcypromine sulfate (Parnate). On assessment, the nurse finds that the patient often uses the herb St. John's wort. What course of action should the nurse take to prevent fatal complications? Stop administering the medication. Instruct the patient to stop using St. John's wort. Suggest a diet that includes tyramine-rich foods. Ask the primary health care provider to prescribe a sympathomimetic drug.

Instruct the patient to stop using St. John's wort. Using the herb St. John's wort along with monoamine oxidase inhibiters (MAOIs) such as tranylcypromine sulfate (Parnate) might lead to a hypertensive crisis. The nurse should instruct the patient to stop using the herb. The nurse should not stop administering the medication unless indicated by the primary health care provider. Tyramine-rich food items and sympathomimetic drugs can also cause a hypertensive crisis when taken along with MAOIs.

A registered nurse is evaluating a student nurse who is performing routine assessments of a patient with signs of bipolar affective disorder. The patient belongs to a different culture and is having difficulty communicating with the nurse. Which action by the registered nurse is appropriate to ensure the patient's well-being? Obtaining an interpreter to complete the assessment Asking family members for help understanding the patient's condition Emphasizing the importance of follow-up visits to the primary health care provider Requesting that the primary health care provider perform the necessary assessments

Obtaining an interpreter to complete the assessment Because the patient speaks a different language and is having trouble communicating, the nurse should obtain an interpreter to assist in performing thorough assessments. Relying on family members is not sufficient, because they may not provide accurate or complete information. The nurse should educate the patient regarding the importance of follow-up visits to the primary health care provider. However, it is essential to understand the patient's condition first. The primary health care provider may be consulted, but an interpreter might be necessary to communicate with the patient.

Which side effect of amitriptyline HCl (Elavil) should the nurse inform a patient about to ensure safety? Increased appetite Delayed micturition Postural hypotension Orthostatic hypotension

Orthostatic hypotension Amitriptyline HCl (Elavil) is a tricyclic antidepressant used in the treatment of depression. Orthostatic hypotension is a common side effect of the medication which occurs because of a disruption in autonomic nervous system activity. Increased appetite and postural hypotension are the common side effects of amoxapine (Asendin), which is an atypical antidepressant. Imipramine HCl (Tofranil) is used in the treatment of enuresis and depressive disorders; therefore, an increased dose or increased intake frequency of the medication would delay micturition.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are popular treatments for depression. Which side effects does the nurse know are atypical of these antidepressants? Select all that apply. Sedation Hypotension Anticholinergic effects Sexual dysfunction Serotonin syndrome

Sedation Hypotension Anticholinergic effects SSRIs and SNRIs are preferred treatments for depression as they have fewer side effects than other classifications of antidepressants. Sedation, hypotension, and anticholinergic effects are uncommon with SSRIs and SNRIs. Sexual dysfunction and serotonin syndrome are both potential side effects of SSRIs and SNRIs.

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. Such drugs do not become effective in 1 week, or 2 to 3 days. The effect occurs long before 2 to 3 months.

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? Ibuprofen Ginkgo 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 primary health care provider prescribes lithium to an Asian client who has a psychotic illness. What will the nurse expect to find in the patient's prescription? The patient has been prescribed a lower than usual dose of the drug. The patient has been prescribed a higher than usual dose of the drug. The patient's drug intake is at more frequent intervals than usual. The patient's drug intake is at less frequent intervals than usual.

The patient has been prescribed a lower than usual dose of the drug. Asian patients require a lower dose of antipsychotic drugs such as lithium to achieve the desired effects. These patients have a slower elimination rate of drugs, and therefore require lower doses. If the patient is prescribed a higher or the usual dose of the drug, because of its high concentration, the patient will be susceptible to developing adverse reactions. An increase or decrease of the frequency of drug administration will not prevent the client from developing adverse effects if the total dose prescribed is usual.

A student nurse is giving examples of different types of depression. Which scenario is an example of reactive depression? The patient has constant mood swings. The patient is sad after the death of a parent. The patient has lost all interest in going to work. The patient shows no interest toward taking care of family.

The patient is sad after the death of a parent. Depression triggered by the loss of a loved one is an example of reactive depression. Mood swings may indicate bipolar affective disorder. Loss of interest in work and home are examples of major depression.

The nurse is assessing a patient who has been undergoing treatment for bipolar disorder for the past year. The nurse finds that patient's sodium level is 110 mEq/L and glucose level is 70 mg/dL. The patient also exhibits signs of neurotoxicity. What should the nurse expect as the reason for these signs in the patient? The patient is taking lithium citrate (Eskalith). 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). Lithium citrate (Eskalith) is used in the treatment of bipolar disorder. Long-term administration of lithium citrate may lead to adverse effects such as hyponatremia, because it depletes the sodium levels. Hyponatremia is a condition in which sodium levels are decreased in the blood, resulting in an electrolyte imbalance. Lithium citrate (Eskalith) can also cause hypoglycemia, because it decreases insulin production, and signs of neurotoxicity because of its effect on the cerebellum. The administration of vilazodone (Viibryd) may result in drowsiness, insomnia, and diarrhea; paroxetine HCl (Paxil) may result in decreased sexual arousal; and mirtazapine (Remeron) may result in an increase in the levels of both norepinephrine and serotonin neurotransmitters in a patient.

The nurse is caring for a patient who is undergoing treatment for bipolar disorder. The patient's caregiver informs the nurse that the patient has become extremely forgetful and is confused much of the time. Which reason does the nurse suspect for this behavior in the patient? The patient is taking lithium citrate (Eskalith). 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). When a patient who is diagnosed with bipolar disorder is administered lithium citrate (Eskalith), it may cause memory loss and confusion, because the medication can inhibit cognitive processing. Vilazodone (Viibryd) causes nausea and vomiting as side effects. Paroxetine HCl (Paxil) may cause sexual dysfunction in men and women. Mirtazapine (Remeron) administration leads to an increase in the levels of both norepinephrine and serotonin in the patient.

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? The patient will have persistent manic symptoms. The patient should have effective relief from the manic symptoms. The patient may have impaired liver and renal functioning. The patient may have cardiac dysrhythmia and tremors.

The patient should have effective relief from the manic symptoms. There is a narrow therapeutic window between the therapeutic and toxic serum levels of lithium. A serum lithium level of 1 to 1.5 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, which is characterized by impaired liver and renal functioning. The adverse effects of lithium toxicity include cardiac dysrhythmia and tremors.

When a nurse is providing patient teaching about antidepressant medications, which method is most effective? Verbal instructions and reinforcement of instructions via videos Printed instructions in the language of choice Websites and videos as determined by the patient's education Doctors, not nurses, teach patients about psychiatric medications

Verbal instructions and reinforcement of instructions via videos Verbal instruction reinforced with visuals from a video is most effective in patient teaching about antidepressant medications because it provides two routes for the learner. Printed instructions will be ineffective if the patient does not read them or does not understand medical terminology. Websites and videos may not be used by the patient on his or her own. It is part of the nurse's responsibility to provide patient education.