CHAPTER 55: DRUG THERAPY FOR DEPRESSION AND MOOD STABILIZATION

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." "This is very good timing for you, but remember that you might have some side effects, especially for the first couple of weeks." "Antidepressants help relieve the lack of energy and concentration during depression but your mood might not be affected." "You'll likely be feeling significantly better by the weekend, but remember to avoid drinking alcohol at the wedding."

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits." Explanation: Peak benefits of SSRIs can take up to six weeks to be realized, and a client is unlikely to notice an effect within a few days. Antidepressants improve mood, not just energy and concentration.

The nurse is reviewing a new client's current medication regimen, which includes a ten-week course of bupropion 150 mg PO b.i.d. The nurse has assessed the client for any history of depression, which the client denies. What assessment question should the nurse ask next? "Are you in the process of quitting smoking?" "Have you ever been diagnosed with obsessive-compulsive disorder?" "Are you receiving treatment for anxiety right now?" "Are you certain that you've never had depression?"

"Are you in the process of quitting smoking?" Explanation: This course of bupropion suggests treatment to support smoking cessation. if the client denies a history of depression, there is no obvious need for the nurse to ask again. Bupropion is not used to treat anxiety disorders or obsessive compulsive disorders.

A client has been taking amitriptyline for the treatment of depression for several months. The client has been experiencing significant anticholinergic effects and has now presented to the emergency department reporting recent nausea, vomiting, dizziness and malaise. What assessment question should the nurse prioritize? "Are you still taking your medication consistently?" "How would you describe your mood over the past several days?" "Have you taken a larger dose that you're prescribed lately?" "When was the last time that you had blood work drawn?"

"Are you still taking your medication consistently?" Explanation: Discontinuation of a TCA can cause a withdrawal syndrome characterized by nausea, headache, vertigo, malaise and nightmares. An increase in dose would exacerbate adverse effects but would not cause this syndrome. The nurse should assess the client's mood in the context of the overall treatment for depression but this is unlikely to relate to these specific physiological issues. Blood levels of TCA are not normally drawn.

A black, male client is prescribed a TCA for his depression. He asks the nurse why the dose he receives is lower than that of his white friend who also takes this medication. How would the nurse respond to the client? "Black clients tend to metabolize TCAs more slowly than white clients do." "Black clients tend to metabolize TCAs more quickly than white clients do." "Black clients experience side effects with higher doses." "Black clients experience suicidal ideation with higher doses."

"Black clients tend to metabolize TCAs more slowly than white clients do." Explanation: Black clients tend to have higher plasma drug levels for a given dose, respond more rapidly, experience a higher incidence of adverse effects, and metabolize TCAs more slowly than white clients. To decrease adverse effects, initial doses may need to be lower than those given to white clients, and later doses should be titrated according to clinical response and serum drug levels.

A client's depression has not responded to conservative treatment so the provider has prescribed phenelzine 15 mg PO t.i.d. What dietary guidelines should the nurse provide to the client? (Select all that apply.) "It's best to take your medication with food so that side effects are reduced." "Don't eat types of cheese that have been aged." "Make sure that you're drinking at least ten to twelve glasses of water each day." "In general, avoid any type of food or drink that's been fermented." "Most meats that have been smoked would be unsafe for you."

"Don't eat types of cheese that have been aged." "In general, avoid any type of food or drink that's been fermented." "Most meats that have been smoked would be unsafe for you." High tyramine foods include aged cheeses, smoked meats, and many types of foods and beverages that have been fermented. Adequate fluid intake is necessary but there is no need to set a minimum of 10 glasses of water per day. The adverse effects of MAOIs are not significantly reduced by taking the medication with food.

A client reports that the selective serotonin reuptake inhibitor (SSRI) prescribed originally has been replaced with venlafaxine. What assessment question should the nurse ask the client to best determine the reason for the change? "Have you been feeling anxious lately?" "How long have you been taking the SSRI?" "Are you feeling more comfortable in social situations now?" "Were you finding it difficult to adhere to your SSRI therapy?"

"Have you been feeling anxious lately?" Explanation: Venlafaxine is a standard first-line treatment for depression as well as generalized anxiety disorder, social phobia, and panic disorder. It would be prescribed if the client was now expressing anxiety in addition to depression. The medication would not be prescribed if progress was being made with social phobias. Questions about SSRI therapy would not be relevant.

A client comes to the clinic with a possible mood disorder diagnosis of unipolar depression. What question by the nurse will best help in assessing this client's mental status? "Why are you feeling sad?" "Have you felt hopeless anytime lately?" "Can you name six things you would like to change in your life?" "What have you eaten in the last two days?"

"Have you felt hopeless anytime lately?" Explanation: A quick depression assessment involves asking the client if he/she has felt helpless or hopeless over the last two weeks. The other questions will not be helpful in assessing the client's current mental status.

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?" "On a scale from zero to ten, how would you rate your anxiety level?" "How are you feeling today?" "Are you feeling happier today than in the past?"

"How would you describe your mood and energy level today?" Explanation: Mirtazapine is an antidepressant and it is prudent for the nurse to assess the client's mood and level of energy. Anxiety is not synonymous with depression and is not treated with this medication. Asking a client how the client feels is often too vague and open-ended to obtain meaningful data. Asking a client if she or she feels "happier" is a closed-ended (yes/no) question and could easily be interpreted by the client as downplaying the severity of depression.

After teaching a client who is prescribed lithium about the drug, the nurse determines that the teaching was successful when the client states which comment? "I need to limit how much I drink." "Salt is something that I need to avoid." "I should take the drug with food." "I need to call the health care professional if I have a painful erection."

"I should take the drug with food." Explanation: With lithium, the client should take the drug with food or immediately after meals, drink at least 10 large glasses of fluid each day, and add extra salt to food. Painful erections are not associated with lithium use.

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client is 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." "I realize this is frustrating but most medications for mood disorders aren't fully effective for two to three months." "I will tell the healthcare provider and see if there is another medication that would be better." "Please come to the clinic immediately so you can be reassessed for suicidal thoughts."

"It may take another two to three weeks before the medication is completely effective." Explanation: Fluoxetine may take up to four weeks to be completely effective. It would not be appropriate for the nurse to ask the healthcare provider to change the medication, and the client has not given any indication of suicidal ideation.

A female client's bipolar disorder symptoms have been successfully managed with lithium for many years. She is scheduled for a CABG and is instructed to stop her lithium 1 to 2 days before surgery and resume when full oral intake of food and fluids is allowed. She asks why she must stop the medication. What is the nurse's best response? "You will not have bipolar symptoms during surgery or immediately afterward because of the anesthetics." "Lithium will cause hypertension during surgery." "Lithium may prolong the effects of anesthetics and neuromuscular blocking drugs." "Lithium may cause cardiac complications during surgery."

"Lithium may prolong the effects of anesthetics and neuromuscular blocking drugs." Explanation: Lithium should be stopped 1 to 2 days before surgery and resumed when full oral intake of food and fluids is allowed. Lithium may prolong the effects of anesthetics and neuromuscular blocking drugs.

The nurse is caring for a client who is prescribed a tricyclic antidepressant for depression. Which teaching will the nurse provide to the client about this medication? Select all that apply. "Report urinary retention." "Take the medication at bedtime." "A skin rash is a common side effect." "Expect to develop an irregular heartbeat." "Call the health care provider if you experience confusion."

"Report urinary retention." "Take the medication at bedtime." "Call the health care provider if you experience confusion." Tricyclic antidepressants are the oldest antidepressants and are the second-line drugs for the treatment of depression. Teaching for tricycle antidepressants includes reporting urinary retention, as this could indicate a potentially serious adverse drug effect. The medication should be taken at bedtime to aid with sleep and to decrease adverse effects. Confusion is not expected and should be reported to the health care provider. A skin rash is not an adverse effect of tricyclic antidepressant, but is an adverse effect of selective serotonin reuptake inhibitors. An irregular heartbeat is an adverse effect that needs to be reported to the health care provider.

A client has been taking Prozac for the past 2 months for depression. She is seeing her gynecologist for premenopausal symptoms, and during the interview with the nurse she says, "I'm interested in trying fluoxetine because my friend is taking it and she says it works great." The nurse's best response is what? "Sarafem and Prozac are different brand names for the same generic medication." "Before changing drugs, it is important to give you enough time to respond to Prozac." "You cannot safely take both drugs at the same time, so it will be important for you and your provider to decide which is best." "When taking both of these drugs, you'll likely be encouraged to take one in the morning and one at night."

"Sarafem and Prozac are different brand names for the same generic medication." Explanation: Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in changing the client's medication regimen. Taking the two drugs together would result in a drug overdose.

The nurse is conducting a preoperative joint replacement session for a client who is scheduled for a knee replacement in 2 weeks. What instructions will the nurse give this client regarding the imipramine the client takes for treatment of depression? "Take half the dose of imipramine for a week prior to your surgery." "Stop taking the imipramine 4 days before surgery." "The health care provider will order IV imipramine for you while you are in the hospital." "Stop taking the imipramine until you have surgery."

"Stop taking the imipramine 4 days before surgery." Explanation: The client must stop taking imipramine a few days prior to surgery and will not be able to resume it for a few days after surgery.

A client explains to a nurse that they have been taking amitriptyline for depression, achieving a modest improvement in mood. The provider recently changed the client's medication to clomipramine. The client is confused and does not understand why their medication was changed to "the same type of drug." What is the nurse's best response? "These drugs are similar but some clients respond better to one than the other." "Did you have your follow-up blood work drawn on schedule as was recommended?" "It's likely that your provider is trying to rule out psychological causes for your depression." "It's likely that your provider felt that clomipramine would have fewer side effects."

"These drugs are similar but some clients respond better to one than the other." Explanation: Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse effects. A client who does not respond to one TCA may respond to another drug from this class. The nurse should avoid speculating about the rationale for the change, but it is unlikely that a difference in adverse effects motivated the change, as these are likely to be similar. Depression is multifactorial, and it is not possible to "rule out" psychological factors. Follow-up blood work is not normally necessary with TCAs.

A 28-year-old client asks his nurse how phenelzine therapy will help him. Which would be an appropriate response by the nurse? "This therapy will help reduce the severity of your bipolar episodes." "The drug will enable you to gain the appropriate weight." "The drug will help increase your attention level." "This therapy will improve your overall mood and increase your social activity."

"This therapy will improve your overall mood and increase your social activity." Explanation: The effectiveness of phenelzine is demonstrated by improved mood and increased social activity in depressed clients. Reduced severity of bipolar episodes indicates success of valproates. Increased attention levels and weight gain, though desired benefits, are not a direct result of the drug therapy.

The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity? 1.8 mEq/L 0.6 mEq/L 0.8 mEq/L 1.2 mEq/L

1.8 mEq/L Explanation: Therapeutic serum lithium levels range from 0.6 mEq/L to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic. All of the other levels would be considered therapeutic.

How long does a patient need to wait after stopping a phenelzine before starting paroxetine? 14 days 1 day 7 days 10 days

14 days Explanation: Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.

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? 1 week 2 weeks 3 weeks 4 weeks

4 weeks Explanation: It may take up to 4 weeks before the full effect of an SSRI is noted.

The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity? A 44-year-old woman with a seizure disorder A 19-year-old man with organic brain disease A 45-year-old man with angina pectoris A 20-year-old woman with renal dysfunction

A 45-year-old man with angina pectoris Explanation: Patients with cardiovascular disease are especially sensitive to the potential cardiotoxicity of nortriptyline and need to be monitored closely. Patients with a history of seizure activity, organic brain disease, and renal dysfunction do not face as high a risk of cardiotoxicity as patients with a preexisting cardiovascular disease.

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 higher dose of the antidepressant A lower dose of the antidepressant More frequent doses of the antidepressant No antidepressants, because they would be contraindicated for this client.

A lower dose of the antidepressant Explanation: Hepatic impairment leads to reduced first-pass metabolism of most antidepressant drugs, resulting in higher plasma levels. The drugs should be used cautiously in clients with severe liver impairment. Cautious use means lower doses, longer intervals between doses, and slower dose increases than usual.

A nurse is aware of the high incidence and prevalence of major depression in the population. Which of the following individuals possesses the clearest risk factors for depression? A man who has a history of intravenous drug use and multiple hospital admissions for subsequent infections A woman whose father had a long history of depression before he committed suicide A man who is experiencing significant lifestyle changes after losing his job A woman who has recently begun treatment for idiopathic seizure activity

A woman whose father had a long history of depression before he committed suicide Explanation: Major risk factors for depression include previous episodes of depression, family history of depression, and being female. Life changes and drug use are associated with the problem but are not noted as major risk factors. Neurological disorders are not closely associated with depression.

A nurse is reviewing the indications for the use of fluoxetine. For what client would this drug be appropriate? A young adult client with bulimia A client with generalized anxiety disorder An adult client who has bipolar disorder A client who has trichotillomania

A young adult client with bulimia Explanation: Fluoxetine is indicated for the treatment of bulimia. Escitalopram is indicated for the treatment of generalized anxiety disorder. Duloxetine is indicated for the treatment of diabetic neuropathic pain. Citalopram is indicated for the treatment of trichotillomania.

A nurse is providing discharge teaching to a client who has a new prescription for fluoxetine (Prozac) for PTSD. Which of the following statements should the nurse include in the teaching? A) "You can have a decreased desire for intimacy while taking this medication." B) "You should take this medication at bedtime to help promote sleep." C) "You will have fewer urinary adverse effects if you urinate just before taking this medication." D) "You will need to wear sunglasses when outdoors due to the light sensitivity caused by this medication."

A) "You can have a decreased desire for intimacy while taking this medication." Decreased libido is a potential adverse effect of fluoxetine and other SSRIs.

A nurse is reviewing lab findings and notes that a client's lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? A) Perform immediate gastric lavage. B) Prepare the client for hemodialysis. C) Administer an additional oral dose of lithium. D) Request a stat repeat of the lab test.

A) Perform immediate gastric lavage. Gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma lithium level of 2.1 mEq/L. This action will lower the client's lithium level.

A nurse is caring for a client who has a new prescription for valproic acid (Depakote). The nurse should instruct the client to have which of the following blood lab tests completed periodically? SELECT ALL THAT APPLY. A) Thrombocyte count B) Glucose C) Amylase D) Liver function tests E) Potassium

A) Thrombocyte count C) Amylase D) Liver function tests Treatment with valproic acid can result in thrombocytopenia, pancreatitis (amylase needs monitoring for this), and potassium.

A patient is beginning a new drug regimen of escitalopram (Lexapro) for depression. Before administering this medication, it is necessary to assess for which of the following? A) prior recent use of monoamine oxidase (MAO) inhibitors B) prior diet high in tyramine-containing foods C) history of cigarette use D) history of seizure disorders

A) prior recent use of monoamine oxidase (MAO) inhibitors A potentially fatal reaction (serotonin syndrome) may occur when monoamine oxidase (MAO) inhibitors and selective serotonin reuptake inhibitors (SSRIs) are used concurrently. The MAO inhibitor should be discontinued 2 weeks before treatment when SSRIs are initiated.

Which side effect of fluoxetine (Prozac) is most commonly the cause for poor client adherence? / A 40-year-old man has been prescribed fluoxetine (Prozac). The patient states he has notcontinued the prescribed therapy even though his depression improved. What assessment is most important for the nurse to make? A) sexual dysfunction B) hypotension C) pain and discomfort D) cardiac dysrhythmia

A) sexual dysfunction Feedback: Fluoxetine (Prozac) produces adverse effects, such as sexual dysfunction. It isimperative that the nurse assess for sexual dysfunction, which is a major reason fornoncompliance in men. The assessment of hypotension is not accurate withoutsymptoms of hypotension. The assessment of pain or discomfort is not accurate in thispatient. The assessment of cardiac dysrhythmia is not accurate in this patient.

A nurse provides instructions to a client taking fluoxetine (Prozac) a selective serotonin reuptake inhibitors (SSRI) antidepressant. The nurse tells the client to take the medication: A. In the morning B. With lunch C. After lunch D. At bedtime

A. In the morning Fluoxetine is used to treat major depressive disorder, bulimia nervosa obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). It is taken early in the morning to prevent interference with sleep.

A patient with major depression has been prescribed fluoxetine. What nursing diagnosis would be most appropriate? A. Social Isolation B. Mobility, Impaired Physical C. Urinary Elimination, Impaired D. Sensory Perception, Disturbed

A. Social Isolation Rationale: The most appropriate nursing diagnosis for the patient taking fluoxetine is social isolation. Impaired physical mobility, impaired urinary elimination, and disturbed sensory perception are not associated with fluoxetine.

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

ALL Vital signs assessment Presence of suicidal ideation Complete medical history Weight Mental status assessment The nurse's preadministration assessment for a client receiving an antidepressant should include vital signs assessment, presence of suicidal ideation, complete medical history, weight, and mental status assessment.

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? Herbal stimulants, caffeine, navy beans, and cheese Coffee, chocolate, organ meats, pasta, and navy beans Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans Herbal stimulants, pasta, organ meats, and egg products

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans Explanation: MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine. Normally, tyramine is deactivated in the GI tract and liver so that large amounts do not reach the systemic circulation. When deactivation is blocked by MAO inhibitors, tyramine is absorbed systemically and transported to adrenergic nerve terminals, where it causes a sudden release of large amounts of norepinephrine. Foods that should be avoided include aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans.

After teaching a group of nursing students about the action of antidepressants, the instructor determines that the teaching was successful when the students correctly choose which drug classes as exerting their effects by inhibiting reuptake of norepinephrine and serotonin? Select all that apply. Amitriptyline Bupropion Clomipramine Duloxetine Venlafaxine

Amitriptyline Clomipramine New research indicates that the effects of antidepressants are related to slow adaptive changes in norepinephrine and serotonin receptor systems. Beta-adrenergics affect epinephrine and norepinephrine interfering with the action in the cardiac and smooth muscles. Baroreceptors affect the vascular system and are antihypertension in action. Cholinergic drugs effect the nicotinic action on the acetylcholine receptor.

Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular? It is an oral drug. It doesn't have side effects. It can be taken during pregnancy. An extended release form is available.

An extended release form is available. Explanation: Venlafaxine mildly blocks reuptake of NE, 5HT, and dopamine and has fewer adverse CNS effects than trazodone. Its popularity has increased with the introduction of an extended-release form that does away with the multiple daily doses that are required with the regular form. Venlafaxine is readily absorbed from the GI tract, extensively metabolized in the liver, and excreted in urine. Adequate studies have not been done in pregnancy and lactation, and it should be used during those times only if the benefit to the mother clearly outweighs the potential risk to the neonate. It is an oral drug, but so are most of the antidepressants It does have side effects.

A woman has a history of long periods of depression interspersed with hypomanic episodes. What mood disorder is the patient most likely suffering from? A) Bipolar disorder type I B) Bipolar disorder type II C) Situational depression D) Coping disorder

Ans: B Feedback: Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women. Bipolar disorder type I is characterized by episodes of major depression plus mania and occurs equally in men and women. Situation depression lasts a shorter amount of time and is related to life events. A coping disorder is not related to hypomania.

A patient is admitted for assessment because of his history of inappropriately flamboyant and extroverted behavior coupled with risk-taking behaviors. The wife states he has also had periods of major depression but refuses to seek help. From what mood disorder is the patient most likely suffering? A) Schizophrenia B) Depression C) Bipolar disorder type I D) Bipolar disorder type II

Ans: C Feedback: Bipolar disorder type I is characterized by episodes of major depression plus mania and occurs equally in men and women. Schizophrenia results from abnormal brain synapses and includes a wide variety of diseases. Depression is a mood disorder, but does not exhibit periods of mania. Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women.

A nurse is preparing a teaching plan for a client who has bipolar disorder and a new prescription for carbamazepine (Tegretol). Which of the following instructions should the nurse include in the teaching? SELECT ALL THAT APPLY. A) "This medication can safely be taken during pregnancy." B) "Eliminate grapefruit juice from your diet." C) "You will need to have a CBC and carbamazepine levels drawn periodically." D) "Notify your provider if you develop a rash." E) "Avoid driving for the first few days after starting this medication."

B) "Eliminate grapefruit juice from your diet." C) "You will need to have a CBC and carbamazepine levels drawn periodically." D) "Notify your provider if you develop a rash." E) "Avoid driving for the first few days after starting this medication." b. grapefruit juice affects carbamazepine metabolism and should be avoided c. carbamazepine blood levels and the CBC should be monitored during therapy. The client is at risk for bone marrow depression while taking carbamazepine and should notify the provider for a sore throat or other manifestations of an infection d. carbamazepine can cause Stevens-Johnson syndrome, which can be fatal. e. effects such as drowsiness or dizziness can occur early in treatment with carbamazepine and the client should avoid activities requiring alertness until those effects subside

An adult client, diagnosed with depression several weeks ago, has begun taking citalopram (Celexa) 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? / A 34-year-old man was diagnosed with depression several weeks ago and began taking citalopram (Celexa) 10 days ago. He has now scheduled an appointment at the clinic and has told the nurse that he intends 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 patient's statement? A) "I'll pass that information along to your care provider; a different drug might be more appropriate for you." B) "I'd encourage you to continue with the drug; it can take several weeks before it improves your mood." C) "People often have unrealistic expectations about how the drug will make them feel." D) "It could be that one of the other medications or supplements you're taking is negating the effects of citalopram."

B) "I'd encourage you to continue with the drug; it can take several weeks before it improves your mood." Feedback: Steady-state blood levels of SSRIs are achieved slowly, over several weeks. This aspect of pharmacokinetics is more likely than a possible drug interaction. The patient should expect to sense an eventual improvement in mood, and it would be premature to change medications.

A man has been taking imipramine (Tofranil) for 1 week for depression. He tells the nurse that he is going to stop taking this medication because it is not working. The best response is which of the following? A) "Contact your prescriber about taking a different antidepressant medication." B) "It may take up to 4 weeks before this medication makes you feel better." C) "You should slowly taper rather than suddenly discontinue this medication." D) "You should take an extra dose today to build up your blood level and get faster results."

B) "It may take up to 4 weeks before this medication makes you feel better." With tricyclic antidepressants (TCAs), therapeutic effects occur 2 to 4 weeks after initiation of therapy. Contacting the prescriber, changing the medication, tapering the medication, or increasing doses are inappropriate given the delayed onset of action with TCAs and the risk of toxic effects if too much of the drug is taken. It is not appropriate for a nurse to advise a client to take a dose that has not been prescribed of a medication.

A nurse is assessing a client who takes lithium carbonate (Lithobid) for the treatment of bipolar disorder. The nurse should identify which of the following findings is a possible indication of toxicity to this medication? A) Severe hypertension B) Coarse tremors C) Constipation D) Muscle spasms

B) Coarse tremors

A nurse is caring for a client who has been taking sertraline (Zoloft) for the past 2 days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome? A) Bruising B) Fever C) Tinnitus D) Rash

B) Fever Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline.

The psychiatric nurse would recognize that venlafaxine's (Effexor) therapeutic effect is achieved by what means? / A patient with a diagnosis of major depression has failed to respond to treatment withSSRIs, and the use of venlafaxine is being considered. The psychiatric nurse would recognize that this drug may have a therapeutic effect by which of the following means? A) Slowing the reuptake of endorphins in the central nervous system (CNS) B) Increasing levels of both serotonin and norepinephrine C) Stimulating synthesis and potentiating the action of dopamine D) Slowing the reuptake of acetylcholine in brain synapses

B) Increasing levels of both serotonin and norepinephrine Feedback: Venlafaxine increases the levels of serotonin and norepinephrine in the brain by preventing the re-uptake of these neurotransmitters known to play an important part in mood. It does not directly affect endorphins or acetylcholine. The drug weakly inhibits dopamine re-uptake.

A client has been prescribed mirtazapine (Remeron). How will it decrease depression? A) It increases concentration of endogenous epinephrine. B) It blocks the presynaptic alpha2-adrenergic receptors. C) It acts on the dopamine-only receptors in the brain. D) It inhibits norepinephrine and serotonin reuptake.

B) It blocks the presynaptic alpha2-adrenergic receptors. Feedback: Mirtazapine blocks presynaptic alpha2-adrenergic receptors (which increase the releaseof norepinephrine), serotonin receptors, and histamine H1 receptors. Consequently, thedrug decreases anxiety, agitation, insomnia, and migraine headaches as well asdepression.

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.

B) SSRIs prevent serotonin from being reabsorbed. Feedback: Fluoxetine and the other SSRIs block the reabsorption of the neurotransmitter serotoninin the brain. This helps elevate mood. SSRIs do not increase serotonin synthesis or thenumber of binding sites. They do not influence the role of GABA.

A patient has been taking a selective serotonin reuptake inhibitor for the treatment of depression. Which of the following represents the action of the medication? A) Selective serotonin reuptake inhibitors block GABA. B) Selective serotonin reuptake inhibitors prevent serotonin from being reabsorbed. C) Selective serotonin reuptake inhibitors increase serotonin synthesis. D) Selective serotonin reuptake inhibitors increase the number of serotonin binding sites.

B) Selective serotonin reuptake inhibitors prevent serotonin from being reabsorbed. Feedback: Fluoxetine and the other SSRIs block the reabsorption of the neurotransmitter serotonin in the brain. This helps elevate mood. SSRIs do not increase serotonin synthesis or the number of binding sites. They do not influence the role of GABA.

A nurse is teaching the importance of proper diet to a patient taking the MAO inhibitor tranylcypromine for depression. Which of the following food selections by the patient indicates that further teaching is needed? A) a tossed salad and a bowl of vegetable soup B) a salami and Swiss cheese sandwich and a banana C) a hamburger and French fries D) a cold plate with cottage cheese, chicken salad, and grapes

B) a salami and Swiss cheese sandwich and a banana The meal containing the sandwich includes foods highest in tyramine. Tyramine is normally broken down by MAO. In the presence of MAO inhibitors, tyramine levels increase. This exerts a pressor effect, as well as increasing the release of norepinephrine from nerve terminals; this can result in a hypertensive crisis.

Which food should the client avoid eating when prescribed phenelzine sulfate (Nardil)? / A patient has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor.Which of the following foods should the patient avoid eating? A) mashed potatoes and roast beef B) aged Swiss cheese and bratwurst C) tortellini in cream sauce D) anise cookies and milk

B) aged Swiss cheese and bratwurst Feedback:When taking an MAO inhibitor, the following foods should be avoided: aged cheesesand meats, concentrated yeast extracts, sauerkraut, and fava beans. None of the otherlisted foods is problematic.

A client, being treated for bipolar disorder with lithium carbonate (Lithobid), has a history of congestive heart failure and hypertension. The client has an increased fluid volume and has recently had difficulty breathing. What laboratory value should the nurse monitor to provide for affect the action of the client's lithium carbonate therapy? Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium? A) hematocrit B) serum sodium C) serum potassium D) white blood cell count

B) serum sodium Feedback: A sodium excess causes more lithium to be excreted and may lower lithium levels to non-therapeutic ranges. An increased lithium level would not be noted with a patient who has fluid volume excess and hypertension. An increased potassium level is unlikely with fluid volume excess. An increased white blood cell count is indicative of infection, from which the patient does not suffer. (Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.)

Which statement about amitriptyline (a TCA) does the nurse identify as being true? A. The drug is administered first thing in the morning. B. The drug should be discontinued slowly. C. The onset of antidepressant effect is 48 hours. D. Hypertension is a frequent side effect of this drug.

B. The drug should be discontinued slowly. (When discontinuing TCAs such as amitriptyline (Elavil), the drug should be gradually decreased to avoid withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. TCAs are given at night to minimize problems caused by their sedative action. The onset of the antidepressant effect of amitriptyline is 1 to 4 weeks. Orthostatic hypotension is a common side effect of amitriptyline)

A client taking lithium carbonate (Lithobid) started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium level is 2 mEq/L. The nurse interprets this value as: A. Within normal limits B. Toxic levels C. Below normal D. Slightly above normal

B. Toxic levels The therapeutic drug serum level of lithium is 0.6 to 1.2 mEq/L.

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 Pain assessment Pulse oximetry Monitoring the client for tardive dyskinesia

Blood pressure monitoring Explanation: The drug-drug interactions that exist with the use of monoamine oxidase inhibitors create a high risk for hypertensive crisis. Blood pressure monitoring is thus among the priority assessments. Tardive dyskinesia is not among the varied signs and symptoms that can result from drug-drug interactions with MAOIs. The nurse should certainly monitor the client's pain and oxygenation, but blood pressure monitoring is the highest priority due to the likelihood and safety risks associated with hypertensive crisis.

The nurse is caring for a 12-year-old child who has been hospitalized with depression, and the health care provider has elected to treat the child with a TCA. The nurse understands that what laboratory test will be routinely ordered by the provider? CBC and chemistry panel and plasma drug levels Hemoglobin and hematocrit and plasma drug levels Chest x-ray and plasma drug levels Blood pressure, ECG, and plasma drug levels

Blood pressure, ECG, and plasma drug levels Explanation: Amitriptyline, desipramine, imipramine, and nortriptyline are the TCAs most commonly prescribed to treat depression in children older than 12 years of age. Because of potentially serious adverse effects, blood pressure, ECG, and plasma drug levels should be monitored.

The nurse is preparing to teach a client basic guidelines for taking phenelzine which was recently prescribed. Which foods should the nurse caution the client to avoid? Select all that apply. Blue cheese Pepperoni Apples Chocolate Celery

Blue cheese Pepperoni Chocolate A nurse educating a client starting phenelzine should educate the client to avoid foods containing tyramine (aged cheese, sour cream, yogurt, beef and chicken livers, pickled herring, fermented meat, undistilled alcoholic beverages, caffeinated beverages, chocolate, certain fruits and vegetables [avocado, bananas, fava beans, raisins, and sauerkraut], yeast extract, and soy sauce) because the combination can result in a life-threatening hypertensive crisis.

A nurse is preparing to administer an antidepressant that affects the neurotransmission of norepinephrine, serotonin, and dopamine. Which drug will the nurse administer? Bupropion Sertraline Phenelzine Amitriptyline

Bupropion Explanation: Atypical antidepressants like bupropion exert their effects by affecting the neurotransmission of norepinephrine, serotonin, and dopamine. Selective serotonin reuptake inhibitors such as sertraline exert their effects by inhibiting reuptake of serotonin. Monoamine oxidase inhibitors such as phenelzine exert their effects by inhibiting the activity of monoamine oxidase. Tricyclic antidepressants such as amitriptyline exert their effects by inhibiting reuptake of norepinephrine and serotonin.

A male client wishes to discontinue his antidepressant secondary to sexual dysfunction. What antidepressant medication may be ordered by his health care provider because it does not interfere with sexual function? Mirtazapine Bupropion Duloxetine Venlafaxine

Bupropion Explanation: Bupropion does not cause orthostatic hypotension or sexual dysfunction.

A nurse is providing teaching to a client who has a new prescription for amitriptyline (Elavil) for treatment of depression. Which of the following should the nurse include in the teaching? SELECT ALL THAT APPLY. A) Expect therapeutic effects in 24 to 48 hr. B) Discontinue the medication after a week of improved mood. C) Change positions slowly to minimize dizziness. D) Decrease dietary fiber intake to control diarrhea. E) Chew sugarless gum to prevent dry mouth.

C) Change positions slowly to minimize dizziness. E) Chew sugarless gum to prevent dry mouth. Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect of amitripyline.Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline.

What fact should underlie the nurse's response to the client who asks to be prescribed a monoamine oxidase (MAO) inhibitor for their long-standing depression? / An elderly woman tells the nurse that she was successfully treated with phenelzine(Nardil) during a bout of severe depression in the 1970s. Her mood has been worsening in recent years as she has dealt with the death of her husband and functional declines. As a result, she has asked the nurse if her care provider is likely to prescribe this same drug. What fact should underlie the nurse's response to the patient? A) Cognitive-behavioral therapy has been found to be more effective than MAO inhibitors, so they are rarely prescribed. B) In most situations, MAO inhibitors have been largely superseded by tricyclic antidepressants. C) The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used. D) MAO inhibitors are rarely used because serum levels must be monitored with blood work every 2 weeks.

C) The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used. Feedback: MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Serum levels do not need to be monitored. The potential benefits of cognitive behavioral therapy do not affect prescribers' decisions to use MAO inhibitors.SSRIs have become the first line of treatment for depression, replacing tricyclic antidepressants.

A woman who is stable on lithium therapy for her bipolar disorder is shortly going to be receiving a drug for her hypertension. Which drug would be of greatest concern if added to the treatment regimen? A) a vasodilator B) an angiotensin-converting enzyme inhibitor C) a diuretic D) a calcium channel blocker

C) a diuretic People who receive diuretics are at high risk for lithium toxicity because the drug is a salt and retained in the absence of sodium.

A client prescribed a selective serotonin reuptake inhibitor (SSRI) has begun taking St. John's wort daily. The nurse should teach that client that this combination may result in what adverse reaction? A patient with a diagnosis of depression states to the nurse that she has started taking St.John's wort to help her feel better and tolerate the demands of parenting. The patient hasbeen taking an SSRI for the past several months. The nurse should teach that patient thatthis combination may result in A) worsened symptoms of depression B) development of blood dyscrasias C) dangerous drug interactions D) hemostatic instability

C) dangerous drug interactions Feedback: Combining St. John's wort with antidepressants can cause serious adverse effects. These effects do not typically include worsened depression, alterations in coagulation, ordyscrasias.

What medication is effective in treating enuresis in children older than 6 years of age? / An 8-year-old child is being seen in the clinic. The mother states he suffers from bedwetting at least four times per week. What medication is effective in treating enuresis in children? A) amitriptyline (Elavil) B) duloxetine (Cymbalta) C) imipramine (Tofranil) D) venlafaxine (Effexor)

C) imipramine (Tofranil) Feedback:Imipramine (Tofranil) is approved for treating childhood enuresis in children older than6 years. Amitriptyline (Elavil) is a tricyclic antidepressant but is not used for childhoodenuresis. Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor that isused for depression. Venlafaxine (Effexor) is a serotonin-norepinephrine reuptakeinhibitor that is used for depression.

Which laboratory value would prevent a client from being prescribed duloxetine (Cymbalta)? / Duloxetine (Cymbalta) is being considered in the treatment of a patient's depression. Which of the following laboratory values would prevent the patient from being treated with this medication? A) decreased hemoglobin level B) decreased potassium level C) increased alanine aminotransferase level (ALT) D) increased erythrocyte sedimentation rate (ESR)

C) increased alanine aminotransferase level (ALT) Feedback: Duloxetine (Cymbalta) is highly protein bound, extensively metabolized by CYP2D6and CYP1A2 enzymes in the liver, and excreted by the kidneys. It is not recommendedfor use in patients with severe renal or any degree of liver impairment. Low hemoglobin, elevated potassium, and increased ESR do not necessarily preclude the useof Cymbalta.

A patient has been taking lithium carbonate (Eskalith) for many years to treat bipolardisorder. Which of the following diets will require the dose of lithium carbonate(Eskalith) be reduced? A) low calorie B) low carbohydrate C) low sodium D) low residue

C) low sodium Feedback: A low-salt (sodium) diet will impair lithium secretion, so the dose of lithium should be reduced. The administration of a low-calorie diet will not affect the dose of lithium. The administration of a low-carbohydrate diet will not affect the dose of lithium. The administration of a low-residue diet will not affect the dose of lithium.

Fluoxetine (Prozac) achieves its effects by A) blocking the uptake of monoamines B) inhibiting monoamine oxidase A (MAO-A) enzyme in nerve terminals C) selectively inhibiting serotonin reuptake D) directly stimulating serotonin receptors

C) selectively inhibiting serotonin reuptake Fluoxetine elevates mood by blocking the reuptake of the neurotransmitter serotonin in the brain.

A client with depression who has been taking amitriptyline (a TCA) for three months returns to the clinic for a follow-up. The priority nursing assessment is for: A. Lack of energy B. Loss of interest in personal appearance C. Suicidal thoughts D. Weight gain

C. Suicidal thoughts Clients may have thoughts about suicide when taking an antidepressant such as amitriptyline, especially clients younger than 24 years old. Other options are signs of depressions but are most likely improved as the treatment goes on.

Before administering an monoamine oxidase inhibitor, it is most important for the nurse to assess the patient's A. sexual history. B. socioeconomic status. C. dietary intake. D. hydration status.

C. dietary intake. (Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users)

A client is prescribed a monoamine oxidase inhibitor (MAOI) for depression. During the initial interview with the client, the nurse discovers that the client is also receiving an adrenergic agent. The nurse would be alert for which potential reaction? Hypertensive episodes Severe convulsions Hyperpyretic episodes Cardiac arrhythmias

Cardiac arrhythmias Explanation: The nurse should identify increased risk for cardiac arrhythmias because of the effects of interaction between MAOIs and adrenergic agents. Increased risk for hypertensive episodes, severe convulsions, and hyperpyretic episodes occur when an MAOI and meperidine are used together.

A nurse is preparing to administer amitriptyline to a client. Which situation will necessitate cautious administration if noted in the medical record? Select all that apply. Cardiac disease Hypothyroidism Diabetes Elderly Adolescence

Cardiac disease Elderly Adolescence Tricyclic antidepressants (TCAs) like amitriptyline can cause cardiac-related adverse reactions, so the nurse should give TCAs with caution to clients with preexisting cardiac disease and elderly clients. Children and adolescents with major depressive disorders have an increased risk of suicidal ideation when prescribed antidepressant medications. Hypothyroidism should be ruled out before administering an antidepressant drug to ensure the signs and symptoms are not related to low thyroid levels. SSRI and MAOI antidepressants should be used cautiously in clients with type 2 diabetes.

A client taking phenelzine presents to the emergency department reporting nausea and a terrible headache after consuming several glasses of red wine. Which additional sign or symptom should the nurse prioritize? Select all that apply. Constricted pupils Chills Chest pain Tachycardia Stiff neck

Chest pain Tachycardia Stiff neck A client experiencing a hypertensive crisis can exhibit the following symptoms: stiff or sore neck, nausea, vomiting, headache, sweating (not chills), fever, chest pain, dilated pupils (not constricted), and bradycardia or tachycardia.

A nurse determines the need to administer a prescribed antidepressant in the morning because of the increased likelihood of insomnia. Which drug would this most likely be? Select all that apply. Amitriptyline Trazodone Citalopram Paroxetine Sertraline

Citalopram Paroxetine Sertraline It is best to administer serotonin reuptake inhibitors, such as citalopram, paroxetine, and sertraline, in the morning as they have a greater likelihood to cause insomnia. Amitriptyline has the adverse effect of sedation. Trazodone has the adverse effect of drowsiness.

The nurse is caring for several clients who all take lithium. The nurse monitors which clients for an increased chance of lithium toxicity? Select all that apply. Client with dehydration Client with a temperature of 102ºF Client who rates his pain at a 6 on a scale of 1-10 Client who takes furosemide (Lasix) for edema Client who has constipation

Client with dehydration Client with a temperature of 102ºF Client who takes furosemide (Lasix) for edema Lithium levels are monitored carefully in clients who sweat profusely, experience diarrhea or vomiting, or have an infection or fever causing fluid loss. Clients who take diuretics or antipsychotics should also be monitored carefully. Neither pain nor constipation will cause alterations in lithium levels.

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. Amoxapine Maprotiline Clomipramine Desipramine

Clomipramine Explanation: Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.

The nurse in a long-term care facility is providing care for an 83-year-old client who has depression and who has been prescribed clomipramine. The client has twice reported urinary hesitation since starting this treatment and required intermittent urinary catheterization overnight to relieve bladder distention. What is the nurse's best action? Contact the care provider promptly to advocate for a change in the medication regimen. Provide the client with increased opportunities for fluid intake. Contact the provider to obtain an order for an indwelling urinary catheter. Monitor the client's urinary function closely over the next 48 hours.

Contact the care provider promptly to advocate for a change in the medication regimen. Explanation: Urinary hesitancy that requires catheterization suggests that the client cannot likely tolerate the anticholinergic effects of this medication. A dose reduction or a change to a different class of antidepressants may be necessary. Increasing fluid intake may exacerbate, rather than relieve, the problem. Indwelling catheters create high risks for infection and loss of function; a change in medication would be a preferred approach. The nurse should monitor the client closely, but interventions are needed in addition to this assessment.

A nurse is caring for a client who has a new prescription for lithium carbonate (Lithobid). When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? A) Avoid the use of acetaminophen for headaches. B) Restrict intake of foods rich in sodium. C) Decrease fluid intake to less than 1500 mL daily. D) Limit aerobic activity in hot weather.

D) Limit aerobic activity in hot weather. The client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity.

An elderly patient is admitted to the medical unit after a fall. At home he is taking amitriptyline (Elavil) 20 mg three times per day. What adverse effect could be related to the patient's fall? A) Urinary frequency B) Urinary retention C) Visual disturbances D) Orthostatic hypotension

D) Orthostatic hypotension Feedback: Orthostatic hypotension is an adverse effect related to amitriptyline (Elavil). Urinary retention (not frequency) is an adverse effect of amitriptyline but is not related to the falls. Visual disturbances are not a common adverse effect.

A patient suffers from depression and states feelings of gloom and inability to perform the activities of daily living. The normal function of which neurotransmitter is most likely impaired? A) Acetylcholine B) Epinephrine C) Insulin D) Serotonin

D) Serotonin Feedback: Serotonin helps regulate several behaviors that are disturbed in depression. Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle. Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas to regulate blood sugar.

A patient suffers from insomnia secondary to temporomandibular joint pain. Which of the following selective serotonin reuptake inhibitors is most effective for treating insomnia? A) Fluoxetine (Prozac) B) Olanzapine (Zyprexa) C) Citalopram hydrobromide (Celexa) D) Trazodone (Desyrel)

D) Trazodone (Desyrel) Feedback: Trazodone (Desyrel) is administered more often for sedation and sleep than depression. Fluoxetine (Prozac) is not administered for sleep. Olanzapine (Zyprexa) is not administered for sleep. Citalopram hydrobromide is not administered for sleep.

A patient taking lithium is having problems with coordination and unstable gait. The patient's lithium level is 2.3 mEq/L. The nurse should do which of the following? A) Continue to administer the lithium three times per day. B) Skip a dose of lithium and then resume the regular medication schedule. C) Administer an extra dose of lithium. D) Withhold the lithium, offer fluids, and notify the prescriber of the lithium level.

D) Withhold the lithium, offer fluids, and notify the prescriber of the lithium level. The therapeutic range of lithium in the serum is 0.5 to 1.2 mEq/L. Adverse effects occur when lithium levels exceed 1.5 mEq/L.

he nurse is teaching a client taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the client understands a low tyramine diet when what meal is chosen? A) chop salad with blue cheese, sardines, and pepperoni B) sandwich with turkey, avocado, and Swiss cheese C) corned beef hash, eggs, and hash browns D) hamburger, French fries, and a strawberry milkshake

D) hamburger, French fries, and a strawberry milkshake (Hamburger, French fries, and a strawberry milkshake do not contain tyramine and, although high in fat, it would not be contraindicated for a client taking an MAOI. Blue cheese, sardines, pepperoni, Swiss cheese, and corned beef are all high in tyramine and would indicate further teaching was needed.)

Monoamine oxidase (MAO) inhibitors are indicated in which of the following? A) in patients who have previously developed serotonin syndrome B) in patients who are first beginning treatment of depression C) in patients who are having trouble sleeping D) in patients who have not responded successfully to selective serotonin reuptake inhibitors and tricyclic antidepressants

D) in patients who have not responded successfully to selective serotonin reuptake inhibitors and tricyclic antidepressants MAO inhibitors are third-line agents for the treatment of depression mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Prescribers are most likely to order MAO inhibitors when a client does not respond to other antidepressant drugs or when electroconvulsive therapy is refused or contraindicated.

Which of the following adverse effects of the imipramine (Tofranil) is considered the most serious? A) dry mouth B) constipation C) urinary retention D) orthostatic hypotension

D) orthostatic hypotension Although urinary retention, constipation, and drymouth are adverse effects related to the anticholinergic properties of imipramine, orthostatic hypotension poses the greatest safety risk to the client. The nurse should instruct the client to rise slowly from a lying or sitting position to a standing one. Additionally, it is necessary to avoid activities that require changes in position until the client knows how he or she is affected by the risk of orthostatic hypotension.

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline (Elavil)? A) urinary frequency B) urinary retention C) visual disturbances D) orthostatic hypotension

D) orthostatic hypotension Feedback: Orthostatic hypotension is an adverse effect related to amitriptyline (Elavil). Urinaryretention (not frequency) is an adverse effect of amitriptyline but is not related to thefalls. Visual disturbances are not a common adverse effect.

A nurse practitioner plans to order lithium for a patient with bipolar disorder. Lithium is contraindicated in a patient with an impairment of which of the following systems? A) respiratory system B) cardiac system C) endocrine system D) renal system

D) renal system Because lithium does not bind with plasma protein and is excreted solely by the kidneys, it is contraindicated in clients with renal system impairment

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? A) acetylcholine B) epinephrine C) insulin D) serotonin

D) serotonin Feedback:Serotonin helps regulate several behaviors that are disturbed in depression.Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle.Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas toregulate blood sugar.

The nurse should prioritize which assessment when caring for a teenager who has recently been prescribed a selective serotonin reuptake inhibitor (SSRI)? / A high school-aged girl has been suffering from major depression for several months, and she has begun treatment with an SSRI. In light of the black box warning accompanying SSRIs, the nurse should prioritize which of the following assessments? A) venous thromboembolism (VTE) B) cardiac rate and rhythm C) hypomanic state D) suicidal ideation

D) suicidal ideation Feedback:The FDA has issued a black box warning alerting health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications. VTE, arrhythmias, and hypomania are not likely adverse effects.

Which selective serotonin reuptake inhibitor is most effective for treating insomnia? A) fluoxetine (Prozac) B) olanzapine (Zyprexa) C) citalopram hydrobromide (Celexa) D) trazodone (Desyrel)

D) trazodone (Desyrel) Feedback: Trazodone (Desyrel) is administered more often for sedation and sleep than depression.Fluoxetine (Prozac) is not administered for sleep. Olanzapine (Zyprexa) is notadministered for sleep. Citalopram hydrobromide is not administered for sleep.

A client is to be switched from fluoxetine (Prozac) to isocarboxazid (Marplan). What client education is most important when changing from fluoxetine to isocarboxazid? A) wait 5 days before starting isocarboxazid B) wait 1 week before starting isocarboxazid C) wait 2 weeks before starting isocarboxazid D) wait 5 weeks before starting isocarboxazid

D) wait 5 weeks before starting isocarboxazid Feedback: If a patient is taking fluoxetine (Prozac) and is being switched to isocarboxazid(Marplan), the fluoxetine should be discontinued at least 5 weeks before starting theMAO inhibitor. Waiting less time than this before starting the isocarboxazid (Marplan)will place the patient at risk for serotonin syndrome.

Which advice will the nurse include when teaching the patient about lithium therapy? A. Take the drug on an empty stomach. B. Eliminate all sodium from your diet. C. Stop taking the lithium when you feel better. D. It may take 1 to 2 weeks before you have any benefits from taking the medication.

D. It may take 1 to 2 weeks before you have any benefits from taking the medication. (The effectiveness of lithium may not be evident until 1 to 2 weeks after the start of therapy. The patient should be taught to maintain adequate sodium intake and to avoid crash diets that affect physical and mental health. Lithium levels are maintained by taking the drug on a daily basis. The patient should be taught to take lithium with meals to decrease gastric irritation.)

A patient with reactive depression is ordered to receive fluoxetine. Which information will the nurse include when teaching this patient? A. The medication takes effect in 1 to 2 days. B. The medication increases libido. C .The medication should be taken with grapefruit juice. D. The medication may cause headaches and insomnia.

D. The medication may cause headaches and insomnia. (Side effects include headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, and sexual dysfunction. The drug takes about 2 to 4 weeks for onset, decreases libido, and has no interaction with grapefruit juice.)

A client is receiving lithium and informs the nurse that they are also taking antacids for heartburn. The nurse would be alert for which reaction? Decreased effectiveness of lithium Increased risk of lithium toxicity Increased risk for bipolar disorder Increased psychotic symptoms TAKE ANOTHER QUIZ

Decreased effectiveness of lithium Explanation: Combining lithium with antacids may result in decreased effectiveness of lithium. This combination will not increase the risk for lithium toxicity, bipolar disorder, or psychotic symptoms. When lithium is combined with diuretics or antipsychotics, there is the increased risk for lithium toxicity. When antipsychotics and anticholinergics are combined there is the increased risk of psychotic symptoms. Lithium is used to treat the manic phase of bipolar disorder.

A client with depression has been prescribed amitriptyline. Which drug action should the nurse integrate into the teaching session for the client? Decreased reuptake of norepinephrine Increased serotonin in the nervous system Increased endogenous norepinephrine Increased endogenous epinephrine

Decreased reuptake of norepinephrine Explanation: The nurse should identify decreased reuptake of norepinephrine as the effect of the tricyclic antidepressant on the client's body. Increased serotonin in the nervous system, increased endogenous norepinephrine, and increased endogenous epinephrine are effects of monoamine oxidase inhibitors.

The nurse is preparing a client for discharge who is taking phenelzine. The nurse instructs the client that which foods cause serious complications? (Select all that apply.) Deer meat Shrimp Rice American cheese Fava beans

Deer meat Shrimp Fava beans Clients who are taking phenelzine must avoid certain foods to prevent serious complications. The client must avoid game meats, soy products, sesame seeds, brewers yeast, sauerkraut, seafood, aged cheeses and meats, and fava beans.

When developing the plan of care for a client who is receiving lithium therapy, which nursing diagnosis would the nurse most likely prioritize? ADL Deficit Sleep Wake Disturbance Malnutrition: Less Than Body Requirements Dehydration

Dehydration Explanation: Fluid balance determines the concentration of lithium in the blood and thus the client's risk for toxicity. Therefore, dehydration is a priority. ADL deficit, sleep wake disturbance, and malnutrition also may apply, but dehydration would be the priority.

The nurse determines the health care provider needs to be contacted after observing which finding on the ongoing assessment of a client receiving an antidepressant? Select all that apply. Weight gain Expressions of guilt Indirect threats of suicide Somnolence Insomnia

Expressions of guilt Indirect threats of suicide Insomnia The nurse should report any of the following to the client's primary health care provider if observed: expressions of guilt, hopelessness, or helplessness; insomnia; weight loss; and direct or indirect threats of suicide. The client will demonstrate insomnia versus somnolence and weight loss versus weight gain.

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? Drowsiness Extreme sadness Severe headache Dilated pupils

Extreme sadness Explanation: The nurse should monitor the patient for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are the symptoms of hypertensive crisis.

The nurse is performing an assessment on a new client and suspects major depression based on which finding? Select all that apply. Feelings of hopelessness Minimal changes in weight Focused concentration Loss of energy Excessive guilt

Feelings of hopelessness Loss of energy Excessive guilt Manifestations of depression include feelings of hopelessness or helplessness, significant (not minimal) weight loss or gain, inability to concentrate (not focused), and excessive guilt.

A nursing instructor has been explaining the differences between different classes of drugs. The instructor determines the class is successful when the students correctly choose which antidepressants prevent the reuptake of serotonin? Select all that apply. Amitriptyline Bupropion Clomipramine Fluoxetine Escitalopram

Fluoxetine Escitalopram Selective serotonin reuptake inhibitors like fluoxetine and escitalopram exert their effects by inhibiting the reuptake of serotonin. Tricyclic antidepressants like amitriptyline and clomipramine exert their effects by inhibiting the reuptake of norepinephrine and serotonin. Bupropion is believed to affect serotonin, norepinephrine, and dopamine receptors.

Which class of antidepressants exerts their effects by inhibiting reuptake serotonin? (Select all that apply.) Amitriptyline Bupropion Clomipramine Fluoxetine Escitalopram

Fluoxetine Escitalopram Selective serotonin reuptake inhibitors, like fluoxetine and escitalopram, exert their effects by inhibiting reuptake of serotonin.

Which agent would a nurse identify as a selective serotonin reuptake inhibitor? Fluvoxamine Selegiline Nefazodone Mirtazapine

Fluvoxamine Explanation: Fluvoxamine is classified as a selective serotonin reuptake inhibitor. Selegiline is not classified as a selective serotonin reuptake inhibitor; it is a MAO-type B inhibitor. Nefazodone is not classified as a selective serotonin reuptake inhibitor. Mirtazapine is not classified as a selective serotonin reuptake inhibitor.

A client has been prescribed a monoamine oxidase inhibitor (MAOI) by the health care provider. Before administration of the drug, the client wants to know about possible adverse reactions. Which would the nurse expect to describe? Photosensitivity Change in libido Hypertensive crisis Skin rash

Hypertensive crisis Explanation: Hypertensive crisis is an adverse reaction of MAOIs. Photosensitivity is an adverse reaction of tricyclic antidepressants. Change in libido and skin rash are adverse reactions of desvenlafaxine and bupropion.

An 11-year-old client has been hospitalized on the adolescent psychiatry unit with severe depression. For the past several weeks, the client has been prescribed a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action? Monitor food intake and eliminate potential sources of tyramine. Assess for weight loss and difficulty sleeping. Monitor the client for migraines. Implement suicide precautions.

Implement suicide precautions. Explanation: Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric clients. The priority concern for the nurse would be safety for the client. Severe headaches and reactions to tyramine-containing foods are associated with monoamine oxidase therapy, not SSRIs. Weight loss and difficulty sleeping are of a lower priority concern than the client's safety.

A female client is prescribed fluoxetine during the third trimester of her pregnancy for depression. After birth, her child exhibits symptoms of neonatal withdrawal syndrome. When would the nurse expect the symptoms to abate? In a few days After 6 weeks In a few hours With administration of fluoxetine

In a few days Explanation: Third-trimester intrauterine exposure to fluoxetine or other SSRIs may result in a neonatal withdrawal syndrome, which shares some similarity to a mild serotonin syndrome. Common symptoms include irritability, prolonged crying, respiratory distress, rigidity, and possibly seizures. Care for an infant with neonatal withdrawal syndrome is supportive; symptoms usually abate within a few days.

The client prescribed an antidepressant reports nausea, dry mouth, diarrhea, and loss of weight. When planning care which suggestions should the nurse include in the teaching for this client? Select all that apply. Increase fiber intake. Decrease fiber intake. Increase fluid intake. Decrease fluid intake. Chew sugarless gum.

Increase fiber intake. Increase fluid intake. Chew sugarless gum. Malnutrition often applies due to various adverse reactions of the medication. To help with antidepressant-induced constipation, the nurse can recommend increased fluid and fiber intake, and for antidepressant-induced dry mouth the nurse can recommend good oral hygiene, frequent sips of water, sugarless gum, and hard candy. Increased fiber intake and fluid intake as well as chew sugarless gum will help improve the client's situation. Decreased fiber intake and fluid intake would further complicate the situation.

Terry, age 46, has a history of bipolar disorder and has been taking lithium for the past 15 years. He recently began showing signs of low thyroid function and changes in his urinary output. Which adverse effect could be affecting Terry's kidneys? Lithium impairs the ability of the kidneys to concentrate urine. Lithium causes a reduction in the glomerular filtration rate. Lithium causes renal insufficiency. Lithium causes a decrease in the levels of antidiuretic hormones.

Lithium impairs the ability of the kidneys to concentrate urine. Explanation: Long-term lithium therapy (exceeding 10 years) commonly impairs the ability of the kidneys to concentrate urine, although this effect is not associated with a reduced glomerular filtration rate or with renal insufficiency. Low thyroid function can also occur in patients receiving long-term lithium therapy.

A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately? Increased urination Muscle twitching Hair loss Increased thirst

Muscle twitching Explanation: Muscle twitching is an early symptom of lithium toxicity and should be reported immediately. Muscle twitching indicates that a dosage change may be needed. Increased thirst and urination are acute effects of lithium, whereas hair loss is a chronic adverse effect.

When describing the action of antidepressants, the nursing instructor would include the belief that they exert their effect by causing slow adaptive changes to which receptor systems? Select all that apply. Beta-adrenergic Baroreceptors Norepinephrine Serotonin Nicotinic

Norepinephrine Serotonin New research indicates that the effects of antidepressants are related to slow adaptive changes in norepinephrine and serotonin receptor systems. Beta-adrenergics affect epinephrine and norepinephrine interfering with the action in the cardiac and smooth muscles. Baroreceptors affect the vascular system and are antihypertension in action. Cholinergic drugs effect the nicotinic action on the acetylcholine receptor.

Which adverse effects would the nurse instruct a client to report to the health care provider immediately when taking trazodone? Hypertension Dizziness Sedation Painful continued erection

Painful continued erection Explanation: Trazodone is associated with a risk for low blood pressure and priapism (a sustained, painful erection). CNS effects, such as dizziness and sedation, occur with this drug but are not a cause for notifying the health care provider.

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? Diazepam Phenelzine Triazolam Paroxetine

Phenelzine Explanation: MAOIs are drugs used in the treatment of mood disorders. They require that the client follow a strict diet that restricts tyramine to prevent a hypertensive crisis. Nardil is an MAOI. Diazepam and triazolam are benzodiazepines and paroxetine is an SSRI.

A group of students are reviewing information about antidepressants that inhibit the activity of monoamine oxidase, leading to increase in epinephrine, norepinephrine, dopamine, and serotonin. The students demonstrate understanding when they identify which drug as acting in this manner? Phenelzine Sertraline Amitriptyline Bupropion

Phenelzine Explanation: Monoamine oxidase inhibitors such as phenelzine exert their effects by inhibiting the activity of monoamine oxidase. Selective serotonin reuptake inhibitors such as sertraline exert their effects by inhibiting reuptake of serotonin. Tricyclic antidepressants such as amitriptyline exert their effects by inhibiting reuptake of norepinephrine and serotonin. Serotonin/norepinephrine or dopamine/norepinephrine reuptake inhibitors such as bupropion affect the neurotransmission of norepinephrine, serotonin, and dopamine.

A client has been diagnosed with depression and prescribed fluoxetine 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription? Question the prescriber about the dose Question the prescriber about the frequency Question the prescriber about the timing Teach the client about possible anticholinergic effects

Question the prescriber about the dose Explanation: Fluoxetine is usually prescribed at 20 mg/day in the morning, with a ceiling of 60 mg per day. Consequently, the nurse should clarify the dose with the prescriber. Anticholinergic effects are not expected with SSRIs such as fluoxetine.

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? Glaucoma Prostatic hypertrophy Renal dysfunction Recent myocardial infarction

Recent myocardial infarction Explanation: A recent myocardial infarction would be a contraindication for use because of the potential occurrence of reinfarction or extension of the infarction due to the drug's cardiac effects. Cautious use and close monitoring would be appropriate for the client with glaucoma and prostatic hypertrophy due to the anticholinergic effects. Cautious use in renal dysfunction also is warranted because the drugs are excreted in the urine.

A client taking mirtazapine for depression reports having a sore throat. Which action will the nurse take to help the client? Instruct the client to gargle with warm salt water. Remind the client to drink six to ten glasses of liquid each day. Report the sore throat to the health care provider. Recommend using over-the-counter throat lozenges.

Report the sore throat to the health care provider. Explanation: Mirtazapine is an atypical antidepressant that has agranulocytosis and severe neutropenia as potential adverse effects. With the report of a sore throat, the health care provider should be notified to determine the course of treatment, as the symptom could indicate an infection. Gargling with salt water, drinking fluids, and using throat lozenges would not be sufficient for the client who is experiencing a sore throat from taking mirtazapine.

A client receiving clomipramine is given a prescription for zolpidem for sleep. The primary health care provider was unaware the client was taking clomipramine. Which reactions might the nurse appraise in this client? Select all that apply. Respiratory depression CNS depression Hypertensive crisis Easy bruising Hyperglycemia

Respiratory depression CNS depression The concomitant administration of tricyclic antidepressants like clomipramine with hypnotics like zolpidem can result in the increased risk of respiratory depression and CNS depression. A hypertensive crisis can occur if MAOIs are combined with foods containing tyramine. Easy bruising and hyperglycemia are not noted adverse effects with any of the antidepressant drugs.

A middle-aged client was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, the client was prescribed phenelzine. When planning this client's subsequent care, what nursing diagnosis should the nurse prioritize? Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine Risk for Constipation related to decreased gastrointestinal peristalsis Risk for Infection related to immunosuppressive effects of phenelzine Risk for Injury related to drug-drug interactions or drug-nutrient interactions

Risk for Injury related to drug-drug interactions or drug-nutrient interactions Explanation: MAOIs such as phenelzine carry a significant risk of injury that results from the multiple interactions associated with these drugs. Infection, impaired tissue perfusion, and constipation are less common, and less serious, adverse effects.

A client with major depression has not experienced an improvement after treatment with SSRIs and electroconvulsive therapy. Consequently, the provider has prescribed isocarboxazid. When planning this client's care, what nursing diagnosis should the nurse prioritize? Risk for injury related to adverse drug effects Urinary retention related to anticholinergic effects Insomnia related to CNS stimulation Risk for imbalanced nutrition (less than body requirements) related to dietary restrictions

Risk for injury related to adverse drug effects Explanation: MAOIs such as isocarboxazid have a very high risk for injury because of the serious and diverse adverse effects. MAOIs do not typically cause anticholinergic effects. Insomnia is a possibility but less of a safety risk than many other adverse effects. Dietary modifications are necessary but these do not normally threaten the client's nutritional status because prohibited foods are not the staples of most individuals' diets.

A nurse caring for a client taking amitriptyline for depression should monitor the client for which adverse events? Select all that apply. Sedation Diarrhea Incontinence Dry mouth Dry eyes

Sedation Dry mouth Dry eyes The use of tricyclic antidepressants like amitriptyline can cause the following side effects: sedation, dry mouth, dry eyes, urinary retention, and constipation. Diarrhea is a known adverse reaction to citalopram, fluvoxamine, paroxetine, phenelzine, tranylcypromine, and isocarboxazid. Incontinence is not noted to be an adverse reaction to antidepressant drugs.

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 Tricyclic Monoamine oxidase inhibitor Benzodiazepine

Selective serotonin reuptake inhibitor Explanation: SSRIs are the most commonly prescribed antidepressants, due to their effectiveness and relatively low levels of adverse effects.

After teaching a group of students about antidepressant therapy, the instructor determines that the teaching was successful when the students correctly choose which as a class of antidepressants? Select all that apply. Selective serotonin reuptake inhibitors Tricyclics Monoamine oxidase inhibitors Benzodiazepines Barbiturates

Selective serotonin reuptake inhibitors Tricyclics Monoamine oxidase inhibitors Antidepressants include selective serotonin reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors. Benzodiazepines and barbiturates are sedative and hypnotics.

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? Concurrently with the paroxetine as it is being tapered Several weeks after stopping the paroxetine Immediately upon stopping the paroxetine. Forty-eight hours after being weaned from the paroxetine

Several weeks after stopping the paroxetine Explanation: Paroxetine, a SSRI, and phenelzine, an MAOI, should not be given together because of the risk for serotonin syndrome. At least 2 weeks and up to 6 weeks should be allowed between the use of the two drugs when switching from one to the other.

A nurse is caring for a client with suicidal tendencies and severe depression. Which would the nurse be alert for when monitoring the client's condition? Urinary retention Visual disturbances Signs of insomnia Photosensitivity

Signs of insomnia Explanation: The nurse should look for signs of insomnia when checking for suicidal tendencies in the client. and report any expressions of guilt, hopelessness, or helplessness; insomnia; weight loss; and direct or indirect threats of suicide. Urinary retention, visual disturbances, and photosensitivity are adverse reactions of tricyclic antidepressants and are not indicative of suicidal tendencies.

A client with depression is prescribed venlafaxine. Which action will the nurse take when the client is unable to swallow the extended-release capsule? Crush the capsules. Sprinkle the contents on applesauce. Dissolve the capsules in water. Open the capsules and have the client chew the contents.

Sprinkle the contents on applesauce. Explanation: Venlafaxine is a serotonin-norepinephrine reuptake inhibitor that is a standard first-line treatment for depression. The medication should be taken with food to decrease adverse gastrointestinal effects. For clients who are unable to swallow extended-release capsules, the capsule can be opened and sprinkled on applesauce and swallowed whole. The capsules and their contents should not be crushed, chewed, or dissolved in water.

A nurse is caring for an older adult client who has been prescribed amoxapine for depression accompanied by anxiety. After administration of the drug, the nurse observes muscle rigidity and sweating. Which action should the nurse prioritize? Suggest the client engage in exercise. Get the client to drink a glass of cold water. Encourage the client to breathe deeply. Stop the drug and contact the health care provider.

Stop the drug and contact the health care provider. Explanation: The nurse should identify these as symptoms of neuroleptic malignant syndrome and discontinue the drug administration and contact the health care provider. Exercising, drinking cold water, and encouraging deep breaths will not help the client with these symptoms.

During initial admission assessment, a 79-year-old client's family mention the client's spouse died 4 months ago. One family member notes, "the healthcare provider had prescribed antidepressant medication" but the client is "talking to people who aren't there." What would the nurse suspect is happening to the client? The client is having hallucinations as an adverse effect of antidepressant therapy. The mental status change is a paradoxical medication effect. The client probably has a urinary tract infection caused by changes in pH from the antidepressant. The client is having delusions because of their depression over the loss of their spouse.

The client is having hallucinations as an adverse effect of antidepressant therapy. Explanation: Older clients may be more susceptible to the adverse effects of antidepressants from unanticipated central nervous system effects to increased sedation, dizziness, and even hallucinations. Although an infection cannot be ruled out without further testing, the history would lead the nurse to the antidepressants as the most likely cause. This is not a paradoxical effect, which is understood as the opposite of the desired therapeutic effect.

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. Electroconvulsive therapy (ECT) will be prescribed 2 to 3 weeks before stopping the fluoxetine. A monoamine oxidase (MAO) inhibitor will be prescribed concurrently with the fluoxetine for 2 to 3 weeks. It will be important that the client avoid stressful situations until another selective serotonin reuptake inhibitor (SSRI) can be prescribed.

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks. Explanation: To avoid antidepressant discontinuation syndrome, it is essential to taper the dosage of the antidepressant and discontinue it gradually, over 6 to 8 weeks, unless severe drug toxicity, anaphylactic reaction, or another life-threatening condition is present. ECT will not avoid this syndrome. Concurrent use of an MAO inhibitor is dangerous. Avoiding stress is advisable but will not minimize the risk of injury in this situation.

A client diagnosed with chronic renal failure is currently taking lithium for severe depression. How will this affect the plan of care? The dose must be markedly reduced, and plasma lithium levels must be closely monitored. The dose will remain constant, but plasma lithium levels must be closely monitored. The drug must be discontinued immediately. No changes to the plan are required.

The dose must be markedly reduced, and plasma lithium levels must be closely monitored. Explanation: Lithium is not metabolized by the body; it is entirely excreted by the kidneys. Lower doses and close monitoring of serum levels are required in clients with renal impairment or other conditions that impair excretion.

A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication? The dosage cannot be divided. It needs to be taken with 8 ounces of liquid. The dosage may need to be increased if they are not feeling better in 2 weeks. The medication should be taken once a day in the morning.

The medication should be taken once a day in the morning. Explanation: A selective serotonin reuptake inhibitor should be taken once a day in the morning unless the dosage is increased or the patient is having severe GI effects. The medication will not require 8 ounces of fluid for absorption and it should be taken for at least 4 weeks before a therapeutic effect is noted.

The nurse is providing educational instruction to a client who has been prescribed lithium. What statement is the priority? While taking lithium, it is very important to maintain a diet that is low in purines. There is a need to carefully match daily doses of lithium to daily symptom severity. There is a need for regularly scheduled blood work to monitor serum levels of lithium. It is important to take selective serotonin reuptake inhibitors (SSRIs) to potentiate the effects of lithium.

There is a need for regularly scheduled blood work to monitor serum levels of lithium. Explanation: During long-term maintenance therapy, it is necessary to measure serum lithium levels at least every 3 months. Measurement is performed more frequently during the beginning of therapy. SSRIs are not necessary, and daily dosing is not matched to short-term symptom severity. A low-purine diet is unnecessary since high-purine foods are related to gout flare-ups and not lithium restrictions.

The nurse is providing education to a client who has been newly diagnosed with bipolar disorder type II. What information should the nurse share concerning the condition? Manic behavior is a hallmark characteristic of this disorder. Severe depression will accompany any serious physical illness. Hypomania is frequently observed in diagnosed male clients. There will be episodes of both major depression and hypomania.

There will be episodes of both major depression and hypomania. Explanation: Bipolar disorder is divided into subtypes that are defined by the presentation of the mood disorder. Bipolar disorder type I is characterized by episodes of major depression plus mania and occurs equally in men and women. Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women. While stress may be a trigger, severe depression is not always triggered by physical illness.

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today? They are under a scheduled drug classification. They are ineffective in treating depression or anxiety disorders. They can cause gastrointestinal (GI) bleeding and esophageal varices. They may cause dangerous interactions with some foods and drugs.

They may cause dangerous interactions with some foods and drugs. Explanation: MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Foods that interact contain tyramine, a monoamine precursor of norepinephrine.

Anticholinergic effects are common adverse events occurring with the use of which classes of antidepressants? Tricyclic antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Atypical antidepressants

Tricyclic antidepressants Explanation: Anticholinergic side effects such as dry mouth, sedation, and urinary retention commonly occur with the use of the tricyclic class of antidepressants. Common adverse effects for selective serotonin reuptake inhibitors are somnolence, dizziness, headache, insomnia, tremor, and weakness. Monoamine oxidase inhibitors' most common side effects include orthostatic hypotension, dizziness, vertigo, headache, and blurred vision. Adverse effects of lithium include tremors, nausea, vomiting, thirst, and polyuria. Toxic reactions may occur when serum lithium levels are greater than 1.5 mEq/L.

Which medications exert their effects by inhibiting reuptake of norepinephrine and serotonin? Tricyclic antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Atypical antidepressants

Tricyclic antidepressants Explanation: Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Monoamine oxidase inhibitors, classified as MAOIs, inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug; it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder (a mood disorder characterized by severe swings from extreme hyperactivity to depression).

The nurse is caring for a client who has just begun to take lithium for treatment of bipolar disease. The nurse instructs the client that his lithium level will need to be monitored at what frequency? Monthly in the morning, 12 hours after the last dose of lithium Four times weekly in the morning, 12 hours after the last dose of lithium Weekly in the morning, 12 hours after the last dose of lithium Two or three times weekly in the morning, 12 hours after the last dose of lithium

Two or three times weekly in the morning, 12 hours after the last dose of lithium Explanation: When lithium therapy is being initiated, the serum drug concentration should be measured two or three times weekly in the morning, 12 hours after the last dose of lithium.

The nurse is caring for a group of clients in a long-term care facility. The nurse is aware that SSRIs are associated with what side effect that is especially undesirable in older adults? Heart failure Weight gain Weight loss Nocturia

Weight loss Explanation: Weight loss is a common side effect of SSRIs and is particularly undesirable in older adults.

The nurse is caring for a client who has been diagnosed with bipolar disorder type II. The nurse knows that this disorder is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in what category of clients? Men Children Women The elderly

Women Explanation: Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women.

A nurse is caring for a client who has been prescribed a monoamine oxidase inhibitor (MAOI). Which food should the nurse instruct the client to avoid? Milk Butter Rice Yogurt

Yogurt Explanation: The nurse should ask the client to avoid yogurt because yogurt contains tyramine, which interacts with MAOIs and causes hypertensive crisis. Milk, butter, and rice do not contain tyramine and hence can be consumed when the client is undergoing treatment with MAOIs.

For which client would the black box warning that is present on all antidepressants be most relevant? an 89-year-old client who is distraught after the recent death of their spouse a 12 year-old child who has been diagnosed with depression by a pediatric psychiatrist a 32 year-old client who uses oral contraceptives and who has depression a 62 year-old client who has depression and ischemic heart disease

a 12 year-old child who has been diagnosed with depression by a pediatric psychiatrist Explanation: A black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. This warning does not address the other listed clients.

The nurse provides care for several clients who are taking antidepressants. Which client should the nurse assess most closely for signs of addiction and anxiety? a client who has experienced unexpected weight loss while taking fluoxetine a client who was recently prescribed venlafaxine a client for whom electroconvulsive therapy (ECT) is being considered a 77 year-old client being treated with an SSRI

a client who was recently prescribed venlafaxine Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, social anxiety disorder; it also diminishes addictive behavior. The nurse should assess for these factors if the client is taking this medication. Prozac and the other SSRIs do not have this specific indication. The fact that ECT is being considered suggests a client's depression is severe, but not necessarily characterized by anxiety and depression.

A client is diagnosed with depression and prescribed sertraline on an outpatient basis. The client should warn the client about what possible adverse effects? Select all that apply. agitation acne on the face and trunk insomnia photosensitivity dry mouth

agitation insomnia dry mouth The adverse effects associated with selective serotonin reuptake inhibitors, which are related to the effects of increased 5-hydroxytriptamine levels, include central nervous system effects (e.g., headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, seizures). Gastrointestinal effects (e.g., nausea, vomiting, diarrhea, dry mouth, anorexia, constipation, changes in taste) often occur, as do genitourinary effects (e.g., painful menstruation, cystitis, sexual dysfunction, urgency, impotence). Adverse effects of sertraline do not include acne or photosensitivity.

What statement should a nurse use to plan a client assessment for the characterizations associated with major depression? an impaired ability to function in activities and relationships a diagnosable lack of self-efficacy and self-advocacy negative thoughts that are unresponsive to reason a quantifiable deficiency of epinephrine

an impaired ability to function in activities and relationships Explanation: Major depression is associated with impaired ability to function in usual activities and relationships. It is not characterized by a lack of response to reason or a deficiency of epinephrine. A lack of self-efficacy and self-advocacy may exist, but this is not a central characteristic of the illness.

A client's depression has not responded to conservative treatments, and the provider has prescribed phenelzine. The client's comorbidities include rheumatoid arthritis and type 1 diabetes. What assessment should the nurse prioritize? assessment for signs and symptoms of hypoglycemia assessment for indications of spontaneous tendon rupture assessment of range of motion and assessment for joint locking assessment for diabetic ketoacidosis (DKA)

assessment for signs and symptoms of hypoglycemia Explanation: A client with type 1 diabetes likely takes insulin, and MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral diabetic agents. DKA is associated with hyperglycemia, not hypoglycemia. This client would have to be monitored closely and appropriate dosage adjustments in insulin made. There is no heightened risk of orthopedic complications.

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. adhere to combination drug therapy. discuss the cultural significance of taking an MAOI. avoid taking the drug on an empty stomach.

avoid use of soy sauce in the diet. Explanation: The client should be instructed to avoid soy sauce, which contains high levels of tyramine. Potentially fatal pharmacodynamic interactions can occur with MAOIs when they are combined with foods rich in tyramine. The client's willingness to adhere to the combination therapy and the cultural significance of taking an MAOI, although important factors to be assessed, are not as important as this safety-related dietary consideration.

Following an extensive diagnostic workup, a 20-year-old man has been diagnosed with bipolar disorder and begun lithium therapy. The nurse's priority assessment in the care of the patient is close monitoring of deep tendon reflexes cranial nerve function. careful monitoring of the patient's serum lithium levels. assessment of the patient's renal and hepatic function. assessment of the patient for signs and symptoms of hypocalcemia and hypophosphatemia.

careful monitoring of the patient's serum lithium levels. Explanation: In order to prevent the risk of lithium toxicity, it is imperative to closely monitor the patient's lithium levels, especially near the initiation of therapy. This is priority over neurological, renal, or hepatic assessments, though each may be indicated. Electrolyte deficiencies are not a common consequence of lithium therapy.

The nurse is creating a care plan for a client taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this client? risk for infection related to immunosuppressant effects of medication risk for impaired skin integrity related to vasodilation and delayed wound healing disturbed thought processes related to CNS effects of medication risk for autonomic dysreflexia related to CNS effects of medication

disturbed thought processes related to CNS effects of medication Explanation: Nursing diagnoses related to SSRI therapy might include disturbed thought processes related to central nervous system effects because adverse effects of SSRIs include headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures. There would be no reason to expect the client is at increased risk for infection. Autonomic dysreflexia applies to clients with spinal cord injury. SSRIs do not affect skin integrity, immunity, or wound healing.

A client's depression is believed to exist because of a deficiency of biogenic amines in key areas of the client's brain. What phenomenon would be most likely to cause this deficiency? slowing of the action of the neurons may lead to their depletion monoamine oxidase (MAO) strengthening the impact of biogenic amines increase in the number or sensitivity of postsynaptic receptors depletion of norepinephrine because biogenic amines feed off of loose particles of the neurotransmitter

increase in the number or sensitivity of postsynaptic receptors Explanation: The three reasons for depression according to the biogenic amine theory include the following: (1) MAO may break down biogenic amine to be recycled or restored in the neuron; (2) rapid fire of the neurons may lead to their depletion; (3) the number or sensitivity of postsynaptic receptors may increase, thus depleting neurotransmitter levels. Amines do not "feed off of" other neurotransmitters.

An older adult was diagnosed with depression several decades ago and has been taking tricyclic antidepressants (TCAs) ever since, with good effect. The nurse should recognize what therapeutic action of this client's medication? inhibiting monoamine oxidase inhibitors that break down norepinephrine inhibiting generalized neuron activity, preventing overexcitability or stimulation blocking the reuptake of serotonin, which increases the levels of norepinephrine inhibiting reuptake of norepinephrine and serotonin

inhibiting reuptake of norepinephrine and serotonin Explanation: TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an accumulation of the neurotransmitters that is thought to create the antidepressant effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.

A 10-year-old client is being seen by a pediatric psychiatrist for severe depression. What antidepressant is approved for administration to this child? trazodone nortriptyline fluvoxamine phenelzine

nortriptyline Explanation: Nortriptyline has established pediatric doses and can be used in children older than 6 years but such children should be monitored closely for adverse effects. Phenelzine is a monoamine oxidase inhibitor (MAOI), a class of drugs that should be avoided in children if at all possible because of the potential for drug-food interactions and the serious adverse effects. Trazodone can be used with children but is not a first-line drug because it has many adverse effects on the central nervous system associated with its use. Luvox is an SSRI that can be used in children to treat obsessive-compulsive disorder but selective serotonin reuptake inhibitors can cause serious adverse effects in children.

The nurse is caring for a client who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication would the nurse consider appropriate for this client? chlorpromazine 25 mg three times daily orally benztropine 2 mg twice daily orally clozapine 200 mg twice daily orally paroxetine 10 mg once daily orally

paroxetine 10 mg once daily orally Explanation: Paroxetine is a selective serotonin reuptake inhibitor indicated for the treatment of depression, obsessive-compulsive disorder, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorders, social phobias, and social anxiety disorders. Chlorpromazine and clozapine are antipsychotic medications, whereas benztropine is a drug used to treat Parkinson disease. None of these would be appropriate options to treat anxiety disorders.

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? cardiac rate and rhythm presence of suicidal ideation improvement in the ability to concentrate indications of a type IV hypersensitivity reaction

presence of suicidal ideation Explanation: It is essential to assess for suicidal thoughts or plans, especially at the beginning of selective serotonin reuptake inhibitor (SSRI) therapy or when dosages are increased or decreased. This supersedes the need to assess for concentration, cardiac function, or hypersensitivity.

A client comes to the mental health clinic for a regular appointment. The client tells the nurse he has been taking oral fluoxetine 20 mg daily for the past 3 weeks and that he has lost 3 lb during that time due to a loss of appetite. What action should the nurse take? reassuring the client that the weight loss is due to diuresis and will resolve once fluid balance is restored recommending the use of over-the-counter multivitamin supplements encouraging the client to increase fat intake to avoid further weight loss reassuring the client that this is a common adverse effect with this medication

reassuring the client that this is a common adverse effect with this medication Explanation: Adverse effects of fluoxetine include anorexia and weight loss. This client's weight loss is modest and would not likely necessitate a change in drug therapy. Although teaching about healthy eating is a good idea, it is more important to teach the client how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The client should increase caloric intake, not just fluid intake. It would not be healthy to recommend exclusively increasing fat intake. The client should continue the medication to see whether therapeutic effects are obtained and adjust nutritional intake if necessary. This weight loss is not solely due to fluid loss. Multivitamins will not reduce weight loss.

After seeking care for persistent exhaustion and sadness, a client has been diagnosed with depression. The nurse should be aware of what potential contributing factors? Select all that apply. serotonin deficiency low levels of norepinephrine excessive cortisol levels high levels of thyroid-stimulating hormone and thyroxine dopamine deficiency

serotonin deficiency low levels of norepinephrine dopamine deficiency A current hypothesis regarding the cause of depression is a deficiency of norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of the brain. Thyroid hormone and cortisol levels have not been implicated in the etiology of depression.

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? paranoia, rapid speech, and difficulty with concentration statements or resignation and futility and a desire to die alternating periods of hypomania and depression reports of headaches, sleepiness, and apathy

statements or resignation and futility and a desire to die Explanation: A black box warning alerts health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications. Consequently, statements alluding to a desire to die should be acted on promptly.

The nurse is caring for a client suspected of developing serotonin syndrome. What frequent assessments should the nurse include in the client's plan of care? Select all that apply. temperature blood pressure cardiac function respiratory function level of consciousness

temperature blood pressure level of consciousness Serotonin syndrome, a serious and sometimes fatal reaction characterized by hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium and coma, muscle rigidity, and seizures, may occur due to combined therapy with an drugs that potentiate serotonin neurotransmission. While worthy of assessment, neither cardiac nor respiratory functions are usually affected.

A client has been prescribed a tricyclic antidepressant. What subsequent adverse effects of this drug should the nurse discuss with the client? Select all that apply. urinary retention blurred vision weight loss dry mouth diarrhea

urinary retention blurred vision dry mouth Adverse effects of tricyclics include sedation, orthostatic hypotension, cardiac arrhythmias, anticholinergic symptoms (e.g., blurred vision, dry mouth, constipation, urinary retention), and weight gain. Diarrhea is an atypical adverse effect.

While taking a drug history, you learn that a new patient is currently taking an MAO inhibitor. Based on this information, you know that patient should not take venlafaxine. phenelzine. lithium carbonate. tranylcypromine.

venlafaxine. Explanation: Venlafaxine is a serotonin and norepinephrine reuptake inhibitor (SNRI). SNRIs should not be taken concurrently with MAO inhibitors because of risks of serotonin syndrome and increased serum levels. Tranylcypromine and phenelzine are MAO inhibitors.

A patient treated for bipolar disorder with lithium carbonate (Eskalith) is scheduled for alithium blood level. What is the therapeutic serum lithium level? A) 0.5 to 1.2 mEq/L B) 1.5 to 2.0 mEq/L C) 2.7 to 2.9 mEq/L D) 2.75 to 3.25 mEq/L

A) 0.5 to 1.2 mEq/L Feedback: The therapeutic serum lithium level is 0.5 to 1.2 mEq/L. A serum lithium level of 2.7 to 2.9 mEq/L is toxic. A serum lithium level of 1.5 to 2.0 mEq/L is toxic. A serum lithium level of 2.75 to 3.25 mEq/L is toxic.

A nurse is caring for a client who has depression and a new prescription for venlafaxine (Effexor). The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication? SELECT ALL THAT APPLY. A) Mydriasis B) Dizziness C) Decreased libio D) Alopecia E) Hypotension

A) Mydriasis B) Dizziness C) Decreased libido

A nurse is caring for a client who has a new prescription for phenelzine (Nardil) for the treatment of depression. Which of the following indicates that the client has developed an adverse effect of this medication? A) Orthostatic hypotension B) Hearing loss C) GI bleeding D) Weight loss

A) Orthostatic hypotension Orthostatic hypotension is an adverse of effect of MAOIs, including phenlzine.

The nurse is interviewing a 75-year-old client and knows that what antidepressant drug class is the first choice for older adults? A) SSRIs B) TCAs C) MAOIs D) Older adults should not receive antidepressant medications.

A) SSRIs

A sometimes fatal syndrome, characterized by hypertensive crisis, extreme agitation progressing to delirium, and coma is known as: Aberrant cardiac conduction syndrome. Serotonin syndrome. Antidepressant discontinuation syndrome. Acute manic syndrome.

Serotonin syndrome. Explanation: Serotonin syndrome, a serious and sometimes fatal reaction characterized by hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium and coma, muscle rigidity, and seizures, may occur due to combined therapy with an SSRI and an MAO inhibitor or other drugs that potentiate serotonin neurotransmission. An SSRI or SNRI and an MAO inhibitor should not be given concurrently or within 2 weeks of each other.

A nurse would assess the client for an increase in anticholinergic symptoms if the client is prescribed cimetidine with which antidepressant? Select all that apply. Phenelzine Sertraline Venlafaxine Clomipramine Escitalopram

Sertraline Venlafaxine Clomipramine Escitalopram The concomitant use of cimetidine and tricyclic antidepressants (clomipramine), serotonin reuptake inhibitors (escitalopram and sertraline), and SNRI/DNRI (venlafaxine) results in increased anticholinergic symptoms. Anticholinergic symptoms have not been noted to occur when MAOIs are combined with another substance. The main reactions are cardiac related (hypotension, hypertensive crisis, cardiac arrhythmias, etc.).

The client presents to the emergency department with a headache in the back of the head, diaphoresis, and neck stiffness. The client's blood pressure measures 180/124 mm Hg and heart rate is 168 beats/min. The spouse says the client is currently prescribed "something for depression" and denies any history of cardiac disease. The nurse should suspect the use of what medication? a monoamine oxidase inhibitor (MAOI) a selective serotonin reuptake inhibitor (SSRI) a tricyclic antidepressant (TCA) an atypical antipsychotic

a monoamine oxidase inhibitor (MAOI) Explanation: MAOIs have several serious adverse effects that can be fatal. This client's symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke. SSRIs and TCAs are not associated with these particular symptoms. Antipsychotics do not have this effect.