Pharmacology Chapter 21

statements or resignation and futility and a desire to die

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?

Fluvoxamine

A client is admitted to the nursing unit with OCD. What drug has been found to be effective for treating OCD?

Extreme sadness

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

"There may be an increased risk of suicide while taking this drug."

A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching?

onset of suicidal ideation.

A 12-year-old client who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for which?

dizziness

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

"Have you felt hopeless anytime lately?"

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?

Question the prescriber about the dose

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?

Hypertensive crisis

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?

SSRIs prevent serotonin from being reabsorbed.

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?

It may take up to two more weeks before the client feels better

A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client?

"It may take another two to three weeks before the medication is completely effective."

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client the clinic reporting not feeling any better. What is the nurse's best response to this client?

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits."

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?

"Have you been feeling anxious lately?"

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?

manic behavior mood swings

A client who has been prescribed long-term lithium therapy reports taking the medication only erratically since starting a new job. What assessments should the nurse prioritize? Select all that apply.

Blood pressure monitoring

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?

"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug

A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?

The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?

Clomipramine

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.

A lower dose of the antidepressant

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?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

Blue cheese Pepperoni Chocolate

A nurse educating a client starting phenelzine should educate the client to avoid which foods? (Select all that apply.)

Hypertension

A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?

Decreased reuptake of norepinephrine

A nurse is caring for a patient with depression. The patient has been prescribed amitriptyline, a tricyclic antidepressant. What should the nurse identify as the effect of this antidepressant on the patient's body?

A client has dysphagia

A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications?

Monitor the client closely for bleeding and review coagulation indices when available.

A tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions?

Selective serotonin reuptake inhibitor

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?

TCAs

The nurse is assessing a 13-year-old client who has symptoms of depression and recognizes that what class of antidepressant medication would not be a drug of choice for an adolescent?

Phenelzine

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?

Asking the client to sit on the side of the bed for 1 minute before getting up

The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension?

improved sleep decreased anxiety interest in physical activity

The nurse is caring for a client taking fluoxetine for depression. Which assessment findings indicate that the medication is effective? Select all that apply.

Deer meat Shrimp Fava beans

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.)

aged cheeses chocolate bananas coffee

The nurse is providing education to a client who has been prescribed monoamine oxidase inhibitor (MAOI) therapy following unsuccessful treatment with other agents. What foods should the nurse instruct the client to avoid? Select all that apply.

"Are you in the process of quitting smoking?"

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?

A severely depressed 14-year-old client who is receiving inpatient care

The psychiatric-mental health nurse is overseeing care of several clients who are being treated with selective serotonin reuptake inhibitors. Which client should the nurse monitor most closely for adverse effects?

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

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

An extended release form is available.

Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular?

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

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

They may cause dangerous interactions with some foods and drugs.

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?

Do not take OTC drugs.

When teaching a patient on an MAO inhibitor, what would be important to include in the teaching?

Fluvoxamine

Which agent would a nurse identify as a selective serotonin reuptake inhibitor?

increased alanine aminotransferase level (ALT)

Which laboratory value would prevent a client from being prescribed duloxetine?

The medications have fewer anticholinergic effects than alternatives.

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?

4 weeks

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?

Assessment of the client's behaviors and thought processes

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

Dangerous drug interactions

A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?

presence of suicidal ideation

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?

Serotonin

A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired?

"Many people find this drug makes them drowsy, so it's best to take it at bedtime." "If you find that you have a dry mouth, try sucking on lozenges or hard candies." "It's possible that you might have a bit of difficulty starting your urine stream." "Let your psychiatrist know promptly if you have any changes in your vision."

An adult client has been diagnosed and the client's psychiatrist has prescribed amitriptyline 100 mg PO daily. What education should the nurse provide about this drug regimen?

Enuresis

Besides being prescribed as an antidepressant, imipramine helps treat which disorder in children?

14 days

How long does a patient need to wait after stopping a phenelzine before starting paroxetine?

A 45-year-old man with liver impairment

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

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?

1.8 mEq/L

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?

A 45-year-old man with angina pectoris

The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?

Sexual dysfunction

The nurse is providing education to a male client who has been prescribed fluoxetine. Which adverse effect should the nurse assess for to help ensure client adherence?

Yogurt

A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid?

In 4 to 6 weeks after stopping the paroxetine

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?

Dry mouth

A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?

Oral

A client is prescribed a tricyclic antidepressant. The nurse would anticipate administering this drug by which route?

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

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

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

A client is receiving a selective serotonin reuptake inhibitor (SSRI) and is being switched to a monoamine oxidase inhibitor (MAOI) due to lack of response. When would the nurse teach the client to begin the MAOI?

avoid use of soy sauce in the diet.

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

The medication should be taken once a day in the morning.

A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication?

"I can apply a new patch to my upper arm, thigh, or torso."

After teaching a client who is to receive transdermal selegiline, which client statement would indicate to the nurse that the client has understood the instructions?

Selective serotonin reuptake inhibitors

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

"I will not eat any aged cheese." "I cannot drink coffee with this medication."

The nurse instructs a client with depression about the drug phenelzine. Which client statements indicate that teaching has been effective? Select all that apply.

orthostatic hypotension

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?