PN119 PrepU Chapter 22

The health care provider would not prescribe duloxetine (Cymbalta) for a client with a mood disorder if the client took which other medication?

A medication for hypertension

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

When taking MAO inhibitors, clients should avoid which foods?

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

A client is diagnosed with depression and prescribed sertraline (Zoloft) on an outpatient basis. The client should warn the client about what possible adverse effects ? Select all that apply.

Agitation Insomnia Dry mouth

A nurse observing a patient notices the patient has developed muscle rigidity, altered mental status, tachycardia, and sweating. Which of the following antidepressants drugs might cause these symptoms? (Choose one)

Amoxapine

Major depression is associated with:

An impaired ability to function in usual activities and relationships.

The nurse is caring for an 8-year-old clinic client who takes imipramine. The nurse should assess this child for a history of what health problem?

Enuresis (bed-wetting)

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?

"Have you felt hopeless anytime lately?"

A patient has been diagnosed with depression. The physician has ordered sertraline. The patient asks, "How soon will it be until I feel better?" What would be the best response?

"The medication will start to work in as soon as 10 days, but it may take up to 4 weeks to be fully effective."

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

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

A client has been taking Prozac for the past two 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 Sarafem 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."

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

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

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

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

A 28-year-old patient asks his nurse how phenelzine therapy would help him. An appropriate response by the nurse would be

"This therapy will improve your overall mood and increase your social activity."

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

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

A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to paroxetine (Paxil). The patient is confused and doesn't understand why the medication was changed. The nurse's best response to the patient would be what?

"Would you like to talk with your physician about this?"

A female client is at the clinic for a follow-up appointment related to treatment for depression. She began taking fluoxetine 2 weeks ago. She tells you, "This medication must not be working, because I don't feel better at all." What would be the nurse's best response?

"You may have to take this drug for a few more days before you feel its effects."

A nurse is reviewing a client's serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?

1.8 mEq/L

When a patient is started on an antidepressant, it is important for the nurse to explain to the patient that it may take time to see a change in mood, but that adverse reaction may occur soon after initiation of therapy. How long can it take for the patient to see the beneficial effects of an antidepressant?

4 weeks

In patients requiring sertraline therapy, which patient would require the closest monitoring by the nurse?

A 45-year-old man with liver impairment

A nurse provides care on a psychiatric unit, and many of the clients on the unit take antidepressants. What client factor would the nurse have to consider when administering these medications?

A client has dysphagia

The client has been depressed since her father died 6 months ago and the health care provider has prescribed amitriptyline.What aspect of this client's health history should prompt the nurse to contact the prescriber?

Ischemic heart disease

Your client informs you that he has been struggling with depression; however, he does not know if it is severe enough to start on medication. Your best response would be:

Antidepressant therapy may be indicated if depressive symptoms persist at least 2 weeks, impair social relationships or work performance, and occur independently of life events.

The nurse is caring for a patient who is taking amitriptyline for depression. What nursing intervention would be most appropriate if this patient developed orthostatic hypotension?

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

The nurse interviews the family of a client hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessments should the nurse specify within this client's plan of care? Select all that apply.

Assessment for suicide risk Assessment of sleep quality and quantity Assessment of the client's affect

A patient has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which food should the patient avoid eating?

Cheddar cheese and bratwurst

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?

Disturbed thought processes related to CNS effects of medication

A patient with a severe depression has been hospitalized, and the physician has ordered amitriptyline. What common adverse effect might this patient have?

Dry mouth

A client's current medication regimen includes clomipramine and the client denies any history of depression. For what other health problem should the nurse assess the client?

Early-onset Alzheimer disease

A client who ingests foods high in tyramine while taking a selective serotonin reuptake inhibitor is at risk for developing severe hypertensive crisis.

False

The nurse is caring for a client who takes venlafaxine (Effexor XR) but does not have a mood disorder. The nurse is aware that SRNIs/DNRIs are prescribed for what other reasons? Select all that apply.

Fibromyalgia Neuropathic pain Aggressive behaviors

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

Fluvoxamine

The nurse knows that a client needs further instruction when he states that he takes his mood disorder medication with which breakfast item?

Grapefruit juice

Mark has been prescribed nortriptyline for depression. Your nursing assessment of Mark reveals a thin male, age 52, with decreased albumin, BUN, creatinine, and protein levels. He has a prior history of alcohol abuse. His history also includes asthma and gastroesophageal reflux. When prescribing nortriptyline, which condition do you know puts Mark at risk for toxicity?

His malnutrition

A patient has been prescribed a monoamine oxidase inhibitor (MAOI) by the physician. Before administration of the drug, the patient wants to know the adverse reactions of the drug. What is an adverse reaction to the drug?

Hypertensive crisis

The nurse is admitting a client who has a possible diagnosis of mood disorder. The nurse assesses the client for symptoms of what medical condition that may be mistaken for a mood disorder?

Hypothyroidism

The nurse is caring for a client who has just begun to take citalopram (Celexa) for a mood disorder. Which over-the-counter medication may decrease the effectiveness of the citalopram?

Ibuprofen

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?

Imipramine (Tofranil)

While studying for an upcoming pharmacology test, a student asks peers what drug would be more effective against depression characterized by anxiety and sleep disturbances. Which drug would the students say would be most effective?

Imipramine (Tofranil)

A 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?

Implement suicide precautions.

An older adult was diagnosed with depression several decades 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 reuptake of norepinephrine and serotonin

A patient has been prescribed mirtazapine (Remeron). How will it decrease migraine headaches and depression?

It blocks the presynaptic alpha2-adrenergic receptors.

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

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

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

Phenelzine (Nardil)

A nurse is caring for a patient being treated for depression. Which of the following interventions should the nurse perform when the patient complains of dry mouth?

Provide sugarless gum or hard candy

A client comes to the mental health clinic for a regular appointment. The client tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take?

Reassuring the client that this is a common adverse effect with this medication

The nurse interviews the family of a patient hospitalized with severe depression and suicidal ideations. What assessment data is important in planning this family's plan of care? (Mark all that apply.)

Recent suicide attempts GI obstruction Affect

Which class of antidepressants exerts its effects by inhibiting reuptake serotonin?

Selective serotonin reuptake inhibitors

A patient suffers from depression and states feelings of gloom and inability to perform the activities of daily living. What neurotransmission is decreased?

Serotonin

A nurse is caring for a patient with suicidal tendencies and severe depression. The nurse is to prepare a report after monitoring the patient's condition. What should the nurse look for in the patient while preparing the report?

Signs of insomnia

Which herbal product should a nurse specifically question patients about due to the potential for adverse reactions when taken with antidepressants?

St. John's wort

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 physician noted right-upper-quadrant tenderness and elevated liver enzyme levels. The physician has prescribed sertraline to treat Ms. Tooka's depression. Which factor would need to be considered prior to administering this medication to her?

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

Ms. Keller has been prescribed sertraline for depression and anxiety. She has been taking the medication for 3 months now. After completing her health history, you note that she is having difficulty sleeping since starting this medication. What would be the best common goal for Ms. Keller, based on your assessment of her sleep dysfunction?

The patient will sleep 8 hours each night.

Ms. Bloom is a 35-year-old woman with depression. What is a realistic goal of antidepressant therapy?

To bring about the greatest relief of symptoms while minimizing unpleasant adverse effects as much as possible

Anticholinergic effects such as dry mouth, sedation, and urinary retention are common adverse events occurring with the use of which classes of antidepressants?

Tricyclic antidepressants

Which class of antidepressants exerts their effects by inhibiting reuptake of norepinephrine and serotonin?

Tricyclic antidepressants

A nurse is working with a Chinese immigrant who is taking an MAOI. The most important instruction to the patient by the nurse will be to

avoid use of soy sauce in the diet.

A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for

dizziness.

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.

A 12-year-old child 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

onset of suicidal ideation.

After teaching a client who is prescribed isocarboxazid, the nurse determines that additional teaching is needed when the client states a need to avoid what food?

whole milk.