prepU ch 21: antidepressant agents
A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?
Salami
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
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?
Selective serotonin reuptake inhibitors
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?
Several weeks after stopping the paroxetine
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?
dizziness
Which laboratory value would prevent a client from being prescribed duloxetine?
increased alanine aminotransferase level (ALT)
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.
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?
Recent myocardial infarction
A client taking phenelzine is at a dinner party and has several glasses of red wine. The client begins to feel nauseated and develops a terrible headache. The client is taken to the nearest emergency department. This client might be experiencing a hypertensive crisis. As the nurse in the ED, what other symptoms might the client experience if they are having a hypertensive crisis? (Select all that apply.)
Tachycardia, Stiff neck, Chest pain
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.
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?
Assessment of the client's behaviors and thought processes
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."
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?"
A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?
Venlafaxine
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."
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 12 year-old client with depression has been prescribed trazodone 1.5 mg/kg/day in three divided doses. The client weighs 110 lbs. How many 50-mg tablets should the nurse administer for each dose?
0.5
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."
A client is prescribed transdermal selegiline. What health education should the nurse provide?
"Place the patch on dry skin on your torso that has no cuts or openings."
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." "Call the health care provider if you experience confusion."
How long does a patient need to wait after stopping a phenelzine before starting paroxetine?
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?
4 weeks
Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?
A 45-year-old man with liver impairment
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?
A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug
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 lower dose of the antidepressant
Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular?
An extended release form is available.
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?
Asking the client to sit on the side of the bed for 1 minute before getting up
A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed?
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.
Clomipramine
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?
Dangerous drug interactions
When teaching a patient on an MAO inhibitor, what would be important to include in the teaching?
Do not take OTC drugs.
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?
Dry mouth
A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?
SSRIs prevent serotonin from being reabsorbed.
Which agent would a nurse identify as a selective serotonin reuptake inhibitor?
Fluvoxamine
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?
Hypertension
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
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?
Monitor the client closely for bleeding and review coagulation indices when available.
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
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?
The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.
A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication?
The medication should be taken once a day in the morning.
Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?
The medications have fewer anticholinergic effects than alternatives.
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?
There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."
What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?
They may cause dangerous interactions with some foods and drugs.
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?
Yogurt
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?
orthostatic hypotension
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?
presence of suicidal ideation