Antidepressant Agents PrepU
What assessment question should the nurse ask a client whose original selective serotonin reuptake inhibitor (SSRI) has been replaced with venlafaxine 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?"
Correct response: "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.
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?"
Correct response: "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.
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? "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."
Correct response: "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 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." "Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." "It's very important that you not take the St. John's wort at the same time of day as your antidepressant." "It's very important that you comply with your prescribed treatment."
Correct response: "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." Explanation: The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rationale. It is true that many herbal remedies contain inconsistent doses, but this is not the primary risk of combining SSRIs with St. John's wort. Taking them at different times of day does not mitigate the risks of an unsafe reaction.
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." "Take the drug daily in the morning for maximum benefit." "Be sure to eat a low fiber diet to prevent diarrhea." "Limit your fluid intake so you don't have to urinate during the night."
Correct response: "Use sugarless hard candies and gum to deal with dry mouth." Explanation: Sugar-free hard candies and gums would help to alleviate dry mouth that may occur due to anticholinergic effects. The client should take a major portion of the dose at bedtime if drowsiness and anticholinergic effects are severe. Fluid restriction should not be encouraged, and would have no benefit. Similarly, a higher fiber diet would be beneficial for maintaining normal bowel function.
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
Correct response: 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
Correct response: 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.
Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse? A 32-year-old man who is obese A 38-year-old woman who has diabetes An 11-year-old child with no other illnesses A 45-year-old man with liver impairment
Correct response: A 45-year-old man with liver impairment Explanation: Caution must be used when administering sertraline in clients with compromised liver function; therefore, the client with the liver impairment would require the closest monitoring. Adjustments such as a lower dosage or less-frequent dosing schedule may need to be made for these clients because the drug is extensively metabolized by the liver. The dosing schedule need not be adjusted in children or in clients with obesity or diabetes.
A client is prescribed isocarboxazid. The nurse is teaching the client about foods to avoid. Which would the nurse include in the teaching? (Select all that apply.) Aged blue cheese Red wine Pepperoni Whole milk Fresh shellfish Sour cream
Correct response: Aged blue cheese Red wine Pepperoni Sour cream Explanation: Isocarboxazid is an MAOI, which necessitates avoiding foods containing tyramine such as aged cheeses, red wines, smoked meats (i.e., pepperoni), and sour cream.
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
Correct response: 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.
A nurse educating a client starting phenelzine should educate the client to avoid which foods? (Select all that apply.) Blue cheese Pepperoni Apples Chocolate Celery
Correct response: Blue cheese Pepperoni Chocolate Explanation: A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid containing tyramine (aged cheese, sour cream, yogurt, beef, chicken livers, pickled herring, fermented meat, undistilled alcoholic beverages, caffeinated beverages, chocolate, certain fruits and vegetables, yeast extract, and soy sauce) as the combination can result in a life-threatening hypertensive crisis.
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? Decreased reuptake of norepinephrine Increased serotonin in the nervous system Increased endogenous norepinephrine Increased endogenous epinephrine
Correct response: Decreased reuptake of norepinephrine Explanation: The nurse should identify decreased reuptake of norepinephrine as the effect of the tricyclic antidepressant on the patient's body. Increased serotonin in the nervous system, increased endogenous norepinephrine, and increased endogenous epinephrine are effects of monoamine oxidase inhibitors.
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 Improvements are likely evident to others even if not to the client The drug requires six to eight weeks before it reaches peak levels The client's pessimism is likely a symptom of the underlying depression
Correct response: It may take up to two more weeks before the client feels better Explanation: It may take up to 4 weeks before the full effect of a SSRI such as escitalopram is noted. This phenomenon is the most likely cause of the client's appraisal, not a lack of perspective or worsening symptoms.
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. Monitor the client for tetany and review serum calcium levels when available. Ask the client at each meal about any episodes of gastroesophageal reflux. Assess the client's blood pressure every six hours for the first week of therapy.
Correct response: Monitor the client closely for bleeding and review coagulation indices when available. Explanation: Combining TCAs with warfarin creates a risk for bleeding, which should be addressed in the nursing care plan. There is no known interaction between TCAs and calcium supplements or bisphosphonates that would create a risk for hypocalcemia. TCAs do not heighten the risk of gastroesophageal reflux. TCAs can affect blood pressure, but this is unrelated to any known drug-drug interactions.
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
Correct response: 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 has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication? SSRIs block GABA function. SSRIs prevent serotonin from being reabsorbed. SSRIs increase serotonin synthesis. SSRIs increase serotonin synthesis.
Correct response: SSRIs prevent serotonin from being reabsorbed. Explanation: 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 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? She should have an ultrasound of the liver to check for disease. The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. The client should have monthly evaluation of liver function to monitor the disease progression. The client should not take any medications because of her liver dysfunction.
Correct response: The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. Explanation: Sertraline should be administered with caution in clients with compromised liver function. Adjustments such as a lower dosage or less-frequent dosing schedule may be made for these clients.
Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression? The medications eliminate the risk of suicide during treatment. The onset of action is sooner than with other medications. The medications have no sexual side effects. The medications have fewer anticholinergic effects than alternatives.
Correct response: The medications have fewer anticholinergic effects than alternatives. Explanation: Currently, the selective serotonin reuptake inhibitors (SSRIs) are the first choice for treating depression. They are preferred over the tricyclic drugs and the MAOIs because they can be less damaging to the heart and have minimal anticholinergic and hypotensive effects. The selection of one SSRI over another is based on individual patient response to a drug and prescriber preference. Adverse effects, which are mild and brief, include gastrointestinal distress (anorexia, nausea, vomiting, and diarrhea), headache, fatigue, insomnia, and sexual dysfunction (delayed ejaculation, inability to achieve orgasm). SSRIs do not necessarily eliminate the risk of suicide.
Which medications exert their effects by inhibiting reuptake of norepinephrine and serotonin? Tricyclic antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Atypical antidepressants
Correct response: 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).
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.
Correct response: 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.
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. diarrhea. increased secretions. facial flushing.
Correct response: dizziness. Explanation: The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.
What medication is effective in treating enuresis in children older than 6 years of age? amitriptyline duloxetine imipramine venlafaxine
Correct response: imipramine Explanation: Imipramine is approved for treating childhood enuresis in children older than 6 years. Amitriptyline is a tricyclic antidepressant but is not used for childhood enuresis. Duloxetine is a serotonin-norepinephrine reuptake inhibitor that is used for depression. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor that is used for depression.
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline? urinary frequency urinary retention visual disturbances orthostatic hypotension
Correct response: orthostatic hypotension Explanation: Orthostatic hypotension, a common cause for falls, is an adverse effect related to tricyclic antidepressants like amitriptyline. 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 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
Correct response: 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, 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
Correct response: 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.
How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)? 14 days 1 day 7 days 10 days
Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.
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
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.
Anticholinergic effects
dry mouth constipation photophobia blurred vision Tachycardia
